Office of the Revisor of Statutes
Minnesota Session Laws - 1993, 1st Special Session
Key: (1) language to be deleted (2) new language
Laws of Minnesota, 1993 First Special Session
CHAPTER 1-H.F.No. 1
An act relating to human services; appropriating money
for human services; amending Minnesota Statutes 1992,
sections 62A.045; 116.76, subdivision 14; 116.78,
subdivisions 4 and 7; 116.79, subdivisions 1 and 4;
116.80, subdivisions 1 and 2; 116.81, subdivision 1;
116.82, subdivision 3; 116.83, subdivisions 1 and 3;
144.122; 144.123, subdivision 1; 144.215, subdivision
3, and by adding a subdivision; 144.226, subdivision
2; 144.3831, subdivision 2; 144.802, subdivision 1;
144.8091, subdivision 1; 144.871, subdivisions 2, 6,
7a, 7b, 9, and by adding subdivisions; 144.872,
subdivisions 2, 3, 4, and by adding a subdivision;
144.873; 144.874, subdivisions 1, 2, 3, 4, 5, 6, 9,
and by adding subdivisions; 144.876, by adding a
subdivision; 144.878, subdivisions 2, 2a, and 5;
144.98, subdivision 5; 144A.04, subdivision 7;
144A.071; 144A.073, subdivisions 2, 3, and by adding a
subdivision; 145.883, subdivision 5; 147.01,
subdivision 6; 147.02, subdivision 1; 148C.01,
subdivisions 3 and 6; 148C.02; 148C.03, subdivisions
1, 2, and 3; 148C.04, subdivisions 2, 3, and 4;
148C.05, subdivision 2; 148C.06; 148C.11, subdivision
3, and by adding a subdivision; 149.04; 157.045;
198.34; 214.01, subdivision 2; 214.04, subdivision 1;
214.06, subdivision 1, and by adding a subdivision;
245.462, subdivisions 4 and 20; 245.464, subdivision
1; 245.466, subdivision 1; 245.474; 245.484; 245.4871,
subdivision 4; 245.4873, subdivision 2; 245.4882,
subdivision 5; 245.652, subdivisions 1 and 4; 245.73,
subdivisions 2, 3, and by adding a subdivision;
246.0135; 246.02, subdivision 2; 246.151, subdivision
1; 246.18, subdivision 4; 252.025, subdivision 4, and
by adding subdivisions; 252.275, subdivisions 1 and 8;
252.41, subdivision 3; 252.46; 252.47; 252.50, by
adding a subdivision; 252A.101, subdivision 7;
252A.111, subdivision 4; 253.015, subdivision 1, and
by adding subdivisions; 253.202; 254.04; 254.05;
254A.17, subdivision 3; 254B.06, subdivision 3;
256.015, subdivision 4; 256.025, subdivisions 1, 2, 3,
and 4; 256.032, subdivision 11; 256.73, subdivisions
2, 3a, 5, and 8; 256.736, subdivisions 10, 10a, 14,
16, and by adding a subdivision; 256.737, subdivisions
1, 1a, 2, and by adding subdivisions; 256.74,
subdivision 1; 256.78; 256.9657, subdivisions 1, 2, 3,
7, and by adding subdivisions; 256.9685, subdivision
1; 256.969, subdivisions 1, 8, 9, as amended, 9a, as
amended, 20, as amended, 22, as amended, and by adding
subdivisions; 256.9695, subdivision 3; 256.983,
subdivision 3; 256B.04, subdivision 16; 256B.042,
subdivision 4; 256B.055, subdivision 1; 256B.056,
subdivisions 1a and 2; 256B.0575; 256B.059,
subdivisions 3 and 5; 256B.0595; 256B.0625,
subdivisions 3, 6a, 7, 11, 13, 13a, 14, 15, 17, 19a,
20, 27, 28, 29, and by adding subdivisions; 256B.0627,
subdivisions 1, 4, and 5; 256B.0628, subdivision 2;
256B.0629, subdivision 4; 256B.0911, subdivisions 2,
3, 4, 6, 7, and by adding a subdivision; 256B.0913,
subdivisions 4, 5, 9, 12, 13, and 14; 256B.0915,
subdivisions 1, 3, and by adding subdivisions;
256B.0917, subdivisions 1, 2, 3, 4, 5, 11, and 12;
256B.093, subdivisions 1 and 3; 256B.15, subdivisions
1 and 2; 256B.19, subdivision 1b, and by adding
subdivisions; 256B.37, subdivisions 3, 5, and by
adding a subdivision; 256B.431, subdivisions 2b, 2o,
13, 14, 15, 21, and by adding subdivisions; 256B.432,
subdivision 5, and by adding a subdivision; 256B.47,
subdivision 3; 256B.48, subdivisions 1 and 2; 256B.49,
by adding a subdivision; 256B.50, subdivision 1b, and
by adding subdivisions; 256B.501, subdivisions 3g, 3i,
12, and by adding a subdivision; 256D.01, subdivision
1a; 256D.02, subdivision 5; 256D.03, subdivisions 3,
4, and 8; 256D.04; 256D.05, by adding a subdivision;
256D.051, subdivisions 1 and 6; 256D.35, subdivision
3a; 256D.44, subdivisions 2 and 3; 256F.06,
subdivision 2; 256I.01; 256I.02; 256I.03, subdivisions
2, 3, and by adding subdivisions; 256I.04,
subdivisions 1, 2, 3, and by adding subdivisions;
256I.05, subdivisions 1, 1a, 2, 8, and by adding a
subdivision; 256I.06; 257.3573, by adding a
subdivision; 257.54; 257.541; 257.55, subdivision 1;
257.57, subdivision 2; 257.59, subdivision 3; 257.73,
subdivision 1; 257.74, subdivision 1; 257.803,
subdivision 1; 259.40, subdivisions 1, 2, 3, 4, 5, 7,
8, and 9; 259.431, subdivision 5; 273.1392; 273.1398,
subdivision 5b; 275.07, subdivision 3; 326.44; 326.75,
subdivision 4; 388.23, subdivision 1; 393.07,
subdivisions 3 and 10; 462A.03, subdivision 15;
518.156, subdivision 1; 518.551, subdivision 5;
518.611, subdivisions 1, 2, 6, and by adding a
subdivision; 518.613, subdivisions 2, 3, and 4;
518.64, subdivision 2; 525.539, subdivision 2;
525.551, subdivision 7; 609.821, subdivisions 1 and 2;
626.559, by adding a subdivision; Laws 1991, chapter
292, article 6, sections 54; and 57, subdivisions 1
and 3; Laws 1992, chapter 513, article 7, section 131;
and Laws 1993, chapter 20, by adding a section;
proposing coding for new law in Minnesota Statutes,
chapters 115C; 116; 144; 198; 214; 245; 252; 254A;
256; 256B; 256E; 256F; 257; 514; proposing coding for
new law as Minnesota Statutes, chapters 144C; and
246B; repealing Minnesota Statutes 1992, sections
116.76, subdivision 7; 116.79, subdivision 3; 116.81,
subdivision 2; 116.83, subdivision 2; 144.8721;
144.874, subdivision 10; 144.878, subdivision 2a;
148B.72; 214.141; 245.711; 245.712; 252.46,
subdivisions 12, 13, and 14; 252.478; 256.985;
256I.03, subdivision 4; 256I.05, subdivisions 4, 9,
and 10; 256I.051; 273.1398, subdivisions 5a and 5c.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
APPROPRIATIONS
Section 1. [HUMAN SERVICES APPROPRIATIONS.]
The sums shown in the columns marked "APPROPRIATIONS" are
appropriated from the general fund, or any other fund named, to
the agencies and for the purposes specified in the following
sections of this article, to be available for the fiscal years
indicated for each purpose. The figures "1994" and "1995" where
used in this article, mean that the appropriation or
appropriations listed under them are available for the fiscal
year ending June 30, 1994, or June 30, 1995, respectively.
SUMMARY BY FUND
1993 DEFICIENCY
General
$13,286,000
APPROPRIATIONS BIENNIAL
1994 1995 TOTAL
General $2,126,783,000 $2,249,286,000 $4,376,069,000
State Government
Special Revenue 21,166,000 20,367,000 41,533,000
Metropolitan Landfill Contingency
Action Fund 191,000 204,000 395,000
Trunk Highway 1,488,000 1,510,000 2,998,000
TOTAL 2,149,628,000 2,271,367,000 4,420,995,000
REVENUE
General 36,219,000 53,308,000 89,527,000
APPROPRIATIONS
Available for the Year
Ending June 30
1994 1995
Sec. 2. COMMISSIONER OF
HUMAN SERVICES
Subdivision 1. Appropriation by Fund
General Fund 2,071,736,000 2,192,990,000
Federal receipts as shown in the
biennial budget document to be used for
financing activities, programs, and
projects under the supervision and
jurisdiction of the commissioner must
be credited to and become a part of the
appropriations provided for in this
section.
The 1996-1997 general fund spending in
the department of human services is
limited to $2,340,864,000 in fiscal
year 1996 and $2,522,864,000 in fiscal
year 1997. Expenditures in the
department may exceed these estimates
only if forecast caseloads increase,
base forecast spending increases,
acuity or casemix results in increases,
or other adjustments are made in
accordance with the department of
finance forecast methodology. After
consultation with the legislature, the
commissioner of finance may also adjust
these limits to recognize any errors or
omissions in the workpapers used to
generate the figure. If the
commissioner determines in the November
or March forecast for fiscal year
1996-1997 that the program expenditures
will exceed the above limit, then in
fiscal years 1996 or 1997 the
commissioner may withhold provider
payments, rateably reduce payments
under the general assistance medical
care program or the medical assistance
program or propose statutory remedies
to the legislature that will bring
expenditures within this limit.
Subd. 2. Finance and Management
Administration
General
$21,815,000 $20,871,000
Federal money received in excess of the
estimates shown in the 1994-1995
department of human services budget
document reduces the state
appropriation by the amount of the
excess receipts, unless the governor
directs otherwise, after consulting
with the legislative advisory
commission.
If the amount of federal money
anticipated to be received is less than
the estimates shown in the 1994-1995
proposed biennial budget document for
the department of human services, the
commissioner of finance shall reduce
the amount available from the direct
appropriation by a corresponding
amount. The reductions must be noted
in the budget document submitted to the
79th legislature, in addition to an
estimate of similar federal money
anticipated for the biennium ending
June 30, 1997. At the end of fiscal
years 1994 and 1995, the chairs of the
human services division of the house
health and human services committee and
the health care and family services
finance division of the senate
committees on health care and family
services shall receive written
notification explaining these
reductions.
The commissioner of human services,
with the approval of the commissioner
of finance and by direction of the
governor after consulting with the
legislative advisory commission, may
transfer unencumbered appropriation
balances among the aid to families with
dependent children, aid to families
with dependent children child care,
Minnesota family investment, general
assistance, general assistance medical
care, medical assistance, Minnesota
supplemental aid, group residential
housing, and work readiness programs,
and the entitlement portion of the
chemical dependency consolidated
treatment fund, and between fiscal
years of the biennium.
Effective the day following final
enactment, the commissioner may
transfer unencumbered appropriation
balances for fiscal year 1993 among the
aid to families with dependent
children, general assistance, general
assistance medical care, medical
assistance, Minnesota supplemental aid,
and work readiness programs, and the
entitlement portion of the chemical
dependency consolidated treatment fund,
with the approval of the commissioner
of finance after notification of the
chair of the senate family services and
health care division and the chair of
the house of representatives human
services division.
Appropriations and federal receipts for
information system projects for MAXIS,
child support enforcement, and the
Minnesota Medicaid information system
must be deposited in the state systems
account authorized in Minnesota
Statutes, section 256.014. Money
appropriated for computer projects
approved by the information policy
office, funded by the legislature, and
approved by the commissioner of finance
may be transferred from one project to
another and from development to
operations as the commissioner of human
services considers necessary. Any
unexpended balance in the appropriation
for these projects does not cancel but
is available for ongoing development
and operations.
Any reduction in the base for GA or
GAMC attributed to the movements of
clients from those programs to the work
readiness pilot projects creating the
work experience component shall be
reinstated as part of the base in the
governor's proposed budget for
1996-1997.
$75,000 is available in the fiscal year
ending June 30, 1994, and $250,000 is
available for the fiscal year ending
June 30, 1995, for the crisis nursery
program. Unexpended money appropriated
for the crisis nursery program in
fiscal year 1994 does not cancel but is
available for fiscal year 1995.
The commissioner of human services
shall establish a special revenue fund
account to manage shared communication
costs necessary for the operation of
the programs the commissioner
supervises. The commissioner may
distribute the costs of operating and
maintaining communication systems to
participants in a manner that reflects
actual system usage. Costs may include
acquisition, licensing, insurance,
maintenance, repair, staff time, and
other direct costs as determined by the
commissioner. The commissioner of
human services may accept for and on
behalf of the state any gift, bequest,
devise, or personal property of any
kind or money tendered to the state for
any purpose pertaining to the
communication activities of the
department. Any money so received must
be deposited in the state communication
systems account. Money collected by
the commissioner for the use of
communication systems must be deposited
in the state communication systems
account and is appropriated to the
commissioner for purposes of this
section.
Before hardware or software valued in
excess of $100,000 can be purchased by
the department of human services, there
must be information policy office
approval that all appropriate policies,
standards, and budget review
requirements and recommendations have
been met.
Subd. 3. Social Services
Administration
General
$68,565,000 $70,103,000
All of the fees paid to the
commissioner for interpreter referral
services for people with hearing
impairments shall be used for direct
client referral activities. None of
the fees shall be used to pay for state
agency administrative and support costs.
The supplemental funding for nutrition
programs serving counties where
congregate and home-delivered meals
were locally financed prior to
participation in the nutrition program
of the Older Americans Act shall be
awarded at no less than the same levels
as in fiscal year 1993.
The Minnesota board on aging, in
cooperation with the area agencies on
aging and statewide senior citizen
organizations, shall develop and
present to the legislature by February
1, 1994, a plan for operating the Aging
Ombudsman programs through grants to
private, nonprofit organizations,
wherever possible. The plan shall
specify a request for proposals process
to solicit applications for areas
currently unserved by grantees. Goals
of the plan and its implementation are
to improve advocacy services for
nursing home residents, acute care
patients, and home care clients by
strengthening quality, access, and
independence, as well as by taking full
advantage of local matching funds. The
plan must include a formula and
rationale for the allocation of state
and federal ombudsman funds among
regions within the state.
For the purpose of transferring certain
persons from the SILS program to the
home and community-based waivered
services program for persons with
mental retardation or related
conditions, the amount of funds
transferred between the
semi-independent living services (SILS)
account or the state community social
services account and the state medical
assistance account shall be based on
each county's participation in
transferring persons to the waivered
services program. No person for whom
these funds are transferred shall be
required to obtain a new living
arrangement, notwithstanding Minnesota
Statutes, section 252.28, subdivision
3, paragraph (4), and Minnesota Rules,
parts 9525.1800, subpart 25a, and
9525.1869, subpart 6. When supported
living services are provided to persons
for whom these funds are transferred,
the commissioner may substitute the
licensing standards of Minnesota Rules,
parts 9525.0500 to 9525.0660, for parts
9525.2000 to 2525.2140, if the services
remain nonresidential as defined in
Minnesota Statutes, section 245A.02,
subdivision 10. For the purpose of
Minnesota Statutes, chapter 256G, when
a service is provided under these
substituted licensing standards, the
status of residence of the recipient of
that service shall continue to be
considered excluded time.
Contingent upon federal approval of
expanding eligibility for home and
community-based services for persons
with mental retardation or related
conditions, the commissioner shall
reduce the state semi-independent
living services (SILS) payments to each
county by the total medical assistance
expenditures for nonresidential
services attributable to former SILS
recipients transferred by the county to
the home and community-based services
program for persons with mental
retardation or related conditions. Of
the reduced SILS payments determined
above, the commissioner shall transfer
to the state medical assistance account
an amount equal to the nonfederal share
of the nonresidential services under
the home and community-based services
for persons with mental retardation or
related conditions. Of the remaining
reduced SILS payments, 80 percent shall
be returned to the SILS grant program
to provide additional SILS services and
20 percent shall be transferred to the
general fund.
An additional $20,000 each year is
appropriated from the children's trust
fund to the special revenue fund for
administration and indirect costs of
the children's trust fund program.
From the money appropriated in this
subdivision, the commissioner shall
transfer $25,000 to the commissioner of
trade and economic development to be
used for an area action planning grant
to a city which has at least 30 percent
renter-occupied housing. The planning
grant must address an area within the
city containing at least 20 percent of
the city's population and at least
three percent of its land. The median
household income of the area must be 80
percent of the county median, or less.
The residential buildings in the area
must be at least 50 percent
renter-occupied and at least 50 percent
of them must have been built before
1970.
The commissioner of human services
shall study and report on the adequacy
and effectiveness of investigations of
child maltreatment in day care centers
licensed under Minnesota Rules, parts
9503.0005 to 9503.0175. The
commissioner shall report back to the
legislature by February 1, 1994, with
recommendations on whether the county
or state agency should conduct such
investigations. In preparing the
study, the commissioner shall consult
with providers and representatives of
county social service agencies.
$54,000 of the funds appropriated to
the commissioner of human services for
operation of the Early Childhood Care
and Education Council under Minnesota
Statutes, section 256H.195, shall be
used to enable the commissioner to
contract with the greater Minneapolis
day care association to establish a
pilot program for training child care
workers. The program shall be subject
to the provisions of Minnesota
Statutes, chapter 178, regarding
masters and apprentices, including but
not limited to, the requirements for an
apprenticeship agreement, the approval
and registration of apprenticeship
programs, and the certification of
completion of apprenticeship.
The pilot project shall be designed to
provide (1) in-service training, (2)
coursework, and (3) salary upgrades,
for child care workers employed in
facilities licensed by the commissioner
of human services under Minnesota
Rules, chapters 9502 and 9503.
Projects shall be designed to train
child care workers to qualify as
assistant teachers, teachers, and
in-service trainers or mentors, in a
sequenced professional development
program. The commissioner shall
evaluate the pilot projects and shall
present a report to the legislature by
February 15, 1995.
The report shall contain
recommendations on the feasibility of
establishing a statewide program for
training child care workers.
Of this appropriation, $250,000 is
available for the planning and design
stage for the social services
information system, which shall include:
(a) general requirements definition for
the county-based system and the state
system;
(b) detailed design specifications;
(c) system life cycle analysis,
including detailed analysis of system
size and scope during its life cycle;
and
(d) implementation plan, including
detailed estimates of costs to
implement and operate the system.
The department shall prepare a report
to the legislature in January 1994
specifying the costs required to
implement and operate the system and
the federal financial participation
rates expected, and seeking approval
for continuation of development and
implementation.
Of this appropriation, $100,000 each
year is for a grant to the New Chance
demonstration project that provides
comprehensive services to young AFDC
recipients who became pregnant as
teenagers and dropped out of high
school. The commissioner shall provide
an annual report on the progress of the
demonstration project, including
specific data on participant outcomes
in comparison to a control group that
received no services. The commissioner
shall also include recommendations on
whether strategies or methods that have
proven successful in the demonstration
project should be incorporated into the
STRIDE employment program for AFDC
recipients.
Of the appropriation for aging services
grants, $50,000 each year is to
increase the appropriation for home
delivered meals.
Of this appropriation, $3,500,000 is
for collaboratives to be spent as
follows: (1) $1,500,000 in fiscal year
1994 for planning grants to
collaboratives, to be awarded according
to procedures published by the
children's cabinet; and (2) $1,000,000
each year of the biennium for
implementation grants to collaboratives
that have plans approved by the
children's cabinet. The commissioner
may transfer any unspent portion of the
appropriation for planning grants to
the fiscal year 1995 appropriation for
program grants with the approval of the
commissioner of finance. None of this
appropriation shall become part of the
base for the 1996-1997 biennium.
Subd. 4. Health Care Administration
General
$1,370,722,000 $1,514,593,000
Notwithstanding Minnesota Statutes,
section 13.03, subdivision 5, the
rate-setting computer program except
the edits and screens for nursing home
payment rates is not trade secret
information and is public data not on
individuals. If a person requests this
data, the commissioner of human
services shall require the requesting
person to pay no more than the actual
costs of searching for and retrieving
the data, including the cost of
employee time, and for making,
certifying, compiling, and
electronically transmitting the copies
of the data or the data, but may not
charge for separating public data from
not public data.
Medical assistance and general
assistance medical care payments for
mental health services provided by
masters-prepared mental health
professionals, except services provided
by community mental health centers,
shall be 75 percent of the rate paid to
doctoral-prepared professionals for
fiscal year 1994 and shall be 80
percent of the rate paid to
doctoral-prepared professionals for
fiscal year 1995.
Money appropriated for preadmission
screening and the alternative care
program for fiscal year 1995 may be
used for these purposes in fiscal year
1994.
In the event that a large
community-based facility licensed under
Minnesota Rules, parts 9525.0215 to
9525.0355, for more than 16 beds, but
not certified as an intermediate care
facility for persons with mental
retardation or related conditions,
closes and alternative services for the
residents are necessary, the
commissioner may transfer on a
quarterly basis to the state medical
assistance account from each affected
county's community social service
allocation an amount equal to the state
share of medical assistance
reimbursement for such residential and
day habilitation services funded by the
medical assistance program and provided
to clients for whom the county is
financially responsible.
The commissioner is authorized to
collect information from providers of
ICF/MR, MR waiver, SILS, and day
training and habilitation services
regarding the total compensation paid
to individuals who claim reimbursement
of all or part of that compensation in
any of those programs, including
non-Minnesota services for
developmentally disabled, if that
individual's total compensation is in
excess of $50,000. The information
shall be provided in a manner specified
by the commissioner within 90 days of
its request.
For this purpose, an individual's total
compensation includes wages, salary,
wages or salaries from consultant
contracts whether or not from related
organizations, board of director fees,
bonuses, deferred compensation,
retirement plans such as IRA's,
pension, and profit sharing plans,
fringe benefits such as life insurance
and health insurance, or other employee
benefits such as use of a vehicle. The
commissioner shall also collect the
hours worked by the individual, the
number facilities or programs served
and the number of clients served within
those facilities or programs by the
individual.
The commissioner shall collect this
information for calendar years 1992 and
1993, and shall analyze and report the
results of this study to the
legislature on January 31, 1994, and
January 31, 1995, respectively. If the
total compensation information is not
provided either in the manner specified
by the commissioner or within 90 days
of the commissioner's request, the
commissioner shall reduce that
provider's payment rates by 5 percent
until the information is provided.
Upon submittal of the information, the
commissioner shall retroactively
reinstate the provider's 5 percent
payment rate reductions.
The nonfederal share of the costs of
case management services provided to
persons with mental retardation or
related conditions who are relocated
from nursing facilities as required by
federal law and who receive home- and
community-based services that are
funded through the waiver granted under
section 1915(c)(7)(B) of the Social
Security Act may be provided from
state-appropriated funding for medical
assistance grants. The division of
cost is subject to Minnesota Statutes,
section 256B.19, and the services are
included as covered programs and
services under Minnesota Statutes,
section 256.025, subdivision 2.
Any money allocated to the alternative
care program that is not spent for the
purposes indicated does not cancel but
shall be transferred to the medical
assistance account.
In the event that federal financial
participation in the Minnesota medical
assistance program is reduced as a
result of a determination that
Minnesota is out of compliance with
Public Law Number 102-234 or its
implementing regulations or with any
other federal law designed to restrict
provider tax programs or
intergovernmental transfers, the
commissioner of human services shall
appeal the determination to the fullest
extent permitted by law and may
rateably reduce all medical assistance
and general assistance medical care
payments to providers other than the
state of Minnesota by a like amount in
order to eliminate any shortfall
resulting from the reduced federal
funding. Any amount later recovered
through the appeals process shall be
used to reimburse providers for any
rateable reductions taken.
Effective for money received on or
after March 25, 1993, and during the
biennium ending June 30, 1995, the
state share of the settlement from the
Sandoz company clozaril litigation
shall be dedicated to the commissioner
of human services to supplement the HIV
drug program that is funded through the
federal Ryan White Act and is available
until expended.
The pharmacy dispensing fee shall be
$4.10 per prescription.
Medical assistance inpatient rates
identified in Minnesota Statutes,
sections 256.9685 to 256.9695, shall be
increased as follows: for inpatient
admissions to (1) a children's
hospital, nine percent; (2) a public
hospital with calendar year 1991
noncapitation medical assistance
inpatient dollar volume in excess of 13
percent of total calendar year 1991
noncapitation medical assistance
inpatient dollar volume, six percent;
and (3) a teaching hospital operated by
the University of Minnesota and having
calendar year 1991 noncapitation
medical assistance inpatient dollar
volume in excess of eight percent of
total calendar year 1991 noncapitation
medical assistance dollar volume, three
percent. For the purposes of this
paragraph, a children's hospital is
defined as one that is engaged in
furnishing services to inpatients who
are predominantly individuals under 18
years of age.
Up to $40,000 of the appropriation for
preadmission screening and alternative
care for fiscal year 1994 may be
transferred to the health care
administration account to pay the
state's share of county claims for
conducting nursing home assessments for
persons with mental illness or mental
retardation as required by Public Law
Number 100-203.
Money appropriated in fiscal year 1994
for the administration and handling of
vaccinations purchased from the Centers
for Disease Control shall be
transferred to the commissioner of
health and is available until expended.
The administration and handling must be
done in a cost-effective manner, either
by using existing storage capacity at
the department of health, or by
contracting out to a private vendor.
For the fiscal year ending June 30,
1994, a newly constructed or newly
established intermediate care facility
for the mentally retarded that is
developed and financed during that
period shall not be subject to the
equity requirements in Minnesota
Statutes, section 256B.501, subdivision
11, paragraph (d), or in Minnesota
Rules, part 9553.0060, subpart 3, item
F, provided that the provider's
interest rate does not exceed the
interest rate available through state
agency tax-exempt financing.
For the fiscal year ending June 30,
1994, if a facility which is in
receivership under Minnesota Statutes,
section 245A.12 or 245A.13, is sold to
an unrelated organization: (a)
notwithstanding Minnesota Statutes,
section 256B.501, subdivision 11, the
facility shall be considered a new
facility for rate setting purposes; and
(b) the facility's historical basis for
the physical plant, land, and land
improvements for each facility must not
exceed the prior owner's aggregate
historical basis for these same assets
for each facility. The allocation of
the purchase price between land, land
improvements, and physical plant shall
be based on the real estate appraisal
using the depreciated replacement cost
method.
The preadmission screening payment to a
county not participating in projects
under Minnesota Statutes, section
256B.0917, shall be the greater of the
county's fiscal year 1993 payment or
the county's fiscal year 1993 estimate
as provided to the commissioner of
human services by February 15, 1992.
Counties participating in projects
under Minnesota Statutes, section
256B.0917, and that did not receive an
inflation adjustment for fiscal year
1993 shall receive a one-time five
percent inflation adjustment to the
payment that they were allotted in
fiscal year 1993.
The commissioner of human services
shall grant inflation adjustments for
nursing facilities with rate years
beginning during the biennium according
to Minnesota Statutes, section
256B.431, subdivision 21, and shall
grant inflation adjustments for
intermediate care facilities for
persons with mental retardation or
related conditions with rate years
beginning during the biennium according
to Minnesota Statutes, section
256B.501, subdivision 3c.
Services provided by a physical therapy
assistant shall be reimbursed at the
same rate as services performed by a
physical therapist when the services of
the physical therapy assistant are
provided under the direction of a
physical therapist who is on the
premises. Services provided by a
physical therapy assistant that are
provided under the direction of a
physical therapist who is not on the
premises shall be reimbursed at 65
percent of the physical therapist
rate. Services provided by an
occupational therapy assistant shall be
reimbursed at the same rate as services
performed by an occupational therapist
when the services of the occupational
therapy assistant are provided under
the direction of the occupational
therapist who is on the premises.
Services provided by an occupational
therapy assistant that are not provided
under the direction of an occupational
therapist who is not on the premises
shall be reimbursed at 65 percent of
the occupational therapist rate.
Notwithstanding statutory provisions to
the contrary, the commissioner of human
services shall increase reimbursement
rates for the following by three
percent for the fiscal year ending June
30, 1995: nursing services and home
health aide services under Minnesota
Statutes, section 256B.0625,
subdivision 6a; personal care services,
and nursing supervision of personal
care services, under Minnesota
Statutes, section 256B.0625,
subdivision 19a; private duty nursing
services under Minnesota Statutes,
section 256B.0625, subdivision 7; home-
and community-based services waiver for
persons with mental retardation and
related conditions under Minnesota
Statutes, section 256B.501; community
alternatives for disabled individuals
waiver under Minnesota Statutes,
section 256B.49; community alternative
care waiver under Minnesota Statutes,
section 256B.49; home- and
community-based services waiver for the
elderly under Minnesota Statutes,
section 256B.0915; alternative care
program under Minnesota Statutes,
section 256B.0913; traumatic brain
injury waiver under Minnesota Statutes,
section 256B.093; adult residential
program grants, under rule 12, under
Minnesota Rules, parts 9535.2000 to
9535.3000; adult and family community
support grants, under rules 14 and 78,
under Minnesota Rules, parts 9535.1700
to 9535.1760; day training and
habilitation services for adults with
mental retardation and related
conditions under Minnesota Statutes,
sections 252.40 to 252.47; and
semi-independent living services under
Minnesota Statutes, section 252.275.
$25,000 is appropriated for the
biennium to the commissioner of human
services for a planning grant for the
30-bed hospital located in Chisago
county.
The commissioner shall implement a
point-of-sale electronic claims
management system to process claims for
medical assistance payment from
pharmacy providers. The system must be
able to perform on-line, real-time
eligibility verifications, and enhanced
claims data capture, for pharmacy
providers by January 31, 1994. No
later than 60 days after that date the
system must be able to perform on-line
real-time adjudication of pharmacy
claims. If the system is not able to
perform the claims adjudication within
60 days after January 31, 1994, the
commissioner must, as soon as possible
thereafter, enter into a contract with
a private vendor for a similar system.
The commissioner of human services may
implement demonstration projects
designed to create alternative delivery
systems for acute and long-term care
services to elderly and disabled
persons which provide increased
coordination, improve access to quality
services, and mitigate future cost
increases. Before implementing the
projects, the commissioner must provide
information regarding the projects to
the appropriate committees of the house
and senate.
Money appropriated for the interagency
long-term care planning committee
(INTERCOM) activity may be transferred
among all agencies specified in
Minnesota Statutes, section 144A.31,
subdivision 1, with the approval of the
members and the commissioner of finance.
The commissioner shall study
modifications to Minnesota Rules, parts
9553.0010 to 9553.0080, governing the
reimbursement system for intermediate
care facilities for persons with mental
retardation, and shall solicit advice
from the public, including provider
groups, advocates, and legislators when
developing rule amendments. The
commissioner shall report to the
legislature by January 31, 1994, on the
status of revision to these rule parts.
Community social services act grant
funds for case management shall be
increased by $600,000 and the medical
assistance account shall be decreased
by the total amount appropriated to the
medical assistance account for the
purposes of preplacement planning for
persons with mental retardation or
related conditions.
The commissioner shall study and report
to the legislature by February 1, 1994,
recommendations on the feasibility of
developing a Medicaid inpatient
hospital payment system similar to the
current Medicare methodology. The
study shall examine at least the
following reimbursement options: (1)
Medicare diagnostic related grouping
methodology, (2) reimbursement of small
volume Medicaid providers on a
percentage-of-charges basis rather than
on a prospective basis; (3) equitable
methods for reimbursing the additional
costs incurred by teaching hospitals,
children's hospitals, and high-volume
Medicaid hospitals; and (4) contracting
with an outside agency for the
administration of the Medicaid
program. The study shall also develop
a plan to combine the medical
assistance inpatient hospital
reimbursement system with the
reimbursement system to be developed by
the health care commission. The
commissioner shall establish a task
force including department staff,
hospital industry representatives, and
health care commission representatives
to assist with the preparation of the
report and recommendations. The report
shall include recommendations on the
feasibility of implementing a new
reimbursement system on July 1, 1994,
and an estimate of the cost or savings
associated with any recommended changes.
The commissioner may not adjust
hospital reimbursement rates to provide
a new hospital payment for short length
of stay mental health patients without
the prior approval of the legislature
unless the adjustment will result in
budget savings.
The commissioner shall apply to the
federal government for a waiver from
Code of Federal Regulations, parts
441.206 and 441.256, which require
certain attachments be included with
Medicaid provider billings, in order to
enable the commissioner to allow
providers to submit most or all bills
electronically.
The commissioner shall allocate money
for home and community-based services
to meet the needs of developmentally
disabled individuals on the following
priority basis: (1) to serve
individuals on county waiting lists;
and (2) to serve individuals who have
been screened for discharge from
regional treatment centers. In
allocating waiver slots to counties
under Minnesota Statutes, sections
256B.092 and 256B.501, the commissioner
shall ensure that at least as many
individuals are served from county
waiting lists as the net census
reduction from regional treatment
centers.
The commissioner of finance shall
transfer $50,000 in fiscal year 1994
and $50,000 in 1995 from the department
of human services' training budget to
the state technical college system.
This transfer is to be used for
customized training of staff who work
directly with persons with
developmental disabilities. Any
unexpended money shall revert to the
general fund.
Effective for services rendered on or
after July 1, 1993, the current medical
assistance payment rate for ambulance
services shall be increased by three
percent.
Money appropriated for a peer grouping
study in fiscal year 1994 but not
expended does not cancel but is
available for this purpose in fiscal
year 1995.
Subd. 5. Family Self-Sufficiency
Administration
General
$350,863,000 $327,109,000
Effective the day following final
enactment, the appropriation in Laws
1991, chapter 292, article 1, section
2, subdivision 4, is increased by
$13,286,000. Of this amount,
$13,186,000 is to cover MAXIS operating
deficiencies in fiscal year 1993 and
$100,000 is to be transferred to the
department of administration
information policy office for an
independent information system review
of MAXIS. The appropriation to the
information policy office does not
cancel but shall be available until
June 30, 1994. The review shall
determine if operating expenses can be
reduced, if distributed processing can
be used, and if system performance can
be improved. Findings of the review
shall be reported to the legislature by
February 1, 1994.
The commissioner shall set the monthly
standard of assistance for general
assistance and work readiness
assistance units consisting of an adult
recipient who is childless and
unmarried or living apart from his or
her parents or a legal guardian at $203.
Federal food stamp employment and
training funds received for the work
readiness program are appropriated to
the commissioner to reimburse counties
for work readiness service expenditures.
Of the appropriation for aid to
families with dependent children, the
commissioner shall provide
supplementary grants not to exceed
$200,000 a year for aid to families
with dependent children. The
commissioner shall include the
following costs in determining the
amount of the supplementary grants:
major home repairs; repair of major
home appliances; utility recaps;
supplementary dietary needs not covered
by medical assistance; and replacements
of furnishings and essential major
appliances.
Any federal money remaining from
receipt of state legalization impact
assistance grants, after reimbursing
the department of education for actual
expenditures, must be deposited in the
aid to families with dependent children
account.
Unexpended money appropriated for (1)
project STRIDE work experience
activities under Minnesota Statutes,
section 256.737; (2) work readiness
employment and training services; (3)
the Minnesota family investment plan;
or (4) the child support restructuring
initiative for fiscal year 1994 does
not cancel but is available for fiscal
year 1995.
Of the appropriation for child support
enforcement, $2,570,000 in fiscal year
1994 and $3,233,000 in fiscal year 1995
is for implementation of the child
support restructuring initiative.
Unexpended funds for fiscal year 1994
do not cancel but are available to the
commissioner for fiscal year 1995.
The commissioner may accept on behalf
of the state any gift or bequest of
money tendered to the state for the
purpose of financing an evaluation of
the Minnesota family investment plan.
Any money so received must be deposited
in the MFIP evaluation account in the
department and is appropriated to the
commissioner for financing of this
evaluation.
For the food stamp program error rate
sanction for federal fiscal year 1986,
the commissioner is granted an
exception to the provisions of
Minnesota Statutes, section 256.01,
subdivision 2, clause (14), requiring
allocation of sanctions to county human
service agencies.
Payments to the commissioner from other
governmental units and private
enterprises for services performed by
the issuance operations center shall be
deposited in the state systems account
authorized in Minnesota Statutes,
section 256.014. The payments so
received by the commissioner are
appropriated for the purposes of that
section for the operation of the
issuance center, and are to be used
according to the provisions of that
section.
The commissioner of the department of
human services is authorized to receive
Hennepin county conversion
contributions of $400,000 per year in
calendar years 1994 and 1995 to be used
for the expansion of electronic benefit
transfer systems to Hennepin county.
Money received from the county shall be
added to the appropriation. Money
received will be applied directly to
project costs and shall not cancel, but
shall remain available for expenditure
until expansion is complete.
The commissioner may accept assignment
of an existing contract for electronic
benefit transfer services, under terms
and conditions approved by the attorney
general. The term of any contract
assigned to the state may not extend
beyond June 30, 1995, and the
commissioner must publish a request for
proposals for succeeding electronic
benefit services in the State Register
before January 1, 1995.
The commissioner shall prepare
materials for submission to the
secretary of the United States
Department of Health and Human Services
and to the Minnesota congressional
delegation to urge the congress to
amend federal law to permit payment of
AFDC benefits to otherwise eligible
families with children in foster care,
as was permitted prior to 1986 under
Title IV-E of the Social Security Act.
The commissioner shall submit
electronic benefit transfer project
plans to the information policy office
for its review and approval. The plans
shall include an evaluation of the
Ramsey county system and a life cycle
analysis of the project. The
department shall examine ways to share
network development and operating costs
with businesses participating in the
electronic benefits program, and ways
that the system can be used for the
delivery of other government services.
Beginning July 1, 1993, the
commissioner of human services shall
develop an intensive training program
for county workers who do general
assistance intake work. The program
shall be designed to provide county
workers with expertise in implementing
the restrictions on eligibility in
general assistance that will take
effect on October 1, 1993. Those
restrictions will affect the
eligibility of undocumented aliens and
nonimmigrants for these programs. The
training programs must be provided to
all county social workers who do
general assistance intake. The
programs shall include training in the
following: federal immigration law,
state and federal human rights and
civil rights standards, and
multi-cultural awareness and
sensitivity. The commissioner shall
report to the legislature by February
15, 1994, on the status of these
training programs.
Effective the day following final
enactment, fiscal year 1993
appropriations made to the commissioner
of human services for computer projects
may be transferred between operations
and development. A transfer under this
paragraph may be made at the discretion
of the commissioner, but must not be
made to any project not previously
approved by the commissioner of finance
and the information policy office.
For the fiscal year ending June 30,
1995, $268,000 is transferred from the
general assistance grants and $195,000
is transferred from the MSA grants to
Hennepin county social services
grants. This amount represents group
residential housing payments for 32
persons receiving services in Hennepin
county from a provider that on August
1, 1984, was licensed under Minnesota
Rules, parts 9525.0520 to 9525.0660,
but funded as a group residence under
general assistance or Minnesota
supplemental aid. These 32 beds are to
be permanently removed from the group
residential census and not replaced by
other group residential housing
agreements.
Subd. 6. Mental Health and Regional
Treatment Center Administration
General
$259,771,000 $260,314,000
For purposes of restructuring the
regional treatment centers and state
nursing homes, any regional treatment
center or state nursing home employee
whose position is to be eliminated
shall be afforded the options provided
in applicable collective bargaining
agreements. All salary and mitigation
allocations from fiscal year 1994 shall
be carried forward into fiscal year
1995. Provided there is no conflict
with any collective bargaining
agreement, any regional treatment
center or state nursing home position
reduction must only be accomplished
through mitigation, attrition,
transfer, and other measures as
provided in state or applicable
collective bargaining agreements and in
Minnesota Statutes, section 252.50,
subdivision 11, and not through layoff.
If the resident population at the
regional treatment centers is projected
to be higher than the estimates upon
which the medical assistance forecast
and budget recommendations for the
1994-95 biennium were based, the amount
of the medical assistance appropriation
that is attributable to the cost of
services that would have been provided
as an alternative to regional treatment
center services, including resources
for community placements and waivered
services for persons with mental
retardation and related conditions, is
transferred to the residential
facilities appropriation.
The commissioner of human services is
prohibited from transferring any
building on the campus of the Faribault
regional treatment center to any other
state agency, or from declaring any
building or acreage on the campus to be
surplus, unless specifically authorized
to do so by the legislature.
The commissioner may determine the need
for conversion of a state-operated home
and community-based service program to
a state-operated intermediate care
facility for persons with mental
retardation if the conversion will
produce a net savings to the state
general fund and the persons receiving
home and community-based services
choose to receive services in an
intermediate care facility for persons
with mental retardation. After the
commissioner has determined the need to
convert the program, the commissioner
of health shall certify the program as
an intermediate care facility for
persons with mental retardation if the
program meets applicable certification
standards.
Of the state enhanced waiver slots
authorized for regional treatment
center downsizing, 32 in fiscal year
1994 and an additional 36 in fiscal
year 1995 shall be for state-operated
services. Of these a minimum of eight
in fiscal year 1994 and an additional
four in fiscal year 1995 shall be
utilized by the Cambridge Regional
Treatment Center and a minimum of eight
in fiscal year 1994 and an additional
four in fiscal year 1995 shall be
utilized at the Fergus Falls regional
treatment center.
Of the enhanced waiver slots authorized
for the Faribault regional treatment
center, 64 shall be for state-operated
services.
Of the enhanced waiver slots authorized
for the Moose Lake regional treatment
center, 12 shall be for state-operated
services.
Any unexpended appropriations from the
regional treatment center supplements
for state enhanced waiver slots shall
be transferred into the regional
treatment center salary account.
The commissioner may transfer
unencumbered appropriation balances
between fiscal years for the state
residential facilities repairs and
betterments account and special
equipment.
Wages for project labor may be paid by
the commissioner of human services out
of repairs and betterments money if the
individual is to be engaged in a
construction project or a repair
project of short-term and nonrecurring
nature. Compensation for project labor
shall be based on the prevailing wage
rates, as defined in Minnesota
Statutes, section 177.42, subdivision 6.
Project laborers are excluded from the
provisions of Minnesota Statutes,
sections 43A.22 to 43A.30, and shall
not be eligible for state-paid
insurance and benefits.
When the operations of the regional
treatment center chemical dependency
fund created in Minnesota Statutes,
section 246.18, subdivision 2, are
impeded by projected cash deficiencies
resulting from delays in the receipt of
grants, dedicated income or other
similar receivables, and when the
deficiencies would be corrected within
the budget period involved, the
commissioner of finance shall transfer
general fund cash reserves into this
account as necessary to meet cash
demands. The cash flow transfers must
be returned to the general fund as soon
as sufficient cash balances are
available in the account to which the
transfer was made. Any interest earned
on general fund cash flow transfers
accrues to the general fund and not the
regional treatment center chemical
dependency fund.
Money is appropriated from the mental
health special projects account for
adults and children with mental illness
from across the state, for a camping
program which utilizes the Boundary
Waters Canoe Area and is cooperatively
sponsored by client advocacy, mental
health treatment, and outdoor
recreation agencies.
Of this appropriation, $560,000 the
first year is for children's integrated
mental health grants. Any money not
expended in the first year is available
the second year. The three positions
to provide technical assistance to
counties are unclassified.
Funds received by the commissioner of
human services from the state lottery
director shall be used for the
compulsive gambling treatment programs
authorized by Minnesota Statutes,
section 245.98, subdivision 2,
including programs operated at the
following facilities: St. Mary's
hospital, Minneapolis; Gamblers Choice,
Intervention Institute, Minneapolis;
Upper Mississippi Health Service,
Bemidji; Gamestar, St. Cloud; Lake
Superior Area Family Services, Duluth;
and Project Turnabout, Granite Falls.
In determining the amount of money to
be given to each facility the
commissioner shall consider the
projected number of clients to be
served, quality of services and whether
the treatment will be inpatient or
outpatient.
Of the appropriation for compulsive
gambling treatment programs and the
council on compulsive gambling under
Minnesota Statutes, section 349.212,
subdivision 2, $25,000 each year shall
be designated for the Minnesota council
on compulsive gambling for the
development of an information gathering
and dissemination network. Any money
allocated or contributed for the
compulsive gambling treatment programs
does not cancel but shall be available
for compulsive gambling treatment
programs.
The legislature recognizes that orderly
transfer of buildings at the Moose Lake
regional center from the commissioner
of human services to the commissioner
of corrections is necessary to assure
the welfare of vulnerable persons, to
facilitate a shared campus, and to
abide by legislated policies concerning
the future of regional treatment
centers and state correctional
facilities.
In accordance with legislative
policies, the transfer of buildings at
the Moose Lake regional center from the
commissioner of human services to the
commissioner of corrections during
fiscal year 1994 shall be carried out
as follows:
(1) The commissioner of human services
shall transfer buildings at the Moose
Lake campus housing persons with mental
illness and psychogeriatric patients to
the commissioner of corrections upon
the commencement of planning and design
for construction of a 100-bed
psychopathic personality treatment
facility at the Moose Lake regional
treatment center;
(2) buildings that house
developmentally disabled persons may be
transferred by the commissioner of
human services to the commissioner of
corrections when the commissioner of
human services certifies that all
persons with developmental disabilities
from the Moose Lake regional center
have been placed in appropriate
community-based programs and that at
least 12 of the same residents have
been placed in state operated community
services; and
(3) buildings housing programs for
chemically dependent persons at the
Moose Lake regional center may be
transferred by the commissioner of
human services to the commissioner of
corrections after alternative
facilities for state operated chemical
dependency programs have been located
off campus in the Moose Lake catchment
area and all program residents and
staff have been relocated to the new
state operated community-based program.
Construction on the 100 unit facility
at Moose Lake for psychopathic
personality patients may not be
commenced until after construction has
been commenced on the 50 bed facility
at St. Peter, except that this
limitation shall not restrict site
preparation. The commissioner of
administration shall report to the
legislature by February 1, 1994, on the
progress on both of the authorized
facilities for psychopathic personality
patients and other bonding projects
related to regional treatment centers.
It is the intent of the legislature
that the transfer of vulnerable
persons, construction of the
psychiatric hospital, and the
conversion of existing buildings at
Moose Lake for use by the department of
corrections shall be coordinated in
order to minimize any disruptive impact
on the care and treatment of vulnerable
persons.
$50,000 is appropriated for the
biennium to the commissioner of human
services for costs associated with
establishing a consolidated financial
record management facility at the
Cambridge regional treatment center.
This facility must be operational by
July 1, 1994. By July 1, 1994, the
commissioner shall report to the
legislature on other opportunities to
consolidate department records at the
regional treatment center.
The transfer of the hospital building
at the Faribault regional treatment
center to the department of
administration, to the department of
corrections, or to any other state
agency, may take place only after
alternative, state-operated, skilled
nursing facility, or intermediate care
facility for persons with mental
retardation and infirmary space has
been developed for residents of the
Faribault regional treatment center.
Agreements between the commissioner of
corrections and the commissioner of
human services concerning operation of
a correctional facility on the Moose
Lake regional treatment center campus
shall include provisions for the
utilization of the regional laundry
facilities at the Brainerd regional
treatment center.
Sec. 3. COMMISSIONER OF HEALTH
Subdivision 1. Total
Appropriation 54,162,000 53,469,000
Summary by Fund
General 37,723,000 37,787,000
Metropolitan Landfill Contingency
Action Fund 191,000 204,000
State Government
Special Revenue 14,760,000 13,968,000
Trunk Highway 1,488,000 1,510,000
The appropriation from the Metropolitan
Landfill Contingency Action Fund is for
monitoring well water supplies and
conducting health assessments in the
metropolitan area.
The appropriation from the trunk
highway fund is for emergency medical
services activities.
Subd. 2. Health Protection 16,741,000 15,825,000
Summary by Fund
General 7,124,000 6,978,000
State Government
Special Revenue 9,448,000 8,665,000
Metropolitan Landfill Contingency
Action Fund 169,000 182,000
Of this appropriation, $150,000 is an
increase for lead activities and
programs of which $25,000 must be used
to provide safe housing, under
Minnesota Statutes, section 144.874,
subdivision 4, to meet the relocation
requirements of residential lead
abatement and $25,000 must be used to
provide grants to nonprofit
community-based organizations in areas
at high risk for toxic lead exposure,
for lead cleanup equipment and material
grants under Minnesota Statutes,
section 144.872, subdivision 4.
Of this appropriation, $40,000 is
appropriated each year to maintain lead
inspector services outside the
seven-county metropolitan area.
Of this appropriation, $75,000 is for a
grant to the World Health Organization
collaborating center for reference and
research on streptococci at the
University of Minnesota to conduct a
study to determine the efficacy of
conducting throat cultures for evidence
of streptococcal infection in selected
symptomatic students. The study must
be conducted in four schools, one of
which is in rural Minnesota and one of
which is in a core city. The study
must be conducted with students in
grades K-12. * (The preceding paragraph
starting "Of" was vetoed by the
governor.)
Subd. 3. Health Care Resources
and Systems 3,680,000 3,671,000
Summary by Fund
General 350,000 350,000
State Government
Special Revenue 3,330,000 3,321,000
Of this appropriation, $75,000 is
appropriated each year to the
commissioner of health for the purposes
of occupational analysis under
Minnesota Statutes, chapter 214. The
commissioner may convene an advisory
committee to assist in developing
recommendations.
Any efforts undertaken by the Minnesota
departments of health or human services
to conduct periodic educational
programs for nursing home residents
shall build on and be coordinated with
the resident and family advisory
council education program established
in Minnesota Statutes, section 144A.33.
Notwithstanding the provisions of
Minnesota Statutes, sections 144.122
and 144.53, the commissioner of health
shall increase the annual licensure fee
charged to a hospital accredited by the
joint commission on accreditation of
health care organizations by $520 and
shall increase the annual licensure fee
charged to nonaccredited hospitals by
$225.
Notwithstanding the provisions of
Minnesota Statutes, sections 144.122,
144.53, and 144A.07, a health care
facility licensed under the provisions
of Minnesota Statutes, chapter 144 or
144A, may submit the required fee for
licensure renewal in quarterly
installments. Any health care facility
requesting to pay the renewal fees in
quarterly payments shall make the
request at the time of license renewal.
Facilities licensed under the
provisions of Minnesota Statutes,
chapter 144, shall submit quarterly
payments by January 1, April 1, July 1,
and October 1 of each year. Nursing
homes licensed under Minnesota
Statutes, chapter 144A, shall submit
the first quarterly payment with the
application for renewal, and the
remaining payments shall be submitted
at three-month intervals from the
license expiration date. The
commissioner of health can require full
payment of any outstanding balance if a
quarterly payment is late. Full
payment of the annual renewal fee will
be required in the event that the
facility is sold or ceases operation
during the licensure year. Failure to
pay the licensure fee is grounds for
the nonrenewal of the license.
The commissioner shall adjust the fees
for hospital licensure renewal in such
a way that fees for hospitals not
accredited by the joint commission on
accreditation of health care
organizations are capped at $2,000,
plus $100 per bed. Any loss of revenue
that results from this cap must be
evenly distributed to hospitals which
are accredited by the joint commission.
The commissioner shall report to the
chairs of the house of representatives
health and housing finance division and
the senate health and family services
finance division by January 1, 1995, on
progress in developing a revised cost
allocation system to determine
licensing fees for health care
facilities and shall recommend language
to modify hospital and nursing home
fees accordingly.
Effective the day following final
enactment, in the event that the
commissioner of health is ordered by a
court or otherwise agrees to assume
responsibility for the handling of
patient's medical records from a closed
hospital, such records shall be
considered as medical data under the
provisions of Minnesota Statutes,
section 13.42, subdivision 3. The
commissioner of health is authorized to
handle and to provide access to these
records in accordance with the
provisions of Minnesota Statutes,
sections 145.30 to 145.32 and 144.335.
A written certification by the
commissioner of health or the
commissioner's designee that a
photographic or photostatic copy of a
record is a complete and correct copy
shall have the same force and effect as
a comparable certification of an
officer or employee in charge of the
records of the closed hospital. Costs
incurred for the handling of these
records pursuant to Minnesota Statutes,
sections 145.30 to 145.32, shall be
considered as a lien on the property of
the closed hospital in accordance with
the provisions of Minnesota Statutes,
section 514.67. At the commissioner of
health's discretion, all or a portion
of this lien may be released in
consideration for payment of a
reasonable portion of the costs
incurred by the commissioner. Any
costs incurred by the commissioner for
the handling of or providing access to
the medical records must be recovered
through charges for the access to
records under Minnesota Statutes,
section 144.335. The commissioner may
contract for services for the handling
of the medical records pursuant to
Minnesota Statutes, sections 145.30 to
145.32, and for the provision of access
to these records. Any revenues
received by the commissioner through
collections from the closed hospital or
from charges for access shall be used
to cover any contractual costs. Any
remaining money shall be deposited into
the state government special revenue
fund.
Minnesota Rules, parts 4655.1070 to
4655.1098, as in effect on September 1,
1989, are adopted as an emergency rule
of the department of health. The
commissioner of health shall publish in
the State Register a notice of intent
to adopt Minnesota Rules, parts
4655.1070 to 4655.1098 [Emergency].
The same notice shall be mailed to all
persons registered with the agency to
receive notice of any rulemaking
proceedings. The emergency rule is
exempt from the requirements of
Minnesota Statutes, sections 14.32 to
14.35, and shall take effect five
working days after publication in the
State Register. Those rules shall
govern the process for granting
exceptions to the moratorium on nursing
homes under Minnesota Statutes, section
144A.073, during the biennium.
Subd. 4. Health Delivery Systems 29,648,000 29,822,000
Summary by Fund
General 28,242,000 28,394,000
Trunk Highway 1,406,000 1,428,000
Of this appropriation, $4,200,000 is an
increase over the base for the WIC
program.
$150,000 in fiscal year 1995 is
appropriated to the ambulance service
personnel longevity award and incentive
trust account. Of this appropriation,
$40,000 is appropriated from the
ambulance service personnel longevity
award and incentive trust account to
the commissioner of health to
administer the ambulance service
personnel longevity award and incentive
program. Of this appropriation,
$45,000 is appropriated from the
ambulance service personnel longevity
award and incentive trust account to
the commissioner of health to redesign
and consolidate the volunteer ambulance
attendant reimbursement database, to
establish the database for the
personnel longevity award and incentive
program, and to purchase computer
equipment for fiscal year 1995.
General fund appropriations for the
women, infants and children food
supplement program (WIC) are available
for either year of the biennium.
Transfers of appropriations between
fiscal years must be for the purpose of
maximizing federal funds or minimizing
fluctuations in the number of
participants.
When cost effective, the commissioner
may use money received for the services
for children with handicaps program to
purchase health coverage for eligible
children.
In the event that Minnesota is required
to comply with the provision in the
federal maternal and child health block
grant law, which requires 30 percent of
the allocation to be spent on primary
services for children, federal funds
allocated to the commissioner of health
under Minnesota Statutes, section
145.882, subdivision 2, may be
transferred to the commissioner of
human services for the purchase of
primary services for children covered
by MinnesotaCare. The commissioner of
human services shall transfer an equal
amount of the money appropriated for
MinnesotaCare to the commissioner of
health to assure access to quality
child health services under Minnesota
Statutes, section 145.88.
General fund appropriations for
treatment services in the services for
children with handicaps program are
available for either year of the
biennium.
Up to $50,000 of the appropriation for
treatment services in the services for
children with handicaps program may be
used to conduct a needs assessment of
children with special health care needs
and their families, and $105,000 must
be used to avoid reducing the nursing
staff due to inflationary increases to
the extent possible with this
appropriation.
Of this appropriation, $50,000 is to
establish and administer a financial
data collection program on ambulance
services licensed in the state. The
commissioner shall coordinate this
program with the data collection
initiatives of Minnesota Statutes,
chapter 62J. In designing the data
collection program, the commissioner
shall consult with the Minnesota
Ambulance Association and regional
emergency medical services programs.
The financial data collection program
must include, but is not limited to,
ambulance charges, third-party
reimbursements, sources of direct and
indirect subsidies, and other costs
involved in providing ambulance care in
Minnesota.
All licensed ambulance services shall
be required to cooperate and report
information requested by the
commissioner. Information collected on
individuals is nonpublic data. The
commissioner may provide summary data
under Minnesota Statutes, section
13.05, subdivision 7, and may release
summary data in reports.
The commissioner shall report to the
legislature by February 1, 1995. The
report must include an analysis of the
financial condition of licensed
ambulance services in Minnesota,
including a description of:
(1) the various organization models
used to finance and deliver ambulance
services;
(2) the factors influencing the total
revenues, rates charged, operational
and other expenses;
(3) limitations and barriers in
collecting data on revenues and
expenses;
(4) the range of revenues collected and
rates charged by type of organizational
model and by region of the state;
(5) any other significant findings
relevant to the financial condition of
ambulance services in the state.
The commissioner may contract for the
collection of data and the creation of
the financial data collection system.
The commissioner shall report to the
legislature on January 15 in each
odd-numbered year all of the above
information. The commissioner shall
assist ambulance services which are
unable to comply with data requests.
Money appropriated is available in
either year of the biennium. For
purposes of establishing the base for
the next biennium, the commissioner of
finance shall assume $70,000 to be
available for each biennium.
The commissioner may sell at market
value, all nonsmoking or tobacco use
prevention advertising materials.
Proceeds from the sale of the
advertising materials are appropriated
to the department of health for its
nonsmoking program.
Effective the day following final
enactment, fiscal year 1993
appropriations for emergency medical
technician training reimbursement under
Minnesota Statutes, section 144.8091,
do not cancel and are available until
expended.
Subd. 5. Health Support Services 4,093,000 4,151,000
Summary by Fund
General 2,007,000 2,065,000
Metropolitan Landfill Contingency
Action Fund 22,000 22,000
Trunk Highway 82,000 82,000
State Government
Special Revenue 1,982,000 1,982,000
Sec. 4. VETERANS NURSING
HOMES BOARD 15,877,000 17,063,000
The board may set costs of care at the
Silver Bay and Luverne facilities based
on costs of average skilled nursing
care provided to residents of the
Minneapolis veterans home.
The veterans homes board shall limit
the total administrative expenditures
for the board and all the homes to no
more than 17 percent of total
expenditures in fiscal year ending June
30, 1994, and 16 percent of total
expenditures in fiscal year ending June
30, 1995. The board may transfer money
between facilities after notifying the
chairs of the health and housing
finance division of the health and
human services committee in the house
of representatives and the chair of the
health and family services finance
division in the senate.
The veterans homes board shall conduct
an alternative site study for the
Minneapolis veterans home.
Of this appropriation, $100,000 in
fiscal year 1995 is for an information
system. All information policy office
requirements must be met before
hardware and software are purchased.
The commissioner of health shall not
apply the provisions of Minnesota
Statutes, section 144.55, subdivision
6, paragraph (b), to the Minnesota
veterans home at Hastings.
The commissioner of health shall not
reduce the licensed bed capacity for
the Minneapolis veterans home in lieu
of presentation to the legislature of
building needs and options by the
veterans homes board of directors.
Sec. 5. HEALTH-RELATED BOARDS
Subdivision 1. Total
Appropriation 6,406,000 6,399,000
The appropriations in this section are
from the state government special
revenue fund.
A board named in this article may
transfer appropriated funds to the
health-related licensing board
administrative services unit within the
board of chiropractic examiners for
additional administrative support
services.
The commissioner of finance shall not
permit the allotment, encumbrance, or
expenditure of money appropriated in
this section in excess of the
anticipated biennial revenues from fees
collected by the boards. Neither this
provision nor Minnesota Statutes,
section 214.06, applies to transfers
from the general contingent account, if
the amount transferred does not exceed
the amount of surplus revenue
accumulated by the transferee during
the previous five years.
Subd. 2. Board of Chiropractic
Examiners 368,000 368,000
Of this appropriation from the state
government special revenue fund,
$63,000 the first year and $63,000 the
second year is to provide
administrative services to all
health-related licensing boards.
Subd. 3. Board of Dentistry 665,000 652,000
Subd. 4. Board of Marriage and
Family Therapy 94,000 94,000
Subd. 5. Board of Medical
Practice 2,045,000 2,045,000
Subd. 6. Board of Nursing 1,501,000 1,504,000
Subd. 7. Board of Nursing
Home Administrators 171,000 171,000
Subd. 8. Board of Optometry 71,000 72,000
Subd. 9. Board of Pharmacy 600,000 602,000
Subd. 10. Board of Podiatry 30,000 30,000
Subd. 11. Board of Psychology 315,000 315,000
Subd. 12. Board of Social Work 438,000 438,000
Subd. 13. Board of Veterinary
Medicine 108,000 108,000
Sec. 6. COUNCIL ON DISABILITY 566,000 566,000
Sec. 7. OMBUDSMAN FOR MENTAL
HEALTH AND MENTAL RETARDATION 881,000 880,000
Sec. 8. CARRYOVER LIMITATION
None of the appropriations in this act
which are allowed to be carried forward
from fiscal year 1994 to fiscal year
1995 shall become part of the base
level funding for the 1995-1997
biennial budget.
Sec. 9. TRANSFERS
Subdivision 1. Approval Required
Transfers may be made by the
commissioners of human services and
health and the veterans nursing homes
board to salary accounts and
unencumbered salary money may be
transferred to the next fiscal year in
order to avoid layoffs with the advance
approval of the commissioner of finance
and upon notification of the chairs of
the senate health care and family
services finance division and the house
of representatives human services
finance and health and housing finance
divisions. Amounts transferred to
fiscal year 1995 shall not increase the
base funding level for the 1996-1997
appropriation. The commissioners and
the board shall not transfer money to
or from the object of expenditure
"grants and aid" without the written
approval of the governor after
consulting with the legislative
advisory commission.
Subd. 2. Transfers of Unencumbered
Appropriations
Positions and administrative money may
be transferred within the departments
of human services and health and within
the programs operated by the veterans
homes board as the commissioners or the
board consider necessary, with the
advance approval of the commissioner of
finance. The commissioners and the
board shall inform the chairs of the
human services finance division of the
house of representatives and the health
care and family services division of
the senate quarterly about transfers
made under this provision.
Sec. 10. PROVISIONS
Money appropriated to the commissioner
of human services and to the veterans
nursing homes board for the purchase of
provisions within the item "current
expense" must be used solely for that
purpose. Money provided and not used
for the purchase of provisions must be
canceled into the fund from which
appropriated, except that money
provided and not used for the purchase
of provisions because of population
decreases may be transferred and used
for the purchase of medical and
hospital supplies with the written
approval of the governor after
consultation with the legislative
advisory commission.
The allowance for food may be adjusted
annually to reflect changes in the
producer price index, as prepared by
the United States Bureau of Labor
Statistics, with the approval of the
commissioner of finance. Adjustments
for fiscal year 1994 and fiscal year
1995 must be based on the June 1993 and
June 1994 producer price index
respectively, but the adjustment must
be prorated if the wholesale food price
index adjustment would require money in
excess of this appropriation.
Sec. 11. SUNSET OF UNCODIFIED LANGUAGE
All uncodified language contained in
this article expires on June 30, 1995,
unless a different expiration is
explicit. All uncodified language
contained in Laws 1992, chapter 513,
article 5, expires on June 30, 1993,
unless a different expiration is
explicit.
ARTICLE 2
DEPARTMENT OF HUMAN SERVICES
FINANCE AND ADMINISTRATION
Section 1. Minnesota Statutes 1992, section 256.025,
subdivision 3, is amended to read:
Subd. 3. [PAYMENT METHODS.] (a) Beginning July 1, 1991,
the state will reimburse counties for the county share of county
agency expenditures for benefits and services distributed under
subdivision 2 and funded by the human services account
established under section 273.1392.
(b) Payments under subdivision 4 are only for client
benefits and services distributed under subdivision 2 and do not
include reimbursement for county administrative expenses.
(c) The state and the county agencies shall pay for
assistance programs as follows:
(1) Where the state issues payments for the programs, the
county shall monthly advance to the state, as required by the
department of human services, the portion of program costs not
met by federal and state funds. The advance shall be an
estimate that is based on actual expenditures from the prior
period and that is sufficient to compensate for the county share
of disbursements as well as state and federal shares of
recoveries;
(2) Where the county agencies issue payments for the
programs, the state shall monthly advance to counties all
federal funds available for those programs together with an
amount of state funds equal to the state share of expenditures;
and
(3) Payments made under this paragraph are subject to
section 256.017. Adjustment of any overestimate or
underestimate in advances shall be made by the state agency in
any succeeding month.
Sec. 2. Minnesota Statutes 1992, section 256.025,
subdivision 4, is amended to read:
Subd. 4. [PAYMENT SCHEDULE.] Except as provided for in
subdivision 3, beginning July 1, 1991, the state will reimburse
counties, according to the following payment schedule, for the
county share of county agency expenditures for the programs
specified in subdivision 2.
(a) Beginning July 1, 1991, the state will reimburse or pay
the county share of county agency expenditures according to the
reporting cycle as established by the commissioner, for the
programs identified in subdivision 2. Payments for the period
of January 1 through July 31, for calendar years 1991, 1992, and
1993, 1994, and 1995 shall be made on or before July 10 in each
of those years. Payments for the period August through December
for calendar years 1991, 1992, and 1993, 1994, and 1995 shall be
made on or before the third of each month thereafter through
December 31 in each of those years.
(b) Payment for 1/24 of the base amount and the January
1994 1996 county share of county agency expenditures growth
amount for the programs identified in subdivision 2 shall be
made on or before January 3, 1994 1996. For the period of
February 1, 1994 1996, through July 31, 1994 1996, payment of
the base amount shall be made on or before July 10, 1994 1996,
and payment of the growth amount over the base amount shall be
made on or before July 10, 1994 1996. Payments for the period
August 1994 1996 through December 1994 1996 shall be made on or
before the third of each month thereafter through December
31, 1994 1996.
(c) Payment for the county share of county agency
expenditures during January 1995 1997 shall be made on or before
January 3, 1995 1997. Payment for 1/24 of the base amount and
the February 1995 1997 county share of county agency
expenditures growth amount for the programs identified in
subdivision 2 shall be made on or before February 3, 1995 1997.
For the period of March 1, 1995 1997, through July 31, 1995
1997, payment of the base amount shall be made on or before July
10, 1995 1997, and payment of the growth amount over the base
amount shall be made on or before July 10, 1995 1997. Payments
for the period August 1995 1997 through December 1995 1997 shall
be made on or before the third of each month thereafter through
December 31, 1995 1997.
(d) Monthly payments for the county share of county agency
expenditures from January 1996 1998 through February 1996 1998
shall be made on or before the third of each month through
February 1996 1998. Payment for 1/24 of the base amount and the
March 1996 1998 county share of county agency expenditures
growth amount for the programs identified in subdivision 2 shall
be made on or before March 1996 1998. For the period of April
1, 1996 1998, through July 31, 1996 1998, payment of the base
amount shall be made on or before July 10, 1996 1998, and
payment of the growth amount over the base amount shall be made
on or before July 10, 1996 1998. Payments for the period August
1996 1998 through December 1996 1998 shall be made on or before
the third of each month thereafter through December 31,
1996 1998.
(e) Monthly payments for the county share of county agency
expenditures from January 1997 1999 through March 1997 1999
shall be made on or before the third of each month through March
1997 1999. Payment for 1/24 of the base amount and the
April 1997 1999 county share of county agency expenditures
growth amount for the programs identified in subdivision 2 shall
be made on or before April 3, 1997 1999. For the period of May
1, 1997 1999, through July 31, 1997 1999, payment of the base
amount shall be made on or before July 10, 1997 1999, and
payment of the growth amount over the base amount shall be made
on or before July 10, 1997 1999. Payments for the period August
1997 1999 through December 1997 1999 shall be made on or before
the third of each month thereafter through December 31,
1997 1999.
(f) Monthly payments for the county share of county agency
expenditures from January 1998 2000 through April 1998 2000
shall be made on or before the third of each month through April
1998 2000. Payment for 1/24 of the base amount and the May 1998
2000 county share of county agency expenditures growth amount
for the programs identified in subdivision 2 shall be made on or
before May 3, 1998 2000. For the period of June 1, 1998 2000,
through July 31, 1998 2000, payment of the base amount shall be
made on or before July 10, 1998 2000, and payment of the growth
amount over the base amount shall be made on or before July
10, 1998 2000. Payments for the period August 1998 2000 through
December 1998 2000 shall be made on or before the third of each
month thereafter through December 31, 1998 2000.
(g) Monthly payments for the county share of county agency
expenditures from January 1999 2001 through May 1999 2001 shall
be made on or before the third of each month through May 1999
2001. Payment for 1/24 of the base amount and the June 1999
2001 county share of county agency expenditures growth amount
for the programs identified in subdivision 2 shall be made on or
before June 3, 1999 2001. Payments for the period July 1999
2001 through December 1999 2001 shall be made on or before the
third of each month thereafter through December 31, 1999 2001.
(h) Effective January 1, 2000 2002, monthly payments for
the county share of county agency expenditures shall be made
subsequent to the first of each month.
Payments under this subdivision are subject to the
provisions of section 256.017.
Sec. 3. [256.026] [ANNUAL APPROPRIATION.]
(a) There shall be appropriated from the general fund to
the commissioner of human services in fiscal year 1994 and each
fiscal year thereafter the amount of $142,339,359, which is the
sum of the amount of human services aid determined for all
counties in Minnesota for calendar year 1992 under Minnesota
Statutes 1992, section 273.1398, subdivision 5a, before any
adjustments for calendar year 1991.
(b) In addition to the amount in paragraph (a), there shall
also be annually appropriated from the general fund to the
commissioner of human services in fiscal years 1996, 1997, 1998,
1999, 2000, and 2001 the amount of $5,930,807.
(c) The amounts appropriated under paragraphs (a) and (b)
shall be used with other appropriations to make payments
required under section 256.025 for fiscal year 1994 and
thereafter.
Sec. 4. Minnesota Statutes 1992, section 273.1392, is
amended to read:
273.1392 [PAYMENT; SCHOOL DISTRICTS; COUNTIES.]
(1) [AIDS TO SCHOOL DISTRICTS.] The amounts of
conservation tax credits under section 273.119; disaster or
emergency reimbursement under section 273.123; attached
machinery aid under section 273.138; homestead credit under
section 273.13; aids and credits under section 273.1398;
enterprise zone property credit payments under section 469.171;
and metropolitan agricultural preserve reduction under section
473H.10, shall be certified to the department of education by
the department of revenue. The amounts so certified shall be
paid according to section 124.195, subdivisions 6 and 10.
(2) [AIDS TO COUNTIES.] The amounts of human services aid
increase determined under section 273.1398, subdivision 5b,
shall be deposited in a human services aid account hereby
created as an account within the state's general fund. The
amount within the account shall annually be transferred to the
department of human services by the department of revenue. The
amounts so transferred shall be paid according to section
256.025.
Sec. 5. Minnesota Statutes 1992, section 273.1398,
subdivision 5b, is amended to read:
Subd. 5b. [STATE AID FOR COUNTY HUMAN SERVICES COSTS.] (a)
Human services aid increase for each county equals an amount
representing the county's costs for human services programs
cited in subdivision 1, paragraph (i). The amount of the aid
increase is calculated as provided in this section. The aid
increase shall be deposited in the human services account
created pursuant to section 273.1392.
(b) On July 15, 1990, each county shall certify to the
department of revenue the estimated difference between the
county's base amount costs as defined in section 256.025 for
human services programs cited in subdivision 1, paragraph (i),
for calendar year 1990 and human services program revenues from
all nonproperty tax sources excluding revenue from state and
federal payments for the programs listed in subdivision 1,
paragraph (i), and revenue from incentive programs pursuant to
sections 256.019, 256.98, subdivision 7, 256D.06, subdivision 5,
256D.15, and 256D.54, subdivision 3, used at the time the levy
was certified in 1989. At that time each county may revise its
estimate for taxes payable in 1990 for purposes of this
subdivision. The human services program estimates provided
pursuant to this clause shall only include those costs and
related revenues up to the extent the county provides benefits
within statutory mandated standards. This amount shall be the
county's human services aid amount under this section.
(c) On July 15, 1991, each county shall certify to the
department of revenue the actual difference between the county's
human services program costs and nonproperty tax revenues as
provided in paragraph (b) for calendar year 1990. If the actual
difference is larger than the estimated difference as calculated
in paragraph (b), the aid amount for the county shall be
increased by that amount. If the actual difference is smaller
than the estimated difference as calculated in paragraph (b),
the aid amount to the county shall be reduced by that amount.
(d) On January 1, 1991, the department of finance shall
certify to the department of revenue the estimated amount of
county receipts deducted from county human services expenditures
pursuant to Minnesota Statutes 1988, section 287.12, in calendar
year 1990. This amount shall be added to the human services aid
increase amount under this section.
Sec. 6. Minnesota Statutes 1992, section 275.07,
subdivision 3, is amended to read:
Subd. 3. The county auditor shall adjust each local
government's levy certified under subdivision 1, except for the
equalization levies defined in section 273.1398, subdivision 2a,
paragraph (a), by the amount of homestead and agricultural
credit aid certified by section 273.1398, subdivision 2, reduced
by the amount under section 273.1398, subdivision 5a; fiscal
disparity homestead and agricultural credit aid under section
273.1398, subdivision 2b; and equalization aid certified by
section 477A.013, subdivision 5.
Sec. 7. [REPEALER.]
Minnesota Statutes 1992, section 273.1398, subdivisions 5a
and 5c, are repealed.
ARTICLE 3
SOCIAL SERVICES AND CHILD WELFARE PROGRAMS
Section 1. Minnesota Statutes 1992, section 145.883,
subdivision 5, is amended to read:
Subd. 5. [LOW INCOME.] "Low income" means an individual or
family with an income determined to be at or below 175 percent
of the income official poverty line defined established by the
office of management and budget and revised annually in
accordance with United States Code, title 42, section 9902, as
amended through December 31, 1982. With respect to an
individual who is a high risk person, "low income" means that
the income of the high risk person or the person's family is
determined to be at or below 200 percent of the income official
poverty line defined established by the office of management and
budget and revised annually in accordance with United States
Code, title 42, section 9902, as amended through December 31,
1982, or that the person is pregnant and determined eligible for
to meet the income eligibility requirements of medical
assistance, MinnesotaCare, or the special supplemental food
program for women, infants and children (WIC). The commissioner
shall establish the low income level for eligibility for
services to children with handicaps.
Sec. 2. Minnesota Statutes 1992, section 148C.01,
subdivision 3, is amended to read:
Subd. 3. [OTHER TITLES.] For the purposes of sections
148C.01 to 148C.11 and 595.02, subdivision 1, all individuals,
except as provided in section 148C.11, who practice, as their
main vocation, chemical dependency counseling as defined in
subdivision 2, regardless of their titles, shall be covered by
sections 148C.01 to 148C.11. This includes, but is not limited
to, individuals who may refer to themselves as "alcoholism
counselor," "drug abuse therapist," "chemical dependency
recovery counselor," "chemical dependency relapse prevention
planner," "addiction therapist," "chemical dependency
intervention specialist," "family chemical dependency
counselor," "chemical health specialist," "chemical health
coordinator," and "substance abuse counselor."
Sec. 3. Minnesota Statutes 1992, section 148C.01,
subdivision 6, is amended to read:
Subd. 6. [COMMISSIONER.] "Commissioner" means the
commissioner of human services health.
Sec. 4. Minnesota Statutes 1992, section 148C.02, is
amended to read:
148C.02 [CHEMICAL DEPENDENCY COUNSELING LICENSING ADVISORY
COUNCIL.]
Subdivision 1. [MEMBERSHIP; STAFF.] (a) The chemical
dependency counseling licensing advisory council consists of 13
members. The governor commissioner shall appoint:
(1) except for those members initially appointed, seven
members who must be licensed chemical dependency counselors;
(2) three members who must be public members as defined by
section 214.02;
(3) one member who must be a director or coordinator of an
accredited chemical dependency training program; and
(4) one member who must be a former consumer of chemical
dependency counseling service and who must have received the
service more than three years before the person's appointment.
The American Indian advisory committee to the department of
human services chemical dependency office shall appoint the
remaining member.
(b) The provision of staff, administrative services, and
office space are as provided in chapter 214.
Subd. 2. [DUTIES.] The council shall study the provision
of chemical dependency counseling and advise the commissioner,
the profession, and the public. The commissioner, after
consultation with the advisory council, shall:
(1) develop rules for the licensure of chemical dependency
counselors; and
(2) administer or contract for the competency testing,
licensing, and ethical review of chemical dependency counselors.
Sec. 5. Minnesota Statutes 1992, section 148C.03,
subdivision 1, is amended to read:
Subdivision 1. [GENERAL.] The commissioner shall:
(a) adopt and enforce rules for licensure of chemical
dependency counselors and for regulation of professional
conduct. The rules must be designed to protect the public;
(b) adopt rules establishing standards and methods of
determining whether applicants and licensees are qualified under
section 148C.04. The rules must provide for examinations and
must; establish standards for professional conduct, including
adoption of a professional code of ethics; and provide for
sanctions as described in section 148C.09;
(c) hold examinations at least twice a year to assess
applicants' knowledge and skills. The examinations may must be
written or and oral and may be administered by the commissioner
or by a nonprofit agency under contract with the commissioner to
administer the licensing examinations. Examinations must
minimize cultural bias and must be balanced in various theories
relative to practice of chemical dependency;
(d) issue licenses to individuals qualified under sections
148C.01 to 148C.11;
(e) issue copies of the rules for licensure to all
applicants;
(f) establish and implement procedures, including a
standard disciplinary process and a code of ethics, to ensure
that individuals licensed as chemical dependency counselors will
comply with the commissioner's rules;
(g) establish, maintain, and publish annually a register of
current licensees;
(h) establish initial and renewal application and
examination fees sufficient to cover operating expenses of the
commissioner;
(i) educate the public about the existence and content of
the rules for chemical dependency counselor licensing to enable
consumers to file complaints against licensees who may have
violated the rules; and
(j) evaluate the rules in order to refine and improve the
methods used to enforce the commissioner's standards.
Sec. 6. Minnesota Statutes 1992, section 148C.03,
subdivision 2, is amended to read:
Subd. 2. [CONTINUING EDUCATION COMMITTEE.] The
commissioner shall appoint or contract for a continuing
education committee of five persons, including a chair, which
shall advise the commissioner on the administration of
continuing education requirements in section 148C.05,
subdivision 2.
Sec. 7. Minnesota Statutes 1992, section 148C.03,
subdivision 3, is amended to read:
Subd. 3. [RESTRICTIONS ON MEMBERSHIP.] A member or an
employee of the department entity that carries out the functions
under this section may not be an officer, employee, or paid
consultant of a trade association in the counseling services
industry.
Sec. 8. Minnesota Statutes 1992, section 148C.04,
subdivision 2, is amended to read:
Subd. 2. [FEE.] Each applicant shall pay a nonrefundable
fee set by the commissioner. Fees paid to the commissioner
shall be deposited in the general special revenue fund.
Sec. 9. Minnesota Statutes 1992, section 148C.04,
subdivision 3, is amended to read:
Subd. 3. [LICENSING REQUIREMENTS FOR CHEMICAL DEPENDENCY
COUNSELOR; EVIDENCE.] (a) To be licensed as a chemical
dependency counselor, an applicant must meet the requirements in
clauses (1) to (3).
(1) Except as provided in subdivision 4, the applicant must
have received an associate degree including 270 clock hours of
chemical dependency education and 880 clock hours of chemical
dependency practicum.
(2) The applicant must have completed a written and oral
case presentation and oral examination that demonstrates
competence in the 12 core functions.
(3) The applicant must have satisfactorily passed a written
examination as established by the commissioner.
(b) To be licensed as a chemical dependency counselor, an
applicant must furnish evidence satisfactory to the commissioner
that the applicant has met the requirements of paragraph (a).
Sec. 10. Minnesota Statutes 1992, section 148C.04,
subdivision 4, is amended to read:
Subd. 4. [ADDITIONAL LICENSING REQUIREMENTS.] Beginning
five years after the effective date of sections 148C.01 to
148C.11 the rules authorized in section 148C.03, subdivision 1,
an applicant for licensure must have received a bachelor's
degree in a human services area, and must have completed 480
clock hours of chemical dependency education and 880 clock hours
of chemical dependency practicum.
Sec. 11. Minnesota Statutes 1992, section 148C.05,
subdivision 2, is amended to read:
Subd. 2. [CONTINUING EDUCATION.] At the time of renewal,
each licensee shall furnish evidence satisfactory to the
commissioner that the licensee has completed annually at least
the equivalent of 40 clock hours of continuing professional
postdegree education every two years, in programs approved by
the commissioner, and that the licensee continues to be
qualified to practice under sections 148C.01 to 148C.11.
Sec. 12. Minnesota Statutes 1992, section 148C.06, is
amended to read:
148C.06 [LICENSE WITHOUT EXAMINATION; TRANSITION PERIOD.]
For two years from July 1, 1993 the effective date of the
rules authorized in section 148C.03, subdivision 1, the
commissioner shall issue a license without examination to an
applicant if the applicant meets one of the following
qualifications:
(a) is credentialed as a certified chemical dependency
counselor (CCDC) or certified chemical dependency counselor
reciprocal (CCDCR) by the Institute for Chemical Dependency
Professionals of Minnesota, Inc.;
(b) has three years or 6,000 hours of supervised chemical
dependency counselor experience as defined by the 12 core
functions, 270 clock hours of chemical dependency training, 300
hours of chemical dependency practicum, and has successfully
completed a written and oral test the requirements in section
148C.04, subdivision 3, paragraph (a), clauses (2) and (3);
(c) has five years or 10,000 hours of chemical dependency
counselor experience as defined by the 12 core functions, 270
clock hours of chemical dependency training, and has
successfully completed a written or oral test the requirements
in section 148C.04, subdivision 3, paragraph (a), clause (2) or
(3), or is credentialed as a certified chemical dependency
practitioner (CCDP) by the Institute for Chemical Dependency
Professionals of Minnesota, Inc.; or
(d) has seven years or 14,000 hours of supervised chemical
dependency counselor experience as defined by the 12 core
functions and 270 clock hours of chemical dependency training
with 60 hours of this training occurring within the past five
years.
After July 1, 1995, Beginning two years after the effective
date of the rules authorized in section 148C.03, subdivision 1,
no person may be licensed without passing the examination
meeting the requirements in section 148C.04, subdivision 3,
paragraph (a), clauses (2) and (3).
Sec. 13. Minnesota Statutes 1992, section 148C.11,
subdivision 3, is amended to read:
Subd. 3. [FEDERALLY RECOGNIZED TRIBES AND PRIVATE
NONPROFIT AGENCIES WITH A MINORITY FOCUS.] (a) The licensing of
chemical dependency counselors who are employed by federally
recognized tribes shall be voluntary.
(b) The commissioner shall develop special licensing
criteria for issuance of a license to chemical dependency
counselors who: (1) are members of ethnic minority groups; and
(2) are employed by private, nonprofit agencies, including
agencies operated by private, nonprofit hospitals, whose primary
agency service focus addresses ethnic minority populations.
These licensing criteria may differ from the licensing criteria
specified in section 148C.04. To develop these criteria, the
commissioner shall establish a committee comprised of but not
limited to representatives from the council on hearing impaired,
the council on affairs of Spanish-speaking people, the council
on Asian-Pacific Minnesotans, the council on Black Minnesotans,
and the Indian affairs council.
Sec. 14. Minnesota Statutes 1992, section 148C.11, is
amended by adding a subdivision to read:
Subd. 5. [CITY, COUNTY, AND STATE AGENCY CHEMICAL
DEPENDENCY COUNSELORS.] The licensing of city, county, and state
agency chemical dependency counselors shall be voluntary. City,
county, and state agencies employing chemical dependency
counselors shall not be required to employ licensed chemical
dependency counselors, nor shall they require their chemical
dependency counselors to be licensed.
Sec. 15. Minnesota Statutes 1992, section 214.01,
subdivision 2, is amended to read:
Subd. 2. [HEALTH-RELATED LICENSING BOARD.] "Health-related
licensing board" means the board of examiners of nursing home
administrators established pursuant to section 144A.19, the
board of medical practice created pursuant to section 147.01,
the board of nursing created pursuant to section 148.181, the
board of chiropractic examiners established pursuant to section
148.02, the board of optometry established pursuant to section
148.52, the board of psychology established pursuant to section
148.90, the social work licensing board pursuant to section
148B.19, the board of marriage and family therapy pursuant to
section 148B.30, the mental health practitioner advisory council
established pursuant to section 148B.62, the chemical dependency
counseling licensing advisory council established pursuant to
section 148C.02, the board of dentistry established pursuant to
section 150A.02, the board of pharmacy established pursuant to
section 151.02, the board of podiatric medicine established
pursuant to section 153.02, and the board of veterinary
medicine, established pursuant to section 156.01.
Sec. 16. Minnesota Statutes 1992, section 252A.101,
subdivision 7, is amended to read:
Subd. 7. [LETTERS OF GUARDIANSHIP.] Letters of
guardianship or conservatorship must be issued by the court and
contain:
(1) the name, address, and telephone number of the person
delegated by the commissioner to act as the guardian or
conservator;
(2) the name, address, and telephone number of the ward or
conservatee; and
(3) (2) the powers to be exercised on behalf of the ward or
conservatee.
The letters must be served by mail upon the ward or
conservatee, the ward's counsel, the commissioner, and the local
agency.
Sec. 17. Minnesota Statutes 1992, section 252A.111,
subdivision 4, is amended to read:
Subd. 4. [APPOINTMENT OF GUARDIAN OR CONSERVATOR OF THE
ESTATE.] If the ward has a personal estate beyond that which is
necessary for the ward's personal and immediate needs, the
commissioner shall determine whether a guardian of the
estate has been should be appointed for the ward. If no
guardian of the estate has been appointed, The commissioner,
after consulting shall consult with the parents, spouse, or
nearest relative of the ward,. The commissioner may petition
the probate court for the appointment of a private guardian or
conservator of the estate of the ward. The commissioner cannot
act as guardian or conservator of the estate for public wards or
public conservatees.
Sec. 18. [254A.085] [HENNEPIN COUNTY PILOT ALTERNATIVE FOR
CHEMICAL DEPENDENCY SERVICES.]
The commissioner of human services shall grant variances
from the requirements of Minnesota Rules, parts 9530.4100 to
9530.4450, and the commissioner of health shall grant variances
from the requirements of Minnesota Rules, parts 4665.0100 to
4665.9900, that are consistent with the provisions of this
section and do not compromise the health or safety of the
clients, to establish a nonmedical detoxification pilot program
in Hennepin county. The program shall be designed to provide
care in a secure shelter for persons diverted or referred from
detoxification facilities, so as to prevent chronic recidivism
and ensure appropriate treatment referrals for persons who are
chemically dependent. For purposes of this section, a "secure
shelter" is a facility licensed by the commissioner of human
services under Minnesota Rules, parts 9530.4100 to 9530.4450,
and this section, and by the commissioner of health as a
supervised living facility to provide care for chemically
dependent persons. A secure shelter is considered a treatment
facility under section 253B.02, subdivision 19. The secure
facility authorized by this section shall be licensed by the
commissioner of human services only after the county has entered
into a contract for the detoxification program authorized by
section 254A.086.
The pilot program established under this section must have
standards for using video and advocacy group members for
monitoring and surveillance to ensure the safety of clients and
staff. In addition, in hiring staff, the program must ensure
that the criminal background check requirements of Minnesota
Rules, part 9543.3040, are met; and the commissioner of human
services must ensure compliance with Minnesota Rules, parts
9543.3000 to 9543.3090. The program administrator and all staff
of a secure shelter who observe or have personal knowledge of
violations of section 626.556 or 626.557 must report to the
office of the ombudsman for mental health and mental retardation
within 24 hours of its occurrence, any serious injury, as
defined in section 245.91, subdivision 6, or the death of a
person admitted to the shelter. The ombudsman shall acknowledge
in writing the receipt of all reports made to the ombudsman's
office under this section. Acknowledgment must be mailed to the
facility and to the county social service agency within five
working days of the day the report was made. In addition, the
program administrator and staff of the facility must comply with
all of the requirements of section 626.557, the vulnerable
adults act. If the program administrator does not suspend the
alleged perpetrator during the pendency of the investigation,
reasons for not doing so must be given to the ombudsman in
writing.
The licenseholder, in coordination with the commissioner of
human services, shall keep detailed records of admissions,
length of stay, client outcomes according to standards set by
the commissioner, discharge destinations, referrals, and costs
of the program. The commissioner of human services shall report
to the legislature by February 15, 1996, on the operation of the
program and shall include recommendations on whether such a
program has been shown to be an effective, safe, and
cost-efficient way to serve clients.
Sec. 19. [254A.086] [CULTURALLY TARGETED DETOXIFICATION
PROGRAM.]
The commissioner of human services shall provide technical
assistance to enable development of a special program designed
to provide culturally targeted detoxification services in
accordance with section 254A.08, subdivision 2. The program
must meet the standards of Minnesota Rules, parts 9530.4100 to
9530.4450, as they apply to detoxification programs. The
program established under this section must have standards for
using video and advocacy group members for monitoring and
surveillance to ensure the safety of clients and staff. In
addition, in hiring staff, the program must ensure that the
criminal background check requirements of Minnesota Rules, part
9543.3040, are met; and the commissioner of human services must
ensure compliance with Minnesota Rules, parts 9543.3000 to
9543.3090. The program administrator and all staff of the
facility must report to the office of the ombudsman for mental
health and mental retardation within 24 hours of its occurrence,
any serious injury, as defined in section 245.91, subdivision 6,
or the death of a person admitted to the shelter. The ombudsman
shall acknowledge in writing the receipt of all reports made to
the ombudsman's office under this section. Acknowledgment must
be mailed to the facility and to the county social service
agency within five working days of the day the report was made.
In addition, the program administrator and staff of the facility
must comply with all of the requirements of section 626.557, the
vulnerable adults act. The program shall be designed with a
community outreach component and shall provide services to
clients in a safe environment and in a culturally specific
manner.
Sec. 20. Minnesota Statutes 1992, section 254A.17,
subdivision 3, is amended to read:
Subd. 3. [STATEWIDE DETOXIFICATION TRANSPORTATION
PROGRAM.] The commissioner shall provide grants to counties,
Indian reservations, other nonprofit agencies, or local
detoxification programs for provision of transportation of
intoxicated individuals to detoxification programs, to open
shelters, and to secure shelters as defined in section 254A.085
and shelters serving intoxicated persons. In state fiscal years
1994 and 1995, funds shall be allocated to counties in
proportion to each county's allocation in fiscal year 1993. In
subsequent fiscal years, funds shall be allocated among counties
annually in proportion to each county's average number of
detoxification admissions for the prior two years, except that
no county shall receive less than $400. Unless a county has
approved a grant of funds under this section, the commissioner
shall make quarterly payments of detoxification funds to a
county only after receiving an invoice describing the number of
persons transported and the cost of transportation services for
the previous quarter. The program administrator and all staff
of the program must report to the office of the ombudsman for
mental health and mental retardation within 24 hours of its
occurrence, any serious injury, as defined in section 245.91,
subdivision 6, or the death of a person admitted to the
shelter. The ombudsman shall acknowledge in writing the receipt
of all reports made to the ombudsman's office under this
section. Acknowledgment must be mailed to the facility and to
the county social service agency within five working days of the
day the report was made. In addition, the program administrator
and staff of the program must comply with all of the
requirements of section 626.557, the vulnerable adults act.
Sec. 21. Minnesota Statutes 1992, section 254B.06,
subdivision 3, is amended to read:
Subd. 3. [PAYMENT; DENIAL.] The commissioner shall pay
eligible vendors for placements made by local agencies under
section 254B.03, subdivision 1, and placements by tribal
designated agencies according to section 254B.09. The
commissioner may reduce or deny payment of the state share when
services are not provided according to the placement criteria
established by the commissioner. The commissioner may pay for
all or a portion of improper county chemical dependency
placements and bill the county for the entire payment made when
the placement did not comply with criteria established by the
commissioner. The commissioner may make payments to vendors and
charge the county 100 percent of the payments if documentation
of a county approved placement is received more than 30 working
days, exclusive of weekends and holidays, after the date
services began; or if the county approved invoice is received by
the commissioner more than 120 days after the last date of
service provided. The commissioner shall not pay vendors until
private insurance company claims have been settled.
Sec. 22. [256.8711] [EMERGENCY ASSISTANCE; INTENSIVE
FAMILY PRESERVATION SERVICES.]
Subdivision 1. [SCOPE OF SERVICES.] For a family
experiencing an emergency as defined in subdivision 2, and for
whom the county authorizes services under subdivision 3,
intensive family preservation services authorized under this
section are:
(1) crisis family-based services;
(2) counseling family-based services; and
(3) mental health family-based services.
Intensive family preservation services also include
family-based life management skills when it is provided in
conjunction with any of the three family-based services in this
subdivision. The intensive family preservation services in
clauses (1), (2), and (3) and life management skills have the
meanings given in section 256F.03, subdivision 5, paragraphs
(a), (b), (c), and (e).
Subd. 2. [DEFINITION OF EMERGENCY.] For the purposes of
this section, an emergency is a situation in which the dependent
children are at risk for out of home placement due to abuse,
neglect, or delinquency; or when the children are returning home
from placements but need services to prevent another placement;
or when the parents are unable to provide care.
Subd. 3. [COUNTY AUTHORIZATION.] The county agency shall
assess current and prospective client families with a dependent
under 21 years of age to determine if there is an emergency, as
defined in subdivision 2, and to determine if there is a need
for intensive family preservation services. Upon such
determinations, during the period October 1, 1993 to September
30, 1995, counties shall authorize intensive family preservation
services for up to 90 days for eligible families under this
section and under section 256.871, subdivisions 1 and 3.
Effective October 1, 1995, the counties' obligations to continue
the base level of expenditures and to expand family preservation
services as defined in section 256F.03, subdivision 5, are
eliminated, with the termination of the federal revenue earned
under this section.
Subd. 4. [COST TO FAMILIES.] Family preservation services
provided under this section or sections 256F.01 to 256F.07 shall
be provided at no cost to the client and without regard to the
client's available income or assets.
Subd. 5. [EMERGENCY ASSISTANCE RESERVE.] The commissioner
shall establish an emergency assistance reserve for families who
receive intensive family preservation services under this
section. A family is eligible to receive assistance once from
the emergency assistance reserve if it received intensive family
preservation services under this section within the past 12
months, but has not received emergency assistance under section
256.871 during that period. The emergency assistance reserve
shall cover the cost of the federal share of the assistance that
would have been available under section 256.871, except for the
provision of intensive family preservation services provided
under this section. The emergency assistance reserve shall be
authorized and paid in the same manner as emergency assistance
is provided under section 256.871. Funds set aside for the
emergency assistance reserve that are not needed as determined
by the commissioner shall be distributed by the terms of
subdivision 6, paragraph (a).
Subd. 6. [DISTRIBUTION OF NEW FEDERAL REVENUE.] (a) All
federal funds not set aside under paragraph (b), and at least 50
percent of all federal funds earned under this section and
earned through assessment activity under subdivision 3, shall be
paid to each county based on its earnings and assessment
activity, respectively, and shall be used by each county to
expand family preservation services as defined in section
256F.03, subdivision 5, and may be used to expand crisis nursery
services. If a county joins a local children's mental health
collaborative as authorized by the 1993 legislature, then the
federal reimbursement received under this paragraph by the
county for providing intensive family preservation services to
children served by the local collaborative shall be transferred
by the county to the integrated fund. The federal reimbursement
transferred to the integrated fund by the county must be used
for intensive family preservation services as defined in section
256F.03, subdivision 5, to the target population.
(b) The commissioner shall set aside a portion, not to
exceed 50 percent, of the federal funds earned under this
section and earned through assessment activity described under
subdivision 3. The set aside funds shall be used to expand
intensive family preservation services statewide and establish
an emergency assistance reserve as provided in subdivision 5.
Except for the portion needed for the emergency assistance
reserve provided in subdivision 5, the commissioner may
distribute the funds set aside through grants to a county or
counties to establish and maintain approved intensive family
preservation services statewide. Funds available for crisis
family-based services through section 256F.05, subdivision 8,
shall be considered in establishing intensive family
preservation services statewide. The commissioner may phase in
intensive family preservation services in a county or group of
counties as new federal funds become available. The
commissioner's priority is to establish a minimum level of
intensive family preservation services statewide.
Subd. 7. [EXPANSION OF SERVICES AND BASE LEVEL OF
EXPENDITURES.] (a) Counties must continue the base level of
expenditures for family preservation services as defined in
section 256F.03, subdivision 5, from any state, county, or
federal funding source, which, in the absence of federal funds
earned under this section and earned through assessment activity
described under subdivision 3, would have been available for
these services. The commissioner shall review the county
expenditures annually, using reports required under sections
245.482, 256.01, subdivision 2, paragraph (17), and 256E.08,
subdivision 8, to ensure that the base level of expenditures for
family preservation services as defined in section 256F.03,
subdivision 5, is continued from sources other than the federal
funds earned under this section and earned through assessment
activity described under subdivision 3.
(b) The commissioner may reduce, suspend, or eliminate
either or both of a county's obligations to continue the base
level of expenditures and to expand family preservation services
as defined in section 256F.03, subdivision 5, if the
commissioner determines that one or more of the following
conditions apply to that county:
(1) imposition of levy limits that significantly reduce
available social service funds;
(2) reduction in the net tax capacity of the taxable
property within a county that significantly reduces available
social service funds;
(3) reduction in the number of children under age 19 in the
county by 25 percent when compared with the number in the base
year using the most recent data provided by the state
demographer's office; or
(4) termination of the federal revenue earned under this
section.
(c) The commissioner may suspend for one year either or
both of a county's obligations to continue the base level of
expenditures and to expand family preservation services as
defined in section 256F.03, subdivision 5, if the commissioner
determines that in the previous year one or more of the
following conditions applied to that county:
(1) the unduplicated number of families who received family
preservation services under section 256F.03, subdivision 5,
paragraphs (a), (b), (c), and (e), equals or exceeds the
unduplicated number of children who entered placement under
sections 257.071 and 393.07, subdivisions 1 and 2 during the
year;
(2) the total number of children in placement under
sections 257.071 and 393.07, subdivisions 1 and 2, has been
reduced by 50 percent from the total number in the base year; or
(3) the average number of children in placement under
sections 257.071 and 393.07, subdivisions 1 and 2, on the last
day of each month is equal to or less than one child per 1,000
children in the county.
(d) For the purposes of this section, the base year is
calendar year 1992. For the purposes of this section, the base
level of expenditures is the level of county expenditures in the
base year for eligible family preservation services under
section 256F.03, subdivision 5, paragraphs (a), (b), (c), and
(e).
Subd. 8. [COUNTY RESPONSIBILITIES.] (a) Notwithstanding
section 256.871, subdivision 6, for intensive family
preservation services provided under this section, the county
agency shall submit quarterly fiscal reports as required under
section 256.01, subdivision 2, clause (17), and provide the
nonfederal share.
(b) County expenditures eligible for federal reimbursement
under this section must not be made from federal funds or funds
used to match other federal funds.
(c) The commissioner may suspend, reduce, or terminate the
federal reimbursement to a county that does not meet the
reporting or other requirements of this section.
Subd. 9. [PAYMENTS.] Notwithstanding section 256.025,
subdivision 2, payments to counties for social service
expenditures for intensive family preservation services under
this section shall be made only from the federal earnings under
this section and earned through assessment activity described
under subdivision 3. Counties may use up to ten percent of
federal earnings received under subdivision 6, paragraph (a), to
cover costs of income maintenance activities related to the
operation of this section and sections 256B.094 and 256F.10.
Subd. 10. [COMMISSIONER RESPONSIBILITIES.] The
commissioner in consultation with counties shall analyze state
funding options to cover costs of counties' base level
expenditures and any expansion of the nonfederal share of
intensive family preservation services resulting from
implementation of this section. The commissioner shall also
study problems of implementation, barriers to maximizing federal
revenue, and the impact on out-of-home placements of
implementation of this section. The commissioner shall report
to the legislature on the results of this analysis and study,
together with recommendations, by February 15, 1995.
Sec. 23. Minnesota Statutes 1992, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 33. [CHILD WELFARE TARGETED CASE
MANAGEMENT.] Medical assistance, subject to federal approval,
covers child welfare targeted case management services as
defined in section 256B.094 to children under age 21 who have
been assessed and determined in accordance with section 256F.11
to be:
(1) at risk of placement or in placement as defined in
section 257.071, subdivision 1;
(2) at risk of maltreatment or experiencing maltreatment as
defined in section 626.556, subdivision 10e; or
(3) in need of protection or services as defined in section
260.015, subdivision 2a.
Sec. 24. [256B.094] [CHILD WELFARE TARGETED CASE
MANAGEMENT SERVICES.]
Subdivision 1. [DEFINITION.] "Child welfare targeted case
management services" means activities that coordinate social and
other services designed to help the child under age 21 and the
child's family gain access to needed social services, mental
health services, habilitative services, educational services,
health services, vocational services, recreational services, and
related services including, but not limited to, the areas of
volunteer services, advocacy, transportation, and legal
services. Case management services include developing an
individual service plan and assisting the child and the child's
family in obtaining needed services through coordination with
other agencies and assuring continuity of care. Case managers
must assess the delivery, appropriateness, and effectiveness of
services on a regular basis.
Subd. 2. [ELIGIBLE SERVICES.] Services eligible for
medical assistance reimbursement include:
(1) assessment of the recipient's need for case management
services to gain access to medical, social, educational, and
other related services;
(2) development, completion, and regular review of a
written individual service plan based on the assessment of need
for case management services to ensure access to medical,
social, educational, and other related services;
(3) routine contact or other communication with the client,
the client's family, primary caregiver, legal representative,
substitute care provider, service providers, or other relevant
persons identified as necessary to the development or
implementation of the goals of the individual service plan,
regarding the status of the client, the individual service plan,
or the goals for the client, exclusive of transportation of the
child;
(4) coordinating referrals for, and the provision of, case
management services for the client with appropriate service
providers, consistent with section 1902(a)(23) of the Social
Security Act;
(5) coordinating and monitoring the overall service
delivery to ensure quality of services;
(6) monitoring and evaluating services on a regular basis
to ensure appropriateness and continued need;
(7) completing and maintaining necessary documentation that
supports and verifies the activities in this subdivision;
(8) traveling to conduct a visit with the client or other
relevant person necessary to the development or implementation
of the goals of the individual service plan; and
(9) coordinating with the medical assistance facility
discharge planner in the 30-day period before the client's
discharge into the community. This case management service
provided to patients or residents in a medical assistance
facility is limited to a maximum of two 30-day periods per
calendar year.
Subd. 3. [COORDINATION AND PROVISION OF SERVICES.] (a) In
a county where a prepaid medical assistance provider has
contracted under section 256B.031 or 256B.69 to provide mental
health services, the case management provider shall coordinate
with the prepaid provider to ensure that all necessary mental
health services required under the contract are provided to
recipients of case management services.
(b) When the case management provider determines that a
prepaid provider is not providing mental health services as
required under the contract, the case management provider shall
assist the recipient to appeal the prepaid provider's denial
pursuant to section 256.045, and may make other arrangements for
provision of the covered services.
(c) The case management provider may bill the provider of
prepaid health care services for any mental health services
provided to a recipient of case management services which the
county arranges for or provides and which are included in the
prepaid provider's contract, and which were determined to be
medically necessary as a result of an appeal pursuant to section
256.045. The prepaid provider must reimburse the mental health
provider, at the prepaid provider's standard rate for that
service, for any services delivered under this subdivision.
(d) If the county has not obtained prior authorization for
this service, or an appeal results in a determination that the
services were not medically necessary, the county may not seek
reimbursement from the prepaid provider.
Subd. 4. [CASE MANAGEMENT PROVIDER.] To be eligible to
receive medical assistance reimbursement, the case management
provider must meet all provider qualification and certification
standards under section 256F.10.
Subd. 5. [CASE MANAGER.] To provide case management
services, a case manager must be employed by and authorized by
the case management provider to provide case management services
and meet all requirements under section 256F.10.
Subd. 6. [MEDICAL ASSISTANCE REIMBURSEMENT OF CASE
MANAGEMENT SERVICES.] (a) Medical assistance reimbursement for
services under this section shall be made on a monthly basis.
Payment is based on face-to-face or telephone contacts between
the case manager and the client, client's family, primary
caregiver, legal representative, or other relevant person
identified as necessary to the development or implementation of
the goals of the individual service plan regarding the status of
the client, the individual service plan, or the goals for the
client. These contacts must meet the minimum standards in
clauses (1) and (2):
(1) there must be a face-to-face contact at least once a
month except as provided in clause (2); and
(2) for a client placed outside of the county of financial
responsibility in an excluded time facility under section
256G.02, subdivision 6, or through the interstate compact on the
placement of children, section 257.40, and the placement in
either case is more than 60 miles beyond the county boundaries,
there must be at least one contact per month and not more than
two consecutive months without a face-to-face contact.
(b) The payment rate is established using time study data
on activities of provider service staff and reports required
under sections 245.482, 256.01, subdivision 2, paragraph (17),
and 256E.08, subdivision 8.
Separate payment rates may be established for different groups
of providers to maximize reimbursement as determined by the
commissioner. The payment rate will be reviewed annually and
revised periodically to be consistent with the most recent time
study and other data. Payment for services will be made upon
submission of a valid claim and verification of proper
documentation described in subdivision 7. Federal
administrative revenue earned through the time study shall be
distributed according to earnings, to counties or groups of
counties which have the same payment rate under this
subdivision, and to the group of counties which are not
certified providers under section 256F.10. The commissioner
shall modify the requirements set out in Minnesota Rules, parts
9550.0300 to 9550.0370, as necessary to accomplish this.
Subd. 7. [DOCUMENTATION FOR CASE RECORD AND CLAIM.] (a)
The assessment, case finding, and individual service plan shall
be maintained in the individual case record under the data
practices act, chapter 13. The individual service plan must be
reviewed at least annually and updated as necessary. Each
individual case record must maintain documentation of routine,
ongoing, contacts and services. Each claim must be supported by
written documentation in the individual case record.
(b) Each claim must include:
(1) the name of the recipient;
(2) the date of the service;
(3) the name of the provider agency and the person
providing service;
(4) the nature and extent of services; and
(5) the place of the services.
Subd. 8. [PAYMENT LIMITATION.] Services that are not
eligible for payment as a child welfare targeted case management
service include, but are not limited to:
(1) assessments prior to opening a case;
(2) therapy and treatment services;
(3) legal services, including legal advocacy, for the
client;
(4) information and referral services that are part of a
county's community social services plan, that are not provided
to an eligible recipient;
(5) outreach services including outreach services provided
through the community support services program;
(6) services that are not documented as required under
subdivision 7 and Minnesota Rules, parts 9505.1800 to 9505.1880;
(7) services that are otherwise eligible for payment on a
separate schedule under rules of the department of human
services;
(8) services to a client that duplicate the same case
management service from another case manager;
(9) case management services provided to patients or
residents in a medical assistance facility except as described
under subdivision 2, clause 9; and
(10) for children in foster care, group homes, or
residential care, payment for case management services is
limited to case management services that focus on permanency
planning or return to the family home and that do not duplicate
the facility's discharge planning services.
Sec. 25. Minnesota Statutes 1992, section 256F.06,
subdivision 2, is amended to read:
Subd. 2. [USES OF GRANTS.] The grant must be used
exclusively for family-based services. The grant may not be
used as a match for other federal money or to meet the
requirements of section 256E.06, subdivision 5.
Sec. 26. [256F.10] [CHILD WELFARE TARGETED CASE
MANAGEMENT.]
Subdivision 1. [ELIGIBILITY.] Persons under 21 years of
age who are eligible to receive medical assistance are eligible
for child welfare targeted case management services under
section 256B.094 and this section if they have received an
assessment and have been determined by the local county agency
to be:
(1) at risk of placement or in placement as described in
section 257.071, subdivision 1;
(2) at risk of maltreatment or experiencing maltreatment as
defined in section 626.556, subdivision 10e; or
(3) in need of protection or services as defined in section
260.015, subdivision 2a.
Subd. 2. [AVAILABILITY OF SERVICES.] Child welfare
targeted case management services are available from providers
meeting qualification requirements and the certification
standards specified in subdivision 4. Eligible recipients may
choose any certified provider of child welfare targeted case
management services.
Subd. 3. [VOLUNTARY PROVIDER PARTICIPATION.] Providers may
seek certification for medical assistance reimbursement to
provide child welfare targeted case management services. The
certification process is initiated by submitting a written
statement of interest to the commissioner.
Certified providers may elect to discontinue participation
by a written notice to the commissioner at least 120 days before
the end of the final calendar quarter of participation.
Subd. 4. [PROVIDER QUALIFICATIONS AND CERTIFICATION
STANDARDS.] The commissioner must certify each provider before
enrolling it as a child welfare targeted case management
provider of services under section 256B.094 and this section.
The certification process shall examine the provider's ability
to meet the qualification requirements and certification
standards in this subdivision and other federal and state
requirements of this service. A certified child welfare
targeted case management provider is an enrolled medical
assistance provider who is determined by the commissioner to
have all of the following:
(1) the legal authority to provide public welfare under
sections 393.01, subdivision 7, and 393.07;
(2) the demonstrated capacity and experience to provide the
components of case management to coordinate and link community
resources needed by the eligible population;
(3) administrative capacity and experience in serving the
target population for whom it will provide services and in
ensuring quality of services under state and federal
requirements;
(4) the legal authority to provide complete investigative
and protective services under section 626.556, subdivision 10,
and child welfare and foster care services under section 393.07,
subdivisions 1 and 2;
(5) a financial management system that provides accurate
documentation of services and costs under state and federal
requirements; and
(6) the capacity to document and maintain individual case
records under state and federal requirements.
Subd. 5. [CASE MANAGERS.] Case managers are individuals
employed by and authorized by the certified child welfare
targeted case management provider to provide case management
services under section 256B.094 and this section. A case
manager must have:
(1) skills in identifying and assessing a wide range of
children's needs;
(2) knowledge of local child welfare and a variety of
community resources and effective use of those resources for the
benefit of the child; and
(3) a bachelor's degree in social work, psychology,
sociology, or a closely related field from an accredited
four-year college or university; or a bachelor's degree from an
accredited four-year college or university in a field other than
social work, psychology, sociology or a closely related field,
plus one year of experience in the delivery of social services
to children as a supervised social worker in a public or private
social services agency.
Subd. 6. [DISTRIBUTION OF NEW FEDERAL REVENUE.] (a) Except
for portion set aside in paragraph (b), the federal funds earned
under this section and section 256B.094 by counties shall be
paid to each county based on its earnings, and must be used by
each county to expand preventive child welfare services.
If a county chooses to be a provider of child welfare targeted
case management and if that county also joins a local children's
mental health collaborative as authorized by the 1993
legislature, then the federal reimbursement received by the
county for providing child welfare targeted case management
services to children served by the local collaborative shall be
transferred by the county to the integrated fund. The federal
reimbursement transferred to the integrated fund by the county
must not be used for residential care other than respite care
described under subdivision 7, paragraph (d).
(b) The commissioner shall set aside a portion of the
federal funds earned under this section to repay the special
revenue maximization account under section 256.01, subdivision
2, clause (15). The repayment is limited to:
(1) the costs of developing and implementing this section
and sections 256.8711 and 256B.094;
(2) programming the information systems; and
(3) the lost federal revenue for the central office claim
directly caused by the implementation of these sections.
Any unexpended funds from the set aside under this
paragraph shall be distributed to counties according to
paragraph (a).
Subd. 7. [EXPANSION OF SERVICES AND BASE LEVEL OF
EXPENDITURES.] (a) Counties must continue the base level of
expenditures for preventive child welfare services from either
or both of any state, county, or federal funding source, which,
in the absence of federal funds earned under this section, would
have been available for these services. The commissioner shall
review the county expenditures annually using reports required
under sections 245.482, 256.01, subdivision 2, paragraph 17, and
256E.08, subdivision 8, to ensure that the base level of
expenditures for preventive child welfare services is continued
from sources other than the federal funds earned under this
section.
(b) The commissioner may reduce, suspend, or eliminate
either or both of a county's obligations to continue the base
level of expenditures and to expand child welfare preventive
services if the commissioner determines that one or more of the
following conditions apply to that county:
(1) imposition of levy limits that significantly reduce
available social service funds;
(2) reduction in the net tax capacity of the taxable
property within a county that significantly reduces available
social service funds;
(3) reduction in the number of children under age 19 in the
county by 25 percent when compared with the number in the base
year using the most recent data provided by the state
demographer's office; or
(4) termination of the federal revenue earned under this
section.
(c) The commissioner may suspend for one year either or
both of a county's obligations to continue the base level of
expenditures and to expand child welfare preventive services if
the commissioner determines that in the previous year one or
more of the following conditions applied to that county:
(1) the total number of children in placement under
sections 257.071 and 393.07, subdivisions 1 and 2, has been
reduced by 50 percent from the total number in the base year; or
(2) the average number of children in placement under
sections 257.071 and 393.07, subdivisions 1 and 2, on the last
day of each month is equal to or less than one child per 1,000
children in the county.
(d) For the purposes of this section, child welfare
preventive services are those services directed toward a
specific child or family that further the goals of section
256F.01 and include assessments, family preservation services,
service coordination, community-based treatment, crisis nursery
services when the parents retain custody and there is no
voluntary placement agreement with a child placing agency,
respite care except when it is provided under a medical
assistance waiver, home-based services, and other related
services. For the purposes of this section, child welfare
preventive services shall not include shelter care placements
under the authority of the court or public agency to address an
emergency, residential services except for respite care, child
care for the purposes of employment and training, adult
services, services other than child welfare targeted case
management when they are provided under medical assistance,
placement services, or activities not directed toward a specific
child or family. Respite care must be planned, routine care to
support the continuing residence of the child with its family or
long-term primary caretaker and must not be provided to address
an emergency.
(e) For the counties beginning to claim federal
reimbursement for services under this section and section
256B.094, the base year is the calendar year ending at least two
calendar quarters before the first calendar quarter in which the
county begins claiming reimbursement. For the purposes of this
section, the base level of expenditures is the level of county
expenditures in the base year for eligible child welfare
preventive services described in this subdivision.
Subd. 8. [PROVIDER RESPONSIBILITIES.] (a) Notwithstanding
section 256B.19, subdivision 1, for the purposes of child
welfare targeted case management under section 256B.094 and this
section, the nonfederal share of costs shall be provided by the
provider of child welfare targeted case management from sources
other than federal funds or funds used to match other federal
funds.
(b) Provider expenditures eligible for federal
reimbursement under this section must not be made from federal
funds or funds used to match other federal funds.
(c) The commissioner may suspend, reduce, or terminate the
federal reimbursement to a provider that does not meet the
reporting or other requirements of section 256B.094 and this
section.
Subd. 9. [PAYMENTS.] Notwithstanding section 256.025,
subdivision 2, payments to certified providers for child welfare
targeted case management expenditures under section 256B.094 and
this section shall only be made of federal earnings from
services provided under section 256B.094 and this section.
Subd. 10. [CENTRALIZED DISBURSEMENT OF MEDICAL ASSISTANCE
PAYMENTS.] Notwithstanding section 256B.041, county payments for
the cost of child welfare targeted case management services
shall not be made to the state treasurer. For the purposes of
child welfare targeted case management services under section
256B.094 and this section, the centralized disbursement of
payments to providers under section 256B.041 consists only of
federal earnings from services provided under section 256B.094
and this section.
Sec. 27. [256F.11] [GRANT PROGRAM FOR CRISIS NURSERIES.]
Subdivision 1. [CRISIS NURSERIES.] The commissioner of
human services shall establish a grant program to assist private
and public agencies and organizations to provide crisis
nurseries to offer temporary care for children who are abused,
neglected, and those children at high risk of abuse and neglect,
and children who are in families receiving child protective
services. This service shall be provided without fee for a
maximum of 30 days in any year. Crisis nurseries shall provide
referral to support services and provide family support services
as needed.
Subd. 2. [FUND DISTRIBUTION.] In distributing funds, the
commissioner shall give priority consideration to agencies and
organizations with experience in working with abused or
neglected children and their families, and with children at high
risk of abuse and neglect and their families, and serve
communities which demonstrate the greatest need for these
services.
(a) The crisis nurseries must:
(1) be available 24 hours a day, seven days a week;
(2) provide services for children up to three days at any
one time;
(3) make referrals for parents to counseling services and
other community resources to help alleviate the underlying cause
of the precipitating stress or crisis;
(4) provide services without a fee for a maximum of 30 days
in any year;
(5) provide services to children from birth to 12 years of
age;
(6) provide an initial assessment and intake interview
conducted by a skilled professional who will identify the
presenting problem and make an immediate referral to an
appropriate agency or program to prevent maltreatment and
out-of-home placement of children;
(7) maintain the clients' confidentiality to the extent
required by law, and also comply with statutory reporting
requirements which may mandate a report to child protective
services;
(8) contain a volunteer component;
(9) provide preservice training and ongoing training to
providers and volunteers;
(10) evaluate the services provided by documenting use of
services, the result of family referrals made to community
resources, and how the services reduced the risk of
maltreatment;
(11) provide age appropriate programming;
(12) provide developmental assessments;
(13) provide medical assessments as determined by using a
risk screening tool;
(14) meet United States Department of Agriculture
regulations concerning meals and provide three meals a day and
three snacks during a 24-hour period; and
(15) provide appropriate sleep and nap arrangements for
children.
(b) The crisis nurseries are encouraged to provide:
(1) on-site support groups for facility model programs, or
agency sponsored parent support groups for volunteer family
model programs;
(2) parent education classes or programs that include
parent-child interaction; and
(3) opportunities for parents to volunteer, if appropriate,
to assist with child care in a supervised setting in order to
enhance their parenting skills and self-esteem, in addition to
providing them the opportunity to give something back to the
program.
(c) Parents shall retain custody of their children during
placement in a crisis facility.
The crisis nurseries are encouraged to include one or more
parents who have used the crisis nursery services on the
program's multidisciplinary advisory board.
Subd. 3. [EVALUATIONS.] The commissioner of human services
shall submit an annual report to the legislature evaluating the
program. The report must include information concerning program
costs, the number of program participants, the program's impact
on family stability, the incidence of abuse and neglect, and all
other relevant information determined by the commissioner.
Sec. 28. [256F.12] [GRANT PROGRAM FOR RESPITE CARE.]
Subdivision 1. [RESPITE CARE PROGRAM.] The commissioner of
human services shall establish a grant program to provide
respite care services to families or caregivers who are under
stress and at risk of abusing or neglecting their children,
families with children suffering from emotional problems, and
families receiving child protective services.
Subd. 2. [SERVICE GOALS.] Respite care programs shall
provide temporary services for families or caregivers in order
to:
(1) allow the family to engage in the family's usual daily
activities;
(2) maintain family stability during crisis situations;
(3) help preserve the family unit by lessening pressures
that might lead to divorce, institutionalization, neglect, or
child abuse;
(4) provide the family with rest and relaxation;
(5) improve the family's ability to cope with daily
responsibilities; and
(6) make it possible for individuals with disabilities to
establish independence and enrich their own growth and
development.
Subd. 3. [DEFINITION.] "Respite care" means in-home or
out-of-home temporary, nonmedical child care for families and
caregivers who are under stress and at risk of abusing or
neglecting their children, and families with children suffering
from emotional problems. Respite care shall be available for
time periods varying from one hour to two weeks.
In-home respite care is provided in the home of the person
needing care.
Out-of-home respite care will be given in the provider's
home or other facility. In these cases, the provider's home or
facility must be currently licensed for day care or foster home
care.
Subd. 4. [SLIDING FEE SCALE.] The commissioner shall
establish a sliding fee scale that takes into account family
income, expenses, and ability to pay. Grant funds shall be used
to subsidize the respite care of children. Funded projects must:
(1) prevent and reduce mental, physical, and emotional
stress on parents and children;
(2) provide training for caregivers;
(3) establish a network of community support groups and
resources for families;
(4) conduct an intake assessment in order to identify the
presenting problems and make appropriate referrals;
(5) provide age appropriate programming; and
(6) ensure that respite care providers complete at least
120 hours of training in child development, child care, and
related issues.
Subd. 5. [EVALUATIONS.] The commissioner of human services
shall submit an annual report to the legislature evaluating
funded programs. The report must include information concerning
program costs, the number of program participants, the impact on
family stability, the incidence of abuse and neglect, and all
other relevant information determined by the commissioner.
Sec. 29. [256F.13] [FAMILY SERVICES COLLABORATIVE.]
Subdivision 1. [FEDERAL REVENUE ENHANCEMENT.] (a) [DUTIES
OF THE COMMISSIONER OF HUMAN SERVICES.] The commissioner of
human services may enter into an agreement with one or more
family services collaboratives to enhance federal reimbursement
under Title IV-E of the Social Security Act and federal
administrative reimbursement under Title XIX of the Social
Security Act. The commissioner shall have the following
authority and responsibilities regarding family services
collaboratives:
(1) the commissioner shall submit amendments to state plans
and seek waivers as necessary to implement the provisions of
this section;
(2) the commissioner shall pay the federal reimbursement
earned under this subdivision to each collaborative based on
their earnings. Notwithstanding section 256.025, subdivision 2,
payments to collaboratives for expenditures under this
subdivision will only be made of federal earnings from services
provided by the collaborative;
(3) the commissioner shall review expenditures of family
services collaboratives using reports specified in the agreement
with the collaborative to ensure that the base level of
expenditures is continued and new federal reimbursement is used
to expand education, social, health, or health-related services
to young children and their families;
(4) the commissioner may reduce, suspend, or eliminate a
family services collaborative's obligations to continue the base
level of expenditures or expansion of services if the
commissioner determines that one or more of the following
conditions apply:
(i) imposition of levy limits that significantly reduce
available funds for social, health, or health-related services
to families and children;
(ii) reduction in the net tax capacity of the taxable
property eligible to be taxed by the lead county or
subcontractor that significantly reduces available funds for
education, social, health, or health-related services to
families and children;
(iii) reduction in the number of children under age 19 in
the county, collaborative service delivery area, subcontractor's
district, or catchment area when compared to the number in the
base year using the most recent data provided by the state
demographer's office; or
(iv) termination of the federal revenue earned under the
family services collaborative agreement;
(5) the commissioner shall not use the federal
reimbursement earned under this subdivision in determining the
allocation or distribution of other funds to counties or
collaboratives;
(6) the commissioner may suspend, reduce, or terminate the
federal reimbursement to a provider that does not meet the
reporting or other requirements of this subdivision;
(7) the commissioner shall recover from the family services
collaborative any federal fiscal disallowances or sanctions for
audit exceptions directly attributable to the family services
collaborative's actions in the integrated fund, or the
proportional share if federal fiscal disallowances or sanctions
are based on a statewide random sample; and
(8) the commissioner shall establish criteria for the
family services collaborative for the accounting and financial
management system that will support claims for federal
reimbursement.
(b) [FAMILY SERVICES COLLABORATIVE RESPONSIBILITIES.] The
family services collaborative shall have the following authority
and responsibilities regarding federal revenue enhancement:
(1) the family services collaborative shall be the party
with which the commissioner contracts. A lead county shall be
designated as the fiscal agency for reporting, claiming, and
receiving payments;
(2) the family services collaboratives may enter into
subcontracts with other counties, school districts, special
education cooperatives, municipalities, and other public and
nonprofit entities for purposes of identifying and claiming
eligible expenditures to enhance federal reimbursement, or to
expand education, social, health, or health-related services to
families and children;
(3) the family services collaborative must continue the
base level of expenditures for education, social, health, or
health-related services to families and children from any state,
county, federal, or other public or private funding source
which, in the absence of the new federal reimbursement earned
under this subdivision, would have been available for those
services, except as provided in subdivision 1, clause (4). The
base year for purposes of this subdivision shall be the
four-quarter calendar year ending at least two calendar quarters
before the first calendar quarter in which the new federal
reimbursement is earned;
(4) the family services collaborative must use all new
federal reimbursement resulting from federal revenue enhancement
to expand expenditures for education, social, health, or
health-related services to families and children beyond the base
level, except as provided in subdivision 1, clause (4);
(5) the family services collaborative must ensure that
expenditures submitted for federal reimbursement are not made
from federal funds or funds used to match other federal funds.
Notwithstanding section 256B.19, subdivision 1, for the purposes
of family services collaborative expenditures under agreement
with the department, the nonfederal share of costs shall be
provided by the family services collaborative from sources other
than federal funds or funds used to match other federal funds;
(6) the family services collaborative must develop and
maintain an accounting and financial management system adequate
to support all claims for federal reimbursement, including a
clear audit trail and any provisions specified in the agreement;
and
(7) the family services collaborative shall submit an
annual report to the commissioner as specified in the agreement.
Subd. 2. [AGREEMENTS WITH FAMILY SERVICES COLLABORATIVES.]
At a minimum, the agreement between the commissioner and the
family services collaborative shall include the following
provisions:
(1) specific documentation of the expenditures eligible for
federal reimbursement;
(2) the process for developing and submitting claims to the
commissioner;
(3) specific identification of the education, social,
health, or health-related services to families and children
which are to be expanded with the federal reimbursement;
(4) reporting and review procedures ensuring that the
family services collaborative must continue the base level of
expenditures for the education, social, health, or
health-related services for families and children as specified
in subdivision 2, clause (3);
(5) reporting and review procedures to ensure that federal
revenue earned under this section is spent specifically to
expand education, social, health, or health-related services for
families and children as specified in subdivision 2, clause (4);
(6) the period of time, not to exceed three years,
governing the terms of the agreement and provisions for
amendments to, and renewal of the agreement; and
(7) an annual report prepared by the family services
collaborative.
Subd. 3. [WAIVER OF RULE REQUIREMENTS.] (a) [REQUESTING
WAIVERS OF STATE OR FEDERAL RULES.] Local family services
collaboratives, including collaboratives in Becker, Cass, and
Ramsey counties, shall be encouraged to seek waivers of state or
federal rules, as necessary to carry out the purposes of this
section. For purposes of this section, "family services
collaborative" has the meaning given it in section 121.8355,
subdivision 1a.
(b) [WAIVER OF STATE RULES.] In order to receive a waiver
of the requirements of any state rule, the collaborative shall
submit a request for a variance to the appropriate
commissioner. The request shall contain assurances that the
waiver will not affect client entitlements to services, will not
abridge any rights guaranteed to the client by state or federal
law, and will not jeopardize the health or safety of the
client. The commissioner shall grant or deny all waiver
requests within 30 days of receiving those requests, by notice
to the collaborative and published notice in the State Register.
(c) [WAIVER OF FEDERAL RULES.] A local collaborative
seeking a waiver from a federal rule shall submit a request, in
writing, to the appropriate commissioner who shall submit the
waiver request to the relevant policy committees of the
legislature. If the legislative committees approve the request,
they shall direct the appropriate state agency to make a
reasonable effort to negotiate a waiver of the federal rule. If
the legislative committees deny the request for a waiver, they
shall jointly notify the local collaborative of the reason for
denying the waiver. If a waiver request is approved for
submission to federal authorities, the commissioner shall submit
all necessary materials to the appropriate federal authorities.
The commissioner shall notify the collaborative and the
legislative committees of the outcome of the federal waiver
request. In every instance in which a federal waiver is
granted, the commissioner shall publish notice of receipt of the
waiver in the State Register.
Sec. 30. Minnesota Statutes 1992, section 257.3573, is
amended by adding a subdivision to read:
Subd. 3. [REVENUE ENHANCEMENT.] The commissioner shall
submit claims for federal reimbursement earned through the
activities and services supported through Indian child welfare
grants. The commissioner may set aside a portion of the federal
funds earned under this subdivision to establish and support a
new Indian child welfare position in the department of human
services to provide program development. The commissioner shall
use any federal revenue not set aside to expand services under
section 257.3571. The federal revenue earned under this
subdivision is available for these purposes until the funds are
expended.
Sec. 31. Minnesota Statutes 1992, section 257.803,
subdivision 1, is amended to read:
Subdivision 1. [AUTHORITY TO DISBURSE FUNDS.] The
commissioner, with the advice and consent of the advisory
council established under this section, may disburse trust fund
money to any public or private nonprofit agency to fund a child
abuse prevention program. State funds appropriated for child
maltreatment prevention grants may be transferred to the
children's trust fund special revenue account and are available
to carry out this section.
Sec. 32. Minnesota Statutes 1992, section 259.40,
subdivision 1, is amended to read:
Subdivision 1. [SUBSIDY PAYMENTS ADOPTION ASSISTANCE.] The
commissioner of human services may make subsidy payments as
necessary after the subsidized adoption agreement is approved to
shall enter into an adoption assistance agreement with an
adoptive parent or parents who adopt a child who meets the
eligibility requirements under title IV-E of the Social Security
Act, United States Code, title 42, section sections 670 to 679a,
or who otherwise meets the requirements in subdivision 4, is a
Minnesota resident and is under guardianship of the commissioner
or of a licensed child placing agency after the final decree of
adoption is issued. The subsidy payments and any subsequent
modifications to the subsidy payments shall be based on the
needs of the adopted person that the commissioner has determined
cannot be met using other resources including programs available
to the adopted person and the adoptive parent or parents.
Sec. 33. Minnesota Statutes 1992, section 259.40,
subdivision 2, is amended to read:
Subd. 2. [SUBSIDY ADOPTION ASSISTANCE AGREEMENT.] The
placing agency shall certify a child as eligible for a subsidy
adoption assistance according to rules promulgated by the
commissioner. When a parent or parents are found and approved
for adoptive placement of a child certified as eligible for a
subsidy adoption assistance, and before the final decree of
adoption is issued, a written agreement must be entered into by
the commissioner, the adoptive parent or parents, and the
placing agency. The written agreement must be in the form
prescribed by the commissioner and must set forth the
responsibilities of all parties, the anticipated duration of the
subsidy adoption assistance payments, and the payment terms.
The subsidy adoption assistance agreement shall be subject to
the commissioner's approval.
The commissioner shall provide adoption subsidies to the
adoptive parent or parents according to the terms of the subsidy
agreement. The subsidy may include payment for basic
maintenance expenses of food, clothing, and shelter; amount of
adoption assistance is subject to the availability of state and
federal funds and shall be determined through agreement with the
adoptive parents. The agreement shall take into consideration
the circumstances of the adopting parent or parents, the needs
of the child being adopted and may provide ongoing monthly
assistance, supplemental maintenance expenses related to the
adopted person's special needs;, nonmedical expenses
periodically necessary for purchase of services, items, or
equipment related to the special needs;, and medical expenses.
The placing agency or the adoptive parent or parents shall
provide written documentation to support requests the need
for subsidy adoption assistance payments. The commissioner may
require periodic reevaluation of subsidy adoption assistance
payments. The amount of the subsidy payment ongoing monthly
adoption assistance granted may in no case exceed that which
would be allowable for the child under foster family care and is
subject to the availability of state and federal funds.
Sec. 34. Minnesota Statutes 1992, section 259.40,
subdivision 3, is amended to read:
Subd. 3. [ANNUAL AFFIDAVIT.] When subsidies adoption
assistance agreements are for more than one year, the adoptive
parents or guardian or conservator shall annually present an
affidavit stating whether the adopted person remains under their
care and whether the need for subsidy adoption assistance
continues to exist. The commissioner may verify the affidavit.
The subsidy adoption assistance agreement shall continue in
accordance with its terms as long as the need for subsidy
adoption assistance continues and the adopted person is under 22
years of age and is the legal or financial dependent of the
adoptive parent or parents or guardian or conservator and is
under 18 years of age. The adoption assistance agreement may be
extended to age 22 as allowed by rules adopted by the
commissioner. Termination or modification of the
subsidy adoption assistance agreement may be requested by the
adoptive parents or subsequent guardian or conservator at any
time. When the commissioner determines that a child is eligible
for adoption assistance under Title IV-E of the Social Security
Act, United States Code, title 42, sections 670 to 676 679a, the
commissioner shall modify the subsidy adoption assistance
agreement in order to obtain the funds under that act.
Sec. 35. Minnesota Statutes 1992, section 259.40,
subdivision 4, is amended to read:
Subd. 4. [ELIGIBILITY CONDITIONS.] The placing agency
shall determine the child's eligibility for adoption assistance
under title IV-E of the Social Security Act. If the child does
not qualify, the placing agency shall certify a child as
eligible for a state-funded subsidy state funded adoption
assistance only if the following criteria are met:
(a) A placement agency has made reasonable efforts to place
the child for adoption without subsidy, but has been
unsuccessful; or Due to the child's characteristics or
circumstances it would be difficult to provide the child and
adoptive home without adoption assistance.
(b)(1) A placement agency has made reasonable efforts to
place the child for adoption without subsidy adoption
assistance, but has been unsuccessful; or
(b)(2) the child's licensed foster parents desire to adopt
the child and it is determined by the placing agency that:
(1) the adoption is in the best interest of the child; and
(2) due to the child's characteristics or circumstances it
would be difficult to provide the child an adoptive home without
subsidy; and.
(c) The child has been a ward of the commissioner or
licensed a Minnesota-licensed child placing agency.
Sec. 36. Minnesota Statutes 1992, section 259.40,
subdivision 5, is amended to read:
Subd. 5. [DETERMINATION OF RESIDENCY.] A child who is a
resident of any county in this state when eligibility for
subsidy adoption assistance is certified shall remain eligible
and receive the subsidy adoption assistance in accordance with
the terms of the subsidy adoption assistance agreement,
regardless of the domicile or residence of the adopting parents
at the time of application for adoptive placement, legal decree
of adoption, or thereafter.
Sec. 37. Minnesota Statutes 1992, section 259.40,
subdivision 7, is amended to read:
Subd. 7. [REIMBURSEMENT OF COSTS.] Subject to rules of the
commissioner, and the provisions of this subdivision a
Minnesota-licensed child placing agency or county social service
agency shall receive a reimbursement from the commissioner equal
to 100 percent of the reasonable and appropriate cost of
providing or purchasing adoption services for a child certified
as eligible for a subsidy, including adoption assistance. Such
assistance may include adoptive family recruitment, counseling,
and special training when needed. A Minnesota-licensed child
placing agency shall receive reimbursement for adoption services
it purchases for or directly provides to an eligible child. A
county social service agency shall receive such reimbursement
only for adoption services it purchases for an eligible child.
A Minnesota-licensed child placing agency or county social
service agency seeking reimbursement under this subdivision
shall enter into a reimbursement agreement with the commissioner
before providing adoption services for which reimbursement is
sought. No reimbursement under this subdivision shall be made
to an agency for services provided prior to entering a
reimbursement agreement. Separate reimbursement agreements
shall be made for each child and separate records shall be kept
on each child for whom a reimbursement agreement is made. Funds
encumbered and obligated under such an agreement for the child
remain available until the terms of the agreement are fulfilled
or the agreement is terminated.
Sec. 38. Minnesota Statutes 1992, section 259.40,
subdivision 8, is amended to read:
Subd. 8. [INDIAN CHILDREN.] The commissioner is encouraged
to work with American Indian organizations to assist in the
establishment of American Indian child adoption organizations
able to be licensed as child placing agencies. Children
certified as eligible for a subsidy adoption assistance under
this section who are protected under the Federal Indian Child
Welfare Act of 1978 should, whenever possible, be served by the
tribal governing body, tribal courts, or a licensed Indian child
placing agency.
Sec. 39. Minnesota Statutes 1992, section 259.40,
subdivision 9, is amended to read:
Subd. 9. [EFFECT ON OTHER AID.] Subsidy Adoption
assistance payments received under this section shall not affect
eligibility for any other financial payments to which a person
may otherwise be entitled.
Sec. 40. Minnesota Statutes 1992, section 525.539,
subdivision 2, is amended to read:
Subd. 2. "Guardian" means a person or entity who is
appointed by the court to exercise all of the powers and duties
designated in section 525.56 for the care of an incapacitated
person or that person's estate, or both.
Sec. 41. Minnesota Statutes 1992, section 525.551,
subdivision 7, is amended to read:
Subd. 7. [NOTIFICATION OF COMMISSIONER OF HUMAN SERVICES.]
If the ward or conservatee is a patient of a state hospital for
the mentally ill, or committed to the, regional center, or any
state-operated service has a guardianship or conservatorship
established, modified, or terminated, the head of the state
hospital, regional center, or state-operated service shall be
notified. If a ward or conservatee is under the guardianship or
conservatorship of the commissioner of human services as
mentally retarded or dependent and neglected or is under the
temporary custody of the commissioner of human services, the
court shall notify the commissioner of human services of the
appointment of a guardian, conservator or successor guardian or
conservator of the estate of the ward or conservatee if the
public guardianship or conservatorship is established, modified,
or terminated.
Sec. 42. Minnesota Statutes 1992, section 626.559, is
amended by adding a subdivision to read:
Subd. 5. [TRAINING REVENUE.] The commissioner of human
services shall submit claims for federal reimbursement earned
through the activities and services supported through department
of human services child protection or child welfare training
funds. Federal revenue earned must be used to improve and
expand training services by the department. The department
expenditures eligible for federal reimbursement under this
section must not be made from federal funds or funds used to
match other federal funds. The federal revenue earned under
this subdivision is available for these purposes until the funds
are expended.
Sec. 43. [BASIC SLIDING FEE; ALLOCATION.]
In fiscal year 1993 only, a maximum of $600,000 in federal
funds designated for the basic sliding fee program shall be
distributed to counties that, due to the allocation formula
change in section 256H.03, subdivision 4, paragraphs (a) to (c),
do not have sufficient funds available in the basic sliding fee
program to continue services in fiscal year 1993 to families
participating in the basic sliding fee program in fiscal year
1992. This maximum of $600,000 increase for the sliding fee
child care fund in fiscal year 1993 is a one-time increase and
does not increase the allocation base for the 1994-1995
biennium. The funds shall be distributed as a supplemental
fiscal year 1993 allocation to counties without regard to the
allocation formula identified in this section. The amount
distributed to a county shall be based on earnings in excess of
its original fiscal year 1993 allocation after the maintenance
of effort requirements in section 256H.12. The sum of a
county's original and supplemental fiscal year 1993 allocations
may not exceed its fiscal year 1992 allocation. If the amount
of funds earned under section 256H.12 is in excess of $600,000,
the distribution shall be prorated to each county based on the
ratio of the county's earnings in excess of its allocation to
the total of all counties' earnings in excess of their
allocations.
Sec. 44. [PINE COUNTY SOCIAL SERVICE GRANT APPLICATION
PROCESS.]
Subdivision 1. [AUTHORIZATION FOR DEMONSTRATION PROJECT.]
The commissioner of human services shall allow Pine county to
send a letter of intent in lieu of completing a grant
application to apply for categorical social service funding as
part of a four-year intergovernmental agreement demonstration
project. The demonstration project is an alternative method of
obtaining social service funding which is part of a larger
project to simplify and consolidate social services planning and
reporting in Pine county. The demonstration project is an
effort to streamline planning and remove administrative burdens
on smaller counties.
Subd. 2. [SOCIAL SERVICE PLAN.] Pine county must amend its
social service plan within 12 months of receiving funding to
incorporate the requirements of the grant application process
into the social service plan.
Subd. 3. [COMPLIANCE AND MONITORING.] The commissioner may
terminate the demonstration project if Pine county is not using
the categorical funding for the intended purpose. The
commissioner shall send Pine county a 60-day notice and provide
an opportunity for Pine county to appeal before terminating the
project.
Subd. 4. [REPORT.] The commissioner shall report to the
legislature annually beginning January 1, 1995. The report
shall evaluate Pine county's intergovernmental agreements
project and also the advantages of the alternative funding
process for counties with a population under 30,000.
Sec. 45. [EFFECTIVE DATES.]
Sections 31 and 43 are effective the day following final
enactment.
ARTICLE 4
DEVELOPMENTAL DISABILITIES
Section 1. Minnesota Statutes 1992, section 252.275,
subdivision 1, is amended to read:
Subdivision 1. [PROGRAM.] The commissioner of human
services shall establish a statewide program to provide support
for persons with mental retardation or related conditions to
live as independently as possible in the community. An
objective of the program is to reduce unnecessary use of
intermediate care facilities for persons with mental retardation
or related conditions and home and community-based services.
The commissioner shall reimburse county boards for the provision
of semi-independent living services licensed by the commissioner
pursuant to provided by agencies or individuals that meet the
applicable standards of sections 245A.01 to 245A.16 and 252.28,
and for the provision of one-time living allowances to secure
and furnish a home for a person who will receive
semi-independent living services under this section, if other
public funds are not available for the allowance.
For the purposes of this section, "semi-independent living
services" means training and assistance in managing money,
preparing meals, shopping, maintaining personal appearance and
hygiene, and other activities which are needed to maintain and
improve an adult with mental retardation or a related
condition's capability to live in the community. Eligible
persons: (1) must be age 18 or older, must need less than a
24-hour plan of care, and; (2) must be unable to function
independently without semi-independent living services; and (3)
must not be at risk of placement in an intermediate care
facility for persons with mental retardation in the absence of
less restrictive services.
Semi-independent living services costs and one-time living
allowance costs may be paid directly by the county, or may be
paid by the recipient with a voucher or cash issued by the
county.
Sec. 2. Minnesota Statutes 1992, section 252.275,
subdivision 8, is amended to read:
Subd. 8. [USE OF FEDERAL FUNDS AND TRANSFER OF FUNDS TO
MEDICAL ASSISTANCE.] (a) The commissioner shall make every
reasonable effort to maximize the use of federal funds for
semi-independent living services.
(b) The commissioner shall reduce the payments to be made
under this section to each county from January 1, 1994 to June
30, 1996, by the amount of the state share of medical assistance
reimbursement for services other than residential services
provided under the home- and community-based waiver program
under section 256B.092 from January 1, 1994 to June 30, 1996,
for clients for whom the county is financially responsible and
who have been transferred by the county from the
semi-independent living services program to the home- and
community-based waiver program. Unless otherwise specified, all
reduced amounts shall be transferred to the medical assistance
state account.
(c) For fiscal year 1997, the base appropriation available
under this section shall be reduced by the amount of the state
share of medical assistance reimbursement for services other
than residential services provided under the home- and
community-based waiver program authorized in section 256B.092
from January 1, 1995 to December 31, 1995, for persons who have
been transferred from the semi-independent living services
program to the home- and community-based waiver program. The
base appropriation for the medical assistance state account
shall be increased by the same amount.
(d) For purposes of calculating the guaranteed floor under
subdivision 4b and to establish the calendar year 1996
allocations, each county's original allocation for calendar year
1995 shall be reduced by the amount transferred to the state
medical assistance account under paragraph (b) during the six
months ending on June 30, 1995. For purposes of calculating the
guaranteed floor under subdivision 4b and to establish the
calendar year 1997 allocations, each county's original
allocation for calendar year 1996 shall be reduced by the amount
transferred to the state medical assistance account under
paragraph (b) during the six months ending on June 30, 1996.
Sec. 3. Minnesota Statutes 1992, section 252.41,
subdivision 3, is amended to read:
Subd. 3. [DAY TRAINING AND HABILITATION SERVICES FOR
ADULTS WITH MENTAL RETARDATION, RELATED CONDITIONS.] "Day
training and habilitation services for adults with mental
retardation and related conditions" means services that:
(1) include supervision, training, assistance, and
supported employment, work-related activities, or other
community-integrated activities designed and implemented in
accordance with the individual service and individual
habilitation plans required under Minnesota Rules, parts
9525.0015 to 9525.0165, to help an adult reach and maintain the
highest possible level of independence, productivity, and
integration into the community;
(2) are provided under contract with the county where the
services are delivered by a vendor licensed under sections
245A.01 to 245A.16 and 252.28, subdivision 2, to provide day
training and habilitation services; and
(3) are regularly provided to one or more adults with
mental retardation or related conditions in a place other than
the adult's own home or residence unless medically
contraindicated.
Day training and habilitation services reimbursable under
this section do not include special education and related
services as defined in the Education of the Handicapped Act,
United States Code, title 20, chapter 33, section 1401, clauses
(6) and (17), or vocational services funded under section 110 of
the Rehabilitation Act of 1973, United States Code, title 29,
section 720, as amended.
Sec. 4. [252.451] [AGREEMENTS WITH BUSINESSES TO PROVIDE
SUPPORT AND SUPERVISION OF PERSONS WITH MENTAL RETARDATION OR
RELATED CONDITIONS IN COMMUNITY-BASED EMPLOYMENT.]
Subdivision 1. [DEFINITION.] For the purposes of this
section, "qualified business" means a business that employs
primarily nondisabled persons and will employ persons with
mental retardation or related conditions. For purposes of this
section, licensed providers of residential services for persons
with mental retardation or related conditions are not a
qualified business. A qualified business and its employees are
exempt from Minnesota Rules, parts 9525.1500 to 9525.1690 and
9525.1800 to 9525.1930.
Subd. 2. [VENDOR PARTICIPATION AND
REIMBURSEMENT.] Notwithstanding requirements in chapter 245A,
and sections 252.28, 252.40 to 252.46, and 256B.501, vendors of
day training and habilitation services may enter into written
agreements with qualified businesses to provide additional
training and supervision needed by individuals to maintain their
employment.
Subd. 3. [AGREEMENT SPECIFICATIONS.] Agreements must
include the following:
(1) the type and amount of supervision and support to be
provided by the business to the individual in accordance with
their needs as identified in their individual service plan;
(2) the methods used to periodically assess the
individual's satisfaction with their work, training, and
support;
(3) the measures taken by the qualified business and the
vendor to ensure the health, safety, and protection of the
individual during working hours, including the reporting of
abuse and neglect under state law and rules;
(4) the training and support services the vendor will
provide to the qualified business, including the frequency of
on-site supervision and support; and
(5) any payment to be made to the qualified business by the
vendor. Payment to the business must be limited to:
(i) additional costs of training coworkers and managers
that exceed ordinary and customary training costs and are a
direct result of employing a person with mental retardation or a
related condition; and
(ii) additional costs for training, supervising, and
assisting the person with mental retardation or a related
condition that exceed normal and customary costs required for
performing similar tasks or duties.
Payments made to a qualified business under this section
must not include incentive payments to the qualified business or
salary supplementation for the person with mental retardation or
a related condition.
Subd. 4. [CLIENT PROTECTION.] Persons receiving training
and support under this section may not be denied their rights or
procedural protections under section 256.045, subdivision 4a, or
256B.092, including the county agency's responsibility to
arrange for appropriate services, as necessary, in the event
that persons lose their job or the contract with the qualified
business is terminated.
Subd. 5. [VENDOR PAYMENT.] (a) For purposes of this
section, the vendor shall bill and the commissioner shall
reimburse for full-day or partial-day services that would
otherwise have been paid to the vendor for providing direct
services provided that:
(1) the vendor provides services and payments to the
business that enable the business to perform services for the
client that the vendor would otherwise need to perform; and
(2) any client for whom a rate will be billed was receiving
full-time services from the vendor on or before July 1, 1993,
and a rate will allow the client to work with support in a
community business instead of receiving any other service from
the vendor.
(b) Medical assistance reimbursement of services provided
to persons receiving day training and habilitation services
under this section is subject to the limitations on
reimbursement for vocational services under federal law and
regulation.
Sec. 5. [252.452] [VENDOR REQUIREMENTS.]
The requirements of Minnesota Rules, parts 9525.1500 to
9525.1690 governing vendors of day training and habilitation
services are amended as provided in paragraphs (a) to (f).
(a) Notwithstanding Minnesota Rules, part 9525.1620,
subpart 2, item B, orientation must be completed within the
first 60 days of employment.
(b) Employees of a business who are subsequently employed
by the day training and habilitation program to provide job
supports to a client at the business site are exempt from the
requirements of Minnesota Rules, part 9525.1620 except for the
explanation required in subpart 2, item A, subitem (4).
(c) Notwithstanding Minnesota Rules, part 9525.1590,
subpart 2, vendors must annually collect data for each person
receiving employment services that is current as of the last day
of the calendar year and includes:
(1) the type of employment activity, location, and job
title;
(2) the number of hours the person worked per week;
(3) the number of disabled coworkers receiving vendor
services at the same work site where the person for whom the
data is reported is working; and
(4) the number of nondisabled and nonsubsidized coworkers
employed at the work site.
(d) Space owned or leased by a vendor that is used solely
as office space for a community-integrated program is exempt
from Minnesota Rules, parts 9525.1520, subpart 2, item B,
subitems (1), (2), and (4); and 9525.1650.
(e) If any of the conditions in clauses (1) to (4) are met,
the vendor may provide support at the office site for five or
fewer persons at any time and be exempt from Minnesota Rules,
parts 9525.1520, subpart 2, item B, subitems (1), (2), and (4);
and 9525.1650, except that the vendor must document that the
building satisfactorily meets local fire regulations. The
documentation may be a copy of the routine fire inspection of
the building. If a routine inspection has not been completed, a
separate inspection must be completed. The conditions are:
(1) the services are temporary, with an anticipated
duration of not more than 60 calendar days, for example when a
person begins services or is between community jobs and must
spend some portion of each service day involved in the
community;
(2) at least 75 percent of the service week is provided
outside the office site in the community;
(3) the use of the space is for planning meetings or other
individualized meetings with persons receiving support; or
(4) the person is in transit to a job site or other
community-based site.
(f) Notwithstanding Minnesota Rules, part 9525.1630,
subparts 4 and 5, the vendor is required to assess and reassess
persons in the areas specified in Minnesota Rules, part
9525.1630, subpart 4, items B to E, as authorized by the case
manager. Items not specifically authorized are not required.
This section expires on the effective date of the
consolidated licensing rules.
Sec. 6. Minnesota Statutes 1992, section 252.46, is
amended to read:
252.46 [PAYMENT RATES.]
Subdivision 1. [RATES.] Payment rates to vendors, except
regional centers, for county-funded day training and
habilitation services and transportation provided to persons
receiving day training and habilitation services established by
a county board are governed by subdivisions 2 to 11
19. "Payment rate" as used in subdivisions 2 to 11 refers to
three kinds of payment rates The commissioner shall approve the
following three payment rates for services provided by a vendor:
(1) a full-day service rate for persons who receive at
least six service hours a day, including the time it takes to
transport the person to and from the service site;
(2) a partial-day service rate that must not exceed 75
percent of the full-day service rate for persons who receive
less than a full day of service; and
(3) a transportation rate for providing, or arranging and
paying for, transportation of a person to and from the person's
residence to the service site.
Medical assistance rates for home and community-based
service provided under section 256B.501, subdivision 4, by
licensed vendors of day training and habilitation services must
not be greater than the rates for the same services established
by counties under sections 252.40 to 252.47. For very dependent
persons with special needs the commissioner may approve an
exception to the approved payment rate under section 256B.501,
subdivision 4 or 8.
Subd. 2. [RATE MINIMUM.] Unless a variance is granted
under subdivision 6, the minimum payment rates set by a county
board for each vendor must be equal to the payment rates
approved by the commissioner for that vendor in effect January 1
of the previous calendar year.
Subd. 3. [RATE MAXIMUM.] Unless a variance is granted
under subdivision 6, the maximum payment rates for each vendor
for a calendar year must be equal to the payment rates approved
by the commissioner for that vendor in effect December 1 of the
previous calendar year. The commissioner of finance shall
include as a budget change request in each biennial detailed
expenditure budget submitted to the legislature under section
16A.11 annual inflation adjustments in reimbursement rates for
each vendor, based upon the projected percentage change in the
urban consumer price index, all items, published by the United
States Department of Labor, for the upcoming calendar year over
the current calendar year. The commissioner shall not provide
an annual inflation adjustment for the biennium ending June 30,
1993.
Subd. 4. [NEW VENDORS.] (a) Payment rates established by a
county for a new vendor for which there were no previous rates
must not exceed 95 percent of the greater of 125 percent of the
statewide median rates or 125 percent of the average payment
rates in the regional development commission district under
sections 462.381 to 462.396 in which the new vendor is
located unless the criteria in paragraph (b) are met. When at
least 50 percent of the persons to be served by the new vendor
are persons discharged from a regional treatment center on or
after January 1, 1990, the recommended payment rates for the new
vendor shall not exceed twice the current statewide average
payment rates.
For purposes of this subdivision, persons discharged from
the regional treatment center do not include persons who
received temporary care under section 252A.111, subdivision 3.
(b) A payment rate equal to 200 percent of the statewide
average rates shall be assigned to persons served by the new
vendor when those persons are persons with very severe
self-injurious or assaultive behaviors, persons with medical
conditions requiring delivery of physician-prescribed medical
interventions at one-to-one staffing for at least 15 minutes
each time they are performed, or persons discharged from a
regional treatment center after May 1, 1993, to the vendor's
program. All other persons for whom the new service is needed
must be assigned a rate equal to 95 percent of the greater of
125 percent of the statewide median rates or 125 percent of the
regional average rates, whichever is higher, and the maximum
payment rate that may be recommended is determined by
multiplying the number of clients at each limit by the rate
corresponding to that limit and dividing the sum by the total
number of clients. When the recommended payment rates exceed 95
percent of 125 percent of the greater of the statewide median or
regional average rates, whichever is higher, the county must
include documentation verifying the medical or behavioral needs
of clients. The approved payment rates must be based on 12
months budgeted expenses divided by at least 90 percent of
authorized service units associated with the new vendor's
licensed capacity. The county must include documentation
verifying the person's discharge from a regional treatment
center and that admission of new clients to existing services
eligible for a rate variance under subdivision 6 was considered
before recommending payment rates for a new vendor. Nothing in
this subdivision permits development of a new program that
primarily results in refinancing of services for individuals
already receiving services in existing programs.
Subd. 5. [SUBMITTING RECOMMENDED RATES.] The county board
shall submit recommended payment rates to the commissioner on
forms supplied by the commissioner at least 60 days before
revised payment rates or payment rates for new vendors are to be
effective. The forms must require include the county board's
written verification of the individual documentation required
under section 252.44, clause (a). If the number of days of
service provided by a licensed vendor are projected to increase,
the county board must recommend payment rates based on the
projected increased days of attendance and resulting lower per
unit fixed costs. Recommended increases in payment rates for
vendors whose approved payment rates are ten or more than ten
percent below the statewide median payment rates must be equal
to the maximum increases allowed for that vendor under
subdivision 3. If a vendor provides services at more than one
licensed site, the county board may recommend the same payment
rates for each site based on the average rate for all sites.
The county board may also recommend differing payment rates for
each licensed site if it would result in a total annual payment
to the vendor that is equal to or less than the total annual
payment that would result if the average rates had been used for
all sites. For purposes of this subdivision, the average
payment rate for all service sites used by a vendor must be
computed by adding the amounts that result when the payment
rates for each licensed site are multiplied by the projected
annual number of service units to be provided at that site and
dividing the sum of those amounts by the total units of service
to be provided by the vendor at all sites.
Subd. 6. [VARIANCES.] (a) A variance from the minimum or
maximum payment rates in subdivisions 2 and 3 may be granted by
the commissioner when the vendor requests and the county board
submits to the commissioner a written variance request on forms
supplied by the commissioner with the recommended payment
rates. The commissioner shall develop by October 1, 1989, a
uniform format for submission of documentation for the variance
requests. This format shall be used by each vendor requesting a
variance. The form shall be developed by the commissioner and
shall be reviewed by representatives of advocacy and provider
groups and counties. A variance to the rate maximum may be
utilized for costs associated with compliance with state
administrative rules, compliance with court orders, capital
costs required for continued licensure, increased insurance
costs, start-up and conversion costs for supported employment,
direct service staff salaries and benefits, and transportation.
The county board shall review all vendors' payment rates that
are ten or more than ten percent lower than the statewide median
payment rates. If the county determines that the payment rates
do not provide sufficient revenue to the vendor for authorized
service delivery the county must recommend a variance under this
section. When the county board contracts for increased services
from any vendor for some or all individuals receiving services
from the vendor, the county board shall review the vendor's
payment rates to determine whether the increase requires that a
variance to the minimum rates be recommended under this section
to reflect the vendor's lower per unit fixed costs., and other
program related costs when any of the criteria in clauses (1) to
(3) is also met:
(1) change is necessary to comply with licensing citations;
(2) a significant change is approved by the commissioner
under section 252.28 that is necessary to provide authorized
services to new clients with very severe self-injurious or
assaultive behavior, or medical conditions requiring delivery of
physician-prescribed medical interventions requiring one-to-one
staffing for at least 15 minutes each time they are performed,
or to new clients directly discharged to the vendor's program
from a regional treatment center; or
(3) a significant increase in the average level of staffing
is needed to provide authorized services approved by the
commissioner under section 252.28, that is necessitated by a
decrease in licensed capacity or loss of clientele when counties
choose alternative services under Laws 1992, chapter 513,
article 9, section 41.
A variance under this paragraph may be approved only if the
costs to the medical assistance program do not exceed the
medical assistance costs for all clients served by the
alternatives and all clients remaining in the existing services.
(b) A variance to the rate minimum may be granted when (1)
the county board contracts for increased services from a vendor
for some or all individuals receiving services from the vendor
lower per unit fixed costs result or (2) when the actual costs
of delivering authorized service over a 12-month contract period
have decreased.
(c) The written variance request under this subdivision
must include documentation that all the following criteria have
been met:
(1) The commissioner and the county board have both
conducted a review and have identified a need for a change in
the payment rates and recommended an effective date for the
change in the rate.
(2) The proposed changes are required for the vendor to
deliver authorized individual services in an effective and
efficient manner.
(3) The proposed changes are necessary to demonstrate
compliance with minimum licensing standards.
(4) The vendor documents that the changes cannot be
achieved by reallocating efforts to reallocate current staff or
by reallocating financial resources.
(5) The county board submits evidence that the need for and
any additional staff staffing needs cannot be met by using
temporary special needs rate exceptions under Minnesota Rules,
parts 9510.1020 to 9510.1140.
(3) The vendor documents that financial resources have been
reallocated before applying for a variance. No variance may be
granted for equipment, supplies, or other capital expenditures
when depreciation expense for repair and replacement of such
items is part of the current rate.
(4) For variances related to loss of clientele, the vendor
documents the other program and administrative expenses, if any,
that have been reduced.
(6) (5) The county board submits verification of the
conditions for which the variance is requested, a description of
the nature and cost of the proposed changes, and how the county
will monitor the use of money by the vendor to make necessary
changes in services.
(7) (6) The county board's recommended payment rates do not
exceed 95 percent of the greater of 125 percent of the current
calendar year's statewide median or 125 percent of the regional
average payment rates., whichever is higher, for each of the
regional commission districts under sections 462.381 to 462.396
in which the vendor is located except for the following: when a
variance is recommended to allow authorized service delivery to
new clients with severe self-injurious or assaultive behaviors
or with medical conditions requiring delivery of physician
prescribed medical interventions, or to persons being directly
discharged from a regional treatment center to the vendor's
program, those persons must be assigned a payment rate of 200
percent of the current statewide average rates. All other
clients receiving services from the vendor must be assigned a
payment rate equal to the vendor's current rate unless the
vendor's current rate exceeds 95 percent of 125 percent of the
statewide median or 125 percent of the regional average payment
rates, whichever is higher. When the vendor's rates exceed 95
percent of 125 percent of the statewide median or 125 percent of
the regional average rates, the maximum rates assigned to all
other clients must be equal to the greater of 95 percent of 125
percent of the statewide median or 125 percent of the regional
average rates. The maximum payment rate that may be recommended
for the vendor under these conditions is determined by
multiplying the number of clients at each limit by the rate
corresponding to that limit and then dividing the sum by the
total number of clients.
(7) The vendor has not received a variance under this
subdivision in the past 12 months.
(d) The commissioner shall have 60 calendar days from the
date of the receipt of the complete request to accept or reject
it, or the request shall be deemed to have been granted. If the
commissioner rejects the request, the commissioner shall state
in writing the specific objections to the request and the
reasons for its rejection.
Subd. 7. [TIME REQUIREMENTS AND APPEALS PROCESS FOR
VARIANCES RATE RECONSIDERATIONS.] The commissioner shall notify
in writing county boards requesting variances within 60 days of
receiving the variance request from the county board. The
notification shall give reasons for denial of the variance, if
it is denied. A host county that disagrees with a rate decision
of the commissioner under subdivision 6 or 9 may request
reconsideration by the commissioner within 45 days after the
date the host county received notification of the commissioner's
decision. The request must state the reasons why the host
county is requesting reconsideration of the rate decision and
present evidence explaining the host county's disagreement with
the rate decision.
The commissioner shall review the host county's evidence
and provide the host county with written notification of the
decision on the request within 60 days. The commissioner's
decision on the request is final.
Until a reconsideration request is decided, payments must
continue at a rate the commissioner determines complies with
this section. If a higher rate is approved, the commissioner
shall order a retroactive payment as determined in the
commissioner's decision.
Subd. 8. [COMMISSIONER'S NOTICE TO BOARDS, VENDORS.] The
commissioner shall notify the county boards and vendors of:
(1) the average regional payment rates and, 95 percent of
125 percent of the average regional payments rates for each of
the regional development commission districts designated in
sections 462.381 to 462.396; and, 95 percent of 125 percent of
the statewide median rates, and 200 percent of the statewide
average rates.
(2) the projected inflation rate for the year in which the
rates will be effective equal to the most recent projected
change in the urban consumer price index, all items, published
by the United States Department of Labor, for the upcoming
calendar year over the current calendar year.
Subd. 9. [APPROVAL OR DENIAL OF RATES.] The commissioner
shall approve the county board's recommended payment rates when
the rates and verification justifying the projected service
units comply with subdivisions 2 to 10 18. The commissioner
shall notify the county board in writing of the approved payment
rates within 60 days of receipt of the rate recommendations. If
the rates are not approved, or if rates different from those
originally recommended are approved, the commissioner shall
within 60 days of receiving the rate recommendation notify the
county board in writing of the reasons for denying or
substituting a different rate for the recommended rates.
Approved payment rates remain effective until the commissioner
approves different rates in accordance with subdivisions 2 and 3.
Subd. 10. [VENDOR'S REPORT; AUDIT.] The vendor shall
report to the commissioner and the county board on forms
prescribed by the commissioner at times specified by the
commissioner. The reports shall include programmatic and fiscal
information. Fiscal information shall be provided in accordance
with an annual audit that complies with the requirements of
Minnesota Rules, parts 9550.0010 to 9550.0092. The audit must
be done in accordance with generally accepted auditing standards
to result in statements that include a balance sheet, income
statement, changes in financial position, and the certified
public accountant's opinion. The audit must provide
supplemental statements for each day training and habilitation
program with an approved unique set of rates.
Subd. 11. [IMPROPER TRANSACTIONS.] Transactions that have
the effect of circumventing subdivisions 1 to 10 18 must not be
considered by the commissioner for the purpose of payment rate
approval under the principle that the substance of the
transaction prevails over the form.
Subd. 12. [RATES ESTABLISHED AFTER 1990.] Unless a
variance is granted under subdivision 6, payment rates
established by a county for calendar year 1990 and which are in
effect December 31, 1990, remain in effect until June 30, 1991.
Payment rates established by a county board to be paid to a
vendor on or after July 1, 1991, must be determined under
permanent rules adopted by the commissioner. Until permanent
rules are adopted, the payment rates must be determined
according to subdivisions 1 to 11 except for the period from
July 1, 1991, through December 31, 1991, when the increase
determined under subdivision 3 must not exceed the projected
percentage change in the urban consumer price index, all items,
published by the United States Department of Labor, for the
current calendar year over the previous calendar year. No
county shall pay a rate that is less than the minimum rate
determined by the commissioner.
In developing procedures for setting minimum payment rates
and procedures for establishing payment rates, the commissioner
shall consider the following factors:
(1) a vendor's payment rate and historical cost in the
previous year;
(2) current economic trends and conditions;
(3) costs that a vendor must incur to operate efficiently,
effectively and economically and still provide training and
habilitation services that comply with quality standards
required by state and federal regulations;
(4) increased liability insurance costs;
(5) costs incurred for the development and continuation of
supported employment services;
(6) cost variations in providing services to people with
different needs;
(7) the adequacy of reimbursement rates that are more than
15 percent below the statewide average; and
(8) other appropriate factors.
The commissioner may develop procedures to establish
differing hourly rates that take into account variations in the
number of clients per staff hour, to assess the need for day
training and habilitation services, and to control the
utilization of services.
In developing procedures for setting transportation rates,
the commissioner may consider allowing the county board to set
those rates or may consider developing a uniform standard.
Medical assistance rates for home and community-based
services provided under section 256B.501 by licensed vendors of
day training and habilitation services must not be greater than
the rates for the same services established by counties under
sections 252.40 to 252.47.
Subd. 13. [REVIEW AND REVISION OF PROCEDURES FOR RATE
EXCEPTIONS FOR VERY DEPENDENT PERSONS WITH SPECIAL NEEDS.] The
commissioner shall review the procedures established in
Minnesota Rules, parts 9510.1020 to 9510.1140, that counties
must follow to seek authorization for a medical assistance rate
exception for services for very dependent persons with special
needs. The commissioner shall appoint an advisory task force to
work with the commissioner. Members of the task force must
include vendors, providers, advocates, and consumers. After
considering the recommendations of the advisory task force and
county rate setting procedures developed under this section, the
commissioner shall:
(1) revise administrative procedures as necessary;
(2) implement new review procedures for county applications
for medical assistance rate exceptions for services for very
dependent persons with special needs in a manner that accounts
for services available to the person within the approved payment
rates of the vendor;
(3) provide training and technical assistance to vendors,
providers, and counties in use of procedures governing medical
assistance rate exceptions for very dependent persons with
special needs and in county rate setting procedures established
under this subdivision; and
(4) develop a strategy and implementation plan for uniform
data collection for use in establishing equitable payment rates
and medical assistance rate exceptions for services provided by
vendors.
Subd. 14. [PILOT STUDY.] The commissioner may initiate a
pilot payment rate system under section 252.47. The pilot
project may establish training and demonstration sites. The
pilot payment rate system must include actual transfers of
funds, not simulated transfers. The pilot payment rate system
may involve vendors representing different geographic regions
and rates of reimbursement. Participation in the pilot project
is voluntary. Selection of participants by the commissioner is
based on the vendor's submission of a complete application form
provided by the commissioner. The application must include
letters of agreement from the host county, counties of financial
responsibility, and residential service providers. Evaluation
of the pilot project must include consideration of the
effectiveness of procedures governing establishment of equitable
payment rates. Implementation of the pilot payment rate system
is contingent upon federal approval and systems feasibility.
The policies and procedures governing administration,
participation, evaluation, service utilization, and payment for
services under the pilot payment rate system are not subject to
the rulemaking requirements of chapter 14.
Subd. 16. [PAYMENT RATE CRITERIA; ALLOCATION OF
EXPENDITURES.] Payment rates approved under subdivision 9 must
reflect the payment rate criteria in paragraphs (a) and (b) and
the allocation principles in paragraph (c).
(a) Payment rates must be based on reasonable costs that
are ordinary, necessary, and related to delivery of authorized
client services.
(b) The commissioner shall not pay for: (i) unauthorized
service delivery; (ii) services provided in accordance with
receipt of a special grant; (iii) services provided under
contract to a local school district; (iv) extended employment
services under Minnesota Rules, parts 3300.1950 to 3300.3050, or
vocational rehabilitation services provided under Title I,
section 110 or Title VI-C, Rehabilitation Act Amendments of
1992, as amended, and not through use of medical assistance or
county social service funds; or (v) services provided to a
client by a licensed medical, therapeutic, or rehabilitation
practitioner or any other vendor of medical care which are
billed separately on a fee for service basis.
(c) On an annual basis, actual and projected contract year
expenses must be allocated to standard budget line items
corresponding to direct and other program and administrative
expenses as submitted to the commissioner with the host county's
recommended payment rates. Central or corporate office costs
must be allocated to licensed vendor sites within the group
served by the central or corporate office according to the cost
allocation principles under section 256B.432.
(d) The vendor must maintain records documenting that
clients received the billed services.
Subd. 17. [HOURLY RATE STRUCTURE.] Counties participating
as host counties under the pilot study of hourly rates
established under Laws 1988, chapter 689, article 2, section
117, may recommend continuation of the hourly rates for
participating vendors. The recommendation must be made annually
under subdivision 5 and according to the methods and standards
provided by the commissioner. The commissioner shall approve
the hourly rates when service authorization, billing, and
payment for services is possible through the Medicaid management
information system and the other criteria in this subdivision
are met.
Subd. 18. [PILOT STUDY RATES.] By January 1, 1994,
counties and vendors operating under the pilot study of hourly
rates established under Laws 1988, chapter 689, article 2,
section 117, shall work with the commissioner to translate the
hourly rates and actual expenditures into rates meeting the
criteria in subdivisions 1 to 16 unless hourly rates are
approved under subdivision 17.
Sec. 7. Minnesota Statutes 1992, section 252.47, is
amended to read:
252.47 [RULES.]
To implement sections 252.40 to 252.47, the commissioner
shall adopt permanent rules under sections 14.01 to 14.38, by
July 1, 1995. The rules may include a plan for phasing in
implementation of the procedures and rates established by the
rules. The phase-in may occur prior to calendar year 1991. The
commissioner shall establish an advisory task force to advise
and make recommendations to the commissioner during the
rulemaking process. The advisory task force must include
legislators, vendors, residential service providers, counties,
consumers, department personnel, and others as determined by the
commissioner.
Sec. 8. [256B.0916] [EXPANSION OF HOME- AND
COMMUNITY-BASED SERVICES.]
(a) The commissioner shall expand availability of home- and
community-based services for persons with mental retardation and
related conditions to the extent allowed by federal law and
regulation and shall assist counties in transferring persons
from semi-independent living services to home- and
community-based services. The commissioner may transfer funds
from the state semi-independent living services account
available under section 252.275, subdivision 8, and state
community social services aids available under section 256E.15
to the medical assistance account to pay for the nonfederal
share of nonresidential and residential home- and
community-based services authorized under section 256B.092 for
persons transferring from semi-independent living services.
(b) Upon federal approval, county boards are not
responsible for funding semi-independent living services as a
social service for those persons who have transferred to the
home- and community-based waiver program as a result of the
expansion under this subdivision. The county responsibility for
those persons transferred shall be assumed under section
256B.092. Notwithstanding the provisions of section 252.275,
the commissioner shall continue to allocate funds under that
section for semi-independent living services and county boards
shall continue to fund services under sections 256E.06 and
256E.14 for those persons who cannot access home- and
community-based services under section 256B.092.
(c) Eighty percent of the state funds made available to the
commissioner under section 252.275 as a result of persons
transferring from the semi-independent living services program
to the home- and community-based services program shall be used
to fund additional persons in the semi-independent living
services program.
Sec. 9. [256E.15] [TRANSFER OF FUNDS TO MEDICAL
ASSISTANCE.]
(a) The commissioner shall reduce the payment to be made
under sections 256E.06 and 256E.14 to each county on July 1,
1994, by the amount of the state share of medical assistance
reimbursement for residential services provided under the home-
and community-based waiver program authorized in section
256B.092 from January 1, 1994 to March 31, 1994, for clients for
whom the county is financially responsible and have transferred
from the semi-independent living services program to the home-
and community-based waiver program. For the purposes of this
section, residential services include supervised living, in-home
support, and respite care services. The commissioner shall
similarly reduce the payments to be made between October 1, 1994
and December 31, 1996, for the quarters between April 1, 1994
and June 30, 1996. All reduced amounts shall be transferred to
the medical assistance state account.
(b) Beginning fiscal year 1997, the appropriation under
sections 256E.06 and 256E.14 shall be reduced by the amount of
the state share of medical assistance reimbursement for
residential services provided under the home- and
community-based waiver program under section 256B.092 from
January 1, 1995 to December 31, 1995, for persons who have
transferred from the semi-independent living services program to
the home- and community-based waiver program. The base
appropriation for the medical assistance state account shall be
increased by the same amount.
Sec. 10. [EXEMPTION FROM RULES GOVERNING DAY TRAINING AND
HABILITATION SERVICES FOR PERSONS WITH MENTAL RETARDATION OR
RELATED CONDITIONS.]
Until the commissioner of human services adopts amended
licensing rules governing these services, providers of day
training and habilitation services are exempt from the following
Minnesota Rules:
(1) part 9525.1540;
(2) part 9525.1550, subparts 2, items C and D; 3; 4, items
B to E; 5; 9 to 11; and 13;
(3) part 9525.1590, subpart 2, item C;
(4) part 9525.1600, subpart 9;
(5) part 9525.1610, subpart 2;
(6) part 9525.1640, subparts 1, items A and F; and 2;
(7) part 9525.1650, subpart 1;
(8) part 9525.1660, subparts 8 and 12; and
(9) part 9525.1670, subparts 1 to 3 and 5.
Sec. 11. [DEMONSTRATION PROJECT.]
(a) The commissioner may establish a demonstration project
to improve the efficiency and effectiveness of service provision
for recipients of services from intermediate care facilities for
persons with mental retardation or related conditions.
The commissioner shall establish procedures to implement
the project. The demonstration project may be coordinated with
other projects authorized in other areas. Participation by
providers in the demonstration project is voluntary. The
commissioner shall seek any necessary federal waivers to
implement the pilot project.
(b) The commissioner may waive rules relating to the
provision of residential services for persons with mental
retardation or related conditions to the extent necessary to
implement the demonstration project. In waiving rules, the
commissioner shall consider the recommendations of persons who
are and who represent consumers and providers of service and of
representatives of state and local agencies administering
services. Individuals receiving services under the
demonstration project may not be denied rights or procedural
protections under Minnesota Statutes, sections 245.825; 245.91
to 245.97; 252.41, subdivision 9; 256.045; 256B.092; 626.556;
and 626.557, including the county agency's responsibility to
arrange for appropriate services and procedures for the
monitoring of psychotropic medications.
(c) The project must meet the following requirements:
(1) persons and their legal representatives, if any, must
be provided with information about the project;
(2) the project must comply with applicable federal
requirements;
(3) the project proposal must include specific measures to
be taken to ensure the health, safety, and protection of the
persons participating; and
(4) persons participating in the project must be informed
when any part of Minnesota Rules is waived.
(d) The commissioner shall request and evaluate proposals
from county agencies and provider organizations to participate.
Upon federal approval, the commissioner shall enter into a
performance-based contract with counties and existing licensed
ICF/MR providers that specifies the amount and conditions of
reimbursement, requirements for monitoring and evaluation, and
expected client-based outcomes. Counties and providers shall
present potential outcome indicators for consideration in the
following areas:
(1) personal health, safety, and comfort;
(2) personal growth, independence, and productivity;
(3) client choice and control over daily life decisions;
(4) consumer, family, and the case manager's satisfaction
with services; and
(5) community inclusion, including social relationships and
participation in valued community roles.
Outcome indicators must be determined by the person and the
legal representative, if any, with assistance from the county
case manager and provider.
(e) The cost of services for intermediate care facilities
for persons with mental retardation paid for under the contract
must not exceed 95 percent of the cost of the services that
would otherwise have been paid to the intermediate care facility
or group of intermediate care facilities during a biennium,
including applicable special needs rates and rate adjustments,
under the reimbursement system in effect at the time the
contracted rate is effective. An intermediate care facility
participating in the demonstration project must continue to be
licensed. After participation in the project, the facility may
be recertified as an intermediate care facility for persons with
mental retardation, notwithstanding the provisions of Minnesota
Statutes, section 252.291, or the services provided under the
demonstration project may be converted to home- and
community-based services authorized under Minnesota Statutes,
section 256B.092, if the applicable standards are met. The rate
paid to a recertified facility must not be greater than the rate
paid to the facility before participation in the project. The
commissioner may establish emergency rate setting procedures to
allow for the transition back to intermediate care services for
persons with mental retardation or related conditions.
Sec. 12. [AUTHORITY TO SEEK FEDERAL WAIVER.]
Subdivision 1. [AUTHORITY.] The commissioner of human
services may seek federal waivers necessary to implement an
integrated management and planning system for persons with
mental retardation or related conditions that would enable the
commissioner to achieve the goals in subdivisions 2 to 4.
Subd. 2. [COMPREHENSIVE REFORM.] The system shall include
new methods of administering services for persons with mental
retardation or related conditions that support the needs of the
persons and their families in the community to the maximum
extent possible.
Subd. 3. [SERVICE ACCESS AND COORDINATION.] The system
must include procedural requirements for accessing services that
are simple and easily understood by the person or their legal
representative, if any. Where duplicative, the requirements
shall be unified or streamlined, as appropriate. Service
coordination activities shall be flexible to allow the person's
needs and preferences to be met.
Subd. 4. [REGULATORY STANDARDS AND QUALITY
ASSURANCE.] Regulatory standards requiring unnecessary
paperwork, determined to be duplicative, or which are
ineffective in establishing accountability in service delivery
must be eliminated. Quality assurance methods must continue to
include safeguards to ensure the health and welfare of persons
receiving services.
Subd. 5. [REPORT.] The commissioner shall report to the
legislature by January 1, 1994, on the results of the waiver
request. If the waiver is approved, the report must include
recommendations to implement the waiver, including budget
recommendations, proposed strategies, and implementation
timelines.
Sec. 13. [DOWNSIZING PILOT PROJECT.]
(a) The commissioner of human services shall establish a
pilot project in Cottonwood county to downsize to 21 beds an
existing 45-bed intermediate care facility for persons with
mental retardation or related conditions. The project must be
approved by the commissioner under Minnesota Statutes, section
252.28, and must include criteria for determining how
individuals are selected for alternative services and the use of
a request for proposal process in selecting the vendors for
alternative services. The project must include:
(1) alternative services for the residents being relocated;
(2) timelines for resident relocation and decertification
of beds; and
(3) adjustment of the facility's operating cost rate under
Minnesota Rules, part 9553.0050, as necessary to implement the
project.
(b) The facility's aggregate investment-per-bed limit in
effect before downsizing must be the facility's
investment-per-bed limit after downsizing. The facility's total
revenues after downsizing must not increase as a result of the
downsizing project. The facility's total revenues before
downsizing are determined by multiplying the payment rate in
effect the day before the downsizing is effective by the number
of resident days for the reporting year preceding the downsizing
project. For the purpose of this project, the average medical
assistance rate for home- and community-based services must not
exceed the rate made available under Laws 1992, chapter 513,
article 5, section 2.
Sec. 14. [REPEALER.]
Minnesota Statutes 1992, section 252.46, subdivisions 12,
13, and 14, are repealed.
Sec. 15. [EFFECTIVE DATE.]
Section 13 is effective July 1, 1994.
ARTICLE 5
HEALTH CARE ADMINISTRATION
Section 1. Minnesota Statutes 1992, section 62A.045, is
amended to read:
62A.045 [PAYMENTS ON BEHALF OF WELFARE RECIPIENTS.]
No policy of accident and sickness insurance regulated
under this chapter; vendor of risk management services regulated
under section 60A.23; nonprofit health service plan corporation
regulated under chapter 62C; health maintenance organization
regulated under chapter 62D; or self-insured plan regulated
under chapter 62E shall contain any provision denying or
reducing benefits because services are rendered to a person who
is eligible for or receiving medical benefits pursuant to
chapter 256; 256B; or 256D or services pursuant to section
252.27; 256.9351 to 256.9361; 260.251, subdivision 1a; or
393.07, subdivision 1 or 2. No insurer providing benefits under
policies covered by this section shall use eligibility for
medical programs named in this section as an underwriting
guideline or reason for nonacceptance of the risk.
Notwithstanding any law to the contrary, when a person
covered under a policy of accident and sickness insurance, risk
management plan, nonprofit health service plan, health
maintenance organization, or self-insured plan receives medical
benefits according to any statute listed in this section,
payment for covered services or notice of denial for services
billed by the provider must be issued directly to the provider.
If a person was receiving medical benefits through the
department of human services at the time a service was provided,
the provider must indicate this benefit coverage on any claim
forms submitted by the provider to the insurer for those
services. If the commissioner of human services notifies the
insurer that the commissioner has made payments to the provider,
payment for benefits or notices of denials issued by the insurer
must be issued directly to the commissioner. Submission by the
department to the insurer of the claim on a department of human
services claim form is proper notice and shall be considered
proof of payment of the claim to the provider and supersedes any
contract requirements of the insurer relating to the form of
submission. Liability to the insured for coverage is satisfied
to the extent that payments for those benefits are made by the
insurer to the provider or the commissioner.
Sec. 2. Minnesota Statutes 1992, section 144A.071, is
amended to read:
144A.071 [MORATORIUM ON CERTIFICATION OF NURSING HOME
BEDS.]
Subdivision 1. [FINDINGS.] The legislature finds that
medical assistance expenditures are increasing at a much faster
rate than the state's ability to pay them; that reimbursement
for nursing home care and ancillary services comprises over half
of medical assistance costs, and, therefore, controlling
expenditures for nursing home care is essential to prudent
management of the state's budget; that construction of new
nursing homes and the addition of more nursing home beds to the
state's long-term care resources inhibits the ability to control
expenditures; that Minnesota already leads the nation in nursing
home expenditures per capita, has the fifth highest number of
beds per capita elderly, and that private paying individuals and
medical assistance recipients have equivalent access to nursing
home care; and that in the absence of a moratorium the increased
numbers of nursing homes and nursing home beds will consume
resources that would otherwise be available to develop a
comprehensive long-term care system that includes a continuum of
care. Unless action is taken, this expansion of bed capacity is
likely to accelerate with the repeal of the certificate of need
program effective March 15, 1984. The legislature also finds
that Minnesota's dependence on institutional care for elderly
persons is due in part to the dearth of alternative services in
the home and community. The legislature also finds that further
increases in the number of licensed nursing home beds,
especially in nursing homes not certified for participation in
the medical assistance program, is contrary to public policy,
because: (1) nursing home residents with limited resources may
exhaust their resources more rapidly in these facilities,
creating the need for a transfer to a certified nursing home,
with the concomitant risk of transfer trauma; (2) a continuing
increase in the number of nursing home beds will foster
continuing reliance on institutional care to meet the long-term
care needs of residents of the state; (3) a further expansion of
nursing home beds will diminish incentives to develop more
appropriate and cost-effective alternative services and divert
community resources that would otherwise be available to fund
alternative services; (4) through corporate reorganization
resulting in the separation of certified and licensed beds, a
nursing home may evade the provisions of section 256B.48,
subdivision 1, clause (a); and (5) it is in the best interests
of the state to ensure that the long-term care system is
designed to protect the private resources of individuals as well
as to use state resources most effectively and efficiently.
The legislature declares that a moratorium on the licensure
and medical assistance certification of new nursing home
beds and construction projects that exceed the lesser of
$500,000 or 25 percent of a facility's appraised value is
necessary to control nursing home expenditure growth and enable
the state to meet the needs of its elderly by providing high
quality services in the most appropriate manner along a
continuum of care.
Subd. 1a. [DEFINITIONS.] For purposes of sections 144A.071
to 144A.073, the following terms have the meanings given them:
(a) "attached fixtures" has the meaning given in Minnesota
Rules, part 9549.0020, subpart 6.
(b) "buildings" has the meaning given in Minnesota Rules,
part 9549.0020, subpart 7.
(c) "capital assets" has the meaning given in section
256B.421, subdivision 16.
(d) "commenced construction" means that all of the
following conditions were met: the final working drawings and
specifications were approved by the commissioner of health; the
construction contracts were let; a timely construction schedule
was developed, stipulating dates for beginning, achieving
various stages, and completing construction; and all zoning and
building permits were applied for.
(e) "completion date" means the date on which a certificate
of occupancy is issued for a construction project, or if a
certificate of occupancy is not required, the date on which the
construction project is available for facility use.
(f) "construction" means any erection, building,
alteration, reconstruction, modernization, or improvement
necessary to comply with the nursing home licensure rules.
(g) "construction project" means:
(1) a capital asset addition to, or replacement of a
nursing home or certified boarding care home that results in new
space or the remodeling of or renovations to existing facility
space;
(2) the remodeling or renovation of existing facility space
the use of which is modified as a result of the project
described in clause (1). This existing space and the project
described in clause (1) must be used for the functions as
designated on the construction plans on completion of the
project described in clause (1) for a period of not less than 24
months; or
(3) capital asset additions or replacements that are
completed within 12 months before or after the completion date
of the project described in clause (1).
(h) "new licensed" or "new certified beds" means:
(1) newly constructed beds in a facility or the
construction of a new facility that would increase the total
number of licensed nursing home beds or certified boarding care
or nursing home beds in the state; or
(2) newly licensed nursing home beds or newly certified
boarding care or nursing home beds that result from remodeling
of the facility that involves relocation of beds but does not
result in an increase in the total number of beds, except when
the project involves the upgrade of boarding care beds to
nursing home beds, as defined in section 144A.073, subdivision
1. "Remodeling" includes any of the type of conversion,
renovation, replacement, or upgrading projects as defined in
section 144A.073, subdivision 1.
(i) "project construction costs" means the cost of the
facility capital asset additions, replacements, renovations, or
remodeling projects, construction site preparation costs, and
related soft costs. Project construction costs also include the
cost of any remodeling or renovation of existing facility space
which is modified as a result of the construction project.
Subd. 2. [MORATORIUM.] The commissioner of health, in
coordination with the commissioner of human services, shall deny
each request by a nursing home or boarding care home, except an
intermediate care facility for the mentally retarded, for
addition of new licensed or certified nursing home or certified
boarding care beds or for a change or changes in the
certification status of existing beds except as provided in
subdivision 3 or 4a, or section 144A.073. The total number of
certified beds in the state shall remain at or decrease from the
number of beds certified on May 23, 1983, except as allowed
under subdivision 3. "Certified bed" means a nursing home bed
or a boarding care bed certified by the commissioner of health
for the purposes of the medical assistance program, under United
States Code, title 42, sections 1396 et seq.
The commissioner of human services, in coordination with
the commissioner of health, shall deny any request to issue a
license under sections 245A.01 to 245A.16 and section 252.28 and
chapter 245A to a nursing home or boarding care home, if that
license would result in an increase in the medical assistance
reimbursement amount. The commissioner of health shall deny
each request for licensure of nursing home beds except as
provided in subdivision 3.
In addition, the commissioner of health must not approve
any construction project whose cost exceeds $500,000, or 25
percent of the facility's appraised value, whichever is less,
unless:
(a) any construction costs exceeding the lesser of $500,000
or 25 percent of the facility's appraised value are not added to
the facility's appraised value and are not included in the
facility's payment rate for reimbursement under the medical
assistance program; or
(b) the project:
(1) has been approved through the process described in
section 144A.073;
(2) meets an exception in subdivision 3 or 4a;
(3) is necessary to correct violations of state or federal
law issued by the commissioner of health;
(4) is necessary to repair or replace a portion of the
facility that was destroyed by fire, lightning, or other hazards
provided that the provisions of subdivision 3 4a, clause
(g) (a), are met; or
(5) as of May 1, 1992, the facility has submitted to the
commissioner of health written documentation evidencing that the
facility meets the "commenced construction" definition as
specified in subdivision 3 1a, clause (b) (d), or that
substantial steps have been taken prior to April 1, 1992,
relating to the construction project. "Substantial steps"
require that the facility has made arrangements with outside
parties relating to the construction project and include the
hiring of an architect or construction firm, submission of
preliminary plans to the department of health or documentation
from a financial institution that financing arrangements for the
construction project have been made; or
(6) is being proposed by a licensed nursing facility that
is not certified to participate in the medical assistance
program and will not result in new licensed or certified beds.
Prior to the final plan approval of any construction
project, the commissioner of health shall be provided with an
itemized cost estimate for the project construction project
costs. If a construction project is anticipated to be completed
in phases, the total estimated cost of all phases of the project
shall be submitted to the commissioner and shall be considered
as one construction project. Once the construction project is
completed and prior to the final clearance by the commissioner,
the total actual project construction costs for the construction
project shall be submitted to the commissioner. If the
final project construction cost exceeds the dollar threshold in
this subdivision, the commissioner of human services shall not
recognize any of the project construction costs or the related
financing costs in excess of this threshold in establishing the
facility's property-related payment rate.
The dollar thresholds for construction projects are as
follows: for construction projects other than those authorized
in clauses (1) to (6), the dollar threshold is $500,000 or 25
percent of appraised value, whichever is less. For projects
authorized after July 1, 1993, under clause (1), the dollar
threshold is the cost estimate submitted with a proposal for an
exception under section 144A.073, plus inflation as calculated
according to section 256B.431, subdivision 3f, paragraph (a).
For projects authorized under clauses (2) to (4), the dollar
threshold is the itemized estimate project construction costs
submitted to the commissioner of health at the time of final
plan approval, plus inflation as calculated according to section
256B.431, subdivision 3f, paragraph (a).
The commissioner of health shall adopt emergency or
permanent rules to implement this section or to amend the
emergency rules for granting exceptions to the moratorium on
nursing homes under section 144A.073. The authority to adopt
emergency rules continues to December 30, 1992.
Subd. 3. [EXCEPTIONS AUTHORIZING AN INCREASE IN BEDS.] The
commissioner of health, in coordination with the commissioner of
human services, may approve the addition of a new certified bed
or the addition of a new licensed nursing home bed, under the
following conditions:
(a) to replace a bed license or certify a new bed in place
of one decertified after May 23, 1983 July 1, 1993, as long as
the number of certified plus newly certified or recertified beds
does not exceed the number of beds licensed or certified on July
1, 1993, or to address an extreme hardship situation, in a
particular county that, together with all contiguous Minnesota
counties, has fewer nursing home beds per 1,000 elderly than the
number that is ten percent higher than the national average of
nursing home beds per 1,000 elderly individuals. For the
purposes of this section, the national average of nursing home
beds shall be the most recent figure that can be supplied by the
federal health care financing administration and the number of
elderly in the county or the nation shall be determined by the
most recent federal census or the most recent estimate of the
state demographer as of July 1, of each year of persons age 65
and older, whichever is the most recent at the time of the
request for replacement. In allowing replacement of a
decertified bed, the commissioners shall ensure that the number
of added or recertified beds does not exceed the total number of
decertified beds in the state in that level of care. An extreme
hardship situation can only be found after the county documents
the existence of unmet medical needs that cannot be addressed by
any other alternatives;
(b) to certify a new bed in a facility that commenced
construction before May 23, 1983. For the purposes of this
section, "commenced construction" means that all of the
following conditions were met: the final working drawings and
specifications were approved by the commissioner of health; the
construction contracts were let; a timely construction schedule
was developed, stipulating dates for beginning, achieving
various stages, and completing construction; and all zoning and
building permits were secured;
(c) to certify beds in a new nursing home that is needed in
order to meet the special dietary needs of its residents, if:
the nursing home proves to the commissioner's satisfaction that
the needs of its residents cannot otherwise be met; elements of
the special diet are not available through most food
distributors; and proper preparation of the special diet
requires incurring various operating expenses, including extra
food preparation or serving items, not incurred to a similar
extent by most nursing homes;
(d) to license a new nursing home bed in a facility that
meets one of the exceptions contained in clauses (a) to (c);
(e) to license nursing home beds in a facility that has
submitted either a completed licensure application or a written
request for licensure to the commissioner before March 1, 1985,
and has either commenced any required construction as defined in
clause (b) before May 1, 1985, or has, before May 1, 1985,
received from the commissioner approval of plans for phased-in
construction and written authorization to begin construction on
a phased-in basis. For the purpose of this clause,
"construction" means any erection, building, alteration,
reconstruction, modernization, or improvement necessary to
comply with the nursing home licensure rules;
(f) (b) to certify or license new beds in a new facility
that is to be operated by the commissioner of veterans affairs
or when the costs of constructing and operating the new beds are
to be reimbursed by the commissioner of veterans affairs or the
United States Veterans Administration; or
(g) to license or certify beds in a new facility
constructed to replace a facility that was destroyed after June
30, 1987, by fire, lightning, or other hazard provided:
(1) destruction was not caused by the intentional act of or
at the direction of a controlling person of the facility;
(2) at the time the facility was destroyed the controlling
persons of the facility maintained insurance coverage for the
type of hazard that occurred in an amount that a reasonable
person would conclude was adequate;
(3) the net proceeds from an insurance settlement for the
damages caused by the hazard are applied to the cost of the new
facility;
(4) the new facility is constructed on the same site as the
destroyed facility or on another site subject to the
restrictions in section 144A.073, subdivision 5; and
(5) the number of licensed and certified beds in the new
facility does not exceed the number of licensed and certified
beds in the destroyed facility;
(h) to license or certify beds that are moved from one
location to another within a nursing home facility, provided the
total costs of remodeling performed in conjunction with the
relocation of beds does not exceed 25 percent of the appraised
value of the facility or $500,000, whichever is less, or to
license or certify beds in a facility for which the total costs
of remodeling or renovation exceed 25 percent of the appraised
value of the facility or $500,000, whichever is less, if the
facility makes a written commitment to the commissioner of human
services that it will not seek to receive an increase in its
property-related payment rate by reason of the remodeling or
renovation;
(i) (c) to license or certify beds in a facility that has
been involuntarily delicensed or decertified for participation
in the medical assistance program, provided that an application
for relicensure or recertification is submitted to the
commissioner within 120 days after delicensure or
decertification;.
(j) to license or certify beds in a project recommended for
approval by the interagency long-term care planning committee
under section 144A.073;
(k) to license nursing home beds in a hospital facility
that are relocated from a different hospital facility under
common ownership or affiliation, provided:
(1) the nursing home beds are not certified for
participation in the medical assistance program; and
(2) the relocation of nursing home beds under this clause
should not exceed a radius of six miles;
(l) to license or certify beds that are moved from one
location to another within an existing identifiable complex of
hospital buildings, from a hospital-attached nursing home to the
hospital building, or from a separate nursing home to a building
formerly used as a hospital, provided the original nursing home
building will no longer be operated as a nursing home and the
building to which the beds are moved will no longer be operated
as a hospital. As a condition of receiving a license or
certification under this clause, the facility must make a
written commitment to the commissioner of human services that it
will not seek to receive an increase in its property-related
payment rate as a result of the relocation. At the time of the
licensure and certification of the nursing home beds, the
commissioner of health shall delicense the same number of acute
care beds within the existing complex of hospital buildings or
building. Relocation of nursing home beds under this clause is
subject to the limitations in section 144A.073, subdivision 5;
(m) to license or certify beds that are moved from an
existing state nursing home to a different state facility,
provided there is no net increase in the number of state nursing
home beds. The relocated beds need not be licensed and
certified at the new location simultaneously with the
delicensing and decertification of the old beds and may be
licensed and certified at any time after the old beds are
delicensed and decertified;
(n) to license new nursing home beds in a continuing care
retirement community affiliated with a national referral center
engaged in substantial programs of patient care, medical
research, and medical education meeting state and national needs
that receives more than 40 percent of its residents from outside
the state for the purpose of meeting contractual obligations to
residents of the retirement community, provided the facility
makes a written commitment to the commissioner of human services
that it will not seek medical assistance certification for the
new beds;
(o) to certify or license new beds in a new facility on the
Red Lake Indian Reservation for which payments will be made
under the Indian Health Care Improvement Act, Public Law Number
94-437, at the rates specified in United States Code, title 42,
section 1396d(b);
(p) to certify and license as nursing home beds boarding
care beds in a certified boarding care facility if the beds meet
the standards for nursing home licensure, or in a facility that
was granted an exception to the moratorium under section
144A.073, and if the cost of any remodeling of the facility does
not exceed 25 percent of the appraised value of the facility or
$500,000, whichever is less; or to license as nursing home beds
boarding care beds in a facility with an addendum to its
provider agreement effective beginning July 1, 1983, if the
boarding care beds to be upgraded meet the standards for nursing
home licensure. If boarding care beds are licensed as nursing
home beds, the number of boarding care beds in the facility must
not increase in the future. The provisions contained in section
144A.073 regarding the upgrading of the facilities do not apply
to facilities that satisfy these requirements;
(q) to license and certify up to 40 beds transferred from
an existing facility owned and operated by the Amherst H. Wilder
Foundation in the city of Saint Paul to a new unit at the same
location as the existing facility that will serve persons with
Alzheimer's disease and other related disorders. The transfer
of beds may occur gradually or in stages, provided the total
number of beds transferred does not exceed 40. At the time of
licensure and certification of a bed or beds in the new unit,
the commissioner of health shall delicense and decertify the
same number of beds in the existing facility. As a condition of
receiving a license or certification under this clause, the
facility must make a written commitment to the commissioner of
human services that it will not seek to receive an increase in
its property-related payment rate as a result of the transfers
allowed under this clause;
(r) to license and certify nursing home beds to replace
currently licensed and certified boarding care beds which may be
located either in a remodeled or renovated boarding care or
nursing home facility or in a remodeled, renovated, newly
constructed, or replacement nursing home facility within the
identifiable complex of health care facilities in which the
currently licensed boarding care beds are presently located,
provided that the number of boarding care beds in the facility
or complex are decreased by the number to be licensed as nursing
home beds and further provided that, if the total costs of new
construction, replacement, remodeling, or renovation exceed ten
percent of the appraised value of the facility or $200,000,
whichever is less, the facility makes a written commitment to
the commissioner of human services that it will not seek to
receive an increase in its property-related payment rate by
reason of the new construction, replacement, remodeling, or
renovation. The provisions contained in section 144A.073
regarding the upgrading of facilities do not apply to facilities
that satisfy these requirements;
(s) to license or certify beds that are moved from a
nursing home to a separate facility under common ownership or
control that was formerly licensed as a hospital and is
currently licensed as a nursing facility and that is located
within eight miles of the original facility, provided the
original nursing home building will no longer be operated as a
nursing home. As a condition of receiving a license or
certification under this clause, the facility must make a
written commitment to the commissioner of human services that it
will not seek to receive an increase in its property-related
payment rate as a result of the relocation;
(t) to license as a nursing home and certify as a nursing
facility a facility that is licensed as a boarding care facility
but not certified under the medical assistance program, but only
if the commissioner of human services certifies to the
commissioner of health that licensing the facility as a nursing
home and certifying the facility as a nursing facility will
result in a net annual savings to the state general fund of
$200,000 or more;
(u) to certify, after September 30, 1992, and prior to July
1, 1993, existing nursing home beds in a facility that was
licensed and in operation prior to January 1, 1992;
(v) to license and certify new nursing home beds to replace
beds in a facility condemned as part of an economic
redevelopment plan in a city of the first class, provided the
new facility is located within one mile of the site of the old
facility. Operating and property costs for the new facility
must be determined and allowed under existing reimbursement
rules; or
(w) to license and certify up to 20 new nursing home beds
in a community-operated hospital and attached convalescent and
nursing care facility with 40 beds on April 21, 1991, that
suspended operation of the hospital in April 1986. The
commissioner of human services shall provide the facility with
the same per diem property-related payment rate for each
additional licensed and certified bed as it will receive for its
existing 40 beds.
Subd. 4. [MONITORING EXCEPTIONS FOR REPLACEMENT BEDS.] The
commissioner of health, in coordination with the commissioner of
human services, shall implement mechanisms to monitor and
analyze the effect of the moratorium in the different geographic
areas of the state. The commissioner of health shall submit to
the legislature, no later than January 15, 1984, and annually
thereafter, an assessment of the impact of the moratorium by
geographic area, with particular attention to service deficits
or problems and a corrective action plan.
Subd. 4a. [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the
best interest of the state to ensure that nursing homes and
boarding care homes continue to meet the physical plant
licensing and certification requirements by permitting certain
construction projects. Facilities should be maintained in
condition to satisfy the physical and emotional needs of
residents while allowing the state to maintain control over
nursing home expenditure growth.
The commissioner of health in coordination with the
commissioner of human services, may approve the renovation,
replacement, upgrading, or relocation of a nursing home or
boarding care home, under the following conditions:
(a) to license or certify beds in a new facility
constructed to replace a facility or to make repairs in an
existing facility that was destroyed or damaged after June 30,
1987, by fire, lightning, or other hazard provided:
(i) destruction was not caused by the intentional act of or
at the direction of a controlling person of the facility;
(ii) at the time the facility was destroyed or damaged the
controlling persons of the facility maintained insurance
coverage for the type of hazard that occurred in an amount that
a reasonable person would conclude was adequate;
(iii) the net proceeds from an insurance settlement for the
damages caused by the hazard are applied to the cost of the new
facility or repairs;
(iv) the new facility is constructed on the same site as
the destroyed facility or on another site subject to the
restrictions in section 144A.073, subdivision 5;
(v) the number of licensed and certified beds in the new
facility does not exceed the number of licensed and certified
beds in the destroyed facility; and
(vi) the commissioner determines that the replacement beds
are needed to prevent an inadequate supply of beds.
Project construction costs incurred for repairs authorized under
this clause shall not be considered in the dollar threshold
amount defined in subdivision 2;
(b) to license or certify beds that are moved from one
location to another within a nursing home facility, provided the
total costs of remodeling performed in conjunction with the
relocation of beds does not exceed 25 percent of the appraised
value of the facility or $500,000, whichever is less;
(c) to license or certify beds in a project recommended for
approval under section 144A.073;
(d) to license or certify beds that are moved from an
existing state nursing home to a different state facility,
provided there is no net increase in the number of state nursing
home beds;
(e) to certify and license as nursing home beds boarding
care beds in a certified boarding care facility if the beds meet
the standards for nursing home licensure, or in a facility that
was granted an exception to the moratorium under section
144A.073, and if the cost of any remodeling of the facility does
not exceed 25 percent of the appraised value of the facility or
$500,000, whichever is less. If boarding care beds are licensed
as nursing home beds, the number of boarding care beds in the
facility must not increase beyond the number remaining at the
time of the upgrade in licensure. The provisions contained in
section 144A.073 regarding the upgrading of the facilities do
not apply to facilities that satisfy these requirements;
(f) to license and certify up to 40 beds transferred from
an existing facility owned and operated by the Amherst H. Wilder
Foundation in the city of St. Paul to a new unit at the same
location as the existing facility that will serve persons with
Alzheimer's disease and other related disorders. The transfer
of beds may occur gradually or in stages, provided the total
number of beds transferred does not exceed 40. At the time of
licensure and certification of a bed or beds in the new unit,
the commissioner of health shall delicense and decertify the
same number of beds in the existing facility. As a condition of
receiving a license or certification under this clause, the
facility must make a written commitment to the commissioner of
human services that it will not seek to receive an increase in
its property-related payment rate as a result of the transfers
allowed under this paragraph;
(g) to license and certify nursing home beds to replace
currently licensed and certified boarding care beds which may be
located either in a remodeled or renovated boarding care or
nursing home facility or in a remodeled, renovated, newly
constructed, or replacement nursing home facility within the
identifiable complex of health care facilities in which the
currently licensed boarding care beds are presently located,
provided that the number of boarding care beds in the facility
or complex are decreased by the number to be licensed as nursing
home beds and further provided that, if the total costs of new
construction, replacement, remodeling, or renovation exceed ten
percent of the appraised value of the facility or $200,000,
whichever is less, the facility makes a written commitment to
the commissioner of human services that it will not seek to
receive an increase in its property-related payment rate by
reason of the new construction, replacement, remodeling, or
renovation. The provisions contained in section 144A.073
regarding the upgrading of facilities do not apply to facilities
that satisfy these requirements;
(h) to license as a nursing home and certify as a nursing
facility a facility that is licensed as a boarding care facility
but not certified under the medical assistance program, but only
if the commissioner of human services certifies to the
commissioner of health that licensing the facility as a nursing
home and certifying the facility as a nursing facility will
result in a net annual savings to the state general fund of
$200,000 or more;
(i) to certify, after September 30, 1992, and prior to July
1, 1993, existing nursing home beds in a facility that was
licensed and in operation prior to January 1, 1992;
(j) to license and certify new nursing home beds to replace
beds in a facility condemned as part of an economic
redevelopment plan in a city of the first class, provided the
new facility is located within one mile of the site of the old
facility. Operating and property costs for the new facility
must be determined and allowed under existing reimbursement
rules;
(k) to license and certify up to 20 new nursing home beds
in a community-operated hospital and attached convalescent and
nursing care facility with 40 beds on April 21, 1991, that
suspended operation of the hospital in April 1986. The
commissioner of human services shall provide the facility with
the same per diem property-related payment rate for each
additional licensed and certified bed as it will receive for its
existing 40 beds;
(l) to license or certify beds in renovation, replacement,
or upgrading projects as defined in section 144A.073,
subdivision 1, so long as the cumulative total costs of the
facility's remodeling projects do not exceed 25 percent of the
appraised value of the facility or $500,000, whichever is less;
(m) to license and certify beds that are moved from one
location to another for the purposes of converting up to five
four-bed wards to single or double occupancy rooms in a nursing
home that, as of January 1, 1993, was county-owned and had a
licensed capacity of 115 beds;
(n) to allow a facility that on April 16, 1993, was a
106-bed licensed and certified nursing facility located in
Minneapolis to layaway all of its licensed and certified nursing
home beds. These beds may be relicensed and recertified in a
newly-constructed teaching nursing home facility affiliated with
a teaching hospital upon approval by the legislature. The
proposal must be developed in consultation with the interagency
committee on long-term care planning. The beds on layaway
status shall have the same status as voluntarily delicensed and
decertified beds, except that beds on layaway status remain
subject to the surcharge in section 256.9657. This layaway
provision expires July 1, 1995;
(o) to allow a project which will be completed in
conjunction with an approved moratorium exception project for a
nursing home in southern Cass county and which is directly
related to that portion of the facility that must be repaired,
renovated, or replaced, to correct an emergency plumbing problem
for which a state correction order has been issued and which
must be corrected by August 31, 1993; or
(p) to allow a facility that on April 16, 1993, was a
368-bed licensed and certified nursing facility located in
Minneapolis to layaway, upon 30 days prior written notice to the
commissioner, up to 30 of the facility's licensed and certified
beds by converting three-bed wards to single or double
occupancy. Beds on layaway status shall have the same status as
voluntarily delicensed and decertified beds except that beds on
layaway status remain subject to the surcharge in section
256.9657, remain subject to the license application and renewal
fees under section 144A.07 and shall be subject to a $100 per
bed reactivation fee. In addition, at any time within three
years of the effective date of the layaway, the beds on layaway
status may be:
(1) relicensed and recertified upon relocation and
reactivation of some or all of the beds to an existing licensed
and certified facility or facilities located in Pine River,
Brainerd, or International Falls; provided that the total
project construction costs related to the relocation of beds
from layaway status for any facility receiving relocated beds
may not exceed the dollar threshold provided in subdivision 2
unless the construction project has been approved through the
moratorium exception process under section 144A.073.
(2) relicensed and recertified, upon reactivation of some
or all of the beds within the facility which placed the beds in
layaway status, if the commissioner has determined a need for
the reactivation of the beds on layaway status.
The property-related payment rate of a facility placing
beds on layaway status must be adjusted by the incremental
change in its rental per diem after recalculating the rental per
diem as provided in section 256B.431, subdivision 3a, paragraph
(d). The property-related payment rate for a facility
relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after
recalculating its rental per diem using the number of beds after
the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month
following the month in which the relicensing and recertification
became effective. Any beds remaining on layaway status more
than three years after the date the layaway status became
effective must be removed from layaway status and immediately
delicensed and decertified.
Subd. 5. [REPORT.] The commissioner of the state planning
agency, in consultation with the commissioners of health and
human services, shall report to the senate health and human
services care committee and the house health and welfare human
services committee by January 15, 1986 and biennially thereafter
regarding:
(1) projections on the number of elderly Minnesota
residents including medical assistance recipients;
(2) the number of residents most at risk for nursing home
placement;
(3) the needs for long-term care and alternative home and
noninstitutional services;
(4) availability of and access to alternative services by
geographic region; and
(5) the necessity or desirability of continuing, modifying,
or repealing the moratorium in relation to the availability and
development of the continuum of long-term care services.
Subd. 6. [PROPERTY-RELATED PAYMENT RATES OF NEW BEDS.] The
property-related payment rates of nursing home or boarding care
home beds certified or recertified under subdivision 3 or 4a,
shall be adjusted according to Minnesota nursing facility
reimbursement laws and rules unless the facility has made a
commitment in writing to the commissioner of human services not
to seek adjustments to these rates due to property-related
expenses incurred as a result of the certification or
recertification. Any licensure or certification action
authorized under repealed statutes which were approved by the
commissioner of health prior to July 1, 1993, shall remain in
effect. Any conditions pertaining to property rate
reimbursement covered by these repealed statutes prior to July
1, 1993, remain in effect.
Subd. 7. [SUBMISSION OF COST INFORMATION.] Before approval
of final construction plans for a nursing home or a certified
boarding care home construction project, the licensee shall
submit to the commissioner of health an itemized statement of
the project construction cost estimates.
If the construction project includes a capital asset
addition, replacement, remodeling, or renovation of space such
as a hospital, apartment, or shared or common areas, the
facility must submit to the commissioner an allocation of
capital asset costs, soft costs, and debt information prepared
according to Minnesota Rules, part 9549.
Project construction cost estimates must be prepared by a
contractor or architect and other licensed participants in the
development of the project.
Subd. 8. [FINAL APPROVAL.] Before conducting the final
inspection of the construction project required by Minnesota
Rules, part 4660.0100, and issuing final clearances for use, the
licensee shall provide to the commissioner of health the total
project construction costs of the construction project. If
total costs are not available, the most recent cost figures
shall be provided. Final cost figures shall be submitted to the
commissioner when available. The commissioner shall provide a
copy of this information to the commissioner of human services.
Sec. 3. Minnesota Statutes 1992, section 144A.073,
subdivision 2, is amended to read:
Subd. 2. [REQUEST FOR PROPOSALS.] At the intervals
specified in rules, the interagency committee shall publish in
the State Register a request for proposals for nursing home
projects to be licensed or certified under section 144A.071,
subdivision 3 4a, clause (j) (c). The notice must describe the
information that must accompany a request and state that
proposals must be submitted to the interagency committee within
90 days of the date of publication. The notice must include the
amount of the legislative appropriation available for the
additional costs to the medical assistance program of projects
approved under this section. If no money is appropriated for a
year, the notice for that year must state that proposals will
not be requested because no appropriations were made. To be
considered for approval, a proposal must include the following
information:
(1) whether the request is for renovation, replacement,
upgrading, or conversion;
(2) a description of the problem the project is designed to
address;
(3) a description of the proposed project;
(4) an analysis of projected costs, including initial
construction and remodeling costs, site preparation costs,
financing costs, and estimated operating costs during the first
two years after completion of the project;
(5) for proposals involving replacement of all or part of a
facility, the proposed location of the replacement facility and
an estimate of the cost of addressing the problem through
renovation;
(6) for proposals involving renovation, an estimate of the
cost of addressing the problem through replacement;
(7) the proposed timetable for commencing construction and
completing the project; and
(8) other information required by rule of the commissioner
of health.
Sec. 4. Minnesota Statutes 1992, section 144A.073,
subdivision 3, is amended to read:
Subd. 3. [REVIEW AND APPROVAL OF PROPOSALS.] Within the
limits of money specifically appropriated to the medical
assistance program for this purpose, the interagency long-term
care planning committee for quality assurance may recommend that
the commissioner of health grant exceptions to the nursing home
licensure or certification moratorium for proposals that satisfy
the requirements of this section. The interagency committee
shall appoint an advisory review panel composed of
representatives of consumers and providers to review proposals
and provide comments and recommendations to the committee. The
commissioners of human services and health shall provide staff
and technical assistance to the committee for the review and
analysis of proposals. The interagency committee shall hold a
public hearing before submitting recommendations to the
commissioner of health on project requests. The committee shall
submit recommendations within 150 days of the date of the
publication of the notice, based on a comparison and ranking of
proposals using the criteria in subdivision 4. The commissioner
of health shall approve or disapprove a project within 30 days
after receiving the committee's recommendations. The cost to
the medical assistance program of the proposals approved must be
within the limits of the appropriations specifically made for
this purpose. Approval of a proposal expires 18 months after
approval by the commissioner of health unless the facility has
commenced construction as defined in section 144A.071,
subdivision 3 1a, paragraph (b) (d). The committee's report to
the legislature, as required under section 144A.31, must include
the projects approved, the criteria used to recommend proposals
for approval, and the estimated costs of the projects, including
the costs of initial construction and remodeling, and the
estimated operating costs during the first two years after the
project is completed.
Sec. 5. Minnesota Statutes 1992, section 144A.073, is
amended by adding a subdivision to read:
Subd. 3b. [AMENDMENTS TO APPROVED PROJECTS.] (a) Nursing
facilities that have received approval on or after July 1, 1993,
for exceptions to the moratorium on nursing homes through the
process described in this section may request amendments to the
designs of the projects by writing the commissioner within 18
months of receiving approval. Applicants shall submit
supporting materials that demonstrate how the amended projects
meet the criteria described in paragraph (b).
(b) The commissioner shall approve requests for amendments
for projects approved on or after July 1, 1993, according to the
following criteria:
(1) the amended project designs must provide solutions to
all of the problems addressed by the original application that
are at least as effective as the original solutions;
(2) the amended project designs may not reduce the space in
each resident's living area or in the total amount of common
space devoted to resident and family uses by more than five
percent;
(3) the costs recognized for reimbursement of amended
project designs shall be the threshold amount of the original
proposal as identified according to section 144A.071,
subdivision 2, except under conditions described in clause (4);
and
(4) total costs up to ten percent greater than the cost
identified in clause (3) may be recognized for reimbursement if
the proposer can document that one of the following
circumstances is true:
(i) changes are needed due to a natural disaster;
(ii) conditions that affect the safety or durability of the
project that could not have reasonably been known prior to
approval are discovered;
(iii) state or federal law require changes in project
design; or
(iv) documentable circumstances occur that are beyond the
control of the owner and require changes in the design.
(c) Approval of a request for an amendment does not alter
the expiration of approval of the project according to
subdivision 3.
Sec. 6. Minnesota Statutes 1992, section 147.01,
subdivision 6, is amended to read:
Subd. 6. [LICENSE SURCHARGE.] In addition to any fee
established under section 214.06, the board shall assess an
annual license surcharge of $400 against each physician licensed
under this chapter. The surcharge applies to a physician who is
licensed as of or after the effective date of this section in
Laws 1992, and whose license is issued or renewed on or after
April 1, 1992, and is assessed as follows:
(1) a physician whose license is issued or renewed between
April 1 and September 30 shall be billed on or before November
15, and the physician must pay the surcharge by December 15; and
(2) a physician whose license is issued or renewed between
October 1 and March 31 shall be billed on or before May 15, and
the physician must pay the surcharge by June 15.
The board shall provide that the surcharge payment must be
remitted to the commissioner of human services to be deposited
in the general fund under section 256.9656. The board shall not
renew the license of a physician who has not paid the surcharge
required under this section. The board shall promptly provide
to the commissioner of human services upon request information
available to the board and specifically required by the
commissioner to operate the provider surcharge program. The
board shall limit the surcharge to physicians residing in
Minnesota and the states contiguous to Minnesota upon
notification from the commissioner of human services that the
federal government has approved a waiver to allow the surcharge
to be applied in that manner.
Sec. 7. Minnesota Statutes 1992, section 147.02,
subdivision 1, is amended to read:
Subdivision 1. [UNITED STATES OR CANADIAN MEDICAL SCHOOL
GRADUATES.] The board shall, with the consent of six of its
members, issue a license to practice medicine to a person who
meets the following requirements:
(a) An applicant for a license shall file a written
application on forms provided by the board, showing to the
board's satisfaction that the applicant is of good moral
character and satisfies the requirements of this section.
(b) The applicant shall present evidence satisfactory to
the board of being a graduate of a medical or osteopathic school
located in the United States, its territories or Canada, and
approved by the board based upon its faculty, curriculum,
facilities, accreditation by a recognized national accrediting
organization approved by the board, and other relevant data, or
is currently enrolled in the final year of study at the school.
(c) The applicant must have passed a comprehensive
examination for initial licensure prepared and graded by the
national board of medical examiners or the federation of state
medical boards. The board shall by rule determine what
constitutes a passing score in the examination.
(d) The applicant shall present evidence satisfactory to
the board of the completion of one year of graduate, clinical
medical training in a program accredited by a national
accrediting organization approved by the board or other graduate
training approved in advance by the board as meeting standards
similar to those of a national accrediting organization.
(e) The applicant shall make arrangements with the
executive director to appear in person before the board or its
designated representative to show that the applicant satisfies
the requirements of this section. The board may establish as
internal operating procedures the procedures or requirements for
the applicant's personal presentation.
(f) The applicant shall pay a fee established by the board
by rule. The fee may not be refunded. Upon application or
notice of license renewal, the board must provide notice to the
applicant and to the person whose license is scheduled to be
issued or renewed of any additional fees, surcharges, or other
costs which the person is obligated to pay as a condition of
licensure. The notice must:
(1) state the dollar amount of the additional costs;
(2) clearly identify to the applicant the payment schedule
of additional costs; and
(3) advise the applicant of the right to apply to be
excused from the surcharge if a waiver is granted under section
256.9657, subdivision 1b, or relinquish the license to practice
medicine in lieu of future payment if applicable.
(g) The applicant must not have engaged in conduct
warranting disciplinary action against a licensee. If the
applicant does not satisfy the requirements of this paragraph,
the board may refuse to issue a license unless it determines
that the public will be protected through issuance of a license
with conditions and limitations the board considers appropriate.
Sec. 8. Minnesota Statutes 1992, section 246.18,
subdivision 4, is amended to read:
Subd. 4. [COLLECTIONS DEPOSITED IN MEDICAL ASSISTANCE
ACCOUNT THE GENERAL FUND.] Except as provided in subdivisions 2
and 5, all receipts from collection efforts for the regional
treatment centers, state nursing homes, and other state
facilities as defined in section 246.50, subdivision 3, must be
deposited in the medical assistance account and are appropriated
for that purpose general fund. The commissioner shall ensure
that the departmental financial reporting systems and internal
accounting procedures comply with federal standards for
reimbursement for program and administrative expenditures and
fulfill the purpose of this paragraph.
Sec. 9. Minnesota Statutes 1992, section 256.015,
subdivision 4, is amended to read:
Subd. 4. [NOTICE.] The state agency must be given notice
of monetary claims against a person, firm, or corporation that
may be liable in damages to the injured person when the state
agency has paid for or become liable for the cost of medical
care or payments related to the injury. Notice must be given as
follows:
(a) Applicants for public assistance shall notify the state
or county agency of any possible claims they may have against a
person, firm, or corporation when they submit the application
for assistance. Recipients of public assistance shall notify
the state or county agency of any possible claims when those
claims arise.
(b) A person providing medical care services to a recipient
of public assistance shall notify the state agency when the
person has reason to believe that a third party may be liable
for payment of the cost of medical care.
(c) A person who is a party to a claim upon which the state
agency may be entitled to a lien under this section shall notify
the state agency of its potential lien claim before filing a
claim, commencing an action, or negotiating a settlement. A
person who is a party to a claim includes the plaintiff, the
defendants, and any other party to the cause of action.
Notice given to the county agency is not sufficient to meet
the requirements of paragraphs (b) and (c).
Sec. 10. [256.027] [USE OF VANS PERMITTED.]
The commissioner, after consultation with the commissioner
of public safety, shall prescribe procedures to permit the
occasional use of lift-equipped vans that have been financed, in
whole or in part, by public money to transport an individual
whose own lift-equipped vehicle is unavailable because of
equipment failure and who is thus unable to complete a trip home
or to a medical facility. For purposes of prescribing these
procedures, the commissioner is exempt from the provisions of
chapter 14. The commissioner shall encourage publicly financed
lift-equipped vans to be made available to a county sheriff's
department, and to other persons who are qualified to drive the
vans and who are also qualified to assist the individual in need
of transportation, for this purpose.
Sec. 11. Minnesota Statutes 1992, section 256.9657,
subdivision 1, is amended to read:
Subdivision 1. [NURSING HOME LICENSE SURCHARGE.] (a)
Effective October 1, 1992 July 1, 1993, each non-state-operated
nursing home licensed under chapter 144A shall pay to the
commissioner an annual surcharge according to the schedule in
subdivision 4. The surcharge shall be calculated as $535 $620
per licensed bed licensed on the previous July 1, except that.
If the number of licensed beds is reduced after July 1 but prior
to August 1, the surcharge shall be based on the number of
remaining licensed beds the second month following the receipt
of timely notice by the commissioner of human services that beds
have been delicensed. A nursing home entitled to a reduction in
the number of beds subject to the surcharge under this provision
must demonstrate to the satisfaction of the commissioner by
August 5 that the number of beds has been reduced. The nursing
home must notify the commissioner of health in writing when beds
are delicensed. The commissioner of health must notify the
commissioner of human services within ten working days after
receiving written notification. If the notification is received
by the commissioner of human services by the 15th of the month,
the invoice for the second following month must be reduced to
recognize the delicensing of beds. Beds on layaway status
continue to be subject to the surcharge. The commissioner of
human services must acknowledge a medical care surcharge appeal
within 30 days of receipt of the written appeal from the
provider.
(b) Effective July 1, 1994, the surcharge in paragraph (a)
shall be increased to $625.
Sec. 12. Minnesota Statutes 1992, section 256.9657, is
amended by adding a subdivision to read:
Subd. 1b. [PHYSICIAN SURCHARGE WAIVER REQUEST.] (a) The
commissioner shall request a waiver from the secretary of health
and human services to exclude from the surcharge under section
147.01, subdivision 6, a physician whose license is issued or
renewed on or after April 1, 1993, and who:
(1) provides physician services at a free clinic, community
clinic, or in an underdeveloped foreign nation and does not
charge for any physician services;
(2) has taken a leave of absence of at least one year from
the practice of medicine but who intends to return to the
practice in the future;
(3) is unable to practice medicine because of terminal
illness or permanent disability as certified by an attending
physician;
(4) is unemployed; or
(5) is retired.
(b) If a waiver is approved under this subdivision, the
commissioner shall direct the board of medical practice to
adjust the physician license surcharge under section 147.01,
subdivision 6, accordingly.
Sec. 13. Minnesota Statutes 1992, section 256.9657, is
amended by adding a subdivision to read:
Subd. 1c. [WAIVER IMPLEMENTATION.] If a waiver is approved
under subdivision 1b, the commissioner shall implement
subdivision 1b as follows:
(a) The commissioner, in cooperation with the board of
medical practice, shall notify each physician whose license is
scheduled to be issued or renewed between April 1 and September
30 that an application to be excused from the surcharge must be
received by the commissioner prior to September 1 of that year
for the period of 12 consecutive calendar months beginning
December 15. For each physician whose license is scheduled to
be issued or renewed between October 1 and March 31, the
application must be received from the physician by March 1 for
the period of 12 consecutive calendar months beginning June 15.
For each physician whose license is scheduled to be issued or
renewed between April 1 and September 30, the commissioner shall
make the notification required in this paragraph by July 1. For
each physician whose license is scheduled to be issued or
renewed between October 1 and March 31, the commissioner shall
make the notification required in this paragraph by January 1.
(b) The commissioner shall establish an application form
for waiver applications. Each physician who applies to be
excused from the surcharge under subdivision 1b, paragraph (a),
clause (1), must include with the application:
(1) a statement from the operator of the facility at which
the physician provides services, that the physician provides
services without charge; and
(2) a statement by the physician that the physician will
not charge for any physician services during the period for
which the exemption from the surcharge is granted.
Each physician who applies to be excused from the surcharge
under subdivision 1b, paragraph (a), clauses (2) to (5), must
include with the application:
(i) the physician's own statement certifying that the
physician does not intend to practice medicine and will not
charge for any physician services during the period for which
the exemption from the surcharge is granted;
(ii) the physician's own statement describing in general
the reason for the leave of absence from the practice of
medicine and the anticipated date when the physician will resume
the practice of medicine, if applicable;
(iii) an attending physician's statement certifying that
the applicant has a terminal illness or permanent disability, if
applicable; and
(iv) the physician's own statement indicating on what date
the physician retired or became unemployed, if applicable.
(c) The commissioner shall notify in writing the physicians
who are excused from the surcharge under subdivision 1b.
(d) A physician who decides to charge for physician
services prior to the end of the period for which the exemption
from the surcharge has been granted under subdivision 1b,
paragraph (a), clause (1), or to return to the practice of
medicine prior to the end of the period for which the exemption
from the surcharge has been granted under subdivision 1b,
paragraph (a), clause (2), (4), or (5), may do so by notifying
the commissioner and shall be responsible for payment of the
full surcharge for that period.
(e) Whenever the commissioner determines that the number of
physicians likely to be excused from the surcharge under
subdivision 1b may cause the physician surcharge to violate the
requirements of Public Law Number 102-234 or regulations adopted
under that law, the commissioner shall immediately notify the
chairs of the senate health care committee and health care and
family services funding division and the house of
representatives human services committee and human services
funding division.
Sec. 14. Minnesota Statutes 1992, section 256.9657,
subdivision 2, is amended to read:
Subd. 2. [HOSPITAL SURCHARGE.] (a) Effective October 1,
1992, each Minnesota hospital except facilities of the federal
Indian Health Service and regional treatment centers shall pay
to the medical assistance account a surcharge equal to 1.4
percent of net patient revenues excluding net Medicare revenues
reported by that provider to the health care cost information
system according to the schedule in subdivision 4.
(b) Effective July 1, 1994, the surcharge under paragraph
(a) is increased to 1.56 percent.
Sec. 15. Minnesota Statutes 1992, section 256.9657,
subdivision 3, is amended to read:
Subd. 3. [HEALTH MAINTENANCE ORGANIZATION SURCHARGE.] (a)
Effective October 1, 1992, each health maintenance organization
with a certificate of authority issued by the commissioner of
health under chapter 62D shall pay to the commissioner of human
services a surcharge equal to six-tenths of one percent of the
total premium revenues of the health maintenance organization as
reported to the commissioner of health according to the schedule
in subdivision 4.
(b) For purposes of this subdivision, total premium revenue
means:
(1) premium revenue recognized on a prepaid basis from
individuals and groups for provision of a specified range of
health services over a defined period of time which is normally
one month, excluding premiums paid to a health maintenance
organization from the Federal Employees Health Benefit Program;
(2) premiums from Medicare wrap-around subscribers for
health benefits which supplement Medicare coverage;
(3) Medicare revenue, as a result of an arrangement between
a health maintenance organization and the health care financing
administration of the federal Department of Health and Human
Services, for services to a Medicare beneficiary; and
(4) medical assistance revenue, as a result of an
arrangement between a health maintenance organization and a
Medicaid state agency, for services to a medical assistance
beneficiary.
If advance payments are made under clause (1) or (2) to the
health maintenance organization for more than one reporting
period, the portion of the payment that has not yet been earned
must be treated as a liability.
Sec. 16. Minnesota Statutes 1992, section 256.9657,
subdivision 7, is amended to read:
Subd. 7. [COLLECTION; CIVIL PENALTIES.] The provisions of
sections 289A.35 to 289A.50 relating to the authority to audit,
assess, collect, and pay refunds of other state taxes may be
implemented by the commissioner of human services with respect
to the tax, penalty, and interest imposed by this section and
section 147.01, subdivision 6. The commissioner of human
services shall impose civil penalties for violation of this
section or section 147.01, subdivision 6, as provided in section
289A.60, and the tax and penalties are subject to interest at
the rate provided in section 270.75. The commissioner of human
services shall have the power to abate penalties and interest
when discrepancies occur resulting from, but not limited to,
circumstances of error and mail delivery. The commissioner of
human services shall bring appropriate civil actions to collect
provider payments due under this section and section 147.01,
subdivision 6.
Sec. 17. Minnesota Statutes 1992, section 256.9685,
subdivision 1, is amended to read:
Subdivision 1. [AUTHORITY.] The commissioner shall
establish procedures for determining medical assistance and
general assistance medical care payment rates under a
prospective payment system for inpatient hospital services in
hospitals that qualify as vendors of medical assistance. The
commissioner shall establish, by rule, procedures for
implementing this section and sections 256.9686, 256.969, and
256.9695. The medical assistance payment rates must be based on
methods and standards that the commissioner finds are adequate
to provide for the costs that must be incurred for the care of
recipients in efficiently and economically operated hospitals.
Services must meet the requirements of section 256B.04,
subdivision 15, or 256D.03, subdivision 7, paragraph (b), to be
eligible for payment except the commissioner may establish
exemptions to specific requirements based on diagnosis,
procedure, or service after notice in the State Register and a
30-day comment period.
Subd. 1a. [ADMINISTRATIVE
RECONSIDERATION.] Notwithstanding sections 256B.04, subdivision
15, and 256D.03, subdivision 7, the commissioner may shall
establish an administrative reconsideration process for appeals
of inpatient hospital services determined to be medically
unnecessary. The reconsideration process shall take place prior
to the contested case procedures of chapter 14 subdivision 1b
and shall be conducted by physicians that are independent of the
case under reconsideration. A majority decision by the
physicians is necessary to make a determination that the
services were not medically necessary.
Subd. 1b. [APPEAL OF RECONSIDERATION.] Notwithstanding
section 256B.72, the commissioner may recover inpatient hospital
payments for services that have been determined to be medically
unnecessary under after the reconsideration process and
determinations. A physician or hospital may appeal the result
of the reconsideration process by submitting a written request
for review to the commissioner within 30 days after receiving
notice of the action. The commissioner shall review the medical
record and information submitted during the reconsideration
process and the medical review agent's basis for the
determination that the services were not medically necessary for
inpatient hospital services. The commissioner shall issue an
order upholding or reversing the decision of the reconsideration
process based on the review. A hospital or physician who is
aggrieved by an order of the commissioner may appeal the order
to the district court of the county in which the physician or
hospital is located by serving a written copy of the notice of
appeal upon the commissioner within 30 days after the date the
commissioner issued the order.
Sec. 18. Minnesota Statutes 1992, section 256.969,
subdivision 1, is amended to read:
Subdivision 1. [HOSPITAL COST INDEX.] (a) The hospital
cost index shall be obtained from an independent source and
shall represent a weighted average of historical, as limited to
statutory maximums, and projected cost change estimates
determined for expense categories to include wages and salaries,
employee benefits, medical and professional fees, raw food,
utilities, insurance including malpractice insurance, and other
applicable expenses as determined by the commissioner. The
index shall reflect Minnesota cost category weights. Individual
indices shall be specific to Minnesota if the commissioner
determines that sufficient accuracy of the hospital cost index
is achieved. The hospital cost index may be used to adjust the
base year operating payment rate through the rate year on an
annually compounded basis. Notwithstanding section 256.9695,
subdivision 3, paragraph (c), the hospital cost index shall not
be effective under the general assistance medical care program
and shall be limited to five percent under the medical
assistance program for admissions occurring during the biennium
ending June 30, 1993, and the hospital cost index under medical
assistance, excluding general assistance medical care, shall be
increased by one percentage point to reflect changes in
technology for admissions occurring after September 30,
1992 1995.
(b) For fiscal years beginning on or after July 1, 1993,
the commissioner of human services shall not provide automatic
annual inflation adjustments for hospital payment rates under
medical assistance, excluding the technology factor under
paragraph (a), nor under general assistance medical care. The
commissioner of finance shall include as a budget change request
in each biennial detailed expenditure budget submitted to the
legislature under section 16A.11 annual adjustments in hospital
payment rates under medical assistance and general assistance
medical care, based upon the hospital cost index.
Sec. 19. Minnesota Statutes 1992, section 256.969,
subdivision 8, is amended to read:
Subd. 8. [UNUSUAL COST OR LENGTH OF STAY EXPERIENCE.] The
commissioner shall establish day and cost outlier thresholds for
each diagnostic category established under subdivision 2 at two
standard deviations beyond the mean length of stay or allowable
cost. Payment for the days and cost beyond the outlier
threshold shall be in addition to the operating and property
payment rates per admission established under subdivisions 2,
2b, and 2c. Payment for outliers shall be at 70 percent of the
allowable operating cost, after adjustment by the case mix
index, hospital cost index, relative values and the
disproportionate population adjustment. The outlier threshold
for neonatal and burn diagnostic categories shall be established
at one standard deviation beyond the mean length of stay or
allowable cost, and payment shall be at 90 percent of allowable
operating cost calculated in the same manner as other outliers.
A hospital may choose an alternative to the 70 percent outlier
payment that is at a minimum of 60 percent and a maximum of 80
percent if the commissioner is notified in writing of the
request by October 1 of the year preceding the rate year. The
chosen percentage applies to all diagnostic categories except
burns and neonates. The percentage of allowable cost that is
unrecognized by the outlier payment shall be added back to the
base year operating payment rate per admission. Cost outliers
shall be calculated using hospital specific allowable cost
data. If a stay is both a day and a cost outlier, outlier
payments shall be based on the higher outlier payment.
Sec. 20. Minnesota Statutes, section 256.969, subdivision
9, as amended by Laws 1993, chapter 20, section 1, is amended to
read:
Subd. 9. [DISPROPORTIONATE NUMBERS OF LOW-INCOME PATIENTS
SERVED.] (a) For admissions occurring on or after October 1,
1992, through December 31, 1992, the medical assistance
disproportionate population adjustment shall comply with federal
law and shall be paid to a hospital, excluding regional
treatment centers and facilities of the federal Indian Health
Service, with a medical assistance inpatient utilization rate in
excess of the arithmetic mean. The adjustment must be
determined as follows:
(1) for a hospital with a medical assistance inpatient
utilization rate above the arithmetic mean for all hospitals
excluding regional treatment centers and facilities of the
federal Indian Health Service but less than or equal to one
standard deviation above the mean, the adjustment must be
determined by multiplying the total of the operating and
property payment rates by the difference between the hospital's
actual medical assistance inpatient utilization rate and the
arithmetic mean for all hospitals excluding regional treatment
centers and facilities of the federal Indian Health Service; and
(2) for a hospital with a medical assistance inpatient
utilization rate above one standard deviation above the mean,
the adjustment must be determined by multiplying the adjustment
that would be determined under clause (1) for that hospital by
1.1. If federal matching funds are not available for all
adjustments under this subdivision, the commissioner shall
reduce payments on a pro rata basis so that all adjustments
qualify for federal match. The commissioner may establish a
separate disproportionate population operating payment rate
adjustment under the general assistance medical care program.
For purposes of this subdivision medical assistance does not
include general assistance medical care. The commissioner shall
report annually on the number of hospitals likely to receive the
adjustment authorized by this section paragraph. The
commissioner shall specifically report on the adjustments
received by public hospitals and public hospital corporations
located in cities of the first class.
(b) For admissions occurring on or after July 1, 1993, the
medical assistance disproportionate population adjustment shall
comply with federal law and shall be paid to a hospital,
excluding regional treatment centers and facilities of the
federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean.
The adjustment must be determined as follows:
(1) for a hospital with a medical assistance inpatient
utilization rate above the arithmetic mean for all hospitals
excluding regional treatment centers and facilities of the
federal Indian Health Service but less than or equal to one
standard deviation above the mean, the adjustment must be
determined by multiplying the total of the operating and
property payment rates by the difference between the hospital's
actual medical assistance inpatient utilization rate and the
arithmetic mean for all hospitals excluding regional treatment
centers and facilities of the federal Indian Health Service.
(2) for a hospital with a medical assistance inpatient
utilization rate above one standard deviation above the mean,
the adjustment must be determined by multiplying the adjustment
that would be determined under clause (1) for that hospital by
1.1. The commissioner may establish a separate disproportionate
population operating payment rate adjustment under the general
assistance medical care program. For purposes of this
subdivision, medical assistance does not include general
assistance medical care. The commissioner shall report annually
on the number of hospitals likely to receive the adjustment
authorized by this paragraph. The commissioner shall
specifically report on the adjustments received by public
hospitals and public hospital corporations located in cities of
the first class; and
(3) for a hospital that (i) had medical assistance
fee-for-service payment volume during calendar year 1991 in
excess of 13 percent of total medical assistance fee-for-service
payment volume; or (ii) had medical assistance fee-for-service
payment volume during calendar year 1991 in excess of eight
percent of total medical assistance fee-for-service payment
volume and is affiliated with the University of Minnesota, a
medical assistance disproportionate population adjustment shall
be paid in addition to any other disproportionate payment due
under this subdivision as follows: $1,010,000 due on the 15th
of each month after noon, beginning July 15, 1993.
(c) The commissioner shall adjust rates paid to a health
maintenance organization under contract with the commissioner to
reflect rate increases provided in paragraph (b), clauses (1)
and (2) on a nondiscounted hospital-specific basis, but shall
not adjust those rates to reflect payments provided in clause
(3).
(d) If federal matching funds are not available for all
adjustments under paragraph (b), the commissioner shall reduce
payments under paragraph (b), clauses (1) and (2), on a pro rata
basis so that all adjustments under paragraph (b) qualify for
federal match.
(e) For purposes of this subdivision, medical assistance
does not include general assistance medical care.
Sec. 21. Minnesota Statutes 1992, section 256.969,
subdivision 9a, as amended by Laws 1993, chapter 20, section 2,
is amended to read:
Subd. 9a. [DISPROPORTIONATE POPULATION ADJUSTMENTS AFTER
JANUARY UNTIL JULY 1, 1993.] (a) For admissions occurring
between January 1, 1993, and June 30, 1993, the adjustment under
this subdivision shall be paid to a hospital, excluding regional
treatment centers and facilities of the federal Indian Health
Service, with a medical assistance inpatient utilization rate in
excess of one standard deviation above the arithmetic mean. The
adjustment must be determined by multiplying the total of the
operating and property payment rates by the difference between
the hospital's actual medical assistance inpatient utilization
rate and the arithmetic mean for all hospitals excluding
regional treatment centers and facilities of the federal Indian
Health Service, and the result must be multiplied by 1.1.
(b) For admissions occurring on or after July 1, 1993, the
medical assistance disproportionate population adjustment shall
comply with federal law and shall be paid to a hospital,
excluding regional treatment centers and facilities of the
federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of one standard deviation
above the arithmetic mean. The adjustment must be determined by
multiplying the operating payment rate by the difference between
the hospital's actual medical assistance inpatient utilization
rate and one standard deviation above the arithmetic mean for
all hospitals excluding regional treatment centers and
facilities of the federal Indian Health Service.
(c) If federal matching funds are not available for all
adjustments under this subdivision, the commissioner shall
reduce payments on a pro rata basis so that all adjustments
qualify for federal match. The commissioner may establish a
separate disproportionate population operating payment rate
adjustment under the general assistance medical care program.
For purposes of this subdivision, medical assistance does not
include general assistance medical care. The commissioner shall
report annually on the number of hospitals likely to receive the
adjustment authorized by this section. The commissioner shall
specifically report on the adjustments received by public
hospitals and public hospital corporations located in cities of
the first class. The provisions of this paragraph are effective
only if federal matching funds are not available for all
adjustments under this subdivision and it is necessary to
implement ratable reductions under subdivision 9b.
Sec. 22. Minnesota Statutes 1992, section 256.969,
subdivision 20, as amended by Laws 1993, chapter 20, section 4,
is amended to read:
Subd. 20. [INCREASES IN MEDICAL ASSISTANCE INPATIENT
PAYMENTS; CONDITIONS.] (a) Medical assistance inpatient payments
shall increase 20 percent for inpatient hospital originally paid
admissions, excluding Medicare crossovers, that occurred between
July 1, 1988, and December 31, 1990, if: (i) the hospital had
100 or fewer Minnesota medical assistance annualized paid
admissions, excluding Medicare crossovers, that were paid by
March 1, 1988, for the period January 1, 1987, to June 30, 1987;
(ii) the hospital had 100 or fewer licensed beds on March 1,
1988; (iii) the hospital is located in Minnesota; and (iv) the
hospital is not located in a city of the first class as defined
in section 410.01. For purposes of this paragraph, medical
assistance does not include general assistance medical care.
(b) Medical assistance inpatient payments shall increase 15
percent for inpatient hospital originally paid admissions,
excluding Medicare crossovers, that occurred between July 1,
1988, and December 31, 1990, if: (i) the hospital had more than
100 but fewer than 250 Minnesota medical assistance annualized
paid admissions, excluding Medicare crossovers, that were paid
by March 1, 1988, for the period January 1, 1987, to June 30,
1987; (ii) the hospital had 100 or fewer licensed beds on March
1, 1988; (iii) the hospital is located in Minnesota; and (iv)
the hospital is not located in a city of the first class as
defined in section 410.01. For purposes of this paragraph,
medical assistance does not include general assistance medical
care.
(c) Medical assistance inpatient payment rates shall
increase 20 percent for inpatient hospital originally paid
admissions, excluding Medicare crossovers, that occur on or
after October 1, 1992, if: (i) the hospital had 100 or fewer
Minnesota medical assistance annualized paid admissions,
excluding Medicare crossovers, that were paid by March 1, 1988,
for the period January 1, 1987, to June 30, 1987; (ii) the
hospital had 100 or fewer licensed beds on March 1, 1988; (iii)
the hospital is located in Minnesota; and (iv) the hospital is
not located in a city of the first class as defined in section
410.01. For a hospital that qualifies for an adjustment under
this paragraph and under subdivision 9, 9a, or 22 or 23, the
hospital must be paid the adjustment under subdivisions 9, 9a,
and 22 and 23, as applicable, plus any amount by which the
adjustment under this paragraph exceeds the adjustment under
those subdivisions. For this paragraph, medical assistance does
not include general assistance medical care.
(d) Medical assistance inpatient payment rates shall
increase 15 percent for inpatient hospital originally paid
admissions, excluding Medicare crossovers, that occur after
September 30, 1992, if: (i) the hospital had more than 100 but
fewer than 250 Minnesota medical assistance annualized paid
admissions, excluding Medicare crossovers, that were paid by
March 1, 1988, for the period January 1, 1987, to June 30, 1987;
(ii) the hospital had 100 or fewer licensed beds on March 1,
1988; (iii) the hospital is located in Minnesota; and (iv) the
hospital is not located in a city of the first class as defined
in section 410.01. For a hospital that qualifies for an
adjustment under this paragraph and under subdivision 9, 9a, or
22 or 23, the hospital must be paid the adjustment under
subdivisions 9, 9a, and 22 and 23, as applicable, plus any
amount by which the adjustment under this paragraph exceeds the
adjustment under those subdivisions. For purposes of this
paragraph, medical assistance does not include general
assistance medical care.
Sec. 23. Minnesota Statutes 1992, section 256.969,
subdivision 22, as amended by Laws 1993, chapter 20, section 5,
is amended to read:
Subd. 22. [HOSPITAL PAYMENT ADJUSTMENT.] For admissions
occurring from January 1, 1993, until June 30, 1993, the
commissioner shall adjust the medical assistance payment paid to
a hospital, excluding regional treatment centers and facilities
of the federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean.
The adjustment must be determined as follows:
(1) for a hospital with a medical assistance inpatient
utilization rate above the arithmetic mean for all hospitals
excluding regional treatment centers and facilities of the
federal Indian Health Service, the adjustment must be determined
by multiplying the total of the operating and property payment
rates by the difference between the hospital's actual medical
assistance inpatient utilization rate and the arithmetic mean
for all hospitals excluding regional treatment centers and
facilities of the federal Indian Health Service; and
(2) for a hospital with a medical assistance inpatient
utilization rate above one standard deviation above the mean,
the adjustment must be determined by multiplying the adjustment
under clause (1) for that hospital by 1.1. Any payment under
this clause must be reduced by the amount of any payment
received under subdivision 9a. For purposes of this
subdivision, medical assistance does not include general
assistance medical care.
This subdivision is effective only if federal matching
funds are not available for all adjustments under this
subdivision and it is necessary to implement ratable reductions
under subdivision 9b.
Sec. 24. Minnesota Statutes 1992, section 256.969, is
amended by adding a subdivision to read:
Subd. 23. [HOSPITAL PAYMENT ADJUSTMENT AFTER JUNE 30,
1993.] (a) For admissions occurring after June 30, 1993, the
commissioner shall adjust the medical assistance payment paid to
a hospital, excluding regional treatment centers and facilities
of the federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean.
The adjustment must be determined as follows:
(1) for a hospital with a medical assistance inpatient
utilization rate above the arithmetic mean for all hospitals
excluding regional treatment centers and facilities of the
federal Indian Health Service, the adjustment must be determined
by multiplying the total of the operating and property payment
rates by the difference between the hospital's actual medical
assistance inpatient utilization rate and the arithmetic mean
for all hospitals excluding regional treatment centers and
facilities of the federal Indian Health Service; and
(2) for a hospital with a medical assistance inpatient
utilization rate above one standard deviation above the mean,
the adjustment must be determined by multiplying the adjustment
under clause (1) for that hospital by 1.1.
(b) Any payment under this subdivision must be reduced by
the amount of any payment received under subdivision 9,
paragraph (b), clause (1) or (2). For purposes of this
subdivision, medical assistance does not include general
assistance medical care.
(c) The commissioner shall adjust rates paid to a health
maintenance organization under contract with the commissioner to
reflect rate increases provided in this section. The adjustment
must be made on a nondiscounted hospital-specific basis.
Sec. 25. Minnesota Statutes 1992, section 256.969, is
amended by adding a subdivision to read:
Subd. 24. [HOSPITAL PEER GROUPS.] For admissions occurring
on or after the later of July 1, 1994, or the implementation
date of the upgrade to the Medicaid management information
system, payment rates of each hospital shall be limited to the
payment rates within its peer group so that the statewide
payment level is reduced by ten percent under the medical
assistance program and by 15 percent under the general
assistance medical care program. For subsequent rate years, the
limits shall be adjusted by the hospital cost index. The
commissioner shall contract for the development of criteria for
and the establishment of the peer groups. Peer groups must be
established based on variables that affect medical assistance
cost such as scope and intensity of services, acuity of
patients, location, and capacity. Rates shall be standardized
by the case mix index and adjusted, if applicable, for the
variable outlier percentage. The peer groups may exclude and
have separate limits or be standardized for operating cost
differences that are not common to all hospitals in order to
establish a minimum number of groups.
Sec. 26. 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 Minnesota and local trade area 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 determined using claim specific
payment changes that result from the rebased rates and revised
methodology in effect after the systems upgrade. The Any
adjustment that is greater than zero shall be rateably reduced
by 20 percent. In addition, every adjustment shall reflect be
reduced for payments under clause (1), and differences in the
hospital cost index and dissimilar rate establishment procedures
such as the variable outlier and the treatment of births and.
Hospitals shall revise claims so that services provided by
rehabilitation units of hospitals are reported separately. The
adjustment shall be in effect for a period not to exceed the
amount of time from July 1, 1992, to the systems upgrade until
the amount due to or owed by the hospital is fully paid over a
number of admissions that is equal to the number of admissions
under adjustment multiplied by 1.5. The adjustment for
admissions occurring from July 1, 1992, to December 31, 1992,
shall be based on claims paid as of August 1, 1993, and the
adjustment shall begin with the effective date of rules
governing rebasing. The adjustment for admissions occurring
from January 1, 1993, to the effective date of the rules shall
be based on claims paid as of February 1, 1994, and shall begin
after the first adjustment period is fully paid. For purposes
of appeals under subdivision 1, the adjustment shall be
considered payment at the time of admission.
Sec. 27. [256B.037] [PROSPECTIVE PAYMENT OF DENTAL
SERVICES.]
Subdivision 1. [CONTRACT FOR DENTAL SERVICES.] The
commissioner may conduct a demonstration project to contract, on
a prospective per capita payment basis, with an organization or
organizations licensed under chapter 62C or 62D, for the
provision of all dental care services beginning July 1, 1994,
under the medical assistance, general assistance medical care,
and MinnesotaCare programs, or when necessary waivers are
granted by the secretary of health and human services, whichever
occurs later. The commissioner shall identify a geographic area
or areas, including both urban and rural areas, where access to
dental services has been inadequate, in which to conduct
demonstration projects. The commissioner shall seek any federal
waivers or approvals necessary to implement this section from
the secretary of health and human services.
The commissioner may exclude from participation in the
demonstration project any or all groups currently excluded from
participation in the prepaid medical assistance program under
section 256B.69.
Subd. 2. [ESTABLISHMENT OF PREPAYMENT RATES.] The
commissioner shall consult with an independent actuary to
establish prepayment rates, but shall retain final authority
over the methodology used to establish the rates. The
prepayment rates shall not result in payments that exceed the
per capita expenditures that would have been made for dental
services by the programs under a fee-for-service reimbursement
system. The package of dental benefits provided to individuals
under this subdivision shall not be less than the package of
benefits provided under the medical assistance fee-for-service
reimbursement system for dental services.
Subd. 3. [APPEALS.] All recipients of services under this
section have the right to appeal to the commissioner under
section 256.045.
Subd. 4. [INFORMATION REQUIRED BY COMMISSIONER.] A
contractor shall submit encounter-specific information as
required by the commissioner, including, but not limited to,
information required for assessing client satisfaction, quality
of care, and cost and utilization of services.
Subd. 5. [OTHER CONTRACTS PERMITTED.] Nothing in this
section prohibits the commissioner from contracting with an
organization for comprehensive health services, including dental
services, under section 256B.031, 256B.035, 256B.69, or 256D.03,
subdivision 4, paragraph (c).
Sec. 28. Minnesota Statutes 1992, section 256B.04,
subdivision 16, is amended to read:
Subd. 16. [PERSONAL CARE SERVICES.] (a) Notwithstanding
any contrary language in this paragraph, the commissioner of
human services and the commissioner of health shall jointly
promulgate rules to be applied to the licensure of personal care
services provided under the medical assistance program. The
rules shall consider standards for personal care services that
are based on the World Institute on Disability's recommendations
regarding personal care services. These rules shall at a
minimum consider the standards and requirements adopted by the
commissioner of health under section 144A.45, which the
commissioner of human services determines are applicable to the
provision of personal care services, in addition to other
standards or modifications which the commissioner of human
services determines are appropriate.
The commissioner of human services shall establish an
advisory group including personal care consumers and providers
to provide advice regarding which standards or modifications
should be adopted. The advisory group membership must include
not less than 15 members, of which at least 60 percent must be
consumers of personal care services and representatives of
recipients with various disabilities and diagnoses and ages. At
least 51 percent of the members of the advisory group must be
recipients of personal care.
The commissioner of human services may contract with the
commissioner of health to enforce the jointly promulgated
licensure rules for personal care service providers.
Prior to final promulgation of the joint rule the
commissioner of human services shall report preliminary findings
along with any comments of the advisory group and a plan for
monitoring and enforcement by the department of health to the
legislature by February 15, 1992.
Limits on the extent of personal care services that may be
provided to an individual must be based on the
cost-effectiveness of the services in relation to the costs of
inpatient hospital care, nursing home care, and other available
types of care. The rules must provide, at a minimum:
(1) that agencies be selected to contract with or employ
and train staff to provide and supervise the provision of
personal care services;
(2) that agencies employ or contract with a qualified
applicant that a qualified recipient proposes to the agency as
the recipient's choice of assistant;
(3) that agencies bill the medical assistance program for a
personal care service by a personal care assistant and
supervision by the registered nurse supervising the personal
care assistant;
(4) that agencies establish a grievance mechanism; and
(5) that agencies have a quality assurance program.
(b) The commissioner may waive the requirement for the
provision of personal care services through an agency in a
particular county, when there are less than two agencies
providing services in that county and shall waive the
requirement for personal care assistants required to join an
agency for the first time during 1993 when personal care
services are provided under a relative hardship waiver under
section 256B.0627, subdivision 4, paragraph (b), clause (7), and
at least two agencies providing personal care services have
refused to employ or contract with the independent personal care
assistant.
Sec. 29. Minnesota Statutes 1992, section 256B.042,
subdivision 4, is amended to read:
Subd. 4. [NOTICE.] The state agency must be given notice
of monetary claims against a person, firm, or corporation that
may be liable to pay part or all of the cost of medical care
when the state agency has paid or become liable for the cost of
that care. Notice must be given as follows:
(a) Applicants for medical assistance shall notify the
state or local agency of any possible claims when they submit
the application. Recipients of medical assistance shall notify
the state or local agency of any possible claims when those
claims arise.
(b) A person providing medical care services to a recipient
of medical assistance shall notify the state agency when the
person has reason to believe that a third party may be liable
for payment of the cost of medical care.
(c) A person who is a party to a claim upon which the state
agency may be entitled to a lien under this section shall notify
the state agency of its potential lien claim before filing a
claim, commencing an action, or negotiating a settlement. A
person who is a party to a claim includes the plaintiff, the
defendants, and any other party to the cause of action.
Notice given to the local agency is not sufficient to meet
the requirements of paragraphs (b) and (c).
Sec. 30. Minnesota Statutes 1992, section 256B.055,
subdivision 1, is amended to read:
Subdivision 1. [CHILDREN ELIGIBLE FOR SUBSIDIZED ADOPTION
ASSISTANCE.] Medical assistance may be paid for a child eligible
for or receiving adoption assistance payments under title IV-E
of the Social Security Act, United States Code, title 42,
sections 670 to 676, and to any child who is not title IV-E
eligible but who was determined eligible for adoption assistance
under Minnesota Statutes, section 259.40 or 259.431, subdivision
4, clauses (a) to (c), and has a special need for medical or
rehabilitative care.
Sec. 31. Minnesota Statutes 1992, section 256B.056,
subdivision 2, is amended to read:
Subd. 2. [HOMESTEAD; EXCLUSION FOR INSTITUTIONALIZED
PERSONS.] The homestead shall be excluded for the first six
calendar months of a person's stay in a long-term care facility
and shall continue to be excluded for as long as the recipient
can be reasonably expected to return, as provided under the
methodologies for the supplemental security income program to
the homestead. For purposes of this subdivision, "reasonably
expected to return to the homestead" means the recipient's
attending physician has certified that the expectation is
reasonable, and the recipient can show that the cost of care
upon returning home will be met through medical assistance or
other sources. The homestead shall continue to be excluded for
persons residing in a long-term care facility if it is used as a
primary residence by one of the following individuals:
(a) the spouse;
(b) a child under age 21;
(c) a child of any age who is blind or permanently and
totally disabled as defined in the supplemental security income
program;
(d) a sibling who has equity interest in the home and who
resided in the home for at least one year immediately before the
date of the person's admission to the facility; or
(e) a child of any age, or, subject to federal approval, a
grandchild of any age, who resided in the home for at least two
years immediately before the date of the person's admission to
the facility, and who provided care to the person that permitted
the person to reside at home rather than in an institution.
Sec. 32. Minnesota Statutes 1992, section 256B.0575, is
amended to read:
256B.0575 [AVAILABILITY OF INCOME FOR INSTITUTIONALIZED
PERSONS.]
When an institutionalized person is determined eligible for
medical assistance, the income that exceeds the deductions in
paragraphs (a) and (b) must be applied to the cost of
institutional care.
(a) The following amounts must be deducted from the
institutionalized person's income in the following order:
(1) the personal needs allowance under section 256B.35 or,
for a veteran who does not have a spouse or child, or a
surviving spouse of a veteran having no child, the amount of any
veteran's pension an improved pension received from the
veteran's administration not exceeding $90 per month;
(2) the personal allowance for disabled individuals under
section 256B.36;
(3) if the institutionalized person has a legally appointed
guardian or conservator, five percent of the recipient's gross
monthly income up to $100 as reimbursement for guardianship or
conservatorship services;
(4) a monthly income allowance determined under section
256B.058, subdivision 2, but only to the extent income of the
institutionalized spouse is made available to the community
spouse;
(5) a monthly allowance for children under age 18 which,
together with the net income of the children, would provide
income equal to the medical assistance standard for families and
children according to section 256B.056, subdivision 4, for a
family size that includes only the minor children. This
deduction applies only if the children do not live with the
community spouse and only if the children resided with the
institutionalized person immediately prior to admission;
(6) a monthly family allowance for other family members,
equal to one-third of the difference between 122 percent of the
federal poverty guidelines and the monthly income for that
family member;
(7) reparations payments made by the Federal Republic of
Germany; and
(8) amounts for reasonable expenses incurred for necessary
medical or remedial care for the institutionalized spouse that
are not medical assistance covered expenses and that are not
subject to payment by a third party.
For purposes of clause (6), "other family member" means a
person who resides with the community spouse and who is a minor
or dependent child, dependent parent, or dependent sibling of
either spouse. "Dependent" means a person who could be claimed
as a dependent for federal income tax purposes under the
Internal Revenue Code.
(b) Income shall be allocated to an institutionalized
person for a period of up to three calendar months, in an amount
equal to the medical assistance standard for a family size of
one if:
(1) a physician certifies that the person is expected to
reside in the long-term care facility for three calendar months
or less;
(2) if the person has expenses of maintaining a residence
in the community; and
(3) if one of the following circumstances apply:
(i) the person was not living together with a spouse or a
family member as defined in paragraph (a) when the person
entered a long-term care facility; or
(ii) the person and the person's spouse become
institutionalized on the same date, in which case the allocation
shall be applied to the income of one of the spouses.
For purposes of this paragraph, a person is determined to be
residing in a licensed nursing home, regional treatment center,
or medical institution if the person is expected to remain for a
period of one full calendar month or more.
Sec. 33. Minnesota Statutes 1992, section 256B.059,
subdivision 3, is amended to read:
Subd. 3. [COMMUNITY SPOUSE ASSET ALLOWANCE.] (a) An
institutionalized spouse may transfer assets to the community
spouse solely for the benefit of the community spouse. Except
for increased amounts allowable under subdivision 4, the maximum
amount of assets allowed to be transferred is the amount which,
when added to the assets otherwise available to the community
spouse, is the greater of as follows:
(1) $12,000 prior to July 1, 1994, the greater of:
(i) $14,148;
(2) (ii) the lesser of the spousal share or $60,000
$70,740; or
(3) (iii) the amount required by court order to be paid to
the community spouse; and
(2) for persons who begin their first continuous period of
institutionalization on or after July 1, 1994, the greater of:
(i) $20,000;
(ii) the lesser of the spousal share or $70,740; or
(iii) the amount required by court order to be paid to the
community spouse.
If the assets available to the community spouse are already
at the limit permissible under this section, or the higher limit
attributable to increases under subdivision 4, no assets may be
transferred from the institutionalized spouse to the community
spouse. The transfer must be made as soon as practicable after
the date the institutionalized spouse is determined eligible for
medical assistance, or within the amount of time needed for any
court order required for the transfer. On January 1, 1990 1994,
and every January 1 thereafter, the $12,000 and $60,000 limits
in this subdivision shall be adjusted by the same percentage
change in the consumer price index for all urban consumers (all
items; United States city average) between the two previous
Septembers. These adjustments shall also be applied to
the $12,000 and $60,000 limits in subdivision 5.
Sec. 34. Minnesota Statutes 1992, section 256B.059,
subdivision 5, is amended to read:
Subd. 5. [ASSET AVAILABILITY.] (a) At the time of
application for medical assistance benefits, assets considered
available to the institutionalized spouse shall be the total
value of all assets in which either spouse has an ownership
interest, reduced by the greater of following:
(1) $12,000; or prior to July 1, 1994, the greater of:
(i) $14,148;
(2) (ii) the lesser of the spousal share or
$60,000 $70,740; or
(3) (iii) the amount required by court order to be paid to
the community spouse;
(2) for persons who begin their first continuous period of
institutionalization on or after July 1, 1994, the greater of:
(i) $20,000;
(ii) the lesser of the spousal share or $70,740; or
(iii) the amount required by court order to be paid to the
community spouse. If the community spouse asset allowance has
been increased under subdivision 4, then the assets considered
available to the institutionalized spouse under this subdivision
shall be further reduced by the value of additional amounts
allowed under subdivision 4.
(b) An institutionalized spouse may be found eligible for
medical assistance even though assets in excess of the allowable
amount are found to be available under paragraph (a) if the
assets are owned jointly or individually by the community
spouse, and the institutionalized spouse cannot use those assets
to pay for the cost of care without the consent of the community
spouse, and if: (i) the institutionalized spouse assigns to the
commissioner the right to support from the community spouse
under section 256B.14, subdivision 2 3; (ii) the
institutionalized spouse lacks the ability to execute an
assignment due to a physical or mental impairment; or (iii) the
denial of eligibility would cause an imminent threat to the
institutionalized spouse's health and well-being.
(c) After the month in which the institutionalized spouse
is determined eligible for medical assistance, during the
continuous period of institutionalization, no assets of the
community spouse are considered available to the
institutionalized spouse, unless the institutionalized spouse
has been found eligible under clause (b).
(d) Assets determined to be available to the
institutionalized spouse under this section must be used for the
health care or personal needs of the institutionalized spouse.
(e) For purposes of this section, assets do not include
assets excluded under section 256B.056, without regard to the
limitations on total value in that section.
Sec. 35. Minnesota Statutes 1992, section 256B.0595, is
amended to read:
256B.0595 [PROHIBITIONS ON TRANSFER; EXCEPTIONS.]
Subdivision 1. [PROHIBITED TRANSFERS.] (a) If a person or
the person's spouse has given away, sold, or disposed of, for
less than fair market value, any asset or interest therein,
except assets other than the homestead that are excluded under
section 256B.056, subdivision 3, within 30 months before or any
time after the date of institutionalization if the person has
been determined eligible for medical assistance, or within 30
months before or any time after the date of the first approved
application for medical assistance if the person has not yet
been determined eligible for medical assistance, the person is
ineligible for long-term care services for the period of time
determined under subdivision 2.
(b) Effective for transfers made on or after July 1, 1993,
or upon federal approval, whichever is later, a person, a
person's spouse, or a person's authorized representative may not
give away, sell, or dispose of, for less than fair market value,
any asset or interest therein, for the purpose of establishing
or maintaining medical assistance eligibility. For purposes of
determining eligibility for medical assistance, any transfer of
an asset within 60 months preceding application for medical
assistance or during the period of medical assistance
eligibility, including assets excluded under section 256B.056,
subdivision 3, for less than fair market value may be
considered. Any transfer for less than fair market value made
within 60 months preceding application for medical assistance or
during the period of medical assistance eligibility is presumed
to have been made for the purpose of establishing or maintaining
medical assistance eligibility and the person is ineligible for
medical assistance for the period of time determined under
subdivision 2, unless the person furnishes convincing evidence
to establish that the transaction was exclusively for another
purpose, or unless the transfer is permitted under subdivisions
3 or 4.
(b) (c) This section applies to transfers, for less than
fair market value, of income or assets that are considered
income in the month received, such as inheritances, court
settlements, and retroactive benefit payments.
(c) (d) This section applies to payments for care or
personal services provided by a relative, unless the
compensation was stipulated in a notarized, written agreement
which was in existence when the service was performed, the care
or services directly benefited the person, and the payments made
represented reasonable compensation for the care or services
provided. A notarized written agreement is not required if
payment for the services was made within 60 days after the
service was provided.
(d) (e) This section applies to the portion of any asset or
interest that a person or a person's spouse transfers to an
irrevocable trust, annuity, or other instrument, that exceeds
the value of the benefit likely to be returned to the person or
spouse while alive, based on estimated life expectancy using the
life expectancy tables employed by the supplemental security
income program to determine the value of an agreement for
services for life. The commissioner may adopt rules reducing
life expectancies based on the need for long-term care.
(e) (f) For purposes of this section, long-term care
services include nursing facility services, and home- and
community-based services provided pursuant to section 256B.491.
For purposes of this subdivision and subdivisions 2, 3, and 4,
"institutionalized person" includes a person who is an inpatient
in a nursing facility, or who is receiving home- and
community-based services under section 256B.491.
Subd. 2. [PERIOD OF INELIGIBILITY.] (a) For any
uncompensated transfer, the number of months of ineligibility
for long-term care services shall be the lesser of 30 months, or
the uncompensated transfer amount divided by the average medical
assistance rate for nursing facility services in the state in
effect on the date of application. The amount used to calculate
the average medical assistance payment rate shall be adjusted
each July 1 to reflect payment rates for the previous calendar
year. The period of ineligibility begins with the month in
which the assets were transferred. If the transfer was not
reported to the local agency at the time of application, and the
applicant received long-term care services during what would
have been the period of ineligibility if the transfer had been
reported, a cause of action exists against the transferee for
the cost of long-term care services provided during the period
of ineligibility, or for the uncompensated amount of the
transfer, whichever is less. The action may be brought by the
state or the local agency responsible for providing medical
assistance under chapter 256G. The uncompensated transfer
amount is the fair market value of the asset at the time it was
given away, sold, or disposed of, less the amount of
compensation received.
(b) For uncompensated transfers made on or after July 1,
1993, or upon federal approval, whichever is later, the number
of months of ineligibility, including partial months, for
medical assistance services shall be the total uncompensated
value of the resources transferred divided by the average
medical assistance rate for nursing facility services in the
state in effect on the date of application. If a calculation of
a penalty period results in a partial month, payments for
medical assistance services will be reduced in an amount equal
to the fraction, except that in calculating the value of
uncompensated transfers, uncompensated transfers not to exceed
$1,000 in total value per month shall be disregarded for each
month prior to the month of application for medical assistance.
The amount used to calculate the average medical assistance
payment rate shall be adjusted each July 1 to reflect payment
rates for the previous calendar year. The period of
ineligibility begins with the month in which the assets were
transferred except that if one or more uncompensated transfers
are made during a period of ineligibility, the total assets
transferred during the ineligibility period shall be combined
and a penalty period calculated to begin in the month the first
uncompensated transfer was made. The penalty in this paragraph
shall not apply to uncompensated transfers of assets not to
exceed a total of $1,000 per month during a medical assistance
eligibility certification period. If the transfer was not
reported to the local agency at the time of application, and the
applicant received medical assistance services during what would
have been the period of ineligibility if the transfer had been
reported, a cause of action exists against the transferee for
the cost of medical assistance services provided during the
period of ineligibility, or for the uncompensated amount of the
transfer, whichever is less. The action may be brought by the
state or the local agency responsible for providing medical
assistance under chapter 256G. The uncompensated transfer
amount is the fair market value of the asset at the time it was
given away, sold, or disposed of, less the amount of
compensation received.
(c) If the total value of all uncompensated transfers made
in a month exceeds $1,000, the disregards allowed under
paragraph (b) do not apply.
Subd. 3. [HOMESTEAD EXCEPTION TO TRANSFER PROHIBITION.]
(a) An institutionalized person is not ineligible for long-term
care services due to a transfer of assets for less than fair
market value if the asset transferred was a homestead and:
(1) title to the homestead was transferred to the
individual's
(i) spouse;
(ii) child who is under age 21;
(iii) blind or permanently and totally disabled child as
defined in the supplemental security income program;
(iv) sibling who has equity interest in the home and who
was residing in the home for a period of at least one year
immediately before the date of the individual's admission to the
facility; or
(v) son or daughter who was residing in the individual's
home for a period of at least two years immediately before the
date of the individual's admission to the facility, and who
provided care to the individual that permitted the individual to
reside at home rather than in an institution or facility;
(2) a satisfactory showing is made that the individual
intended to dispose of the homestead at fair market value or for
other valuable consideration; or
(3) the local agency grants a waiver of the excess
resources created by the uncompensated transfer because denial
of eligibility would cause undue hardship for the individual,
based on imminent threat to the individual's health and
well-being.
(b) When a waiver is granted under paragraph (a), clause
(3), a cause of action exists against the person to whom the
homestead was transferred for that portion of long-term care
services granted within 30 months of the transfer or the amount
of the uncompensated transfer, whichever is less, together with
the costs incurred due to the action. The action may be brought
by the state or the local agency responsible for providing
medical assistance under chapter 256G.
(c) Effective for transfers made on or after July 1, 1993,
or upon federal approval, whichever is later, an
institutionalized person is not ineligible for medical
assistance services due to a transfer of assets for less than
fair market value if the asset transferred was a homestead and:
(1) title to the homestead was transferred to the
individual's
(i) spouse;
(ii) child who is under age 21;
(iii) blind or permanently and totally disabled child as
defined in the supplemental security income program;
(iv) sibling who has equity interest in the home and who
was residing in the home for a period of at least one year
immediately before the date of the individual's admission to the
facility; or
(v) son or daughter who was residing in the individual's
home for a period of at least two years immediately before the
date of the individual's admission to the facility, and who
provided care to the individual that permitted the individual to
reside at home rather than in an institution or facility;
(2) a satisfactory showing is made that the individual
intended to dispose of the homestead at fair market value or for
other valuable consideration; or
(3) the local agency grants a waiver of the excess
resources created by the uncompensated transfer because denial
of eligibility would cause undue hardship for the individual,
based on imminent threat to the individual's health and
well-being.
(d) When a waiver is granted under paragraph (c), clause
(3), a cause of action exists against the person to whom the
homestead was transferred for that portion of medical assistance
services granted during the period of ineligibility under
subdivision 2, or the amount of the uncompensated transfer,
whichever is less, together with the costs incurred due to the
action. The action may be brought by the state or the local
agency responsible for providing medical assistance under
chapter 256G.
Subd. 4. [OTHER EXCEPTIONS TO TRANSFER PROHIBITION.] (a)
An institutionalized person who has made, or whose spouse has
made a transfer prohibited by subdivision 1, is not ineligible
for long-term care services if one of the following conditions
applies:
(1) the assets were transferred to the community spouse, as
defined in section 256B.059; or
(2) the institutionalized spouse, prior to being
institutionalized, transferred assets to a spouse, provided that
the spouse to whom the assets were transferred does not then
transfer those assets to another person for less than fair
market value. (At the time when one spouse is
institutionalized, assets must be allocated between the spouses
as provided under section 256B.059); or
(3) the assets were transferred to the individual's child
who is blind or permanently and totally disabled as determined
in the supplemental security income program; or
(4) a satisfactory showing is made that the individual
intended to dispose of the assets either at fair market value or
for other valuable consideration; or
(5) the local agency determines that denial of eligibility
for long-term care services would work an undue hardship and
grants a waiver of excess assets. When a waiver is granted, a
cause of action exists against the person to whom the assets
were transferred for that portion of long-term care services
granted within 30 months of the transfer, or the amount of the
uncompensated transfer, whichever is less, together with the
costs incurred due to the action. The action may be brought by
the state or the local agency responsible for providing medical
assistance under this chapter.
(b) Effective for transfers made on or after July 1, 1993,
or upon federal approval, whichever is later, an
institutionalized person who has made, or whose spouse has made
a transfer prohibited by subdivision 1, is not ineligible for
medical assistance services if one of the following conditions
applies:
(1) the assets were transferred to the community spouse, as
defined in section 256B.059; or
(2) the institutionalized spouse, prior to being
institutionalized, transferred assets to a spouse, provided that
the spouse to whom the assets were transferred does not then
transfer those assets to another person for less than fair
market value. (At the time when one spouse is
institutionalized, assets must be allocated between the spouses
as provided under section 256B.059); or
(3) the assets were transferred to the individual's child
who is blind or permanently and totally disabled as determined
in the supplemental security income program; or
(4) a satisfactory showing is made that the individual
intended to dispose of the assets either at fair market value or
for other valuable consideration; or
(5) the local agency determines that denial of eligibility
for medical assistance services would work an undue hardship and
grants a waiver of excess assets. When a waiver is granted, a
cause of action exists against the person to whom the assets
were transferred for that portion of medical assistance services
granted during the period of ineligibility determined under
subdivision 2 or the amount of the uncompensated transfer,
whichever is less, together with the costs incurred due to the
action. The action may be brought by the state or the local
agency responsible for providing medical assistance under this
chapter.
Subd. 5. [NOTICE OF RECEIPT OF FEDERAL WAIVER.] In every
instance in which a federal waiver that allows the
implementation of a provision in this section is granted, the
commissioner shall publish notice of receipt of the waiver in
the state register.
Sec. 36. Minnesota Statutes 1992, section 256B.0625,
subdivision 3, is amended to read:
Subd. 3. [PHYSICIANS' SERVICES.] Medical assistance covers
physicians' services. Rates paid for anesthesiology services
provided by physicians shall be according to the formula
utilized in the Medicare program and shall use a conversion
factor "at percentile of calendar year set by legislature."
Sec. 37. Minnesota Statutes 1992, section 256B.0625,
subdivision 6a, is amended to read:
Subd. 6a. [HOME HEALTH SERVICES.] Home health services are
those services specified in Minnesota Rules, part 9505.0290.
Medical assistance covers home health services at a recipient's
home residence. Medical assistance does not cover home health
services at for residents of a hospital, nursing facility,
intermediate care facility, or a health care facility licensed
by the commissioner of health, unless the program is funded
under a home- and community-based services waiver or unless the
commissioner of human services has prior authorized skilled
nurse visits for less than 90 days for a resident at an
intermediate care facility for persons with mental retardation,
to prevent an admission to a hospital or nursing facility or
unless a resident who is otherwise eligible is on leave from the
facility and the facility either pays for the home health
services or forgoes the facility per diem for the leave days
that home health services are used. Home health services must
be provided by a Medicare certified home health agency. All
nursing and home health aide services must be provided according
to section 256B.0627.
Sec. 38. Minnesota Statutes 1992, section 256B.0625,
subdivision 7, is amended to read:
Subd. 7. [PRIVATE DUTY NURSING.] Medical assistance covers
private duty nursing services in a recipient's home. Recipients
who are authorized to receive private duty nursing services in
their home may use approved hours outside of the home during
hours when normal life activities take them outside of their
home and when, without the provision of private duty nursing,
their health and safety would be jeopardized. Medical
assistance does not cover private duty nursing services at for
residents of a hospital, nursing facility, intermediate care
facility, or a health care facility licensed by the commissioner
of health, except as authorized in section 256B.64 for
ventilator-dependent recipients in hospitals or unless a
resident who is otherwise eligible is on leave from the facility
and the facility either pays for the private duty nursing
services or forgoes the facility per diem for the leave days
that private duty nursing services are used. Total hours of
service and payment allowed for services outside the home cannot
exceed that which is otherwise allowed in an in-home setting
according to section 256B.0627. All private duty nursing
services must be provided according to the limits established
under section 256B.0627. Private duty nursing services may not
be reimbursed if the nurse is the spouse of the recipient or the
parent or foster care provider of a recipient who is under age
18, or the recipient's legal guardian.
Sec. 39. Minnesota Statutes 1992, section 256B.0625,
subdivision 11, is amended to read:
Subd. 11. [NURSE ANESTHETIST SERVICES.] Medical assistance
covers nurse anesthetist services. Rates paid for
anesthesiology services provided by certified registered nurse
anesthetists shall be according to the formula utilized in the
Medicare program and shall use the conversion factor that is
used by the Medicare program.
Sec. 40. Minnesota Statutes 1992, section 256B.0625,
subdivision 13, is amended to read:
Subd. 13. [DRUGS.] (a) Medical assistance covers drugs if
prescribed by a licensed practitioner and dispensed by a
licensed pharmacist, or by a physician enrolled in the medical
assistance program as a dispensing physician. The commissioner,
after receiving recommendations from the Minnesota professional
medical association associations and the Minnesota pharmacists
association professional pharmacist associations, shall
designate a formulary committee to advise the commissioner on
the names of drugs for which payment is made, recommend a system
for reimbursing providers on a set fee or charge basis rather
than the present system, and develop methods encouraging use of
generic drugs when they are less expensive and equally effective
as trademark drugs. The commissioner shall appoint the
formulary committee members no later than 30 days following July
1, 1981. The formulary committee shall consist of nine members,
four of whom shall be physicians who are not employed by the
department of human services, and a majority of whose practice
is for persons paying privately or through health insurance,
three of whom shall be pharmacists who are not employed by the
department of human services, and a majority of whose practice
is for persons paying privately or through health insurance, a
consumer representative, and a nursing home representative.
Committee members shall serve two-year three-year terms and
shall serve without compensation. Members may be reappointed
once. The commissioner shall establish a drug formulary. Its
establishment and publication shall not be subject to the
requirements of the administrative procedure act, but the
formulary committee shall review and comment on the formulary
contents. The formulary committee shall review and recommend
drugs which require prior authorization. The formulary
committee may recommend drugs for prior authorization directly
to the commissioner, as long as opportunity for public input is
provided. Prior authorization may be requested by the
commissioner based on medical and clinical criteria before
certain drugs are eligible for payment. Before a drug may be
considered for prior authorization at the request of the
commissioner:
(1) the drug formulary committee must develop criteria to
be used for identifying drugs; the development of these criteria
is not subject to the requirements of chapter 14, but the
formulary committee shall provide opportunity for public input
in developing criteria;
(2) the drug formulary committee must hold a public forum
and receive public comment for an additional 15 days; and
(3) the commissioner must provide information to the
formulary committee on the impact that placing the drug on prior
authorization will have on the quality of patient care and
information regarding whether the drug is subject to clinical
abuse or misuse. Prior authorization may be required by the
commissioner before certain formulary drugs are eligible for
payment. The formulary shall not include: drugs or products
for which there is no federal funding; over-the-counter drugs,
except for antacids, acetaminophen, family planning products,
aspirin, insulin, products for the treatment of lice, and
vitamins for children under the age of seven and pregnant or
nursing women; or any other over-the-counter drug identified by
the commissioner, in consultation with the drug formulary
committee as necessary, appropriate and cost effective for the
treatment of certain specified chronic diseases, conditions or
disorders, and this determination shall not be subject to the
requirements of chapter 14, the administrative procedure act;
nutritional products, except for those products needed for
treatment of phenylketonuria, hyperlysinemia, maple syrup urine
disease, a combined allergy to human milk, cow milk, and soy
formula, or any other childhood or adult diseases, conditions,
or disorders identified by the commissioner as requiring a
similarly necessary nutritional product; anorectics; and drugs
for which medical value has not been established. Nutritional
products needed for the treatment of a combined allergy to human
milk, cow's milk, and soy formula require prior authorization.
Separate payment shall not be made for nutritional products for
residents of long-term care facilities; payment for dietary
requirements is a component of the per diem rate paid to these
facilities. Payment to drug vendors shall not be modified
before the formulary is established except that the commissioner
shall not permit payment for any drugs which may not by law be
included in the formulary, and the commissioner's determination
shall not be subject to chapter 14, the administrative procedure
act. The commissioner shall publish conditions for prohibiting
payment for specific drugs after considering the formulary
committee's recommendations.
(b) The basis for determining the amount of payment shall
be the lower of the actual acquisition costs of the drugs plus a
fixed dispensing fee established by the commissioner, the
maximum allowable cost set by the federal government or by the
commissioner plus the fixed dispensing fee or the usual and
customary price charged to the public. Actual acquisition cost
includes quantity and other special discounts except time and
cash discounts. The actual acquisition cost of a drug may be
estimated by the commissioner. The maximum allowable cost of a
multisource drug may be set by the commissioner and it shall be
comparable to, but no higher than, the maximum amount paid by
other third party payors in this state who have maximum
allowable cost programs. Establishment of the amount of payment
for drugs shall not be subject to the requirements of the
administrative procedure act. An additional dispensing fee of
$.30 may be added to the dispensing fee paid to pharmacists for
legend drug prescriptions dispensed to residents of long-term
care facilities when a unit dose blister card system, approved
by the department, is used. Under this type of dispensing
system, the pharmacist must dispense a 30-day supply of drug.
The National Drug Code (NDC) from the drug container used to
fill the blister card must be identified on the claim to the
department. The unit dose blister card containing the drug must
meet the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the
pharmacy for reuse. The pharmacy provider will be required to
credit the department for the actual acquisition cost of all
unused drugs that are eligible for reuse. Over-the-counter
medications must be dispensed in the manufacturer's unopened
package. The commissioner may permit the drug clozapine to be
dispensed in a quantity that is less than a 30-day supply.
Whenever a generically equivalent product is available, payment
shall be on the basis of the actual acquisition cost of the
generic drug, unless the prescriber specifically indicates
"dispense as written - brand necessary" on the prescription as
required by section 151.21, subdivision 2. Implementation of
any change in the fixed dispensing fee that has not been subject
to the administrative procedure act is limited to not more than
180 days, unless, during that time, the commissioner initiates
rulemaking through the administrative procedure act.
(c) Until January 4, 1993, or the date the on-line,
real-time Medicaid Management Information System (MMIS) upgrade
is successfully implemented, as determined by the commissioner
of administration, whichever occurs last, a pharmacy provider
may require individuals who seek to become eligible for medical
assistance under a one-month spend-down, as provided in section
256B.056, subdivision 5, to pay for services to the extent of
the spend-down amount at the time the services are provided. A
pharmacy provider choosing this option shall file a medical
assistance claim for the pharmacy services provided. If medical
assistance reimbursement is received for this claim, the
pharmacy provider shall return to the individual the total
amount paid by the individual for the pharmacy services
reimbursed by the medical assistance program. If the claim is
not eligible for medical assistance reimbursement because of the
provider's failure to comply with the provisions of the medical
assistance program, the pharmacy provider shall refund to the
individual the total amount paid by the individual. Pharmacy
providers may choose this option only if they apply similar
credit restrictions to private pay or privately insured
individuals. A pharmacy provider choosing this option must
inform individuals who seek to become eligible for medical
assistance under a one-month spend-down of (1) their right to
appeal the denial of services on the grounds that they have
satisfied the spend-down requirement, and (2) their potential
eligibility for the health right program or the children's
health plan.
Sec. 41. Minnesota Statutes 1992, section 256B.0625,
subdivision 13a, is amended to read:
Subd. 13a. [DRUG UTILIZATION REVIEW BOARD.] A 12-member
drug utilization review board is established. The board is
comprised of six licensed physicians actively engaged in the
practice of medicine in Minnesota; five licensed pharmacists
actively engaged in the practice of pharmacy in Minnesota; and
one consumer representative. The board shall be staffed by an
employee of the department who shall serve as an ex officio
nonvoting member of the board. The members of the board shall
be appointed by the commissioner and shall serve three-year
terms. The physician members shall be selected from a list
lists submitted by the Minnesota professional medical
association associations. The pharmacist members shall be
selected from a list lists submitted by the Minnesota
professional pharmacist Association associations. The
commissioner shall appoint the initial members of the board for
terms expiring as follows: four members for terms expiring June
30, 1995; four members for terms expiring June 30, 1994; and
four members for terms expiring June 30, 1993. Members may be
reappointed once. The board shall annually elect a chair from
among the members.
The commissioner shall, with the advice of the board:
(1) implement a medical assistance retrospective and
prospective drug utilization review program as required by
United States Code, title 42, section 1396r-8(g)(3);
(2) develop and implement the predetermined criteria and
practice parameters for appropriate prescribing to be used in
retrospective and prospective drug utilization review;
(3) develop, select, implement, and assess interventions
for physicians, pharmacists, and patients that are educational
and not punitive in nature;
(4) establish a grievance and appeals process for
physicians and pharmacists under this section;
(5) publish and disseminate educational information to
physicians and pharmacists regarding the board and the review
program;
(6) adopt and implement procedures designed to ensure the
confidentiality of any information collected, stored, retrieved,
assessed, or analyzed by the board, staff to the board, or
contractors to the review program that identifies individual
physicians, pharmacists, or recipients;
(7) establish and implement an ongoing process to (i)
receive public comment regarding drug utilization review
criteria and standards, and (ii) consider the comments along
with other scientific and clinical information in order to
revise criteria and standards on a timely basis; and
(8) adopt any rules necessary to carry out this section.
The board may establish advisory committees. The
commissioner may contract with appropriate organizations to
assist the board in carrying out the board's duties. The
commissioner may enter into contracts for services to develop
and implement a retrospective and prospective review program.
The board shall report to the commissioner annually on
December 1. The commissioner shall make the report available to
the public upon request. The report must include information on
the activities of the board and the program; the effectiveness
of implemented interventions; administrative costs; and any
fiscal impact resulting from the program.
Sec. 42. Minnesota Statutes 1992, section 256B.0625,
subdivision 15, is amended to read:
Subd. 15. [HEALTH PLAN PREMIUMS AND COPAYMENTS.] Medical
assistance covers health care prepayment plan premiums and,
insurance premiums if paid directly to a vendor and
supplementary medical insurance benefits under Title XVIII of
the Social Security Act, and copayments if determined to be
cost-effective by the commissioner. For purposes of obtaining
Medicare part A and part B, and copayments, expenditures may be
made even if federal funding is not available.
Sec. 43. Minnesota Statutes 1992, section 256B.0625,
subdivision 17, is amended to read:
Subd. 17. [TRANSPORTATION COSTS.] (a) Medical assistance
covers transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by
nonambulatory persons in obtaining emergency or nonemergency
medical care when paid directly to an ambulance company, common
carrier, or other recognized providers of transportation
services. For the purpose of this subdivision, a person who is
incapable of transport by taxicab or bus shall be considered to
be nonambulatory.
(b) Medical assistance covers special transportation, as
defined in Minnesota Rules, part 9505.0315, subpart 1, item F,
if the provider receives and maintains a current physician's
order by the recipient's attending physician. The commissioner
shall establish maximum medical assistance reimbursement rates
for special transportation services for persons who need a
wheelchair lift van or stretcher-equipped vehicle and for those
who do not need a wheelchair lift van or stretcher-equipped
vehicle. The average of these two rates must not exceed $13 $14
for the base rate and $1 $1.10 per mile. Special transportation
provided to nonambulatory persons who do not need a wheelchair
lift van or stretcher-equipped vehicle, may be reimbursed at a
lower rate than special transportation provided to persons who
need a wheelchair lift van or stretcher-equipped vehicle.
Sec. 44. Minnesota Statutes 1992, section 256B.0625,
subdivision 19a, is amended to read:
Subd. 19a. [PERSONAL CARE SERVICES.] Medical assistance
covers personal care services in a recipient's home. Recipients
who can direct their own care, or persons who cannot direct
their own care when authorized by the responsible party, may use
approved hours outside the home when normal life activities take
them outside the home and when, without the provision of
personal care, their health and safety would be jeopardized.
Medical assistance does not cover personal care services at for
residents of a hospital, nursing facility, intermediate care
facility or a, health care facility licensed by the commissioner
of health, or unless a resident who is otherwise eligible is on
leave from the facility and the facility either pays for the
personal care services or forgoes the facility per diem for the
leave days that personal care services are used except as
authorized in section 256B.64 for ventilator-dependent
recipients in hospitals. Total hours of service and payment
allowed for services outside the home cannot exceed that which
is otherwise allowed for personal care services in an in-home
setting according to section 256B.0627. All personal care
services must be provided according to section 256B.0627.
Personal care services may not be reimbursed if the personal
care assistant is the spouse of the recipient or the parent of a
recipient under age 18, the responsible party or the foster care
provider of a recipient who cannot direct the recipient's own
care or the recipient's legal guardian unless, in the case of a
foster provider, a county or state case manager visits the
recipient as needed, but no less than every six months, to
monitor the health and safety of the recipient and to ensure the
goals of the care plan are met. Parents of adult recipients,
adult children of the recipient or adult siblings of the
recipient may be reimbursed for personal care services if they
are granted a waiver under section 256B.0627.
Sec. 45. Minnesota Statutes 1992, section 256B.0625,
subdivision 27, is amended to read:
Subd. 27. [ORGAN AND TISSUE TRANSPLANTS.] Medical
assistance coverage for organ and tissue transplant procedures
is limited to those procedures covered by the Medicare program,
provided those; heart-lung transplants for persons with primary
pulmonary hypertension and performed at Minnesota transplant
centers meeting united network for organ sharing criteria to
perform heart-lung transplants; lung transplants using cadaveric
donors and performed at Minnesota transplant centers meeting
united network for organ sharing criteria to perform lung
transplants; pancreas transplants for uremic diabetic recipients
of kidney transplants and performed at Minnesota facilities
meeting united network for organ sharing criteria to perform
pancreas transplants; and allogeneic bone marrow transplants for
persons with stage III or IV Hodgkin's disease. Transplant
procedures must comply with all applicable laws, rules, and
regulations governing (1) coverage by the Medicare program, (2)
federal financial participation by the Medicaid program, and (3)
coverage by the Minnesota medical assistance
program. Transplant centers must meet american society of
hematology and clinical oncology criteria for bone marrow
transplants and be located in Minnesota to receive reimbursement
for bone marrow transplants.
Sec. 46. Minnesota Statutes 1992, section 256B.0625,
subdivision 28, is amended to read:
Subd. 28. [CERTIFIED NURSE PRACTITIONER SERVICES.] Medical
assistance covers services performed by a certified pediatric
nurse practitioner, a certified family nurse practitioner, a
certified adult nurse practitioner, a certified
obstetric/gynecological nurse practitioner, or a certified
geriatric nurse practitioner in independent practice, if the
services are otherwise covered under this chapter as a physician
service, and if the service is within the scope of practice of
the nurse practitioner's license as a registered nurse, as
defined in section 148.171.
Sec. 47. Minnesota Statutes 1992, section 256B.0625,
subdivision 29, is amended to read:
Subd. 29. [PUBLIC HEALTH NURSING CLINIC SERVICES.] Medical
assistance covers the services of a certified public health
nurse or a registered nurse practicing in a public health
nursing clinic that is a department of, or that operates under
the direct authority of, a unit of government, if the service is
within the scope of practice of the public health or registered
nurse's license as a registered nurse, as defined in section
148.171.
Sec. 48. Minnesota Statutes 1992, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 34. [NUTRITIONAL PRODUCTS.] Medical assistance
covers nutritional products needed for treatment of
phenylketonuria, hyperlysinemia, maple syrup urine disease, a
combined allergy to human milk, cow's milk, and soy formula, or
any other childhood or adult diseases, conditions, or disorders
identified by the commissioner as requiring a similarly
necessary nutritional product. Nutritional products needed for
the treatment of a combined allergy to human milk, cow's milk,
and soy formula require prior authorization. Separate payment
shall not be made for nutritional products for residents of
long-term care facilities; payment for dietary requirements is a
component of the per diem rate paid to these facilities.
Sec. 49. Minnesota Statutes 1992, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 35. [AMERICAN INDIAN HEALTH SERVICES
FACILITIES.] Medical assistance payments to American Indian
health services facilities for outpatient medical services
billed after June 30, 1990, must be in accordance with the rate
published by the United States Assistant Secretary for Health
under the authority of United States Code, title 42, sections
248(a) and 249(b). General assistance medical care payments to
American Indian health services facilities for the provision of
outpatient medical care services billed after June 30, 1990,
must be in accordance with the general assistance medical care
rates paid for the same services when provided in a facility
other than an American Indian health service facility.
Sec. 50. [256B.0626] [ESTIMATION OF 50TH PERCENTILE OF
PREVAILING CHARGES.]
(a) The 50th percentile of the prevailing charge for the
base year identified in statute must be estimated by the
commissioner in the following situations:
(1) there were less than ten billings in the calendar year
specified in legislation governing maximum payment rates;
(2) the service was not available in the calendar year
specified in legislation governing maximum payment rates;
(3) the payment amount is the result of a provider appeal;
(4) the procedure code description has changed since the
calendar year specified in legislation governing maximum payment
rates, and, therefore, the prevailing charge information
reflects the same code but a different procedure description; or
(5) the 50th percentile reflects a payment which is grossly
inequitable when compared with payment rates for procedures or
services which are substantially similar.
(b) When one of the situations identified in paragraph (a)
occurs, the commissioner shall use the following methodology to
reconstruct a rate comparable to the 50th percentile of the
prevailing rate:
(1) refer to information which exists for the first nine
billings in the calendar year specified in legislation governing
maximum payment rates; or
(2) refer to surrounding or comparable procedure codes; or
(3) refer to the 50th percentile of years subsequent to the
calendar year specified in legislation governing maximum payment
rates, and reduce that amount by applying an appropriate
Consumer Price Index formula; or
(4) refer to relative value indexes; or
(5) refer to reimbursement information from other third
parties, such as Medicare.
Sec. 51. Minnesota Statutes 1992, section 256B.0627,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITION.] (a) "Home care services"
means a health service, determined by the commissioner as
medically necessary, that is ordered by a physician and
documented in a care plan that is reviewed by the physician at
least once every 60 days for the provision of home health
services, or private duty nursing, or at least once every 365
days for personal care. Home care services are provided to the
recipient at the recipient's residence that is a place other
than a hospital or long-term care facility or as specified in
section 256B.0625.
(b) "Medically necessary" has the meaning given in
Minnesota Rules, parts 9505.0170 to 9505.0475.
(c) "Care plan" means a written description of the services
needed which is signed developed by the supervisory nurse
together with the recipient or responsible party and includes a
detailed description of the covered home care services, who is
providing the services, frequency and duration of services, and
expected outcomes and goals including expected date of goal
accomplishment. The provider must give the recipient or
responsible party a copy of the completed care plan within 30
days of beginning home care services.
(d) "Responsible party" means an individual residing with a
recipient of personal care services who is capable of providing
the supportive care necessary to assist the recipient to live in
the community, is at least 18 years old, and is not a personal
care assistant. Responsible parties who are parents of minors
or guardians of minors or incapacitated persons may delegate the
responsibility to another adult during a temporary absence of at
least 24 hours but not more than six months. The person
delegated as a responsible party must be able to meet the
definition of responsible party, except that the delegated
responsible party is required to reside with the recipient only
while serving as the responsible party. Foster care license
holders may be designated the responsible party for residents of
the foster care home if case management is provided as required
in section 256B.0625, subdivision 19a. For persons who, as of
April 1, 1992, are sharing personal care services in order to
obtain the availability of 24-hour coverage, an employee of the
personal care provider organization may be designated as the
responsible party if case management is provided as required in
section 256B.0625, subdivision 19a.
Sec. 52. Minnesota Statutes 1992, section 256B.0627,
subdivision 4, is amended to read:
Subd. 4. [PERSONAL CARE SERVICES.] (a) The personal care
services that are eligible for payment are the following:
(1) bowel and bladder care;
(2) skin care to maintain the health of the skin;
(3) delegated therapy tasks specific to maintaining a
recipient's optimal level of functioning, including range of
motion and muscle strengthening exercises;
(4) respiratory assistance;
(5) transfers and ambulation;
(6) bathing, grooming, and hairwashing necessary for
personal hygiene;
(7) turning and positioning;
(8) assistance with furnishing medication that is normally
self-administered;
(9) application and maintenance of prosthetics and
orthotics;
(10) cleaning medical equipment;
(11) dressing or undressing;
(12) assistance with food, nutrition, and diet activities;
(13) accompanying a recipient to obtain medical diagnosis
or treatment;
(14) helping the recipient to complete daily living skills
such as personal and oral hygiene and medication schedules
assisting, monitoring, or prompting the recipient to complete
the services in clauses (1) to (13);
(15) supervision redirection, monitoring, and observation
that are medically necessary because of the recipient's
diagnosis or disability; and and an integral part of completing
the personal cares described in clauses (1) to (14);
(16) redirection and intervention for behavior, including
observation and monitoring;
(17) interventions for seizure disorders including
monitoring and observation if the recipient has had a seizure
that requires intervention within the past three months; and
(18) incidental household services that are an integral
part of a personal care service described in clauses (1)
to (15) (17).
For purposes of this subdivision, monitoring and
observation means watching for outward visible signs that are
likely to occur and for which there is a covered personal care
service or an appropriate personal care intervention.
(b) The personal care services that are not eligible for
payment are the following:
(1) personal care services that are not in the care plan
developed by the supervising registered nurse in consultation
with the personal care assistants and the recipient or the
responsible party directing the care of the recipient;
(2) services that are not supervised by the registered
nurse;
(3) services provided by the recipient's spouse, legal
guardian, or parent of a minor child;
(4) services provided by a foster care provider of a
recipient who cannot direct their own care, unless monitored by
a county or state case manager under section 256B.0625,
subdivision 19a;
(5) services provided by the residential or program license
holder in a residence for more than four persons;
(6) services that are the responsibility of a residential
or program license holder under the terms of a service agreement
and administrative rules;
(5) (7) sterile procedures;
(6) (8) injections of fluids into veins, muscles, or skin;
(7) (9) services provided by parents of adult recipients,
adult children, or siblings, unless these relatives meet one of
the following hardship criteria and the commissioner waives this
requirement:
(i) the relative resigns from a part-time or full-time job
to provide personal care for the recipient;
(ii) the relative goes from a full-time to a part-time job
with less compensation to provide personal care for the
recipient;
(iii) the relative takes a leave of absence without pay to
provide personal care for the recipient;
(iv) the relative incurs substantial expenses by providing
personal care for the recipient; or
(v) because of labor conditions, the relative is needed in
order to provide an adequate number of qualified personal care
assistants to meet the medical needs of the recipient;
(8) (10) homemaker services that are not an integral part
of a personal care services; and
(9) (11) home maintenance, or chore services.
Sec. 53. Minnesota Statutes 1992, section 256B.0627,
subdivision 5, is amended to read:
Subd. 5. [LIMITATION ON PAYMENTS.] Medical assistance
payments for home care services shall be limited according to
this subdivision.
(a) [EXEMPTION FROM PAYMENT LIMITATIONS.] The level, or
the number of hours or visits of a specific service, of home
care services to a recipient that began before and is continued
without increase on or after December 1987, shall be exempt from
the payment limitations of this section, as long as the services
are medically necessary.
(b) [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A
recipient may receive the following amounts of home care
services during a calendar year:
(1) a total of 40 home health aide visits or skilled nurse
visits under section 256B.0625, subdivision 6a; and
(2) a total of ten hours of nursing supervision under
section 256B.0625, subdivision 7 or 19a up to two assessments by
a supervising registered nurse to determine a recipient's need
for personal care services, develop a care plan, and obtain
prior authorization. Additional visits may be authorized by the
commissioner if there are circumstances that necessitate a
change in provider.
(c) [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care
services above the limits in paragraph (b) must receive the
commissioner's prior authorization, except when:
(1) the home care services were required to treat an
emergency medical condition that if not immediately treated
could cause a recipient serious physical or mental disability,
continuation of severe pain, or death. The provider must
request retroactive authorization no later than five working
days after giving the initial service. The provider must be
able to substantiate the emergency by documentation such as
reports, notes, and admission or discharge histories;
(2) the home care services were provided on or after the
date on which the recipient's eligibility began, but before the
date on which the recipient was notified that the case was
opened. Authorization will be considered if the request is
submitted by the provider within 20 working days of the date the
recipient was notified that the case was opened; or
(3) a third party payor for home care services has denied
or adjusted a payment. Authorization requests must be submitted
by the provider within 20 working days of the notice of denial
or adjustment. A copy of the notice must be included with the
request; or
(4) the commissioner has determined that a county or state
human services agency has made an error.
(d) [RETROACTIVE AUTHORIZATION.] A request for retroactive
authorization under paragraph (c) will be evaluated according to
the same criteria applied to prior authorization requests.
Implementation of this provision shall begin no later than
October 1, 1991, except that recipients who are currently
receiving medically necessary services above the limits
established under this subdivision may have a reasonable amount
of time to arrange for waivered services under section 256B.49
or to establish an alternative living arrangement. All current
recipients shall be phased down to the limits established under
paragraph (b) on or before April 1, 1992.
(e) [ASSESSMENT AND CARE PLAN.] The home care provider
shall conduct an initially, and at least annually thereafter, a
face-to-face assessment of the recipient and complete a care
plan using forms specified by the commissioner. For the
recipient to receive, or continue to receive, home care
services, the provider must submit evidence necessary for the
commissioner to determine the medical necessity of the home care
services. The provider shall submit to the commissioner the
assessment, the care plan, and other information necessary to
determine medical necessity such as diagnostic or testing
information, social or medical histories, and hospital or
facility discharge summaries. To continue to receive home care
services when the recipient displays no significant change, the
supervising nurse has the option to review with the
commissioner, or the commissioner's designee, the care plan on
record and receive authorization for up to an additional 12
months.
(f) [PRIOR AUTHORIZATION.] The commissioner, or the
commissioner's designee, shall review the assessment, the care
plan, and any additional information that is submitted. The
commissioner shall, within 30 days after receiving a complete
request, assessment, and care plan, authorize home care services
as follows:
(1) [HOME HEALTH SERVICES.] All home health services
provided by a nurse or a home health aide that exceed the limits
established in paragraph (b) must be prior authorized by the
commissioner or the commissioner's designee. Prior
authorization must be based on medical necessity and
cost-effectiveness when compared with other care options. When
home health services are used in combination with personal care
and private duty nursing, the cost of all home care services
shall be considered for cost-effectiveness. The commissioner
shall limit nurse and home health aide visits to no more than
one visit each per day.
(2) [PERSONAL CARE SERVICES.] (i) All personal care
services must be prior authorized by the commissioner or the
commissioner's designee except for the limits on supervision
established in paragraph (b). The amount of personal care
services authorized must be based on the recipient's case mix
classification according to section 256B.0911, except that home
care rating. A child may not be found to be dependent in an
activity of daily living if because of the child's age an adult
would either perform the activity for the child or assist the
child with the activity and the amount of assistance needed is
similar to the assistance appropriate for a typical child of the
same age. Based on medical necessity, the commissioner may
authorize:
(A) up to two times the average number of direct care hours
provided in nursing facilities for the recipient's comparable
case mix level; or
(B) up to three times the average number of direct care
hours provided in nursing facilities for recipients who have
complex medical needs or are dependent in at least seven
activities of daily living and need physical assistance with
eating or have a neurological diagnosis; or
(C) up to 60 percent of the average reimbursement rate, as
of July 1, 1991, plus any inflation adjustment provided, for
care provided in a regional treatment center for recipients who
have complex behaviors Level I behavior; or
(D) up to the amount the commissioner would pay, as of July
1, 1991, plus any inflation adjustment provided, for care
provided in a regional treatment center for recipients referred
to the commissioner by a regional treatment center preadmission
evaluation team. For purposes of this clause, home care
services means all services provided in the home or community
that would be included in the payment to a regional treatment
center; or
(E) up to the amount medical assistance would reimburse for
facility care for recipients referred to the commissioner by a
preadmission screening team established under section 256B.0911
or 256B.092.; and
(F) a reasonable amount of time for the necessary provision
of nursing supervision of personal care services.
(ii) The number of direct care hours shall be determined
according to the annual cost reports which are report submitted
to the department by nursing facilities each year. The average
number of direct care hours, as established by May 1, 1992,
shall be calculated and incorporated into the home care limits
on July 1 each year, 1992. These limits shall be calculated to
the nearest quarter hour.
(iii) The case mix level home care rating shall be
determined by the commissioner or the commissioner's designee
based on information submitted to the commissioner by the
personal care provider on forms specified by the commissioner.
The forms home care rating shall be a combination of current
assessment tools developed under sections 256B.0911 and 256B.501
with an addition for seizure activity that will assess the
frequency and severity of seizure activity and with adjustments,
additions, and clarifications that are necessary to reflect the
needs and conditions of children and nonelderly adults who need
home care. The commissioner shall establish these forms and
protocols under this section and shall use the advisory group
established in section 256B.04, subdivision 16, for consultation
in establishing the forms and protocols by October 1, 1991.
(iv) A recipient shall qualify as having complex medical
needs if the care required is difficult to perform and because
of recipient's medical condition requires more time than
community-based standards allow or the recipient's condition or
treatment requires more training or requires more skill than
would ordinarily be required and the recipient needs or has one
or more of the following:
(A) daily tube feedings;
(B) daily parenteral therapy;
(C) wound or decubiti care;
(D) postural drainage, percussion, nebulizer treatments,
suctioning, tracheotomy care, oxygen, mechanical ventilation;
(E) catheterization;
(F) ostomy care;
(G) quadriplegia; or
(H) other comparable medical conditions or treatments the
commissioner determines would otherwise require institutional
care.
(v) A recipient shall qualify as having complex Level I
behavior if there is reasonable supporting evidence that the
recipient exhibits on a daily basis, or that without
supervision, observation, or redirection would exhibit, one or
more of the following behaviors that cause, or have the
potential to cause:
(A) self-injurious behavior injury to his or her own body;
(B) unusual or repetitive habits physical injury to other
people; or
(C) withdrawal behavior;
(D) hurtful behavior to others;
(E) socially offensive behavior;
(F) destruction of property; or
(G) a need for constant one-to-one supervision for
self-preservation.
(vi) The complex behaviors in clauses (A) to (G) have the
meanings developed under section 256B.501 Time authorized for
personal care relating to Level I behavior in subclause (v),
items (A) to (C), shall be based on the predictability,
frequency, and amount of intervention required.
(vii) A recipient shall qualify as having Level II behavior
if the recipient exhibits on a daily basis one or more of the
following behaviors that interfere with the completion of
personal care services under subdivision 4, paragraph (a):
(A) unusual or repetitive habits;
(B) withdrawn behavior; or
(C) offensive behavior.
(viii) A recipient with a home care rating of Level II
behavior in subclause (vii), items (A) to (C), shall be rated as
comparable to a recipient with complex medical needs under
subclause (iv). If a recipient has both complex medical needs
and Level II behavior, the home care rating shall be the next
complex category up to the maximum rating under subclause (i),
item (B).
(3) [PRIVATE DUTY NURSING SERVICES.] All private duty
nursing services shall be prior authorized by the commissioner
or the commissioner's designee. Prior authorization for private
duty nursing services shall be based on medical necessity and
cost-effectiveness when compared with alternative care options.
The commissioner may authorize medically necessary private duty
nursing services in quarter-hour units when:
(i) the recipient requires more individual and continuous
care than can be provided during a nurse visit; or
(ii) the cares are outside of the scope of services that
can be provided by a home health aide or personal care assistant.
The commissioner may authorize:
(A) up to two times the average amount of direct care hours
provided in nursing facilities statewide for case mix
classification "K" as established by the annual cost report
submitted to the department by nursing facilities in May 1992;
(B) private duty nursing in combination with other home
care services up to the total cost allowed under clause (2);
(C) up to 16 hours per day if the recipient requires more
nursing than the maximum number of direct care hours as
established in item (A) and the recipient meets the hospital
admission criteria established under Minnesota Rules, parts
9505.0500 to 9505.0540.
The commissioner may authorize up to 16 hours per day of
private duty nursing services or up to 24 hours per day of
private duty nursing services until such time as the
commissioner is able to make a determination of eligibility for
recipients who are cooperatively applying for home care services
under the community alternative care program developed under
section 256B.49, or until it is determined by the appropriate
regulatory agency that a health benefit plan is or is not
required to pay for appropriate medically necessary health care
services. Recipients or their representatives must
cooperatively assist the commissioner in obtaining this
determination. Recipients who are eligible for the community
alternative care program may not receive more hours of nursing
under this section than would otherwise be authorized under
section 256B.49.
(4) [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is
ventilator-dependent, the monthly medical assistance
authorization for home care services shall not exceed what the
commissioner would pay for care at the highest cost hospital
designated as a long-term hospital under the Medicare program.
For purposes of this clause, home care services means all
services provided in the home that would be included in the
payment for care at the long-term hospital.
"Ventilator-dependent" means an individual who receives
mechanical ventilation for life support at least six hours per
day and is expected to be or has been dependent for at least 30
consecutive days.
(g) [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner
or the commissioner's designee shall determine the time period
for which a prior authorization shall remain valid be effective.
If the recipient continues to require home care services beyond
the duration of the prior authorization, the home care provider
must request a new prior authorization through the process
described above. Under no circumstances, other than the
exceptions in subdivision 5, paragraph (c), shall a prior
authorization be valid prior to the date the commissioner
receives the request or for more than 12 months. A recipient
who appeals a reduction in previously authorized home care
services may request that the continue previously authorized
services, other than temporary services under paragraph (i), be
continued pending an appeal under section 256.045, subdivision
10. The commissioner must provide a detailed explanation of why
the authorized services are reduced in amount from those
requested by the home care provider.
(h) [APPROVAL OF HOME CARE SERVICES.] The commissioner or
the commissioner's designee shall determine the medical
necessity of home care services, the level of caregiver
according to subdivision 2, and the institutional comparison
according to this subdivision, the cost-effectiveness of
services, and the amount, scope, and duration of home care
services reimbursable by medical assistance, based on the
assessment, the care plan, the recipient's age, the cost of
services, the recipient's medical condition, and diagnosis or
disability. The commissioner may publish additional criteria
for determining medical necessity according to section 256B.04.
(i) [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.]
Providers may request a temporary authorization for home care
services by telephone. The commissioner may approve a temporary
level of home care services based on the assessment and care
plan information provided by an appropriately licensed nurse.
Authorization for a temporary level of home care services is
limited to the time specified by the commissioner, but shall not
exceed 30 45 days. The level of services authorized under this
provision shall have no bearing on a future prior authorization.
(j) [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.]
Home care services provided in an adult or child foster care
setting must receive prior authorization by the department
according to the limits established in paragraph (b).
The commissioner may not authorize:
(1) home care services that are the responsibility of the
foster care provider under the terms of the foster care
placement agreement and administrative rules;
(2) personal care services when the foster care license
holder is also the personal care provider or personal care
assistant unless the recipient can direct the recipient's own
care, or case management is provided as required in section
256B.0625, subdivision 19a;
(3) personal care services when the responsible party is an
employee of, or under contract with, or has any direct or
indirect financial relationship with the personal care provider
or personal care assistant, unless case management is provided
as required in section 256B.0625, subdivision 19a;
(4) home care services when the number of foster care
residents is greater than four unless the county responsible for
the recipient's foster placement made the placement prior to
April 1, 1992, requests that home care services be provided, and
case management is provided as required in section 256B.0625,
subdivision 19a; or
(5) home care services when combined with foster care
payments, other than room and board payments plus the cost of
home- and community-based waivered services unless the costs of
home care services and waivered services are combined and
managed under the waiver program, that exceed the total amount
that public funds would pay for the recipient's care in a
medical institution.
Sec. 54. Minnesota Statutes 1992, section 256B.0628,
subdivision 2, is amended to read:
Subd. 2. [CONTRACTOR DUTIES.] (a) The commissioner may
contract with or employ qualified registered nurses and
necessary support staff, or contract with qualified agencies, to
provide home care prior authorization and review services for
medical assistance recipients who are receiving home care
services.
(b) Reimbursement for the prior authorization function
shall be made through the medical assistance administrative
authority. The state shall pay the nonfederal share. The
contractor must functions will be to:
(1) assess the recipient's individual need for services
required to be cared for safely in the community;
(2) ensure that a care plan that meets the recipient's
needs is developed by the appropriate agency or individual;
(3) ensure cost-effectiveness of medical assistance home
care services;
(4) recommend to the commissioner the approval or denial of
the use of medical assistance funds to pay for home care
services when home care services exceed thresholds established
by the commissioner under Minnesota Rules, parts 9505.0170 to
9505.0475;
(5) reassess the recipient's need for and level of home
care services at a frequency determined by the commissioner; and
(6) conduct on-site assessments when determined necessary
by the commissioner and recommend changes to care plans that
will provide more efficient and appropriate home care.
(c) In addition, the contractor may be requested by the
commissioner to or the commissioner's designee may:
(1) review care plans and reimbursement data for
utilization of services that exceed community-based standards
for home care, inappropriate home care services, medical
necessity, home care services that do not meet quality of care
standards, or unauthorized services and make appropriate
referrals to the commissioner within the department or to other
appropriate entities based on the findings;
(2) assist the recipient in obtaining services necessary to
allow the recipient to remain safely in or return to the
community;
(3) coordinate home care services with other medical
assistance services under section 256B.0625;
(4) assist the recipient with problems related to the
provision of home care services; and
(5) assure the quality of home care services.
(d) For the purposes of this section, "home care services"
means medical assistance services defined under section
256B.0625, subdivisions 6a, 7, and 19a.
Sec. 55. Minnesota Statutes 1992, section 256B.0629,
subdivision 4, is amended to read:
Subd. 4. [RESPONSIBILITIES OF THE COMMISSIONER.] (a) The
commissioner shall periodically:
(1) Recommend to the legislature criteria governing the
eligibility of organ and tissue transplant procedures for
reimbursement from medical assistance and general assistance
medical care. Procedures approved by Medicare are automatically
eligible for medical assistance and general assistance medical
care reimbursement. Additional procedures are eligible for
reimbursement only upon approval by the legislature. Only
procedures if they are recommended by both the task force and
the commissioner may be considered by the legislature.
(2) Recommend to the legislature criteria for certifying
transplant centers within and outside of Minnesota where
Minnesotans receiving medical assistance and general assistance
medical care may obtain transplants. Additional centers may be
certified only upon approval of the legislature. Only centers
recommended by the task force and the commissioner may be
considered by the legislature.
Sec. 56. Minnesota Statutes 1992, section 256B.0911,
subdivision 2, is amended to read:
Subd. 2. [PERSONS REQUIRED TO BE SCREENED; EXEMPTIONS.]
All applicants to Medicaid certified nursing facilities must be
screened prior to admission, regardless of income, assets, or
funding sources, except the following:
(1) patients who, having entered acute care facilities from
certified nursing facilities, are returning to a certified
nursing facility;
(2) residents transferred from other certified nursing
facilities;
(3) individuals 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 prior to admission and
provides an update to the screening team on the 30th day after
admission;
(4) individuals who have a contractual right to have their
nursing facility care paid for indefinitely by the veteran's
administration; or
(5) (4) individuals who are enrolled in the Ebenezer/Group
Health social health maintenance organization project at the
time of application to a nursing home; or
(6) individuals who are screened by another state within
three months before admission to a certified nursing facility.
Regardless of the exemptions in clauses (2) to (6) (4),
persons who have a diagnosis or possible diagnosis of mental
illness, mental retardation, or a related condition must be
screened before admission unless the admission prior to
screening is authorized by the local mental health authority or
the local developmental disabilities case manager, or unless
authorized by the county agency according to Public Law Number
101-508.
Persons transferred from an acute care facility to a
certified nursing facility may be admitted to the nursing
facility before screening, if authorized by the county agency;
however, the person must be screened within ten working days
after the admission. Before admission to a Medicaid certified
nursing home or boarding care home, all persons must be screened
and approved for admission through an assessment process. The
nursing facility is authorized to conduct case mix assessments
which are not conducted by the county public health nurse under
Minnesota Rules, part 9549.0059. The designated county agency
is responsible for distributing the quality assurance and review
form for all new applicants to nursing homes.
Other persons who are not applicants to nursing facilities
must be screened if a request is made for a screening.
Sec. 57. Minnesota Statutes 1992, section 256B.0911, is
amended by adding a subdivision to read:
Subd. 2a. [SCREENING REQUIREMENTS.] Persons may be
screened by telephone or in a face-to-face consultation. The
screener will identify each individual's needs according to the
following categories: (1) needs no face-to-face screening; (2)
needs an immediate face-to-face screening interview; or (3)
needs a face-to-face screening interview after admission to a
certified nursing facility or after a return home. Persons who
are not admitted to a Medicaid certified nursing facility must
be screened within ten working days after the date of referral.
Persons admitted on a nonemergency basis to a Medicaid certified
nursing facility must be screened prior to the certified nursing
facility admission. Persons admitted to the Medicaid certified
nursing facility from the community on an emergency basis or
from an acute care facility on a nonworking day must be screened
the first working day after admission and the reason for the
emergency admission must be certified by the attending physician
in the person's medical record.
Sec. 58. Minnesota Statutes 1992, section 256B.0911,
subdivision 3, is amended to read:
Subd. 3. [PERSONS RESPONSIBLE FOR CONDUCTING THE
PREADMISSION SCREENING.] (a) A local screening team shall be
established by the county agency and the county public health
nursing service of the local board of health board of
commissioners. Each local screening team shall be composed
consist of screeners who are a social worker and a public health
nurse from their respective county agencies. If a county does
not have a public health nurse available, it may request
approval from the commissioner to assign a county registered
nurse with at least one year experience in home care to
participate on the team. Two or more counties may collaborate
to establish a joint local screening team or teams.
(b) Both members of the team must conduct the screening.
However, individuals who are being transferred from an acute
care facility to a certified nursing facility and individuals
who are admitted to a certified nursing facility on an emergency
basis may be screened by only one member of the screening team
in consultation with the other member.
(c) In assessing a person's needs, each screening
team screeners shall have a physician available for consultation
and shall consider the assessment of the individual's attending
physician, if any. The individual's physician shall be included
on the screening team if the physician chooses to participate.
Other personnel may be included on the team as deemed
appropriate by the county agencies.
(d) If a person who has been screened must be reassessed to
assign a case mix classification because admission to a nursing
facility 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.
Sec. 59. Minnesota Statutes 1992, section 256B.0911,
subdivision 4, is amended to read:
Subd. 4. [RESPONSIBILITIES OF THE COUNTY AGENCY AND THE
SCREENING TEAM.] (a) The county agency shall:
(1) provide information and education to the general public
regarding availability of the preadmission screening program;
(2) accept referrals from individuals, families, human
service and health professionals, and hospital and nursing
facility personnel;
(3) assess the health, psychological, and social needs of
referred individuals and identify services needed to maintain
these persons in the least restrictive environments;
(4) determine if the individual screened needs nursing
facility level of care;
(5) assess active treatment specialized service needs in
cooperation with based upon an evaluation by:
(i) a qualified independent mental health professional for
persons with a primary or secondary diagnosis of a serious
mental illness; and
(ii) a qualified mental retardation professional for
persons with a primary or secondary diagnosis of mental
retardation or related conditions. For purposes of this clause,
a qualified mental retardation professional must meet the
standards for a qualified mental retardation professional in
Code of Federal Regulations, title 42, section 483.430;
(6) make recommendations for individuals screened regarding
cost-effective community services which are available to the
individual;
(7) make recommendations for individuals screened regarding
nursing home placement when there are no cost-effective
community services available;
(8) develop an individual's community care plan and provide
follow-up services as needed; and
(9) prepare and submit reports that may be required by the
commissioner of human services.
The county agency may determine in cooperation with the
local board of health that the public health nursing agency of
the local board of health is the lead agency which is
responsible for all of the activities above except clause (5).
(b) The screening team screener shall document that the
most cost-effective alternatives available were offered to the
individual or the individual's legal representative. For
purposes of this section, "cost-effective alternatives" means
community services and living arrangements that cost the same or
less than nursing facility care.
The screening shall be conducted within ten working days
after the date of referral or, for those approved for transfer
from an acute care facility to a certified nursing facility,
within ten working days after admission to the nursing facility.
(c) For persons who are eligible for medical assistance or
who would be eligible within 180 days of admission to a nursing
facility and who are admitted to a nursing facility, the nursing
facility must include the screening team a screener or the case
manager in the discharge planning process for those individuals
who the team has determined have discharge potential. The
screening team screener or the case manager must ensure a smooth
transition and follow-up for the individual's return to the
community.
Local screening teams Screeners shall cooperate with other
public and private agencies in the community, in order to offer
a variety of cost-effective services to the disabled and
elderly. The screening team screeners shall encourage the use
of volunteers from families, religious organizations, social
clubs, and similar civic and service organizations to provide
services.
Sec. 60. Minnesota Statutes 1992, section 256B.0911,
subdivision 6, is amended to read:
Subd. 6. [REIMBURSEMENT PAYMENT FOR PREADMISSION
SCREENING.] (a) The total screening cost payment for each county
must be paid monthly by certified nursing facilities in the
county. The monthly amount to be paid by each nursing facility
for each fiscal year must be determined by dividing the county's
estimate of the total annual cost of allocation for screenings
allowed in the county for the following rate year by 12 to
determine the monthly cost estimate payment and allocating the
monthly cost estimate payment to each nursing facility based on
the number of licensed beds in the nursing facility.
(b) The rate allowed for a screening where two team members
are present shall be the actual costs up to $195. The rate
allowed for a screening where only one team member is present
shall be the actual costs up to $117. Annually on July 1, the
commissioner shall adjust the rate up to the percentage change
forecast in the fourth quarter of the prior calendar year by the
Home Health Agency Market Basket of Operating Costs, unless
otherwise adjusted by statute. The Home Health Agency Market
Basket of Operating Costs is published by Data Resources, Inc.
(c) The monthly cost estimate for each certified nursing
facility must be submitted to the state by the county no later
than February 15 of each year for inclusion in the nursing
facility's payment rate on the following rate year. The
commissioner shall include the reported annual estimated cost of
screenings for each nursing facility as an operating cost of
that nursing facility in accordance with section 256B.431,
subdivision 2b, paragraph (g). The monthly cost estimates
approved by the commissioner must be sent to the nursing
facility by the county no later than April 15 of each year.
(d) If in more than ten percent of the total number of
screenings performed by a county in a fiscal year for all
individuals regardless of payment source, the screening
timelines were not met because a county was late in screening
the individual, the county is solely responsible for paying the
cost of those delayed screenings that exceed ten percent.
(b) Payments for screening activities are available to the
county or counties to cover staff salaries and expenses to
provide the screening function. The lead agency shall employ,
or contract with other agencies to employ, within the limits of
available funding, sufficient personnel to conduct the
preadmission screening activity while meeting the state's
long-term care outcomes and objectives as defined in section
256B.0917, subdivision 1. The local agency shall be accountable
for meeting local objectives as approved by the commissioner in
the CSSA biennial plan.
(e) (c) Notwithstanding section 256B.0641, overpayments
attributable to payment of the screening costs under the medical
assistance program may not be recovered from a facility.
(f) (d) The commissioner of human services shall amend the
Minnesota medical assistance plan to include reimbursement for
the local screening teams.
Sec. 61. Minnesota Statutes 1992, section 256B.0911,
subdivision 7, is amended to read:
Subd. 7. [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.]
(a) Medical assistance reimbursement for nursing facilities
shall be authorized for a medical assistance recipient only if a
preadmission screening has been conducted prior to admission or
the local county agency has authorized an exemption. Medical
assistance reimbursement for nursing facilities shall not be
provided for any recipient who the local screening team screener
has determined does not meet the level of care criteria for
nursing facility placement or, if indicated, has not had a level
II PASARR evaluation completed unless an admission for a
recipient with mental illness is approved by the local mental
health authority or an admission for a recipient with mental
retardation or related condition is approved by the state mental
retardation authority. The commissioner shall make a request to
the health care financing administration for a waiver allowing
screening team approval of Medicaid payments for certified
nursing facility care. An individual has a choice and makes the
final decision between nursing facility placement and community
placement after the screening team's recommendation, except as
provided in paragraphs (b) and (c). However,
(b) The local county mental health authority or the local
state mental retardation authority under Public Law Numbers
100-203 and 101-508 may prohibit admission to a nursing
facility, if the individual does not meet the nursing facility
level of care criteria or does need active treatment needs
specialized services as defined in Public Law Numbers 100-203
and 101-508. For purposes of this section, "specialized
services" for a person with mental retardation or a related
condition means "active treatment" as that term is defined in
Code of Federal Regulations, title 42, section 483.440(a)(1).
(c) Upon the receipt by the commissioner of approval by the
secretary of health and human services of the waiver requested
under paragraph (a), the local screener shall deny medical
assistance reimbursement for nursing facility care for an
individual whose long-term care needs can be met in a
community-based setting and whose cost of community-based home
care services is less than 75 percent of the average payment for
nursing facility care for that individual's case mix
classification, and who is either:
(i) a current medical assistance recipient being screened
for admission to a nursing facility; or
(ii) an individual who would be eligible for medical
assistance within 180 days of entering a nursing facility and
who meets a nursing facility level of care.
(d) Appeals from the screening team's recommendation or the
county agency's final decision shall be made according to
section 256.045, subdivision 3.
Sec. 62. Minnesota Statutes 1992, section 256B.0913,
subdivision 4, is amended to read:
Subd. 4. [ELIGIBILITY FOR FUNDING FOR SERVICES FOR
NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services
under the alternative care program is available to persons who
meet the following criteria:
(1) the person has been screened by the county screening
team or, if previously screened and served under the alternative
care program, assessed by the local county social worker or
public health nurse;
(2) the person is age 65 or older;
(3) the person would be financially eligible for medical
assistance within 180 days of admission to a nursing facility;
(4) the person meets the asset transfer requirements of the
medical assistance program;
(5) the screening team would recommend nursing facility
admission or continued stay for the person if alternative care
services were not available;
(5) (6) the person needs services that are not available at
that time in the county through other county, state, or federal
funding sources; and
(6) (7) the monthly cost of the alternative care services
funded by the program for this person does not exceed 75 percent
of the statewide average monthly medical assistance payment for
nursing facility care at the individual's case mix
classification to which the individual would be assigned under
Minnesota Rules, parts 9549.0050 to 9549.0059.
(b) Individuals who meet the criteria in paragraph (a) and
who have been approved for alternative care funding are called
180-day eligible clients.
(c) The statewide average payment for nursing facility care
is the statewide average monthly nursing facility rate in effect
on July 1 of the fiscal year in which the cost is incurred, less
the statewide average monthly income of nursing facility
residents who are age 65 or older and who are medical assistance
recipients in the month of March of the previous fiscal year.
This monthly limit does not prohibit the 180-day eligible client
from paying for additional services needed or desired.
(d) In determining the total costs of alternative care
services for one month, the costs of all services funded by the
alternative care program, including supplies and equipment, must
be included.
(e) Alternative care funding under this subdivision is not
available for a person who is a medical assistance recipient or
who would be eligible for medical assistance without a
spend-down if the person applied, unless authorized by the
commissioner. The commissioner may authorize alternative care
money to be used to meet a portion of a medical assistance
income spend-down for persons residing in adult foster care who
would otherwise be served under the alternative care program.
The alternative care payment is limited to the difference
between the recipient's negotiated foster care room and board
rate and the medical assistance income standard for one elderly
person plus the medical assistance personal needs allowance for
a person residing in a long-term care facility. A person whose
application for medical assistance is being processed may be
served under the alternative care program for a period up to 60
days. If the individual is found to be eligible for medical
assistance, the county must bill medical assistance retroactive
to from the date of eligibility the individual was found
eligible for the medical assistance services provided that are
reimbursable under the elderly waiver program.
(f) Alternative care funding is not available for a person
who resides in a licensed nursing home or boarding care home,
except for case management services which are being provided in
support of the discharge planning process.
Sec. 63. Minnesota Statutes 1992, section 256B.0913,
subdivision 5, is amended to read:
Subd. 5. [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a)
Alternative care funding may be used for payment of costs of:
(1) adult foster care;
(2) adult day care;
(3) home health aide;
(4) homemaker services;
(5) personal care;
(6) case management;
(7) respite care;
(8) assisted living; and
(9) residential care services;
(10) care-related supplies and equipment.;
(b) The county agency may use up to ten percent of the
annual allocation of alternative care funding for payment of
costs of
(11) meals delivered to the home,;
(12) transportation,;
(13) skilled nursing,;
(14) chore services,;
(15) companion services,;
(16) nutrition services,; and
(17) training for direct informal caregivers.
The commissioner shall determine the impact on alternative
care costs of allowing these additional services to be provided
and shall report the findings to the legislature by February 15,
1993, including any recommendations regarding provision of the
additional services.
(c) (b) The county agency must ensure that the funds are
used only to supplement and not supplant services available
through other public assistance or services programs.
(d) These services must be provided by a licensed provider,
a home health agency certified for reimbursement under Titles
XVIII and XIX of the Social Security Act, or by (c) Unless
specified in statute, the service standards for alternative care
services shall be the same as the service standards defined in
the elderly waiver. Persons or agencies must be employed by or
contracted under a contract with the county agency or the public
health nursing agency of the local board of health in order to
receive funding under the alternative care program.
(e) (d) The adult foster care rate shall be considered a
difficulty of care payment and shall not include room and
board. The adult foster care daily rate shall be negotiated
between the county agency and the foster care provider. The
rate established under this section shall not exceed 75 percent
of the state average monthly nursing home payment for the case
mix classification to which the individual receiving foster care
is assigned, and it must allow for other alternative care
services to be authorized by the case manager.
(f) (e) Personal care services may be provided by a
personal care provider organization. A county agency may
contract with a relative of the client to provide personal care
services, but must ensure nursing supervision. Covered personal
care services defined in section 256B.0627, subdivision 4, must
meet applicable standards in Minnesota Rules, part 9505.0335.
(g) (f) Costs for supplies and equipment that exceed $150
per item per month must have prior approval from the
commissioner. A county may use alternative care funds to
purchase supplies and equipment from a non-Medicaid certified
vendor if the cost for the items is less than that of a Medicaid
vendor.
(g) For purposes of this section, residential care services
are services which are provided to individuals living in
residential care homes. Residential care homes are currently
licensed as board and lodging establishments and are registered
with the department of health as providing special services.
Residential care services are defined as "supportive services"
and "health-related services." "Supportive services" means the
provision of up to 24-hour supervision and oversight.
Supportive services includes: (1) transportation, when provided
by the residential care center only; (2) socialization, when
socialization is part of the plan of care, has specific goals
and outcomes established, and is not diversional or recreational
in nature; (3) assisting clients in setting up meetings and
appointments; (4) assisting clients in setting up medical and
social services; (5) providing assistance with personal laundry,
such as carrying the client's laundry to the laundry room.
Assistance with personal laundry does not include any laundry,
such as bed linen, that is included in the room and board rate.
Health-related services are limited to minimal assistance with
dressing, grooming, and bathing and providing reminders to
residents to take medications that are self-administered or
providing storage for medications, if requested. Individuals
receiving residential care services cannot receive both personal
care services and residential care services.
(h) For the purposes of this section, "assisted living"
refers to supportive services provided by a single vendor to two
or more alternative care clients who reside in the same
apartment building of ten three or more units. These services
may include care coordination, the costs of preparing one or
more nutritionally balanced meals per day, general oversight,
and other supportive services which the vendor is licensed to
provide according to sections 144A.43 to 144A.49, and which
would otherwise be available to individual alternative care
clients. Reimbursement from the lead agency shall be made to
the vendor as a monthly capitated rate negotiated with the
county agency. The capitated rate shall not exceed the state
share of the greater of either the statewide or any of the
geographic groups' weighted average monthly medical assistance
nursing facility payment rate of the case mix resident class to
which the 180-day eligible client would be assigned under
Minnesota Rules, parts 9549.0050 to 9549.0059. The capitated
rate may not cover rent and direct food costs. Assisted living
services are defined as up to 24-hour supervision, and
oversight, supportive services as defined in clause (1),
individualized home care aide tasks as defined in clause (2),
and individualized home management tasks as defined in clause
(3) provided to residents of a residential center living in
their units or apartments with a full kitchen and bathroom. A
full kitchen includes a stove, oven, refrigerator, food
preparation counter space, and a kitchen utensil storage
compartment. Assisted living services must be provided by the
management of the residential center or by providers under
contract with the management or with the county.
(1) Supportive services include:
(i) socialization, when socialization is part of the plan
of care, has specific goals and outcomes established, and is not
diversional or recreational in nature;
(ii) assisting clients in setting up meetings and
appointments; and
(iii) providing transportation, when provided by the
residential center only.
Individuals receiving assisted living services will not
receive both assisted living services and homemaking or personal
care services. Individualized means services are chosen and
designed specifically for each resident's needs, rather than
provided or offered to all residents regardless of their
illnesses, disabilities, or physical conditions.
(2) Home care aide tasks means:
(i) preparing modified diets, such as diabetic or low
sodium diets;
(ii) reminding residents to take regularly scheduled
medications or to perform exercises;
(iii) household chores in the presence of technically
sophisticated medical equipment or episodes of acute illness or
infectious disease;
(iv) household chores when the resident's care requires the
prevention of exposure to infectious disease or containment of
infectious disease; and
(v) assisting with dressing, oral hygiene, hair care,
grooming, and bathing, if the resident is ambulatory, and if the
resident has no serious acute illness or infectious disease.
Oral hygiene means care of teeth, gums, and oral prosthetic
devices.
(3) Home management tasks means:
(i) housekeeping;
(ii) laundry;
(iii) preparation of regular snacks and meals; and
(iv) shopping.
A person's eligibility to reside in the building must not
be contingent on the person's acceptance or use of the assisted
living services. Assisted living services as defined in this
section shall not be authorized in boarding and lodging
establishments licensed according to sections 157.01 to 157.031.
Reimbursement for assisted living services and residential
care services shall be made by the lead agency to the vendor as
a monthly rate negotiated with the county agency. The rate
shall not exceed the nonfederal share of the greater of either
the statewide or any of the geographic groups' weighted average
monthly medical assistance nursing facility payment rate of the
case mix resident class to which the 180-day eligible client
would be assigned under Minnesota Rules, parts 9549.0050 to
9549.0059, except for alternative care assisted living projects
established under chapter 256 whose rates may not exceed 65
percent of either the statewide or any of the geographic groups'
weighted average monthly medical assistance nursing facility
payment rate of the case mix resident class to which the 180-day
eligible client would be assigned under Minnesota Rules, parts
9549.0050 to 9549.0059. The rate may not cover rent and direct
food costs.
(i) For purposes of this section, companion services are
defined as nonmedical care, supervision and oversight, provided
to a functionally impaired adult. Companions may assist the
individual with such tasks as meal preparation, laundry and
shopping, but do not perform these activities as discrete
services. The provision of companion services does not entail
hands-on medical care. Providers may also perform light
housekeeping tasks which are incidental to the care and
supervision of the recipient. This service must be approved by
the case manager as part of the care plan. Companion services
must be provided by individuals or nonprofit organizations who
are under contract with the local agency to provide the
service. Any person related to the waiver recipient by blood,
marriage or adoption cannot be reimbursed under this service.
Persons providing companion services will be monitored by the
case manager.
(j) For purposes of this section, training for direct
informal caregivers is defined as a classroom or home course of
instruction which may include: transfer and lifting skills,
nutrition, personal and physical cares, home safety in a home
environment, stress reduction and management, behavioral
management, long-term care decision making, care coordination
and family dynamics. The training is provided to an informal
unpaid caregiver of a 180-day eligible client which enables the
caregiver to deliver care in a home setting with high levels of
quality. The training must be approved by the case manager as
part of the individual care plan. Individuals, agencies, and
educational facilities which provide caregiver training and
education will be monitored by the case manager.
Sec. 64. Minnesota Statutes 1992, section 256B.0913,
subdivision 9, is amended to read:
Subd. 9. [CONTRACTING PROVISIONS FOR PROVIDERS.] The lead
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 program
or waiver programs under sections 256B.0915 and 256B.49,
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. The lead agency shall also document to the
commissioner that the agency allowed potential providers an
opportunity to be selected to contract with the county agency.
Funds reimbursed to counties under this subdivision are subject
to audit by the commissioner for fiscal and utilization control.
The lead agency 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.
Sec. 65. Minnesota Statutes 1992, section 256B.0913,
subdivision 12, is amended to read:
Subd. 12. [CLIENT PREMIUMS.] (a) A premium is required for
all 180-day eligible clients to help pay for the cost of
participating in the program. The amount of the premium for the
alternative care client shall be determined as follows:
(1) when the alternative care client's gross income less
recurring and predictable medical expenses is greater than the
medical assistance income standard but less than 150 percent of
the federal poverty guideline, and total assets are less than
$6,000, the fee is zero;
(2) when the alternative care client's gross income less
recurring and predictable medical expenses is greater than 150
percent of the federal poverty guideline and total assets are
less than $6,000, the fee is 25 percent of the cost of
alternative care services or the difference between 150 percent
of the federal poverty guideline and the client's gross
income less recurring and predictable medical expenses,
whichever is less; and
(3) when the alternative care client's total assets are
greater than $6,000, the fee is 25 percent of the cost of
alternative care services.
For married persons, total assets are defined as the total
marital assets less the estimated community spouse asset
allowance, under section 256B.059, if applicable. For married
persons, total income is defined as the client's income less the
monthly spousal allotment, under section 256B.058.
All alternative care services except case management shall
be included in the estimated costs for the purpose of
determining 25 percent of the costs.
The monthly premium shall be calculated and be payable in
the month in which the alternative care services begin and shall
continue unaltered for six months until the semiannual
reassessment unless the actual cost of services falls below the
fee.
(b) The fee shall be waived by the commissioner when:
(1) a person who is residing in a nursing facility is
receiving case management only;
(2) a person is applying for medical assistance;
(3) a married couple is requesting an asset assessment
under the spousal impoverishment provisions;
(4) a person is a medical assistance recipient, but has
been approved for alternative care-funded assisted living
services;
(5) a person is found eligible for alternative care, but is
not yet receiving alternative care services;
(6) a person is an adult foster care resident for whom
alternative care funds are being used to meet a portion of the
person's medical assistance spend-down, as authorized in
subdivision 4; and
(7) a person's fee under paragraph (a) is less than $25.
(c) The county agency must collect the premium from the
client and forward the amounts collected to the commissioner in
the manner and at the times prescribed by the commissioner.
Money collected must be deposited in the general fund and is
appropriated to the commissioner for the alternative care
program. The client must supply the county with the client's
social security number at the time of application. If a client
fails or refuses to pay the premium due, the county shall supply
the commissioner with the client's social security number and
other information the commissioner requires to collect the
premium from the client. The commissioner shall collect unpaid
premiums using the revenue recapture act in chapter 270A and
other methods available to the commissioner. The commissioner
may require counties to inform clients of the collection
procedures that may be used by the state if a premium is not
paid.
(d) The commissioner shall begin to adopt emergency or
permanent rules governing client premiums within 30 days after
July 1, 1991, including criteria for determining when services
to a client must be terminated due to failure to pay a premium.
Sec. 66. Minnesota Statutes 1992, section 256B.0913,
subdivision 13, is amended to read:
Subd. 13. [COUNTY ALTERNATIVE CARE BIENNIAL PLAN.] The
commissioner shall establish by rule, in accordance with chapter
14, procedures for the submittal and approval of a biennial
county plan for the administration of the alternative care
program and the coordination with other planning processes for
the older adult. In addition to the procedures in rule, The
county biennial plan for the preadmission screening program, the
alternative care program, waivers for the elderly under section
256B.0915, and waivers for the disabled under section 256B.49,
shall be incorporated into the biennial community social
services act plan and shall meet the regulations and timelines
of that plan. This county biennial plan shall also include:
(1) information on the administration of the preadmission
screening program;
(2) information on the administration of the home- and
community-based services waivers for the elderly under section
256B.0915, and for the disabled under section 256B.49; and
(3) an application for targeted funds under subdivision 11;
and
(4) an optional notice of intent to apply to participate in
the long-term care projects under section 256B.0917 information
on the administration of the alternative care program.
Sec. 67. Minnesota Statutes 1992, section 256B.0913,
subdivision 14, is amended to read:
Subd. 14. [REIMBURSEMENT AND RATE ADJUSTMENTS.] (a)
Reimbursement for expenditures for the alternative care services
shall be through the invoice processing procedures of the
department's Medicaid Management Information System (MMIS), only
with the approval of the client's case manager. To receive
reimbursement, the county or vendor must submit invoices within
120 days following the month of service. The county agency and
its vendors under contract shall not be reimbursed for services
which exceed the county allocation.
(b) If a county collects less than 50 percent of the client
premiums due under subdivision 12, the commissioner may withhold
up to three percent of the county's final alternative care
program allocation determined under subdivisions 10 and 11.
(c) Beginning July 1, 1991, the state will reimburse
counties, up to the limits of state appropriations, according to
the payment schedule in section 256.025 for the county share of
costs incurred under this subdivision on or after January 1,
1991, for individuals who would be eligible for medical
assistance within 180 days of admission to a nursing home.
(d) For fiscal years beginning on or after July 1, 1993,
the commissioner of human services shall not provide automatic
annual inflation adjustments for alternative care services. The
commissioner of finance shall include as a budget change request
in each biennial detailed expenditure budget submitted to the
legislature under section 16A.11 annual adjustments in
reimbursement rates for alternative care services based on the
forecasted percentage change in the Home Health Agency Market
Basket of Operating Costs, for the fiscal year beginning July 1,
compared to the previous fiscal year, unless otherwise adjusted
by statute. The Home Health Agency Market Basket of Operating
Costs is published by Data Resources, Inc. The forecast to be
used is the one published for the calendar quarter beginning
January 1, six months prior to the beginning of the fiscal year
for which rates are set.
(e) The county shall negotiate individual rates with
vendors and may be reimbursed for actual costs up to the greater
of the county's current approved rate or 60 percent of the
maximum rate in fiscal year 1994 and 65 percent of the maximum
rate in fiscal year 1995 for each alternative care service.
Notwithstanding any other rule or statutory provision to the
contrary, the commissioner shall not be authorized to increase
rates by an annual inflation factor, unless so authorized by the
legislature.
(f) On July 1, 1993, the commissioner shall increase the
maximum rate for home delivered meals to $4.50 per meal.
Sec. 68. Minnesota Statutes 1992, section 256B.0915,
subdivision 1, is amended to read:
Subdivision 1. [AUTHORITY.] The commissioner is authorized
to apply for a home- and community-based services waiver for the
elderly, authorized under section 1915(c) of the Social Security
Act, in order to obtain federal financial participation to
expand the availability of services for persons who are eligible
for medical assistance. The commissioner may apply for
additional waivers or pursue other federal financial
participation which is advantageous to the state for funding
home care services for the frail elderly who are eligible for
medical assistance. The provision of waivered services
to elderly and disabled medical assistance recipients must
comply with the criteria approved in the waiver.
Sec. 69. Minnesota Statutes 1992, section 256B.0915, is
amended by adding a subdivision to read:
Subd. 1a. [ELDERLY WAIVER CASE MANAGEMENT
SERVICES.] Elderly case management services under the home and
community-based services waiver for elderly individuals are
available from providers meeting qualification requirements and
the standards specified in subdivision 1b. Eligible recipients
may choose any qualified provider of elderly case management
services.
Sec. 70. Minnesota Statutes 1992, section 256B.0915, is
amended by adding a subdivision to read:
Subd. 1b. [PROVIDER QUALIFICATIONS AND STANDARDS.] The
commissioner must enroll qualified providers of elderly case
management services under the home and community-based waiver
for the elderly under section 1915(c) of the Social Security
Act. The enrollment process shall ensure the provider's ability
to meet the qualification requirements and standards in this
subdivision and other federal and state requirements of this
service. A elderly case management provider is an enrolled
medical assistance provider who is determined by the
commissioner to have all of the following characteristics:
(1) the legal authority for alternative care program
administration under section 256B.0913;
(2) the demonstrated capacity and experience to provide the
components of case management to coordinate and link community
resources needed by the eligible population;
(3) administrative capacity and experience in serving the
target population for whom it will provide services and in
ensuring quality of services under state and federal
requirements;
(4) the legal authority to provide preadmission screening
under section 256B.0911, subdivision 4;
(5) a financial management system that provides accurate
documentation of services and costs under state and federal
requirements; and
(6) the capacity to document and maintain individual case
records under state and federal requirements.
Sec. 71. Minnesota Statutes 1992, section 256B.0915, is
amended by adding a subdivision to read:
Subd. 1c. [CASE MANAGEMENT ACTIVITIES UNDER THE STATE
PLAN.] The commissioner shall seek an amendment to the home and
community-based services waiver for the elderly to implement the
provisions of subdivisions 1a and 1b. If the commissioner is
unable to secure the approval of the secretary of health and
human services for the requested waiver amendment by December
31, 1993, the commissioner shall amend the medical assistance
state plan to provide that case management provided under the
home and community-based services waiver for the elderly is
performed by counties as an administrative function for the
proper and effective administration of the state medical
assistance plan. Notwithstanding section 256.025, subdivision
3, the state shall reimburse counties for the nonfederal share
of costs for case management performed as an administrative
function under the home and community-based services waiver for
the elderly.
Sec. 72. Minnesota Statutes 1992, section 256B.0915,
subdivision 3, is amended to read:
Subd. 3. [LIMITS OF CASES, RATES, REIMBURSEMENT, AND
FORECASTING.] (a) The number of medical assistance waiver
recipients that a county may serve must be allocated according
to the number of medical assistance waiver cases open on July 1
of each fiscal year. Additional recipients may be served with
the approval of the commissioner.
(b) The monthly limit for the cost of waivered services to
an individual waiver client shall be the statewide average
payment rate of the case mix resident class to which the waiver
client would be assigned under medical assistance case mix
reimbursement system. The statewide average payment rate is
calculated by determining the statewide average monthly nursing
home rate effective July 1 of the fiscal year in which the cost
is incurred, less the statewide average monthly income of
nursing home residents who are age 65 or older, and who are
medical assistance recipients in the month of March of the
previous state fiscal year. The following costs must be
included in determining the total monthly costs for the waiver
client:
(1) cost of all waivered services, including extended
medical supplies and equipment; and
(2) cost of skilled nursing, home health aide, and personal
care services reimbursable by medical assistance.
(c) Medical assistance funding for skilled nursing
services, home health aide, and personal care services for
waiver recipients must be approved by the case manager and
included in the individual care plan.
(d) Expenditures for extended medical supplies and
equipment that cost over $150 per month for both the elderly
waiver and the disabled waiver must have the commissioner's
prior approval.
(e) For the fiscal year beginning on July 1, 1993, and for
subsequent fiscal years, the commissioner of human services
shall not provide automatic annual inflation adjustments for
home- and community-based waivered services. The commissioner
of finance shall include as a budget change request in each
biennial detailed expenditure budget submitted to the
legislature under section 16A.11 annual adjustments in
reimbursement rates for home- and community-based waivered
services, based on the forecasted percentage change in the Home
Health Agency Market Basket of Operating Costs, for the fiscal
year beginning July 1, compared to the previous fiscal year,
unless otherwise adjusted by statute. The Home Health Agency
Market Basket of Operating Costs is published by Data Resources,
Inc. The forecast to be used is the one published for the
calendar quarter beginning January 1, six months prior to the
beginning of the fiscal year for which rates are set. The adult
foster care rate shall be considered a difficulty of care
payment and shall not include room and board.
(f) The adult foster care daily rate for the elderly and
disabled waivers shall be negotiated between the county agency
and the foster care provider. The rate established under this
section shall not exceed the state average monthly nursing home
payment for the case mix classification to which the individual
receiving foster care is assigned, and it must allow for other
waiver and medical assistance home care services to be
authorized by the case manager.
(g) The assisted living and residential care service rates
for elderly and disabled waivers shall be made to the vendor as
a monthly rate negotiated with the county agency. The rate
shall not exceed the nonfederal share of the greater of either
the statewide or any of the geographic groups' weighted average
monthly medical assistance nursing facility payment rate of the
case mix resident class to which the elderly or disabled client
would be assigned under Minnesota Rules, parts 9549.0050 to
9549.0059. The rate may not cover direct rent or food costs.
(h) The county shall negotiate individual rates with
vendors and may be reimbursed for actual costs up to the greater
of the county's current approved rate or 60 percent of the
maximum rate in fiscal year 1994 and 65 percent of the maximum
rate in fiscal year 1995 for each service within each program.
(i) On July 1, 1993, the commissioner shall increase the
maximum rate for home-delivered meals to $4.50 per meal.
(f) (j) Reimbursement for the medical assistance recipients
under the approved waiver shall be made from the medical
assistance account through the invoice processing procedures of
the department's Medicaid Management Information System (MMIS),
only with the approval of the client's case manager. The budget
for the state share of the Medicaid expenditures shall be
forecasted with the medical assistance budget, and shall be
consistent with the approved waiver.
(g) (k) Beginning July 1, 1991, the state shall reimburse
counties according to the payment schedule in section 256.025
for the county share of costs incurred under this subdivision on
or after January 1, 1991, for individuals who are receiving
medical assistance.
Sec. 73. Minnesota Statutes 1992, section 256B.0917,
subdivision 1, is amended to read:
Subdivision 1. [PURPOSE, MISSION, GOALS, AND OBJECTIVES.]
(a) The purpose of implementing seniors' agenda for independent
living (SAIL) projects under this section is to demonstrate a
new cooperative strategy for the long-term care system in the
state of Minnesota.
The projects are part of the initial biennial plan for a
20-year strategy. The mission of the 20-year strategy is to
create a new community-based care paradigm for long-term care in
Minnesota in order to maximize independence of the older adult
population, and to ensure cost-effective use of financial and
human resources. The goals for the 20-year strategy are to:
(1) achieve a broad awareness and use of low-cost home care
and other residential alternatives to nursing homes;
(2) develop a statewide system of information and
assistance to enable easy access to long-term care services;
(3) develop sufficient alternatives to nursing homes to
serve the increased number of people needing long-term care;
(4) maintain the moratorium on new construction of nursing
home beds and to lower the percentage of elderly persons served
in institutional settings; and
(5) build a community-based approach and community
commitment to delivering long-term care services for elderly
persons in their homes.
(b) The objective for the fiscal years 1992 1994 and 1993
1995 biennial plan is to implement continue at least four but
not more than six projects in anticipation of a statewide
program. These projects will begin continue the process of
implementing: (1) a coordinated planning and administrative
process; (2) a refocused function of the preadmission screening
program; (3) the development of additional home, community, and
residential alternatives to nursing homes; (4) a program to
support the informal caregivers for elderly persons; (5)
programs to strengthen the use of volunteers; and (6) programs
to support the building of community commitment to provide
long-term care for elderly persons.
This is done in conjunction with an expanded role of the
interagency long-term care planning committee as described in
section 144A.31. The services offered through these projects
will be available to those who have their own funds to pay for
services, as well as to persons who are eligible for medical
assistance and to persons who are 180-day eligible clients to
the extent authorized in this section.
Sec. 74. Minnesota Statutes 1992, section 256B.0917,
subdivision 2, is amended to read:
Subd. 2. [DESIGN OF SAIL PROJECTS; LOCAL LONG-TERM CARE
COORDINATING TEAM.] (a) The commissioner of human services in
conjunction with the interagency long-term care planning
committee's long-range strategic plan shall establish contract
with SAIL projects in four to six counties or groups of counties
to demonstrate the feasibility and cost-effectiveness of a local
long-term care strategy that is consistent with the state's
long-term care goals identified in subdivision 1. The
commissioner shall publish a notice in the State Register
announcing the availability of project funding and giving
instructions for making an application. The instructions for
the application shall identify the amount of funding available
for project components.
(b) To be selected for the project, a county board or
boards must establish a long-term care coordinating team
consisting of county social service agencies, public health
nursing service agencies, local boards of health, and the area
agencies on aging in a geographic area which is responsible for:
(1) developing a local long-term care strategy consistent
with state goals and objectives;
(2) submitting an application to be selected as a project;
(3) coordinating planning for funds to provide services to
elderly persons, including funds received under Title III of the
Older Americans Act, Community Social Services Act, Title XX of
the Social Security Act and the Local Public Health Act; and
(4) ensuring efficient services provision and
nonduplication of funding.
(c) The board or boards shall designate a public agency to
serve as the lead agency. The lead agency receives and manages
the project funds from the state and is responsible for the
implementation of the local strategy. If selected as a project,
the local long-term care coordinating team must semiannually
evaluate the progress of the local long-term care strategy in
meeting state measures of performance and results as established
in the contract.
(d) Each member of the local coordinating team must
indicate its endorsement of the local strategy. The local
long-term care coordinating team may include in its membership
other units of government which provide funding for services to
the frail elderly. The team must cooperate with consumers and
other public and private agencies, including nursing homes, in
the geographic area in order to develop and offer a variety of
cost-effective services to the elderly and their caregivers.
(e) The board or boards shall apply to be selected as a
project. If the project is selected, the commissioner of human
services shall contract with the lead agency for the project and
shall provide additional administrative funds for implementing
the provisions of the contract, within the appropriation
available for this purpose.
(f) Projects shall be selected according to the following
conditions:.
(1) No project may be selected unless it demonstrates that:
(i) the objectives of the local project will help to
achieve the state's long-term care goals as defined in
subdivision 1;
(ii) in the case of a project submitted jointly by several
counties, all of the participating counties are contiguous;
(iii) there is a designated local lead agency that is
empowered to make contracts with the state and local vendors on
behalf of all participants;
(iv) the project proposal demonstrates that the local
cooperating agencies have the ability to perform the project as
described and that the implementation of the project has a
reasonable chance of achieving its objectives;
(v) the project will serve an area that covers at least
four counties or contains at least 2,500 persons who are 85
years of age or older, according to the projections of the state
demographer or the census if the data is more recent; and
(vi) the local coordinating team documents efforts of
cooperation with consumers and other agencies and organizations,
both public and private, in planning for service delivery.
(2) If only two projects are selected, at least one of them
must be from a metropolitan statistical area as determined by
the United States Census Bureau; if three or four projects are
selected, at least one but not more than two projects must be
from a metropolitan statistical area; and if more than four
projects are selected, at least two but not more than three
projects must be from a metropolitan statistical area.
(3) Counties or groups of counties that submit a proposal
for a project shall be assigned to types defined by
institutional utilization rate and population growth rate in the
following manner:
(i) Each county or group of counties shall be measured by
the utilization rate of nursing homes and boarding care homes
and by the projected growth rate of its population aged 85 and
over between 1990 and 2000. For the purposes of this section,
"utilization rate" means the proportion of the seniors aged 65
or older in the county or group of counties who reside in a
licensed nursing home or boarding care home as determined by the
most recent census of residents available from the department of
health and the population estimates of the state demographer or
the census, whichever is more recent. The "projected growth
rate" is the rate of change in the county or group of counties
of the population group aged 85 or older between 1990 and 2000
according to the projections of the state demographer.
(ii) The institutional utilization rate of a county or
group of counties shall be converted to a category by assigning
a "high utilization" category if the rate is above the median
rate of all counties, and a "low utilization" category
otherwise. The projected growth rate of a county or group of
counties shall be converted to a category by assigning a score
of "high growth" category if the rate is above the median rate
of all counties, and a "low growth" category otherwise.
(iii) Types of areas shall be defined by the four
combinations of the scores defined in item (ii): type 1 is low
utilization - high growth, type 2 is high utilization - high
growth, type 3 is high utilization - low growth, and type 4 is
low utilization - low growth. Each county or group of counties
making a proposal shall be assigned to one of these types.
(4) Projects shall be selected from each of the types in
the order that the types are listed in paragraph (3), item
(iii), with available funding allocated to projects until it is
exhausted, with no more than 30 percent of available funding
allocated to any one project. Available funding includes state
administrative funds which have been appropriated for screening
functions in subdivision 4, paragraph (b), clause (3), and for
service developers and incentive grants in subdivision 5.
(5) If more than one county or group of counties within one
of the types defined by paragraph (3) proposes a special project
that meets all of the other conditions in paragraphs (1) and
(2), the project that demonstrates the most cost-effective
proposals in terms of the number of nursing home placements that
can be expected to be diverted or converted to alternative care
services per unit of cost shall be selected.
(6) If more than one county applies for a specific project
under this subdivision, all participating county boards must
indicate intent to work cooperatively through individual board
resolutions or a joint powers agreement.
Sec. 75. Minnesota Statutes 1992, section 256B.0917,
subdivision 3, is amended to read:
Subd. 3. [LOCAL LONG-TERM CARE STRATEGY.] The local
long-term care strategy must list performance outcomes and
indicators which meet the state's objectives. The local
strategy must provide for:
(1) accessible information, assessment, and preadmission
screening activities as described in subdivision 4;
(2) an application for expansion increase in numbers of
alternative care targeted funds clients served under section
256B.0913, for serving 180-day eligible clients, including those
who are relocated from nursing homes, which results in a
reduction of the medical assistance nursing home caseload; and
(3) the development of additional services such as adult
family foster care homes; family adult day care; assisted living
projects and congregate housing service projects in apartment
buildings; expanded home care services for evenings and
weekends; expanded volunteer services; and caregiver support and
respite care projects.
The county or groups of counties selected for the projects
shall be required to comply with federal regulations,
alternative care funding policies in section 256B.0913, and the
federal waiver programs' policies in section 256B.0915. The
requirements for preadmission screening as are defined in
section 256B.0911, subdivisions 1 to 6, are waived for those
counties selected as part of a long-term care strategy project.
For persons who are eligible for medical assistance or who are
180-day eligible clients and who are screened after nursing
facility admission, the nursing facility must include a screener
in the discharge planning process for those individuals who the
screener has determined have discharge potential. The agency
responsible for the screening function in subdivision 4 must
ensure a smooth transition and follow-up for the individual's
return to the community. Requirements for an access, screening,
and assessment function replace the preadmission screening
requirements and are defined in subdivision 4. Requirements for
the service development and service provision are defined in
subdivision 5.
Sec. 76. Minnesota Statutes 1992, section 256B.0917,
subdivision 4, is amended to read:
Subd. 4. [ACCESSIBLE INFORMATION, SCREENING, AND
ASSESSMENT FUNCTION.] (a) The projects selected by and under
contract with the commissioner shall establish an accessible
information, screening, and assessment function for persons who
need assistance and information regarding long-term care. This
accessible information, screening, and assessment activity shall
include information and referral, early intervention, follow-up
contacts, telephone triage as defined in paragraph
(f) screening, home visits, assessments, preadmission screening,
and relocation case management for the frail elderly and their
caregivers in the area served by the county or counties. The
purpose is to ensure that information and help is provided to
elderly persons and their families in a timely fashion, when
they are making decisions about long-term care. These functions
may be split among various agencies, but must be coordinated by
the local long-term care coordinating team.
(b) Accessible information, screening, and assessment
functions shall be reimbursed as follows:
(1) The screenings of all persons entering nursing homes
shall be reimbursed by the nursing homes in the counties of the
project, through the same policy that is in place in fiscal year
1992 as established as defined in section 256B.0911. The amount
a nursing home pays to the county agency is that amount
identified and approved in the February 15, 1991, estimated
number of screenings and associated expenditures. This amount
remains the same for fiscal year 1993, subdivision 6; and
(2) The level I screenings and the level II assessments
required by Public Law Numbers 100-203 and 101-508 (OBRA) for
persons with mental illness, mental retardation, or related
conditions, are reimbursed through administrative funds with 75
percent federal funds and 25 percent state funds, as allowed by
federal regulations and established in the contract; and
(3) Additional state administrative funds shall be
available for the access, screening, and assessment activities
that are not reimbursed under clauses clause (1) and (2). This
amount shall not exceed the amount authorized in the guidelines
and in instructions for the application and must be within the
amount appropriated for this activity.
(c) The amounts available under paragraph (b) are available
to the county or counties involved in the project to cover staff
salaries and expenses to provide the services in this
subdivision. The lead agency shall employ, or contract with
other agencies to employ, within the limits of available
funding, sufficient personnel to provide the services listed in
this subdivision.
(d) Any information and referral functions funded by other
sources, such as Title III of the Older Americans Act and Title
XX of the Social Security Act and the Community Social Services
Act, shall be considered by the local long-term care
coordinating team in establishing this function to avoid
duplication and to ensure access to information for persons
needing help and information regarding long-term care.
(e) The staffing for the screening and assessment function
must include, but is not limited to, a county social worker and
a county public health nurse. The social worker and public
health nurse are responsible for all assessments that are
required to be completed by a professional. However, only one
of these professionals is required to be present for the
assessment. If a county does not have a public health nurse
available, it may request approval from the commissioner to
assign a county registered nurse with at least one year of
experience in home care to conduct the assessment.
(f) All persons entering a Medicaid certified nursing home
or boarding care home must be screened through an assessment
process, although the decision to conduct a face-to-face
interview is left with the county social worker and the county
public health nurse. All applicants to nursing homes must be
screened and approved for admission by the county social worker
or the county public health nurse named by the lead agency or
the agencies which are under contract with the lead agency to
manage the access, screening, and assessment functions. For
applicants who have a diagnosis of mental illness, mental
retardation, or a related condition, and are subject to the
provisions of Public Law Numbers 100-203 and 101-508, their
admission must be approved by the local mental health authority
or the local developmental disabilities case manager.
The commissioner shall develop instructions and assessment
forms for telephone triage and on-site screenings to ensure that
federal regulations and waiver provisions are met.
For purposes of this section, the term "telephone triage"
refers to a telephone or face-to-face consultation between
health care and social service professionals during which the
clients' circumstances are reviewed and the county agency
professional sorts the individual into categories: (1) needs no
screening, (2) needs an immediate screening, or (3) needs a
screening after admission to a nursing home or after a return
home. The county agency professional shall authorize admission
to a nursing home according to the provisions in section
256B.0911, subdivision 7.
(g) The requirements for case mix assessments by a
preadmission screening team may be waived and the nursing home
shall complete the case mix assessments which are not conducted
by the county public health nurse according to the procedures
established under Minnesota Rules, part 9549.0059. The
appropriate county or the lead agency is responsible for
distributing the quality assurance and review form for all new
applicants to nursing homes.
(h) (d) The lead agency or the agencies under contract with
the lead agency which are responsible for the accessible
information, screening, and assessment function must complete
the forms and reports required by the commissioner as specified
in the contract.
Sec. 77. Minnesota Statutes 1992, section 256B.0917,
subdivision 5, is amended to read:
Subd. 5. [SERVICE DEVELOPMENT AND SERVICE DELIVERY.] (a)
In addition to the access, screening, and assessment activity,
each local strategy may include provisions for the following:
(1) expansion of alternative care to serve an increased
caseload, over the fiscal year 1991 average caseload, of at
least 100 persons each year who are assessed prior to nursing
home admission and persons who are relocated from nursing homes,
which results in a reduction of the medical assistance nursing
home caseload;
(2) the addition of a full-time staff person who is
responsible to develop the following services and recruit
providers as established in the contract:
(i) additional adult family foster care homes;
(ii) family adult day care providers as defined in section
256B.0919, subdivision 2;
(iii) an assisted living program in an apartment;
(iv) a congregate housing service project in a subsidized
housing project; and
(v) the expansion of evening and weekend coverage of home
care services as deemed necessary by the local strategic plan;
(3) (2) small incentive grants to new adult family care
providers for renovations needed to meet licensure requirements;
(4) (3) a plan to apply for a congregate housing service
project as identified in section 256.9751, authorized by the
Minnesota board on aging, to the extent that funds are
available;
(5) (4) a plan to divert new applicants to nursing homes
and to relocate a targeted population from nursing homes, using
the individual's own resources or the funding available for
services;
(6) (5) one or more caregiver support and respite care
projects, as described in subdivision 6; and
(7) (6) one or more living-at-home/block nurse projects, as
described in subdivisions 7 to 10.
(b) The expansion of alternative care clients under
paragraph (a) shall be accomplished with the funds provided
under section 256B.0913, and includes the allocation of targeted
funds. The funding for all participating counties must be
coordinated by the local long-term care coordinating team and
must be part of the local long-term care strategy. Targeted
Alternative care funds received through the SAIL project
approval process may be transferred from one SAIL county to
another within a designated SAIL project area during a fiscal
year as authorized by the local long-term care coordinating team
and approved by the commissioner. The base allocation used for
a future year shall reflect the final transfer. Each county
retains responsibility for reimbursement as defined in section
256B.0913, subdivision 12. All other requirements for the
alternative care program must be met unless an exception is
provided in this section. The commissioner may establish by
contract a reimbursement mechanism for alternative care that
does not require invoice processing through the Medical
Assistance Management Information System (MMIS). The
commissioner and local agencies must assure that the same client
and reimbursement data is obtained as is available under MMIS.
(c) The administration of these components is the
responsibility of the agencies selected by the local
coordinating team and under contract with the local lead
agency. However, administrative funds for paragraph (a),
clauses (2) to (5), and grant funds for paragraph (a), clauses
(6) and (7), shall be granted to the local lead agency. The
funding available for each component is based on the plan
submitted and the amount negotiated in the contract.
Sec. 78. Minnesota Statutes 1992, section 256B.0917,
subdivision 11, is amended to read:
Subd. 11. [SAIL EVALUATION AND EXPANSION.] The
commissioner shall evaluate the success of the SAIL projects
against the objective stated in subdivision 1, paragraph (b),
and recommend to the legislature the continuation or expansion
of the long-term care strategy by February 15, 1993 1995.
Sec. 79. Minnesota Statutes 1992, section 256B.0917,
subdivision 12, is amended to read:
Subd. 12. [PUBLIC AWARENESS CAMPAIGN.] The commissioner,
with assistance from the commissioner of health and with the
advice of the long-term care planning committee, shall contract
for a public awareness campaign to educate the general public,
seniors, consumers, caregivers, and professionals about the
aging process, the long-term care system, and alternatives
available including alternative care and residential
alternatives. Particular emphasis will be given to informing
consumers on how to access the alternatives and obtain
information on the long-term care system. The commissioner
shall pursue the development of new names for preadmission
screening, alternative care, and foster care, and other services
as deemed necessary for the public awareness campaign.
Sec. 80. Minnesota Statutes 1992, section 256B.093,
subdivision 1, is amended to read:
Subdivision 1. [STATE TRAUMATIC BRAIN INJURY CASE
MANAGEMENT PROGRAM.] The commissioner of human services shall:
(1) establish and maintain statewide traumatic brain injury
case management program;
(2) designate a full-time position to supervise and
coordinate services and policies for persons with traumatic
brain injuries;
(3) contract with qualified agencies or employ staff to
provide statewide administrative case management; and
(4) establish an advisory committee to provide
recommendations in a report to the department commissioner
regarding program and service needs of persons with traumatic
brain injuries. The advisory committee shall consist of no less
than ten members and no more than 30 members. The commissioner
shall appoint all advisory committee members to one- or two-year
terms and appoint one member as chair; and
(5) investigate the need for the development of rules or
statutes for:
(i) traumatic brain injury home and community-based
services waiver; and
(ii) traumatic brain injury services not covered by any
other statute or rule.
Sec. 81. Minnesota Statutes 1992, section 256B.093,
subdivision 3, is amended to read:
Subd. 3. [CASE MANAGEMENT TRAUMATIC BRAIN INJURY PROGRAM
DUTIES.] The department shall fund case management under this
subdivision using medical assistance administrative funds. Case
management The traumatic brain injury program duties include:
(1) assessing the person's individual needs for services
required to prevent institutionalization;
(2) ensuring that a care plan that addresses the person's
needs is developed, implemented, and monitored on an ongoing
basis by the appropriate agency or individual;
(3) assisting the person in obtaining services necessary to
allow the person to remain in the community;
(4) coordinating home care services with other medical
assistance services under section 256B.0625;
(5) ensuring appropriate, accessible, and cost-effective
medical assistance services;
(6) recommending to the commissioner the approval or denial
of the use of medical assistance funds to pay for home care
services when home care services exceed thresholds established
by the commissioner under section 256B.0627;
(7) assisting the person with problems related to the
provision of home care services;
(8) ensuring the quality of home care services;
(9) reassessing the person's need for and level of home
care services at a frequency determined by the commissioner; and
(10) recommending to the commissioner the approval or
denial of medical assistance funds to pay for out-of-state
placements for traumatic brain injury services and in-state
traumatic brain injury services provided by designated Medicare
long-term care hospitals;
(11) coordinating the traumatic brain injury home and
community-based waiver; and
(12) approving traumatic brain injury waiver care plans.
Sec. 82. Minnesota Statutes 1992, section 256B.15,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITION.] For purposes of this section,
"medical assistance" includes the medical assistance program
under this chapter and the general assistance medical care
program under chapter 256D, but does not include the alternative
care program under this chapter for nonmedical assistance
recipients under section 256B.0913, subdivision 4.
Sec. 83. Minnesota Statutes 1992, section 256B.15,
subdivision 2, is amended to read:
Subd. 2. [LIMITATIONS ON CLAIMS.] The claim shall include
only the total amount of medical assistance rendered after age
65 or during a period of institutionalization described in
subdivision 1 1a, clause (b), and the total amount of general
assistance medical care rendered, and shall not include
interest. Claims that have been allowed but not paid shall bear
interest according to section 524.3-806, paragraph (d). A claim
against the estate of a surviving spouse who did not receive
medical assistance, for medical assistance rendered for the
predeceased spouse, is limited to the value of the assets of the
estate that were marital property or jointly owned property at
any time during the marriage.
Sec. 84. Minnesota Statutes 1992, section 256B.19,
subdivision 1b, is amended to read:
Subd. 1b. [PORTION OF NONFEDERAL SHARE TO BE PAID BY
GOVERNMENT HOSPITALS.] (a) In addition to the percentage
contribution paid by a county under subdivision 1, the
governmental units designated in this subdivision shall be
responsible for an additional portion of the nonfederal share of
medical assistance costs attributable to them. For purposes of
this subdivision, "designated governmental unit" means Hennepin
county, and the public corporation known as Ramsey Health Care,
Inc. which is operated under the authority of chapter 246A and
the University of Minnesota. For purposes of this subdivision,
"public hospital" means the Hennepin County Medical Center, and
the University of Minnesota hospital and the St. Paul-Ramsey
Medical Center.
(b) Each of the governmental units designated in this
subdivision From July 1, 1993 through June 30, 1994, Hennepin
county shall on a monthly basis transfer an amount equal to two
1.8 percent of the public hospital's net patient revenues,
excluding net Medicare revenue to the state Medicaid agency.
(c) Effective July 1, 1994, each of the governmental units
designated in paragraph (a) shall on a monthly basis transfer an
amount equal to 1.8 percent of the public hospital's net patient
revenues, excluding net Medicare revenue, to the state Medicaid
agency.
(d) These sums shall be part of the local designated
governmental unit's portion of the nonfederal share of medical
assistance costs, but shall not be subject to payback provisions
of section 256.025.
Sec. 85. Minnesota Statutes 1992, section 256B.19, is
amended by adding a subdivision to read:
Subd. 1c. [ADDITIONAL PORTION OF NONFEDERAL SHARE.] In
addition to any payment required under subdivision 1b, Hennepin
county and the University of Minnesota shall be responsible for
a monthly transfer payment of $1,000,000, due before noon on the
15th of each month beginning July 15, 1993. These sums shall be
part of the designated governmental unit's portion of the
nonfederal share of medical assistance costs, but shall not be
subject to payback provisions of section 256.025.
Sec. 86. Minnesota Statutes 1992, section 256B.19, is
amended by adding a subdivision to read:
Subd. 1d. [PORTION OF NONFEDERAL SHARE TO BE PAID BY
CERTAIN COUNTIES.] In addition to the percentage contribution
paid by a county under subdivision 1, the governmental units
designated in this subdivision shall be responsible for an
additional portion of the nonfederal share of medical assistance
cost. For purposes of this subdivision, "designated
governmental unit" means the counties of Becker, Beltrami,
Clearwater, Cook, Dodge, Hubbard, Itasca, Lake, Mahnomen,
Pennington, Pipestone, Ramsey, St. Louis, Steele, Todd,
Traverse, and Wadena.
Beginning in 1994, each of the governmental units
designated in this subdivision shall transfer before noon on May
31 to the state Medicaid agency an amount equal to the number of
licensed beds in any nursing home owned by the county multiplied
by $5,723. If two or more counties own a nursing home, the
payment shall be prorated. These sums shall be part of the
designated governmental unit's portion of the nonfederal share
of medical assistance costs, but shall not be subject to payback
provisions of section 256.025.
Sec. 87. Minnesota Statutes 1992, section 256B.37,
subdivision 3, is amended to read:
Subd. 3. [NOTICE.] The state agency must be given notice
of monetary claims against a person, firm, or corporation that
may be liable in damages, or otherwise obligated to pay part or
all of the cost of medical care when the state agency has paid
or become liable for the cost of care. Notice must be given as
follows:
(a) Applicants for medical assistance shall notify the
state or local agency of any possible claims when they submit
the application. Recipients of medical assistance shall notify
the state or local agency of any possible claims when those
claims arise.
(b) A person providing medical care services to a recipient
of medical assistance shall notify the state agency when the
person has reason to believe that a third party may be liable
for payment of the cost of medical care.
(c) A person who is party to a claim upon which the state
agency may be entitled to subrogation under this section shall
notify the state agency of its potential subrogation claim
before filing a claim, commencing an action, or negotiating a
settlement. A person who is a party to a claim includes the
plaintiff, the defendants, and any other party to the cause of
action.
Notice given to the local agency is not sufficient to meet
the requirements of paragraphs (b) and (c).
Sec. 88. Minnesota Statutes 1992, section 256B.37,
subdivision 5, is amended to read:
Subd. 5. [PRIVATE BENEFITS TO BE USED FIRST.] Private
accident and health care coverage for medical services is
primary coverage and must be exhausted before medical assistance
is paid. When a person who is otherwise eligible for medical
assistance has private accident or health care coverage,
including a prepaid health plan, the private health care
benefits available to the person must be used first and to the
fullest extent. Supplemental payment may be made by medical
assistance, but the combined total amount paid must not exceed
the amount payable under medical assistance in the absence of
other coverage. Medical assistance must not make supplemental
payment for covered services rendered by a vendor who
participates or contracts with a health coverage plan if the
plan requires the vendor to accept the plan's payment as payment
in full.
Sec. 89. Minnesota Statutes 1992, section 256B.37, is
amended by adding a subdivision to read:
Subd. 5a. [SUPPLEMENTAL PAYMENT BY MEDICAL ASSISTANCE.]
Medical assistance payment will not be made when either covered
charges are paid in full by a third party or the provider has an
agreement to accept payment for less than charges as payment in
full. Payment for patients that are simultaneously covered by
medical assistance and a liable third party other than Medicare
will be determined as the lesser of clauses (1) to (3):
(1) the patient liability according to the provider/insurer
agreement;
(2) covered charges minus the third party payment amount;
or
(3) the medical assistance rate minus the third party
payment amount.
A negative difference will not be implemented.
Sec. 90. Minnesota Statutes 1992, section 256B.431,
subdivision 2b, is amended to read:
Subd. 2b. [OPERATING COSTS, AFTER JULY 1, 1985.] (a) For
rate years beginning on or after July 1, 1985, the commissioner
shall establish procedures for determining per diem
reimbursement for operating costs.
(b) The commissioner shall contract with an econometric
firm with recognized expertise in and access to national
economic change indices that can be applied to the appropriate
cost categories when determining the operating cost payment rate.
(c) The commissioner shall analyze and evaluate each
nursing facility's cost report of allowable operating costs
incurred by the nursing facility during the reporting year
immediately preceding the rate year for which the payment rate
becomes effective.
(d) The commissioner shall establish limits on actual
allowable historical operating cost per diems based on cost
reports of allowable operating costs for the reporting year that
begins October 1, 1983, taking into consideration relevant
factors including resident needs, geographic location, size of
the nursing facility, and the costs that must be incurred for
the care of residents in an efficiently and economically
operated nursing facility. In developing the geographic groups
for purposes of reimbursement under this section, the
commissioner shall ensure that nursing facilities in any county
contiguous to the Minneapolis-St. Paul seven-county metropolitan
area are included in the same geographic group. The limits
established by the commissioner shall not be less, in the
aggregate, than the 60th percentile of total actual allowable
historical operating cost per diems for each group of nursing
facilities established under subdivision 1 based on cost reports
of allowable operating costs in the previous reporting year.
For rate years beginning on or after July 1, 1989, facilities
located in geographic group I as described in Minnesota Rules,
part 9549.0052, on January 1, 1989, may choose to have the
commissioner apply either the care related limits or the other
operating cost limits calculated for facilities located in
geographic group II, or both, if either of the limits calculated
for the group II facilities is higher. The efficiency incentive
for geographic group I nursing facilities must be calculated
based on geographic group I limits. The phase-in must be
established utilizing the chosen limits. For purposes of these
exceptions to the geographic grouping requirements, the
definitions in Minnesota Rules, parts 9549.0050 to 9549.0059
(Emergency), and 9549.0010 to 9549.0080, apply. The limits
established under this paragraph remain in effect until the
commissioner establishes a new base period. Until the new base
period is established, the commissioner shall adjust the limits
annually using the appropriate economic change indices
established in paragraph (e). In determining allowable
historical operating cost per diems for purposes of setting
limits and nursing facility payment rates, the commissioner
shall divide the allowable historical operating costs by the
actual number of resident days, except that where a nursing
facility is occupied at less than 90 percent of licensed
capacity days, the commissioner may establish procedures to
adjust the computation of the per diem to an imputed occupancy
level at or below 90 percent. The commissioner shall establish
efficiency incentives as appropriate. The commissioner may
establish efficiency incentives for different operating cost
categories. The commissioner shall consider establishing
efficiency incentives in care related cost categories. The
commissioner may combine one or more operating cost categories
and may use different methods for calculating payment rates for
each operating cost category or combination of operating cost
categories. For the rate year beginning on July 1, 1985, the
commissioner shall:
(1) allow nursing facilities that have an average length of
stay of 180 days or less in their skilled nursing level of care,
125 percent of the care related limit and 105 percent of the
other operating cost limit established by rule; and
(2) exempt nursing facilities licensed on July 1, 1983, by
the commissioner to provide residential services for the
physically handicapped under Minnesota Rules, parts 9570.2000 to
9570.3600, from the care related limits and allow 105 percent of
the other operating cost limit established by rule.
For the purpose of calculating the other operating cost
efficiency incentive for nursing facilities referred to in
clause (1) or (2), the commissioner shall use the other
operating cost limit established by rule before application of
the 105 percent.
(e) The commissioner shall establish a composite index or
indices by determining the appropriate economic change
indicators to be applied to specific operating cost categories
or combination of operating cost categories.
(f) Each nursing facility shall receive an operating cost
payment rate equal to the sum of the nursing facility's
operating cost payment rates for each operating cost category.
The operating cost payment rate for an operating cost category
shall be the lesser of the nursing facility's historical
operating cost in the category increased by the appropriate
index established in paragraph (e) for the operating cost
category plus an efficiency incentive established pursuant to
paragraph (d) or the limit for the operating cost category
increased by the same index. If a nursing facility's actual
historic operating costs are greater than the prospective
payment rate for that rate year, there shall be no retroactive
cost settle-up. In establishing payment rates for one or more
operating cost categories, the commissioner may establish
separate rates for different classes of residents based on their
relative care needs.
(g) The commissioner shall include the reported actual real
estate tax liability or payments in lieu of real estate tax of
each nursing facility as an operating cost of that nursing
facility. Allowable costs under this subdivision for payments
made by a nonprofit nursing facility that are in lieu of real
estate taxes shall not exceed the amount which the nursing
facility would have paid to a city or township and county for
fire, police, sanitation services, and road maintenance costs
had real estate taxes been levied on that property for those
purposes. For rate years beginning on or after July 1, 1987,
the reported actual real estate tax liability or payments in
lieu of real estate tax of nursing facilities shall be adjusted
to include an amount equal to one-half of the dollar change in
real estate taxes from the prior year. The commissioner shall
include a reported actual special assessment, and reported
actual license fees required by the Minnesota department of
health, for each nursing facility as an operating cost of that
nursing facility. For rate years beginning on or after July 1,
1989, the commissioner shall include a nursing facility's
reported public employee retirement act contribution for the
reporting year as apportioned to the care-related operating cost
categories and other operating cost categories multiplied by the
appropriate composite index or indices established pursuant to
paragraph (e) as costs under this paragraph. Total adjusted
real estate tax liability, payments in lieu of real estate tax,
actual special assessments paid, the indexed public employee
retirement act contribution, and license fees paid as required
by the Minnesota department of health, for each nursing facility
(1) shall be divided by actual resident days in order to compute
the operating cost payment rate for this operating cost
category, (2) shall not be used to compute the care-related
operating cost limits or other operating cost limits established
by the commissioner, and (3) shall not be increased by the
composite index or indices established pursuant to paragraph
(e), unless otherwise indicated in this paragraph.
(h) For rate years beginning on or after July 1, 1987, the
commissioner shall adjust the rates of a nursing facility that
meets the criteria for the special dietary needs of its
residents as specified in section 144A.071, subdivision 3,
clause (c), and the requirements in section 31.651. The
adjustment for raw food cost shall be the difference between the
nursing facility's allowable historical raw food cost per diem
and 115 percent of the median historical allowable raw food cost
per diem of the corresponding geographic group.
The rate adjustment shall be reduced by the applicable
phase-in percentage as provided under subdivision 2h.
Sec. 91. Minnesota Statutes 1992, section 256B.431,
subdivision 2o, is amended to read:
Subd. 2o. [SPECIAL PAYMENT RATES FOR SHORT-STAY NURSING
FACILITIES.] Notwithstanding contrary provisions of this section
and rules adopted by the commissioner, for the rate years
beginning on or after July 1, 1992 1993, a nursing facility
whose average length of stay for the rate preceding reporting
year beginning July 1, 1991, is (1) less than 180 days; or (2)
less than 225 days in a nursing facility with more than 315
licensed beds must be reimbursed for allowable costs up to 125
percent of the total care-related limit and 105 percent of the
other-operating-cost limit for hospital-attached nursing
facilities. The A nursing facility that received the benefit of
this limit during the rate year beginning July 1, 1992,
continues to receive this rate during the rate year beginning
July 1, 1993, even if the facility's average length of stay is
more than 180 days in the rate years subsequent to the rate year
beginning July 1, 1991. For purposes of this subdivision, a
nursing facility shall compute its average length of stay by
dividing the nursing facility's actual resident days for the
reporting year by the nursing facility's total resident
discharges for that reporting year.
Sec. 92. Minnesota Statutes 1992, section 256B.431, is
amended by adding a subdivision to read:
Subd. 2r. [PAYMENT RESTRICTIONS ON LEAVE DAYS.] Effective
July 1, 1993, the commissioner shall limit payment for leave
days in a nursing facility to 79 percent of that nursing
facility's total payment rate for the involved resident.
Sec. 93. Minnesota Statutes 1992, section 256B.431,
subdivision 13, is amended to read:
Subd. 13. [HOLD-HARMLESS PROPERTY-RELATED RATES.] (a)
Terms used in subdivisions 13 to 21 shall be as defined in
Minnesota Rules, parts 9549.0010 to 9549.0080, and this section.
(b) Except as provided in this subdivision, for rate
periods beginning on October 1, 1992, and for rate years
beginning after June 30, 1993, the property-related rate for a
nursing facility shall be the greater of $4 or the
property-related payment rate in effect on September 30, 1992.
In addition, the incremental increase in the nursing facility's
rental rate will be determined under Minnesota Rules, parts
9549.0010 to 9549.0080, and this section.
(c) Notwithstanding Minnesota Rules, part 9549.0060,
subpart 13, item F, a nursing facility that has a sale permitted
under subdivision 14 after June 30, 1992, shall receive the
property-related payment rate in effect at the time of the sale
or reorganization. For rate periods beginning after October 1,
1992, and for rate years beginning after June 30, 1993, a
nursing facility shall receive, in addition to its
property-related payment rate in effect at the time of the sale,
the incremental increase allowed under subdivision 14.
(d) For rate years beginning after June 30, 1993, the
property-related rate for a nursing facility licensed after July
1, 1989, after relocating its beds from a separate nursing home
to a building formerly used as a hospital and sold during the
cost reporting year ending September 30, 1991, shall be its
property-related rate prior to the sale in addition to the
incremental increases provided under this section effective on
October 1, 1992, of 29 cents per day, and any incremental
increases after October 1, 1992, calculated by using its rental
rate under Minnesota Rules, parts 9549.0010 to 9549.0080, and
this section, recognizing the current appraised value of the
facility at the new location, and including as allowable debt
otherwise allowable debt incurred to remodel the facility in the
new location prior to the relocation of beds.
Sec. 94. Minnesota Statutes 1992, section 256B.431,
subdivision 14, is amended to read:
Subd. 14. [LIMITATIONS ON SALES OF NURSING FACILITIES.]
(a) For rate periods beginning on October 1, 1992, and for rate
years beginning after June 30, 1993, a nursing facility's
property-related payment rate as established under subdivision
13 shall be adjusted by either paragraph (b) or (c) for the sale
of the nursing facility, including sales occurring after June
30, 1992, as provided in this subdivision.
(b) If the nursing facility's property-related payment rate
under subdivision 13 prior to sale is greater than the nursing
facility's rental rate under Minnesota Rules, parts 9549.0010 to
9549.0080, and this section prior to sale, the nursing
facility's property-related payment rate after sale shall be the
greater of its property-related payment rate under subdivision
13 prior to sale or its rental rate under Minnesota Rules, parts
9549.0010 to 9549.0080, and this section calculated after sale.
(c) If the nursing facility's property-related payment rate
under subdivision 13 prior to sale is equal to or less than the
nursing facility's rental rate under Minnesota Rules, parts
9549.0010 to 9549.0080, and this section prior to sale, the
nursing facility's property-related payment rate after sale
shall be the nursing facility's property-related payment rate
under subdivision 13 plus the difference between its rental rate
calculated under Minnesota Rules, parts 9549.0010 to 9549.0080,
and this section prior to sale and its rental rate calculated
under Minnesota Rules, parts 9549.0010 to 9549.0080, and this
section calculated after sale.
(d) For purposes of this subdivision, "sale" means the
purchase of a nursing facility's capital assets with cash or
debt. The term sale does not include a stock purchase of a
nursing facility or any of the following transactions:
(1) a sale and leaseback to the same licensee that does not
constitute a change in facility license;
(2) a transfer of an interest to a trust;
(3) gifts or other transfers for no consideration;
(4) a merger of two or more related organizations;
(5) a change in the legal form of doing business, other
than a publicly held organization that becomes privately held or
vice versa;
(6) the addition of a new partner, owner, or shareholder
who owns less than 20 percent of the nursing facility or the
issuance of stock; and
(7) a sale, merger, reorganization, or any other transfer
of interest between related organizations other than those
permitted in this section.
(e) For purposes of this subdivision, "sale" includes the
sale or transfer of a nursing facility to a close relative as
defined in Minnesota Rules, part 9549.0020, subpart 38, item C,
upon the death of an owner, due to serious illness or
disability, as defined under the Social Security Act, under
United States Code, title 42, section 423(d)(1)(A), or upon
retirement of an owner from the business of owning or operating
a nursing home at 62 years of age or older. For sales to a
close relative allowed under this paragraph, otherwise
nonallowable debt resulting from seller financing of all or a
portion of the debt resulting from the sale shall be allowed and
shall not be subject to Minnesota Rules, part 9549.0060, subpart
5, item E, provided that in addition to existing requirements
for allowance of debt and interest, the debt is subject to
repayment through annual principal payments and the interest
rate on the related organization debt does not exceed three
percentage points above the posted yield for standard
conventional fixed rate mortgages of the Federal Home Loan
Mortgage Corporation for delivery in 60 days in effect on the
day of sale. If at any time, the seller forgives the related
organization debt allowed under this paragraph for other than
equal amount of payment on that debt, then the buyer shall pay
to the state the total revenue received by the nursing facility
after the sale attributable to the amount of allowable debt
which has been forgiven. Any assignment, sale, or transfer of
the debt instrument entered into by the close relatives, either
directly or indirectly, which grants to the close relative buyer
the right to receive all or a portion of the payments under the
debt instrument shall, effective on the date of the transfer,
result in the prospective reduction in the corresponding portion
of the allowable debt and interest expense. Upon the death of
the close relative seller, any remaining balance of the close
relative debt must be refinanced and such refinancing shall be
subject to the provisions of Minnesota Rules, part 9549.0060,
subpart 7, item G. This paragraph shall not apply to sales
occurring on or after June 30, 1997.
(e) (f) For purposes of this subdivision, "effective date
of sale" means the later of either the date on which legal title
to the capital assets is transferred or the date on which
closing for the sale occurred.
(f) (g) The effective day for the property-related payment
rate determined under this subdivision shall be the first day of
the month following the month in which the effective date of
sale occurs or October 1, 1992, whichever is later, provided
that the notice requirements under section 256B.47, subdivision
2, have been met.
(g) (h) Notwithstanding Minnesota Rules, part 9549.0060,
subparts 5, item A, subitems (3) and (4), and 7, items E and F,
the commissioner shall limit the total allowable debt and
related interest for sales occurring after June 30, 1992, to the
sum of clauses (1) to (3):
(1) the historical cost of capital assets, as of the
nursing facility's most recent previous effective date of sale
or, if there has been no previous sale, the nursing facility's
initial historical cost of constructing capital assets;
(2) the average annual capital asset additions after
deduction for capital asset deletions, not including
depreciations; and
(3) one-half of the allowed inflation on the nursing
facility's capital assets. The commissioner shall compute the
allowed inflation as described in paragraph (h).
(h) (i) For purposes of computing the amount of allowed
inflation, the commissioner must apply the following principles:
(1) the lesser of the Consumer Price Index for all urban
consumers or the Dodge Construction Systems Costs for Nursing
Homes for any time periods during which both are available must
be used. If the Dodge Construction Systems Costs for Nursing
Homes becomes unavailable, the commissioner shall substitute the
index in subdivision 3f, or such other index as the secretary of
the health care financing administration may designate;
(2) the amount of allowed inflation to be applied to the
capital assets in paragraph (g), clauses (1) and (2), must be
computed separately;
(3) the amount of allowed inflation must be determined on
an annual basis, prorated on a monthly basis for partial years
and if the initial month of use is not determinable for a
capital asset, then one-half of that calendar year shall be used
for purposes of prorating;
(4) the amount of allowed inflation to be applied to the
capital assets in paragraph (g), clauses (1) and (2), must not
exceed 300 percent of the total capital assets in any one of
those clauses; and
(5) the allowed inflation must be computed starting with
the month following the nursing facility's most recent previous
effective date of sale or, if there has been no previous sale,
the month following the date of the nursing facility's initial
occupancy, and ending with the month preceding the effective
date of sale.
(i) (j) If the historical cost of a capital asset is not
readily available for the date of the nursing facility's most
recent previous sale or if there has been no previous sale for
the date of the nursing facility's initial occupancy, then the
commissioner shall limit the total allowable debt and related
interest after sale to the extent recognized by the Medicare
intermediary after the sale. For a nursing facility that has no
historical capital asset cost data available and does not have
allowable debt and interest calculated by the Medicare
intermediary, the commissioner shall use the historical cost of
capital asset data from the point in time for which capital
asset data is recorded in the nursing facility's audited
financial statements.
(j) (k) The limitations in this subdivision apply only to
debt resulting from a sale of a nursing facility occurring after
June 30, 1992, including debt assumed by the purchaser of the
nursing facility.
Sec. 95. Minnesota Statutes 1992, section 256B.431,
subdivision 15, is amended to read:
Subd. 15. [CAPITAL REPAIR AND REPLACEMENT COST REPORTING
AND RATE CALCULATION.] For rate years beginning after June 30,
1993, a nursing facility's capital repair and replacement
payment rate shall be established annually as provided in
paragraphs (a) to (d).
(a) Notwithstanding Minnesota Rules, part 9549.0060,
subpart 12, the costs of acquiring any of the following items,
including cash payment for equity investment and principal and
interest expense for debt financing, shall be reported in the
capital repair and replacement cost category when the cost of
the item exceeds $500:
(1) wall coverings;
(2) paint;
(3) floor coverings;
(4) window coverings;
(5) roof repair;
(6) heating or cooling system repair or replacement;
(7) window repair or replacement;
(8) initiatives designed to reduce energy usage by the
facility if accompanied by an energy audit prepared by a
professional engineer or architect registered in Minnesota, or
by an auditor certified under Minnesota Rules, part 7635.0130,
to do energy audits and the energy audit identifies the
initiative as a conservation measure; and
(9) capitalized repair or replacement of capital assets not
included in the equity incentive computations under subdivision
16.
(b) To compute the capital repair and replacement payment
rate, the allowable annual repair and replacement costs for the
reporting year must be divided by actual resident days for the
reporting year. The annual allowable capital repair and
replacement costs shall not exceed $150 per licensed bed. The
excess of the allowed capital repair and replacement costs over
the capital repair and replacement limit shall be a cost
carryover to succeeding cost reporting periods, except that sale
of a facility, under subdivision 14, shall terminate the
carryover of all costs except those incurred in the most recent
cost reporting year. The termination of the carryover shall
have effect on the capital repair and replacement rate on the
same date as provided in subdivision 14, paragraph (f), for the
sale. For rate years beginning after June 30, 1994, the capital
repair and replacement limit shall be subject to the index
provided in subdivision 3f, paragraph (a). For purposes of this
subdivision, the number of licensed beds shall be the number
used to calculate the nursing facility's capacity days. The
capital repair and replacement rate must be added to the nursing
facility's total payment rate.
(c) Capital repair and replacement costs under this
subdivision shall not be counted as either care-related or other
operating costs, nor subject to care-related or other operating
limits.
(d) If costs otherwise allowable under this subdivision are
incurred as the result of a project approved under the
moratorium exception process in section 144A.073, or in
connection with an addition to or replacement of buildings,
attached fixtures, or land improvements for which the total
historical cost of these assets exceeds the lesser of $150,000
or ten percent of the nursing facility's appraised value, these
costs must be claimed under subdivision 16 or 17, as appropriate.
Sec. 96. Minnesota Statutes 1992, section 256B.431,
subdivision 21, is amended to read:
Subd. 21. [INDEXING THRESHHOLDS THRESHOLDS.] Beginning
January 1, 1993, and each January 1 thereafter, the commissioner
shall annually update the dollar threshholds thresholds in
subdivisions 15, paragraph (d), 16, and 17, and in section
144A.071, subdivision subdivisions 2 and 3 4a,
clauses (h) (b) and (p) (e), by the inflation index referenced
in subdivision 3f, paragraph (a).
Sec. 97. Minnesota Statutes 1992, section 256B.431, is
amended by adding a subdivision to read:
Subd. 22. [CHANGES TO NURSING FACILITY REIMBURSEMENT.] The
nursing facility reimbursement changes in paragraphs (a) to (e)
apply to Minnesota Rules, parts 9549.0010 to 9549.0080, and this
section, and are effective for rate years beginning on or after
July 1, 1993, unless otherwise indicated.
(a) In addition to the approved pension or profit sharing
plans allowed by the reimbursement rule, the commissioner shall
allow those plans specified in Internal Revenue Code, sections
403(b) and 408(k).
(b) The commissioner shall allow as workers' compensation
insurance costs under section 256B.421, subdivision 14, the
costs of workers' compensation coverage obtained under the
following conditions:
(1) a plan approved by the commissioner of commerce as a
Minnesota group or individual self-insurance plan as provided in
sections 79A.03;
(2) a plan in which:
(i) the nursing facility, directly or indirectly, purchases
workers' compensation coverage in compliance with section
176.181, subdivision 2, from an authorized insurance carrier;
(ii) a related organization to the nursing facility
reinsures the workers' compensation coverage purchased, directly
or indirectly, by the nursing facility; and
(iii) all of the conditions in clause (4) are met;
(3) a plan in which:
(i) the nursing facility, directly or indirectly, purchases
workers' compensation coverage in compliance with section
176.181, subdivision 2, from an authorized insurance carrier;
(ii) the insurance premium is calculated retrospectively,
including a maximum premium limit, and paid using the paid loss
retro method; and
(iii) all of the conditions in clause (4) are met;
(4) additional conditions are:
(i) the costs of the plan are allowable under the federal
Medicare program;
(ii) the reserves for the plan are maintained in an account
controlled and administered by a person which is not a related
organization to the nursing facility;
(iii) the reserves for the plan cannot be used, directly or
indirectly, as collateral for debts incurred or other
obligations of the nursing facility or related organizations to
the nursing facility;
(iv) if the plan provides workers' compensation coverage
for non-Minnesota nursing facilities, the plan's cost
methodology must be consistent among all nursing facilities
covered by the plan, and if reasonable, is allowed
notwithstanding any reimbursement laws regarding cost allocation
to the contrary;
(v) central, affiliated, corporate, or nursing facility
costs related to their administration of the plan are costs
which must remain in the nursing facility's administrative cost
category and must not be allocated to other cost categories; and
(vi) required security deposits, whether in the form of
cash, investments, securities, assets, letters of credit, or in
any other form are not allowable costs for purposes of
establishing the facilities payment rate.
(5) any costs allowed pursuant to clauses (1) to (3) are
subject to the following requirements:
(i) If the nursing facility is sold or otherwise ceases
operations, the plan's reserves must be subject to an
actuarially based settle-up after 36 months from the date of
sale or the date on which operations ceased. The facility's
medical assistance portion of the total excess plan reserves
must be paid to the state within 30 days following the date on
which excess plan reserves are determined.
(ii) Any distribution of excess plan reserves made to or
withdrawals made by the nursing facility or a related
organization are applicable credits and must be used to reduce
the nursing facility's workers' compensation insurance costs in
the reporting period in which a distribution or withdrawal is
received.
(iii) If reimbursement for the plan is sought under the
federal Medicare program, and is audited pursuant to the
Medicare program, the nursing facility must provide a copy of
Medicare's final audit report, including attachments and
exhibits, to the commissioner within 30 days of receipt by the
nursing facility or any related organization. The commissioner
shall implement the audit findings associated with the plan upon
receipt of Medicare's final audit report. The department's
authority to implement the audit findings is independent of its
authority to conduct a field audit.
(6) the commissioner shall have authority to adopt
emergency rules to implement this paragraph.
(c) In the determination of incremental increases in the
nursing facility's rental rate as required in subdivisions 14 to
21, except for a refinancing permitted under subdivision 19, the
commissioner must adjust the nursing facility's property-related
payment rate for both incremental increases and decreases in
recomputations of its rental rate.
(d) A nursing facility's administrative cost limitation
must be modified as follows:
(1) if the nursing facility's licensed beds exceed 195
licensed beds, the general and administrative cost category
limitation shall be 13 percent;
(2) if the nursing facility's licensed beds are more than
150 licensed beds, but less than 196 licensed beds, the general
and administrative cost category limitation shall be 14 percent;
or
(3) if the nursing facility's licensed beds is less than
151 licensed beds, the general and administrative cost category
limitation shall remain at 15 percent.
(e) The care related operating rate shall be increased by
eight cents to reimburse facilities for unfunded federal
mandates, including costs related to hepatitis B vaccinations.
Sec. 98. Minnesota Statutes 1992, section 256B.431 is
amended by adding a subdivision to read:
Subd. 23. [COUNTY NURSING HOME PAYMENT ADJUSTMENTS.] (a)
Beginning in 1994, the commissioner shall pay a nursing home
payment adjustment on May 31 after noon to a county in which is
located a nursing home that, as of January 1 of the previous
year, was county-owned and had over 40 beds and medical
assistance occupancy in excess of 50 percent during the
reporting year ending September 30, 1991. The adjustment shall
be an amount equal to $16 per calendar day multiplied by the
number of beds licensed in the facility as of September 30, 1991.
(b) Payments under paragraph (a) are excluded from medical
assistance per diem rate calculations. These payments are
required notwithstanding any rule prohibiting medical assistance
payments from exceeding payments from private pay residents. A
facility receiving a payment under paragraph (a) may not
increase charges to private pay residents by an amount
equivalent to the per diem amount payments under paragraph (a)
would equal if converted to a per diem.
Sec. 99. Minnesota Statutes 1992, section 256B.431, is
amended by adding a subdivision to read:
Subd. 24. [MODIFIED EFFICIENCY INCENTIVE.] Notwithstanding
section 256B.74, subdivision 3, for the rate year beginning July
1, 1993, the maximum efficiency incentive is $2.20, and for rate
years beginning on or after July 1, 1994, the commissioner shall
determine a nursing facility's efficiency incentive by first
computing the amount by which the facility's other operating
cost limit exceeds its nonadjusted other operating cost per diem
for that rate year. The commissioner shall then use the
following table to compute the nursing facility's efficiency
incentive. Each increment or partial increment the nursing
facility's nonadjusted other operating per diem is below its
other operating cost limit shall be multiplied by the
corresponding percentage for that per diem increment. The sum
of each of those computations shall be the nursing facility's
efficiency incentive.
Other Operating Cost Percentage Applied
Per Diem Increment to Each Per Diem
Below Facility Limit Increment
Less than $0.50 70 percent
$0.50 to less than $0.70 10 percent
$0.70 to less than $0.90 15 percent
$0.90 to less than $1.10 20 percent
$1.10 to less than $1.30 25 percent
$1.30 to less than $1.50 30 percent
$1.50 to less than $1.70 35 percent
$1.70 to less than $1.90 40 percent
$1.90 to less than $2.10 45 percent
$2.10 to less than $2.30 50 percent
$2.30 to less than $2.50 55 percent
$2.50 to less than $2.70 60 percent
$2.70 to less than $2.90 65 percent
$2.90 to less than $3.10 70 percent
$3.10 to less than $3.30 75 percent
$3.30 to less than $3.50 80 percent
$3.50 to less than $3.70 85 percent
$3.70 to less than $3.90 90 percent
$3.90 to less than $4.10 95 percent
$4.10 to less than $4.30 100 percent
The maximum efficiency incentive is $2.44 per resident day.
Sec. 100. Minnesota Statutes 1992, section 256B.432,
subdivision 5, is amended to read:
Subd. 5. [ALLOCATION OF REMAINING COSTS; ALLOCATION
RATIO.] (a) After the costs that can be directly identified
according to subdivisions 3 and 4 have been allocated, the
remaining central, affiliated, or corporate office costs must be
allocated between the long-term care facility operations and the
other activities or facilities unrelated to the long-term care
facility operations based on the ratio of expenses total
operating costs.
(b) For purposes of allocating these remaining central,
affiliated, or corporate office costs, the numerator for the
allocation ratio shall be determined as follows:
(1) for long-term care facilities that are related
organizations or are controlled by a central, affiliated, or
corporate office under a management agreement, the numerator of
the allocation ratio shall be equal to the sum of the
total operating costs incurred by each related organization or
controlled long-term care facility;
(2) for a central, affiliated, or corporate office
providing goods or services to related organizations that are
not long-term care facilities, the numerator of the allocation
ratio shall be equal to the sum of the total operating costs
incurred by the non-long-term care related organizations;
(3) for a central, affiliated, or corporate office
providing goods or services to unrelated long-term care
facilities under a consulting agreement, the numerator of the
allocation ratio shall be equal to the greater of directly
identified central, affiliated, or corporate costs or the
contracted amount; or
(4) for business activities that involve the providing of
goods or services to unrelated parties which are not long-term
care facilities, the numerator of the allocation ratio shall be
equal to the greater of directly identified costs or revenues
generated by the activity or function.
(c) The denominator for the allocation ratio is the sum of
the numerators in paragraph (b), clauses (1) to (4).
Sec. 101. Minnesota Statutes 1992, section 256B.432, is
amended by adding a subdivision to read:
Subd. 8. [ADEQUATE DOCUMENTATION SUPPORTING LONG-TERM CARE
FACILITY PAYROLLS.] Beginning July 1, 1993, payroll records
supporting compensation costs claimed by long-term care
facilities must be supported by affirmative time and attendance
records prepared by each individual at intervals of not more
than one month. The affirmative time and attendance record must
identify the individual's name; the days worked during each pay
period; the number of hours worked each day; and the number of
hours taken each day by the individual for vacation, sick, and
other leave. The affirmative time and attendance record must
include a signed verification by the individual and the
individual's supervisor, if any, that the entries reported on
the record are correct.
Sec. 102. Minnesota Statutes 1992, section 256B.47,
subdivision 3, is amended to read:
Subd. 3. [ALLOCATION OF COSTS.] To ensure the avoidance of
double payments as required by section 256B.433, the direct and
indirect reporting year costs of providing residents of nursing
facilities that are not hospital attached with therapy services
that are billed separately from the nursing facility payment
rate or according to Minnesota Rules, parts 9500.0750 to
9500.1080, must be determined and deducted from the appropriate
cost categories of the annual cost report as follows:
(a) The costs of wages and salaries for employees providing
or participating in providing and consultants providing services
shall be allocated to the therapy service based on direct
identification.
(b) The costs of fringe benefits and payroll taxes relating
to the costs in paragraph (a) must be allocated to the therapy
service based on direct identification or the ratio of total
costs in paragraph (a) to the sum of total allowable salaries
and the costs in paragraph (a).
(c) The costs of housekeeping, plant operations and
maintenance, real estate taxes, special assessments, and
insurance, other than the amounts classified as a fringe
benefit, must be allocated to the therapy service based on the
ratio of service area square footage to total facility square
footage.
(d) The costs of bookkeeping and medical records must be
allocated to the therapy service either by the method in
paragraph (e) or based on direct identification. Direct
identification may be used if adequate documentation is provided
to, and accepted by, the commissioner.
(e) The costs of administrators, bookkeeping, and medical
records salaries, except as provided in paragraph (d), must be
allocated to the therapy service based on the ratio of the total
costs in paragraphs (a) to (d) to the sum of total allowable
nursing facility costs and the costs in paragraphs (a) to (d).
(f) The cost of property must be allocated to the therapy
service and removed from the rental per diem nursing facility's
property-related payment rate, based on the ratio of service
area square footage to total facility square footage multiplied
by the building capital allowance property-related payment rate.
Sec. 103. Minnesota Statutes 1992, section 256B.48,
subdivision 1, is amended to read:
Subdivision 1. [PROHIBITED PRACTICES.] A nursing facility
is not eligible to receive medical assistance payments unless it
refrains from all of the following:
(a) Charging private paying residents rates for similar
services which exceed those which are approved by the state
agency for medical assistance recipients as determined by the
prospective desk audit rate, except under the following
circumstances: the nursing facility may (1) charge private
paying residents a higher rate for a private room, and (2)
charge for special services which are not included in the daily
rate if medical assistance residents are charged separately at
the same rate for the same services in addition to the daily
rate paid by the commissioner. Services covered by the payment
rate must be the same regardless of payment source. Special
services, if offered, must be available to all residents in all
areas of the nursing facility and charged separately at the same
rate. Residents are free to select or decline special
services. Special services must not include services which must
be provided by the nursing facility in order to comply with
licensure or certification standards and that if not provided
would result in a deficiency or violation by the nursing
facility. Services beyond those required to comply with
licensure or certification standards must not be charged
separately as a special service if they were included in the
payment rate for the previous reporting year. A nursing
facility that charges a private paying resident a rate in
violation of this clause is subject to an action by the state of
Minnesota or any of its subdivisions or agencies for civil
damages. A private paying resident or the resident's legal
representative has a cause of action for civil damages against a
nursing facility that charges the resident rates in violation of
this clause. The damages awarded shall include three times the
payments that result from the violation, together with costs and
disbursements, including reasonable attorneys' fees or their
equivalent. A private paying resident or the resident's legal
representative, the state, subdivision or agency, or a nursing
facility may request a hearing to determine the allowed rate or
rates at issue in the cause of action. Within 15 calendar days
after receiving a request for such a hearing, the commissioner
shall request assignment of an administrative law judge under
sections 14.48 to 14.56 to conduct the hearing as soon as
possible or according to agreement by the parties. The
administrative law judge shall issue a report within 15 calendar
days following the close of the hearing. The prohibition set
forth in this clause shall not apply to facilities licensed as
boarding care facilities which are not certified as skilled or
intermediate care facilities level I or II for reimbursement
through medical assistance.
(b) Requiring an applicant for admission to the facility,
or the guardian or conservator of the applicant, as a condition
of admission, to pay any fee or deposit in excess of $100, loan
any money to the nursing facility, or promise to leave all or
part of the applicant's estate to the facility.
(c) Requiring any resident of the nursing facility to
utilize a vendor of health care services who is a licensed
physician or pharmacist chosen by the nursing facility.
(d) Providing differential treatment on the basis of status
with regard to public assistance.
(e) Discriminating in admissions, services offered, or room
assignment on the basis of status with regard to public
assistance or refusal to purchase special services. Admissions
discrimination shall include, but is not limited to:
(1) basing admissions decisions upon assurance by the
applicant to the nursing facility, or the applicant's guardian
or conservator, that the applicant is neither eligible for nor
will seek public assistance for payment of nursing facility care
costs; and
(2) engaging in preferential selection from waiting lists
based on an applicant's ability to pay privately or an
applicant's refusal to pay for a special service.
The collection and use by a nursing facility of financial
information of any applicant pursuant to a preadmission
screening program established by law shall not raise an
inference that the nursing facility is utilizing that
information for any purpose prohibited by this paragraph.
(f) Requiring any vendor of medical care as defined by
section 256B.02, subdivision 7, who is reimbursed by medical
assistance under a separate fee schedule, to pay any amount
based on utilization or service levels or any portion of the
vendor's fee to the nursing facility except as payment for
renting or leasing space or equipment or purchasing support
services from the nursing facility as limited by section
256B.433. All agreements must be disclosed to the commissioner
upon request of the commissioner. Nursing facilities and
vendors of ancillary services that are found to be in violation
of this provision shall each be subject to an action by the
state of Minnesota or any of its subdivisions or agencies for
treble civil damages on the portion of the fee in excess of that
allowed by this provision and section 256B.433. Damages awarded
must include three times the excess payments together with costs
and disbursements including reasonable attorney's fees or their
equivalent.
(g) Refusing, for more than 24 hours, to accept a resident
returning to the same bed or a bed certified for the same level
of care, in accordance with a physician's order authorizing
transfer, after receiving inpatient hospital services.
The prohibitions set forth in clause (b) shall not apply to
a retirement facility with more than 325 beds including at least
150 licensed nursing facility beds and which:
(1) is owned and operated by an organization tax-exempt
under section 290.05, subdivision 1, clause (i); and
(2) accounts for all of the applicant's assets which are
required to be assigned to the facility so that only expenses
for the cost of care of the applicant may be charged against the
account; and
(3) agrees in writing at the time of admission to the
facility to permit the applicant, or the applicant's guardian,
or conservator, to examine the records relating to the
applicant's account upon request, and to receive an audited
statement of the expenditures charged against the applicant's
individual account upon request; and
(4) agrees in writing at the time of admission to the
facility to permit the applicant to withdraw from the facility
at any time and to receive, upon withdrawal, the balance of the
applicant's individual account.
For a period not to exceed 180 days, the commissioner may
continue to make medical assistance payments to a nursing
facility or boarding care home which is in violation of this
section if extreme hardship to the residents would result. In
these cases the commissioner shall issue an order requiring the
nursing facility to correct the violation. The nursing facility
shall have 20 days from its receipt of the order to correct the
violation. If the violation is not corrected within the 20-day
period the commissioner may reduce the payment rate to the
nursing facility by up to 20 percent. The amount of the payment
rate reduction shall be related to the severity of the violation
and shall remain in effect until the violation is corrected.
The nursing facility or boarding care home may appeal the
commissioner's action pursuant to the provisions of chapter 14
pertaining to contested cases. An appeal shall be considered
timely if written notice of appeal is received by the
commissioner within 20 days of notice of the commissioner's
proposed action.
In the event that the commissioner determines that a
nursing facility is not eligible for reimbursement for a
resident who is eligible for medical assistance, the
commissioner may authorize the nursing facility to receive
reimbursement on a temporary basis until the resident can be
relocated to a participating nursing facility.
Certified beds in facilities which do not allow medical
assistance intake on July 1, 1984, or after shall be deemed to
be decertified for purposes of section 144A.071 only.
Sec. 104. Minnesota Statutes 1992, section 256B.48,
subdivision 2, is amended to read:
Subd. 2. [REPORTING REQUIREMENTS.] No later than December
31 of each year, a skilled nursing facility or intermediate care
facility, including boarding care facilities, which receives
medical assistance payments or other reimbursements from the
state agency shall:
(a) Provide the state agency with a copy of its audited
financial statements. The audited financial statements must
include a balance sheet, income statement, statement of the rate
or rates charged to private paying residents, statement of
retained earnings, statement of cash flows, notes to the
financial statements, audited applicable supplemental
information, and the certified public accountant's or licensed
public accountant's opinion. The examination by the certified
public accountant or licensed public accountant shall be
conducted in accordance with generally accepted auditing
standards as promulgated and adopted by the American Institute
of Certified Public Accountants. Beginning with the reporting
year which begins October 1, 1992, a nursing facility is no
longer required to have a certified audit of its financial
statements. The cost of a certified audit shall not be an
allowable cost in that reporting year, nor in subsequent
reporting years unless the nursing facility submits its
certified audited financial statements in the manner otherwise
specified in this subdivision. A nursing facility which does
not submit a certified audit must submit its working trial
balance;
(b) Provide the state agency with a statement of ownership
for the facility;
(c) Provide the state agency with separate, audited
financial statements as specified in clause (a) for every other
facility owned in whole or part by an individual or entity which
has an ownership interest in the facility;
(d) Upon request, provide the state agency with separate,
audited financial statements as specified in clause (a) for
every organization with which the facility conducts business and
which is owned in whole or in part by an individual or entity
which has an ownership interest in the facility;
(e) Provide the state agency with copies of leases,
purchase agreements, and other documents related to the lease or
purchase of the nursing facility;
(f) Upon request, provide the state agency with copies of
leases, purchase agreements, and other documents related to the
acquisition of equipment, goods, and services which are claimed
as allowable costs; and
(g) Permit access by the state agency to the certified
public accountant's and licensed public accountant's audit
workpapers which support the audited financial statements
required in clauses (a), (c), and (d).
Documents or information provided to the state agency
pursuant to this subdivision shall be public. If the
requirements of clauses (a) to (g) are not met, the
reimbursement rate may be reduced to 80 percent of the rate in
effect on the first day of the fourth calendar month after the
close of the reporting year, and the reduction shall continue
until the requirements are met.
Both nursing facilities and intermediate care facilities
for the mentally retarded must maintain statistical and
accounting records in sufficient detail to support information
contained in the facility's cost report for at least five six
years, including the year following the submission of the cost
report. For computerized accounting systems, the records must
include copies of electronically generated media such as
magnetic discs and tapes.
Sec. 105. Minnesota Statutes 1992, section 256B.49, is
amended by adding a subdivision to read:
Subd. 5. [PROVIDE WAIVER ELIGIBILITY FOR CERTAIN
CHRONICALLY ILL AND CERTAIN DISABLED PERSONS.] Chronically ill
or disabled individuals, who are likely to reside in acute care
if waiver services were not provided, could be found eligible
for services under this section without regard to age.
Sec. 106. Minnesota Statutes 1992, section 256B.50,
subdivision 1b, is amended to read:
Subd. 1b. [FILING AN APPEAL.] To appeal, the provider
shall file with the commissioner a written notice of appeal; the
appeal must be postmarked or received by the commissioner within
60 days of the date the determination of the payment rate was
mailed or personally received by a provider, whichever is
earlier. The notice of appeal must specify each disputed item;
the reason for the dispute; the total dollar amount in dispute
for each separate disallowance, allocation, or adjustment of
each cost item or part of a cost item; the computation that the
provider believes is correct; the authority in statute or rule
upon which the provider relies for each disputed item; the name
and address of the person or firm with whom contacts may be made
regarding the appeal; and other information required by the
commissioner. The commissioner shall review an appeal by a
nursing facility, if the appeal was sent by certified mail and
postmarked prior to August 1, 1991, and would have been received
by the commissioner within the 60-day deadline if it had not
been delayed due to an error by the postal service.
Sec. 107. Minnesota Statutes 1992, section 256B.50, is
amended by adding a subdivision to read:
Subd. 1h. [APPEALS REVIEW PROJECT.] (a) The appeals review
procedure described in this subdivision is effective for desk
audit appeals for rate years beginning between July 1, 1993, and
June 30, 1997, and for field audit appeals filed during that
time period. For appeals reviewed under this subdivision,
subdivision 1c applies only to contested case demands under
paragraph (d) and subdivision 1d does not apply.
(b) The commissioner shall review appeals and issue a
written determination on each appealed item within one year of
the due date of the appeal. Upon mutual agreement, the
commissioner and the provider may extend the time for issuing a
determination for a specified period. The commissioner shall
notify the provider by first class mail of the determination.
The determination takes effect 30 days following the date of
issuance specified in the determination.
(c) In reviewing the appeal, the commissioner may request
additional written or oral information from the provider. The
provider has the right to present information by telephone or in
person concerning the appeal to the commissioner prior to the
issuance of the determination if a conference is requested
within six months of the date the appeal was received by the
commissioner. Statements made during the review process are not
admissible in a contested case hearing under paragraph (d)
absent an express stipulation by the parties to the contested
case.
(d) For an appeal item on which the provider disagrees with
the determination, the provider may file with the commissioner a
written demand for a contested case hearing to determine the
proper resolution of specified appeal items. The demand must be
postmarked or received by the commissioner within 30 days of the
date of issuance specified in the determination. The
commissioner shall refer any contested case demand to the office
of the attorney general. When a contested case demand is
referred to the office of the attorney general, the contested
case procedures described in subdivision 1c apply and the
written determination issued by the commissioner is of no effect.
(e) The commissioner has discretion to issue to the
provider a proposed resolution for specified appeal items upon a
request from the provider filed separately from the notice of
appeal. The proposed resolution is final upon written
acceptance by the provider within 30 days of the date the
proposed resolution was mailed to or personally received by the
provider, whichever is earlier.
(f) The commissioner may use the procedures described in
this subdivision to resolve appeals filed prior to July 1, 1993.
Sec. 108. Minnesota Statutes 1992, section 256B.50, is
amended by adding a subdivision to read:
Subd. 3. [TIME AND ATTENDANCE DISPUTED ITEMS.] The
commissioner shall settle unresolved appeals by a nursing
facility of disallowances or adjustments of compensation costs
for rate years beginning prior to June 30, 1994, by recognizing
the compensation costs reported by the nursing facility when the
appealed disallowances or adjustments were based on a
determination of inadequate documentation of time and attendance
or equivalent records to support payroll costs. The recognition
of costs provided in this subdivision pertains only to appeals
of disallowances and adjustments based solely on disputed time
and attendance or equivalent records. Appeals of disallowances
and adjustments of compensation costs based on other grounds,
including misrepresentation of costs or failure to meet the
general cost criteria under Minnesota Rules, parts 9549.0010 to
9549.0080, are not governed by this subdivision.
Sec. 109. Minnesota Statutes 1992, section 256B.501,
subdivision 3g, is amended to read:
Subd. 3g. [ASSESSMENT OF RESIDENTS.] For rate years
beginning on or after October 1, 1990, the commissioner shall
establish program operating cost rates for care of residents in
facilities that take into consideration service characteristics
of residents in those facilities. To establish the service
characteristics of residents, the quality assurance and review
teams in the department of health shall assess all residents
annually beginning January 1, 1989, using a uniform assessment
instrument developed by the commissioner. This instrument shall
include assessment of the client's services identified as needed
and provided to each client to address behavioral needs,
integration into the community, ability to perform activities of
daily living, medical and therapeutic needs, and other relevant
factors determined by the commissioner. The commissioner may
adjust the program operating cost rates of facilities based on a
comparison of client service characteristics, resource needs,
and costs. The commissioner may adjust a facility's payment
rate during the rate year when accumulated changes in the
facility's average service units exceed the minimums established
in the rules required by subdivision 3j. By January 30, 1994,
the commissioner shall report to the legislature on:
(1) the assessment process and scoring system utilized;
(2) possible utilization of assessment information by
facilities for management purposes; and
(3) possible application of the assessment for purposes of
adjusting the operating cost rates of facilities based on a
comparison of client services characteristics, resource needs,
and costs.
Sec. 110. Minnesota Statutes 1992, section 256B.501,
subdivision 3i, is amended to read:
Subd. 3i. [SCOPE.] Subdivisions 3a to 3e and 3h do not
apply to facilities whose payment rates are governed by
Minnesota Rules, part 9553.0075.
Sec. 111. Minnesota Statutes 1992, section 256B.501, is
amended by adding a subdivision to read:
Subd. 5a. [CHANGES TO ICF/MR REIMBURSEMENT.] The
reimbursement rule changes in paragraphs (a) to (e) apply to
Minnesota Rules, parts 9553.0010 to 9553.0080, and this section,
and are effective for rate years beginning on or after October
1, 1993, unless otherwise specified.
(a) The maximum efficiency incentive shall be $1.50 per
resident per day.
(b) If a facility's capital debt reduction allowance is
greater than 50 cents per resident per day, that facility's
capital debt reduction allowance in excess of 50 cents per
resident day shall be reduced by 25 percent.
(c) Beginning with the biennial reporting year which begins
January 1, 1993, a facility is no longer required to have a
certified audit of its financial statements. The cost of a
certified audit shall not be an allowable cost in that reporting
year, nor in subsequent reporting years unless the facility
submits its certified audited financial statements in the manner
otherwise specified in this subdivision. A nursing facility
which does not submit a certified audit must submit its working
trial balance.
(d) In addition to the approved pension or profit sharing
plans allowed by the reimbursement rule, the commissioner shall
allow those plans specified in Internal Revenue Code, sections
403(b) and 408(k).
(e) The commissioner shall allow as workers' compensation
insurance costs under this section, the costs of workers'
compensation coverage obtained under the following conditions:
(1) a plan approved by the commissioner of commerce as a
Minnesota group or individual self-insurance plan as provided in
sections 79A.03;
(2) a plan in which:
(i) the facility, directly or indirectly, purchases
workers' compensation coverage in compliance with section
176.181, subdivision 2, from an authorized insurance carrier;
(ii) a related organization to the facility reinsures the
workers' compensation coverage purchased, directly or
indirectly, by the facility; and
(iii) all of the conditions in clause (4) are met;
(3) a plan in which:
(i) the facility, directly or indirectly, purchases
workers' compensation coverage in compliance with section
176.181, subdivision 2, from an authorized insurance carrier;
(ii) the insurance premium is calculated retrospectively,
including a maximum premium limit, and paid using the paid loss
retro method; and
(iii) all of the conditions in clause (4) are met;
(4) additional conditions are:
(i) the reserves for the plan are maintained in an account
controlled and administered by a person which is not a related
organization to the facility;
(ii) the reserves for the plan cannot be used, directly or
indirectly, as collateral for debts incurred or other
obligations of the facility or related organizations to the
facility;
(iii) if the plan provides workers' compensation coverage
for non-Minnesota facilities, the plan's cost methodology must
be consistent among all facilities covered by the plan, and if
reasonable, is allowed notwithstanding any reimbursement laws
regarding cost allocation to the contrary;
(iv) central, affiliated, corporate, or nursing facility
costs related to their administration of the plan are costs
which must remain in the nursing facility's administrative cost
category, and must not be allocated to other cost categories;
and
(v) required security deposits, whether in the form of
cash, investments, securities, assets, letters of credit, or in
any other form are not allowable costs for purposes of
establishing the facilities payment rate;
(5) any costs allowed pursuant to clauses (1) to (3) are
subject to the following requirements:
(i) If the facility is sold or otherwise ceases operations,
the plan's reserves must be subject to an actuarially based
settle-up after 36 months from the date of sale or the date on
which operations ceased. The facility's medical assistance
portion of the total excess plan reserves must be paid to the
state within 30 days following the date on which excess plan
reserves are determined;
(ii) Any distribution of excess plan reserves made to or
withdrawals made by the facility or a related organization are
applicable credits and must be used to reduce the facility's
workers' compensation insurance costs in the reporting period in
which a distribution or withdrawal is received; and
(iii) If the plan is audited pursuant to the Medicare
program, the facility must provide a copy of Medicare's final
audit report, including attachments and exhibits, to the
commissioner within 30 days of receipt by the facility or any
related organization. The commissioner shall implement the
audit findings associated with the plan upon receipt of
Medicare's final audit report. The department's authority to
implement the audit findings is independent of its authority to
conduct a field audit; and
(6) the commissioner shall have authority to adopt
emergency rules to implement this paragraph.
Sec. 112. Minnesota Statutes 1992, section 256B.501,
subdivision 12, is amended to read:
Subd. 12. [ICF/MR SALARY ADJUSTMENTS.] For the rate period
beginning January 1, 1992, and ending September 30, 1993, the
commissioner shall add the appropriate salary adjustment cost
per diem calculated in paragraphs (a) to (d) to the total
operating cost payment rate of each facility. The salary
adjustment cost per diem must be determined as follows:
(a) [COMPUTATION AND REVIEW GUIDELINES.] Except as
provided in paragraph (c), a state-operated community service,
and any facility whose payment rates are governed by closure
agreements, receivership agreements, or Minnesota Rules, part
9553.0075, are not eligible for a salary adjustment otherwise
granted under this subdivision. For purposes of the salary
adjustment per diem computation and reviews in this subdivision,
the term "salary adjustment cost" means the facility's allowable
program operating cost category employee training expenses, and
the facility's allowable salaries, payroll taxes, and fringe
benefits. The term does not include these same salary-related
costs for both administrative or central office employees.
For the purpose of determining the amount of salary
adjustment to be granted under this subdivision, the
commissioner must use the reporting year ending December 31,
1990, as the base year for the salary adjustment per diem
computation. For the purpose of each year's both years' salary
adjustment cost review, the commissioner must use the facility's
salary adjustment cost for the reporting year ending December
31, 1991, as the base year. If the base year and the
reporting year years subject to review include salary cost
reclassifications made by the department, the commissioner must
reconcile those differences before completing the salary
adjustment per diem review.
(b) [SALARY ADJUSTMENT PER DIEM COMPUTATION.] For the rate
period beginning January 1, 1992, each facility shall receive a
salary adjustment cost per diem equal to its salary adjustment
costs multiplied by 1-1/2 percent, and then divided by the
facility's resident days.
(c) [ADJUSTMENTS FOR NEW FACILITIES.] For newly
constructed or newly established facilities, except for
state-operated community services, whose payment rates are
governed by Minnesota Rules, part 9553.0075, if the settle-up
cost report includes a reporting year which is subject to review
under this subdivision, the commissioner shall adjust the rule
provision governing the maximum settle-up payment rate by
increasing the .4166 percent for each full month of the
settle-up cost report to .7083. For any subsequent rate period
which is authorized for salary adjustments under this
subdivision, the commissioner shall compute salary adjustment
cost per diems by annualizing the salary adjustment costs for
the settle-up cost report period and treat that period as the
base year for purposes of reviewing salary adjustment cost per
diems.
(d) [SALARY ADJUSTMENT PER DIEM REVIEW.] The commissioner
shall review the implementation of the salary adjustments on a
per diem basis. For reporting years ending December 31, 1992,
and December 31, 1993, the commissioner must review and
determine the amount of change in salary adjustment costs in
each both of the above reporting years over the base year after
the reporting year ending December 31, 1993. In the case of
each review, The commissioner must inflate the base year's
salary adjustment costs by the cumulative percentage increase
granted in paragraph (b), plus three percentage points for each
of the two years reviewed. The commissioner must then compare
each facility's salary adjustment costs for the reporting year
divided by the facility's resident days for that both reporting
year years to the base year's inflated salary adjustment cost
divided by the facility's resident days for the base year. If
the facility has had a one-time program operating cost
adjustment settle-up during any of the reporting years subject
to review, the commissioner must remove the per diem effect of
the one-time program adjustment before completing the review and
per diem comparison.
The review and per diem comparison must be done by the
commissioner each year following after the reporting years
subject to review year ending December 31, 1993. If the salary
adjustment cost per diem for the reporting year years being
reviewed is less than the base year's inflated salary adjustment
cost per diem, the commissioner must recover the difference
within 120 days after the date of written notice. The amount of
the recovery shall be equal to the per diem difference
multiplied by the facility's resident days in the reporting year
years being reviewed. Written notice of the amount subject to
recovery must be given by the commissioner following each both
reporting year years reviewed. Interest charges must be
assessed by the commissioner after the 120th day of that notice
at the same interest rate the commissioner assesses for other
balance outstanding.
Sec. 113. Minnesota Statutes 1992, section 256D.03,
subdivision 4, is amended to read:
Subd. 4. [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] (a)
For a person who is eligible under subdivision 3, paragraph (a),
clause (3), general assistance medical care covers:
(1) inpatient hospital services;
(2) outpatient hospital services;
(3) services provided by Medicare certified rehabilitation
agencies;
(4) prescription drugs and other products recommended
through the process established in section 256B.0625,
subdivision 13;
(5) equipment necessary to administer insulin and
diagnostic supplies and equipment for diabetics to monitor blood
sugar level;
(6) eyeglasses and eye examinations provided by a physician
or optometrist;
(7) hearing aids;
(8) prosthetic devices;
(9) laboratory and X-ray services;
(10) physician's services;
(11) medical transportation;
(12) chiropractic services as covered under the medical
assistance program;
(13) podiatric services;
(14) dental services;
(15) outpatient services provided by a mental health center
or clinic that is under contract with the county board and is
established under section 245.62;
(16) day treatment services for mental illness provided
under contract with the county board;
(17) prescribed medications for persons who have been
diagnosed as mentally ill as necessary to prevent more
restrictive institutionalization;
(18) case management services for a person with serious and
persistent mental illness who would be eligible for medical
assistance except that the person resides in an institution for
mental diseases;
(19) psychological services, medical supplies and
equipment, and Medicare premiums, coinsurance and deductible
payments; and
(20) medical equipment not specifically listed in this
paragraph when the use of the equipment will prevent the need
for costlier services that are reimbursable under this
subdivision; and
(21) services performed by a certified pediatric nurse
practitioner, a certified family nurse practitioner, a certified
adult nurse practitioner, a certified obstetric/gynecological
nurse practitioner, or a certified geriatric nurse practitioner
in independent practice, if the services are otherwise covered
under this chapter as a physician service, and if the service is
within the scope of practice of the nurse practitioner's license
as a registered nurse, as defined in section 148.171.
(b) For a recipient who is eligible under subdivision 3,
paragraph (a), clause (1) or (2), general assistance medical
care covers the services listed in paragraph (a) with the
exception of special transportation services.
(c) In order to contain costs, the commissioner of human
services shall select vendors of medical care who can provide
the most economical care consistent with high medical standards
and shall where possible contract with organizations on a
prepaid capitation basis to provide these services. The
commissioner shall consider proposals by counties and vendors
for prepaid health plans, competitive bidding programs, block
grants, or other vendor payment mechanisms designed to provide
services in an economical manner or to control utilization, with
safeguards to ensure that necessary services are provided.
Before implementing prepaid programs in counties with a county
operated or affiliated public teaching hospital or a hospital or
clinic operated by the University of Minnesota, the commissioner
shall consider the risks the prepaid program creates for the
hospital and allow the county or hospital the opportunity to
participate in the program in a manner that reflects the risk of
adverse selection and the nature of the patients served by the
hospital, provided the terms of participation in the program are
competitive with the terms of other participants considering the
nature of the population served. Payment for services provided
pursuant to this subdivision shall be as provided to medical
assistance vendors of these services under sections 256B.02,
subdivision 8, and 256B.0625. For payments made during fiscal
year 1990 and later years, the commissioner shall consult with
an independent actuary in establishing prepayment rates, but
shall retain final control over the rate methodology.
(d) The commissioner of human services may reduce payments
provided under sections 256D.01 to 256D.21 and 261.23 in order
to remain within the amount appropriated for general assistance
medical care, within the following restrictions.
For the period July 1, 1985, to December 31, 1985,
reductions below the cost per service unit allowable under
section 256.966, are permitted only as follows: payments for
inpatient and outpatient hospital care provided in response to a
primary diagnosis of chemical dependency or mental illness may
be reduced no more than 30 percent; payments for all other
inpatient hospital care may be reduced no more than 20 percent.
Reductions below the payments allowable under general assistance
medical care for the remaining general assistance medical care
services allowable under this subdivision may be reduced no more
than ten percent.
For the period January 1, 1986, to December 31, 1986,
reductions below the cost per service unit allowable under
section 256.966 are permitted only as follows: payments for
inpatient and outpatient hospital care provided in response to a
primary diagnosis of chemical dependency or mental illness may
be reduced no more than 20 percent; payments for all other
inpatient hospital care may be reduced no more than 15 percent.
Reductions below the payments allowable under general assistance
medical care for the remaining general assistance medical care
services allowable under this subdivision may be reduced no more
than five percent.
For the period January 1, 1987, to June 30, 1987,
reductions below the cost per service unit allowable under
section 256.966 are permitted only as follows: payments for
inpatient and outpatient hospital care provided in response to a
primary diagnosis of chemical dependency or mental illness may
be reduced no more than 15 percent; payments for all other
inpatient hospital care may be reduced no more than ten
percent. Reductions below the payments allowable under medical
assistance for the remaining general assistance medical care
services allowable under this subdivision may be reduced no more
than five percent.
For the period July 1, 1987, to June 30, 1988, reductions
below the cost per service unit allowable under section 256.966
are permitted only as follows: payments for inpatient and
outpatient hospital care provided in response to a primary
diagnosis of chemical dependency or mental illness may be
reduced no more than 15 percent; payments for all other
inpatient hospital care may be reduced no more than five percent.
Reductions below the payments allowable under medical assistance
for the remaining general assistance medical care services
allowable under this subdivision may be reduced no more than
five percent.
For the period July 1, 1988, to June 30, 1989, reductions
below the cost per service unit allowable under section 256.966
are permitted only as follows: payments for inpatient and
outpatient hospital care provided in response to a primary
diagnosis of chemical dependency or mental illness may be
reduced no more than 15 percent; payments for all other
inpatient hospital care may not be reduced. Reductions below
the payments allowable under medical assistance for the
remaining general assistance medical care services allowable
under this subdivision may be reduced no more than five percent.
There shall be no copayment required of any recipient of
benefits for any services provided under this subdivision. A
hospital receiving a reduced payment as a result of this section
may apply the unpaid balance toward satisfaction of the
hospital's bad debts.
(e) Any county may, from its own resources, provide medical
payments for which state payments are not made.
(f) Chemical dependency services that are reimbursed under
chapter 254B must not be reimbursed under general assistance
medical care.
(g) The maximum payment for new vendors enrolled in the
general assistance medical care program after the base year
shall be determined from the average usual and customary charge
of the same vendor type enrolled in the base year.
(h) The conditions of payment for services under this
subdivision are the same as the conditions specified in rules
adopted under chapter 256B governing the medical assistance
program, unless otherwise provided by statute or rule.
Sec. 114. Minnesota Statutes 1992, section 256D.03,
subdivision 8, is amended to read:
Subd. 8. [PRIVATE INSURANCE POLICIES.] (a) Private
accident and health care coverage for medical services is
primary coverage and must be exhausted before general assistance
medical care is paid. When a person who is otherwise eligible
for general assistance medical care has private accident or
health care coverage, including a prepaid health plan, the
private health care benefits available to the person must be
used first and to the fullest extent. Supplemental payment may
be made by general assistance medical care, but the combined
total amount paid must not exceed the amount payable under
general assistance medical care in the absence of other
coverage. General assistance medical care must not make
supplemental payment for covered services rendered by a vendor
who participates or contracts with any health coverage plan if
the plan requires the vendor to accept the plan's payment as
payment in full. General assistance medical care payment will
not be made when either covered charges are paid in full by a
third party or the provider has an agreement to accept payment
for less than charges as payment in full. Payment for patients
that are simultaneously covered by general assistance medical
care and a liable third party other than Medicare will be
determined as the lesser of clauses (1) to (3):
(1) the patient liability according to the provider/insurer
agreement;
(2) covered charges minus the third party payment amount;
or
(3) the general assistance medical care rate minus the
third party payment amount.
A negative difference will not be implemented.
(b) When a parent or a person with an obligation of support
has enrolled in a prepaid health care plan under section
518.171, subdivision 1, the commissioner of human services shall
limit the recipient of general assistance medical care to the
benefits payable under that prepaid health care plan to the
extent that services available under general assistance medical
care are also available under the prepaid health care plan.
(c) Upon furnishing general assistance medical care or
general assistance to any person having private accident or
health care coverage, or having a cause of action arising out of
an occurrence that necessitated the payment of assistance, the
state agency shall be subrogated, to the extent of the cost of
medical care, subsistence, or other payments furnished, to any
rights the person may have under the terms of the coverage or
under the cause of action.
This right of subrogation includes all portions of the
cause of action, notwithstanding any settlement allocation or
apportionment that purports to dispose of portions of the cause
of action not subject to subrogation.
(d) To recover under this section, the attorney general or
the appropriate county attorney, acting upon direction from the
attorney general, may institute or join a civil action to
enforce the subrogation rights established under this section.
(e) The state agency must be given notice of monetary
claims against a person, firm, or corporation that may be liable
in damages, or otherwise obligated to pay part or all of the
costs related to an injury when the state agency has paid or
become liable for the cost of care or payments related to the
injury. Notice must be given as follows:
(i) Applicants for general assistance or general assistance
medical care shall notify the state or county agency of any
possible claims when they submit the application. Recipients of
general assistance or general assistance medical care shall
notify the state or county agency of any possible claims when
those claims arise.
(ii) A person providing medical care services to a
recipient of general assistance medical care shall notify the
state agency when the person has reason to believe that a third
party may be liable for payment of the cost of medical care.
(iii) A person who is party to a claim upon which the state
agency may be entitled to subrogation under this section shall
notify the state agency of its potential subrogation claim
before filing a claim, commencing an action, or negotiating a
settlement. A person who is a party to a claim includes the
plaintiff, the defendants, and any other party to the cause of
action.
Notice given to the county agency is not sufficient to meet
the requirements of paragraphs (b) and (c).
(f) Upon any judgment, award, or settlement of a cause of
action, or any part of it, upon which the state agency has a
subrogation right, including compensation for liquidated,
unliquidated, or other damages, reasonable costs of collection,
including attorney fees, must be deducted first. The full
amount of general assistance or general assistance medical care
paid to or on behalf of the person as a result of the injury
must be deducted next and paid to the state agency. The rest
must be paid to the public assistance recipient or other
plaintiff. The plaintiff, however, must receive at least
one-third of the net recovery after attorney fees and collection
costs.
Sec. 115. Minnesota Statutes 1992, section 259.431,
subdivision 5, is amended to read:
Subd. 5. [MEDICAL ASSISTANCE; DUTIES OF THE COMMISSIONER
OF HUMAN SERVICES.] The commissioner of human services shall:
(a) Issue a medical assistance identification card to any
child with special needs who is title IV-E eligible, or who is
not title IV-E eligible but was determined by another state to
have a special need for medical or rehabilitative care, and who
is a resident in this state and is the subject of an adoption
assistance agreement with another state when a certified copy of
the adoption assistance agreement obtained from the adoption
assistance state has been filed with the commissioner. The
adoptive parents shall be required at least annually to show
that the agreement is still in force or has been renewed.
(b) Consider the holder of a medical assistance
identification card under this subdivision as any other
recipient of medical assistance under chapter 256B; process and
make payment on claims for the recipient in the same manner as
for other recipients of medical assistance.
(c) Provide coverage and benefits for a child who is title
IV-E eligible or who is not title IV-E eligible but was
determined to have a special need for medical or rehabilitative
care and who is in another state and who is covered by an
adoption assistance agreement made by the commissioner for the
coverage or benefits, if any, which is not provided by the
resident state. The adoptive parents acting for the child may
submit evidence of payment for services or benefit amounts not
payable in the resident state and shall be reimbursed. However,
there shall be no reimbursement for services or benefit amounts
covered under any insurance or other third party medical
contract or arrangement held by the child or the adoptive
parents.
(d) Publish emergency and permanent rules implementing this
subdivision. Such rules shall include procedures to be followed
in obtaining prior approvals for services which are required for
the assistance.
Sec. 116. Minnesota Statutes 1992, section 393.07,
subdivision 3, is amended to read:
Subd. 3. [FEDERAL SOCIAL SECURITY.] The county welfare
board shall be charged with the duties of administration of all
forms of public assistance and public child welfare or other
programs within the purview of the federal Social Security Act,
other than public health nursing and home health services, and
which now are, or hereafter may be, imposed on the commissioner
of human services by law, of both children and adults. The
duties of such county welfare board shall be performed in
accordance with the standards and rules which may be promulgated
by the commissioner of human services in order to achieve the
purposes of the law and to comply with the requirements of the
federal Social Security Act needed to qualify the state to
obtain grants-in-aid available under that act. Notwithstanding
the provisions of any other law to the contrary, the welfare
board may shall delegate to the director the authority to
determine eligibility and disburse funds without first securing
board action, provided that the director shall present to the
board, at the next scheduled meeting, any such action taken for
ratification by the board.
Sec. 117. [514.980] [MEDICAL ASSISTANCE LIENS;
DEFINITIONS.]
Subdivision 1. [APPLICABILITY.] The definitions in this
section apply to sections 514.980 to 514.985.
Subd. 2. [MEDICAL ASSISTANCE AGENCY OR AGENCY.] "Medical
assistance agency" or "agency" means the state or any county
medical assistance agency that provides a medical assistance
benefit.
Subd. 3. [MEDICAL ASSISTANCE BENEFIT.] "Medical assistance
benefit" means a benefit provided under chapter 256B to a person
while in a medical institution. A "medical institution" is
defined as a nursing facility, intermediate care facility for
persons with mental retardation, or inpatient hospital.
Sec. 118. [514.981] [MEDICAL ASSISTANCE LIEN.]
Subdivision 1. [PROPERTY SUBJECT TO LIEN; LIEN AMOUNT.] (a)
Subject to sections 514.980 to 514.985, payments made by a
medical assistance agency to provide medical assistance benefits
to a medical assistance recipient who owns property in this
state or to the recipient's spouse constitute a lien in favor of
the agency upon all real property that is owned by the medical
assistance recipient on or after the time when the recipient is
institutionalized.
(b) The amount of the lien is limited to the same extent as
a claim against the estate under section 256B.15, subdivision 2.
Subd. 2. [ATTACHMENT.] (a) A medical assistance lien
attaches and becomes enforceable against specific real property
as of the date when the following conditions are met:
(1) payments have been made by an agency for a medical
assistance benefit;
(2) notice and an opportunity for a hearing have been
provided under paragraph (b);
(3) a lien notice has been filed as provided in section
514.982;
(4) if the property is registered property, the lien notice
has been memorialized on the certificate of title of the
property affected by the lien notice; and
(5) all restrictions against enforcement have ceased to
apply.
(b) An agency may not file a medical assistance lien notice
until the medical assistance recipient and the recipient's
spouse or their legal representatives have been sent, by
certified or registered mail, written notice of the agency's
lien rights and there has been an opportunity for a hearing
under section 256.045. In addition, the agency may not file a
lien notice unless the agency determines as medically verified
by the recipient's attending physician that the medical
assistance recipient cannot reasonably be expected to be
discharged from a medical institution and return home.
(c) An agency may not file a medical assistance lien notice
against real property while it is the home of the recipient's
spouse.
(d) An agency may not file a medical assistance lien notice
against real property that was the homestead of the medical
assistance recipient or the recipient's spouse when the medical
assistance recipient received medical institution services if
any of the following persons are lawfully residing in the
property:
(1) a child of the medical assistance recipient if the
child is under age 21 or is blind or permanently and totally
disabled according to the supplemental security income criteria;
(2) a child of the medical assistance recipient if the
child resided in the homestead for at least two years
immediately before the date the medical assistance recipient
received medical institution services, and the child provided
care to the medical assistance recipient that permitted the
recipient to live without medical institution services; or
(3) a sibling of the medical assistance recipient if the
sibling has an equity interest in the property and has resided
in the property for at least one year immediately before the
date the medical assistance recipient began receiving medical
institution services.
(e) A medical assistance lien applies only to the specific
real property described in the lien notice.
Subd. 3. [CONTINUATION OF LIEN NOTICE AND LIEN.] A medical
assistance lien notice remains effective from the time it is
filed until it can be disregarded under sections 514.980 to
514.985. A medical assistance lien that has attached to
specific real property continues until the lien is satisfied,
becomes unenforceable under subdivision 6, or is released and
discharged under subdivision 5.
Subd. 4. [LIEN PRIORITY.] A medical assistance lien that
attaches to specific real property is subject to the rights of
any other person whose interest in the real property is
perfected before a lien notice has been filed under section
514.982, including:
(a) an owner, other than the recipient or recipient's
spouse;
(b) a purchaser;
(c) a holder of a mortgage or security interest; or
(d) a judgment lien creditor.
The rights of the other person have the same protections against
a medical assistance lien as are afforded against a judgment
lien that arises out of an unsecured obligation and that arises
as of the time of the filing of the medical assistance lien
notice under section 514.982. A medical assistance lien is
inferior to a lien for taxes or special assessments or other
lien that would be superior to the perfected lien of a judgment
creditor.
Subd. 5. [RELEASE.] (a) An agency that files a medical
assistance lien notice shall release and discharge the lien in
full if:
(1) the medical assistance recipient is discharged from the
medical institution and returns home;
(2) the medical assistance lien is satisfied;
(3) the agency has received reimbursement for the amount
secured by the lien or a legally enforceable agreement has been
executed providing for reimbursement of the agency for that
amount; or
(4) the medical assistance recipient, if single, or the
recipient's surviving spouse, has died, and a claim may not be
filed against the estate of the decedent under section 256B.15,
subdivision 3.
(b) Upon request, the agency that files a medical
assistance lien notice shall release a specific parcel of real
property from the lien if:
(1) the property is or was the homestead of the recipient's
spouse during the time of the medical assistance recipient's
institutionalization, or the property is or was attributed to
the spouse under section 256B.059, subdivision 3 or 4, and the
spouse is not receiving medical assistance benefits;
(2) the property would be exempt from a claim against the
estate under section 256B.15, subdivision 4;
(3) the agency receives reimbursement, or other collateral
sufficient to secure payment of reimbursement, in an amount
equal to the lesser of the amount secured by the lien, or the
amount the agency would be allowed to recover upon enforcement
of the lien against the specific parcel of property if the
agency attempted to enforce the lien on the date of the request
to release the lien; or
(4) the medical assistance lien cannot lawfully be enforced
against the property because of an error, omission, or other
material defect in procedure, description, identity, timing, or
other prerequisite to enforcement.
(c) The agency that files a medical assistance lien notice
may release the lien if the attachment or enforcement of the
lien is determined by the agency to be contrary to the public
interest.
(d) The agency that files a medical assistance lien notice
shall execute the release of the lien and file the release as
provided in section 514.982, subdivision 2.
Subd. 6. [TIME LIMITS; CLAIM LIMITS.] (a) A medical
assistance lien is not enforceable against specific real
property if any of the following occurs:
(1) the lien is not satisfied or proceedings are not
lawfully commenced to foreclose the lien within 18 months of the
agency's receipt of notice of the death of the medical
assistance recipient or the death of the surviving spouse,
whichever occurs later; or
(2) the lien is not satisfied or proceedings are not
lawfully commenced to foreclose the lien within three years of
the death of the medical assistance recipient or the death of
the surviving spouse, whichever occurs later. This limitation
is tolled during any period when the provisions of section
514.983, subdivision 2, apply to delay enforcement of the lien.
(b) A medical assistance lien is not enforceable against
the real property of an estate to the extent there is a
determination by a court of competent jurisdiction, or by an
officer of the court designated for that purpose, that there are
insufficient assets in the estate to satisfy the agency's
medical assistance lien in whole or in part in accordance with
the priority of claims established by chapters 256B and 524.
The agency's lien remains enforceable to the extent that assets
are available to satisfy the agency's lien, subject to the
priority of other claims, and to the extent that the agency's
claim is allowed against the estate under chapters 256B and 524.
Sec. 119. [514.982] [MEDICAL ASSISTANCE LIEN NOTICE.]
Subdivision 1. [CONTENTS.] A medical assistance lien
notice must be dated and must contain:
(1) the full name, last known address, and social security
number of the medical assistance recipient and the full name,
address, and social security number of the recipient's spouse;
(2) a statement that medical assistance payments have been
made to or for the benefit of the medical assistance recipient
named in the notice, specifying the first date of eligibility
for benefits;
(3) a statement that all interests in real property owned
by the persons named in the notice may be subject to or affected
by the rights of the agency to be reimbursed for medical
assistance benefits; and
(4) the legal description of the real property upon which
the lien attaches, and whether the property is registered
property.
Subd. 2. [FILING.] Any notice, release, or other document
required to be filed under sections 514.980 to 514.985 must be
filed in the office of the county recorder or registrar of
titles, as appropriate, in the county where the real property is
located. Notwithstanding section 386.77, the agency shall pay
the applicable filing fee for any document filed under sections
514.980 to 514.985. The commissioner of human services shall
reimburse the county agency for filing fees paid under this
section. An attestation, certification, or acknowledgment is
not required as a condition of filing. Upon filing of a medical
assistance lien notice, the registrar of titles shall record it
on the certificate of title of each parcel of property described
in the lien notice. The county recorder of each county shall
establish an index of medical assistance lien notices, other
than those that affect only registered property, showing the
names of all persons named in the medical assistance lien
notices filed in the county, arranged alphabetically. The index
must be combined with the index of state tax lien notices. The
filing or mailing of any notice, release, or other document
under sections 514.980 to 514.985 is the responsibility of the
agency. The agency shall send a copy of the medical assistance
lien notice by registered or certified mail to each record owner
and mortgagee of the real property.
Sec. 120. [514.983] [LIEN ENFORCEMENT; LIMITATION.]
Subdivision 1. [FORECLOSURE PROCEDURE.] Subject to
subdivision 2, a medical assistance lien may be enforced by the
agency that filed it by foreclosure in the manner provided for
foreclosure of a judgment lien under chapter 550.
Subd. 2. [HOMESTEAD PROPERTY.] (a) A medical assistance
lien may not be enforced against homestead property of the
medical assistance recipient or the spouse while it remains the
lawful residence of the medical assistance recipient's spouse.
(b) A medical assistance lien remains enforceable as
provided in sections 514.980 to 514.985, notwithstanding any law
limiting the enforceability of a judgment.
Sec. 121. [514.984] [LIEN DOES NOT AFFECT OTHER REMEDIES.]
Sections 514.980 to 514.985 do not limit the right of an
agency to file a claim against the estate of a medical
assistance recipient or the estate of the spouse or limit any
other claim for reimbursement of agency expenses or the
availability of any other remedy provided to the agency.
Sec. 122. [514.985] [AMOUNTS RECEIVED TO SATISFY LIEN.]
Amounts received by the state to satisfy a medical
assistance lien filed by the state must be deposited in the
state treasury and credited to the fund from which the medical
assistance payments were made. Amounts received by a county
medical assistance agency to satisfy a medical assistance lien
filed by the county medical assistance agency must be deposited
in the county treasury and credited to the fund from which the
medical assistance payments were made.
Sec. 123. Laws 1992, chapter 513, article 7, section 131,
is amended to read:
Sec. 131. [PHYSICIAN AND DENTAL REIMBURSEMENT.]
(a) The physician reimbursement increase provided in
Minnesota Statutes, section 256B.74, subdivision 2, shall not be
implemented. Effective for services rendered on or after
October 1, 1992, the commissioner shall make payments for
physician services as follows:
(1) payment for level one Health Care Finance
Administration's common procedural coding system (HCPCS) codes
titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum,
and postpartum care," "critical care," caesarean delivery and
pharmacologic management provided to psychiatric patients, and
HCPCS level three codes for enhanced services for prenatal high
risk, shall be paid at the lower of (i) submitted charges, or
(ii) 25 percent above the rate in effect on June 30, 1992. If
the rate on any procedure code within these categories is
different than the rate that would have been paid under the
methodology in Minnesota Statutes, section 256B.74, subdivision
2, then the larger rate shall be paid;
(2) payments for all other services shall be paid at the
lower of (i) submitted charges, or (ii) 15.4 percent above the
rate in effect on June 30, 1992; and
(3) all physician rates shall be converted from the 50th
percentile of 1982 to the 50th percentile of 1989, less the
percent in aggregate necessary to equal the above
increases except that payment rates for home health agency
services shall be the rates in effect on September 30, 1992.
(b) The dental reimbursement increase provided in Minnesota
Statutes, section 256B.74, subdivision 5, shall not be
implemented. Effective for services rendered on or after
October 1, 1992, the commissioner shall make payments for dental
services as follows:
(1) dental services shall be paid at the lower of (i)
submitted charges, or (ii) 25 percent above the rate in effect
on June 30, 1992; and
(2) dental rates shall be converted from the 50th
percentile of 1982 to the 50th percentile of 1989, less the
percent in aggregate necessary to equal the above increases.
(c) An entity that operates both a Medicare certified
comprehensive outpatient rehabilitation facility and a facility
which was certified prior to January 1, 1993, that is licensed
under Minnesota Rules, parts 9570.2000 to 9570.3600, and for
whom at least 33 percent of the clients receiving rehabilitation
services in the most recent calendar year are medical assistance
recipients, shall be reimbursed by the commissioner for
rehabilitation services at rates that are 38 percent greater
than the maximum reimbursement rate allowed under paragraph (a),
clause (2), when those services are (1) provided within the
comprehensive outpatient rehabilitation facility and (2)
provided to residents of nursing facilities owned by the entity.
Sec. 124. Laws 1993, chapter 20, is amended by adding a
section to read:
Sec. 7. [HOSPITAL REIMBURSEMENT FOR INPATIENT SERVICES.]
The commissioner may consider indigent care payments as
disproportionate population adjustments for eligible hospitals,
if so permitted by the secretary of health and human services.
Sec. 125. [REPORT ON LONG-TERM CARE INSURANCE.]
The interagency long-term care planning committee must
report to the legislature by January 15, 1994, on the
feasibility of implementing a long-term care insurance program.
The report shall evaluate the potential impact on the medical
assistance budget of allowing persons with at least two years of
long-term care insurance coverage to waive the asset test for
medical assistance eligibility, or of other incentives to
encourage the purchase of long term care insurance. The report
shall also evaluate the availability of private long-term care
insurance, and the feasibility of state-sponsored long-term care
insurance if inadequate private long-term care insurance exists.
Sec. 126. [REPORT ON HOSPITAL PEER GROUPING.]
The commissioner of human services shall report to the
legislature by November 15, 1993, on the peer grouping plan
developed under Minnesota Statutes, section 256.969, subdivision
24. The report shall describe the peer grouping plan in detail,
including the variables used to create the groups and the
treatment of operating cost differences that are not common to
all hospitals. The report must also indicate how the peer
grouping plan will affect each individual hospital. The
commissioner shall form a task force of representatives from the
department of human services and from the hospital industry to
provide technical assistance in the development of the peer
grouping plan.
Sec. 127. [PHYSICIAN SURCHARGE STUDY.]
The commissioner of human services, in cooperation with the
commissioner of revenue, shall study and recommend to the
legislature by January 15, 1994, a plan to replace the physician
license surcharge with a surcharge on the tax levied on
physicians under Minnesota Statutes, section 295.52. The plan
must be designed to take effect July 1, 1994, and to raise an
amount of revenue equal to the amount anticipated from the
current surcharge.
Sec. 128. [STUDY OF BED REDISTRIBUTION.]
The interagency long-term care planning committee shall
present to the legislature, by January 15, 1994, recommendations
for redistributing existing nursing home beds and certified
boarding care home beds to meet demographic need. The
recommendations must include, but are not limited to, comment on
the concepts of bed layaway and bed transfer. The interagency
long-term care planning committee shall convene a task force
comprised of providers, consumers, and state agency staff to
develop these recommendations.
Sec. 129. [LEGISLATIVE INTENT.]
Sections 6 and 15, paragraph (b); and the amendment to
paragraph (a), clause (3), in section 123, are intended to
clarify, rather than to change, the original intent of the
statutes amended.
Sec. 130. [WAIVER REQUEST TO LIMIT ASSET TRANSFERS.]
The commissioner of human services shall seek federal law
changes and federal waivers necessary to implement the
amendments to Minnesota Statutes, section 256B.0595.
Sec. 131. [NURSING HOME SURCHARGE DISCLOSURE.]
A nursing home licensed under Minnesota Statutes, chapter
144A, and not certified to participate in the medical assistance
program shall include the following in 10-point type in any rate
notice issued after the effective date of this section: THE
NURSING HOME SURCHARGE THAT APPLIES TO THIS FACILITY EFFECTIVE
OCTOBER 1, 1992, THROUGH JUNE 30, 1993, IS $535 PER BED PER
YEAR, OR $1.47 PER DAY. THE SURCHARGE IS INCREASED EFFECTIVE
JULY 1, 1993, TO $620 PER BED PER YEAR, OR A TOTAL OF $1.70 PER
DAY AND EFFECTIVE JULY 1, 1994, TO $625 PER BED PER YEAR, OR A
TOTAL OF $1.72 PER DAY. ANY RATE IN EXCESS OF THESE AMOUNTS IS
NOT DUE TO THE NURSING HOME SURCHARGE.
Sec. 132. [REPORT TO THE LEGISLATURE.]
The commissioner of human services, in coordination with
the commissioner of finance, shall study and report to the
legislature by January 15, 1994, on the following: (1)
recommendations on how to phase out provider surcharge
collections, and (2) an evaluation of compliance by the
commissioner of finance with the paragraph in Laws 1992, chapter
513, article 5, section 2, subdivision 1, which required the
commissioner of finance to (i) prepare a biennial budget for
fiscal years 1994-95 that did not include provider surcharge
revenues in excess of the estimated costs associated with the
MinnesotaCare program, and (ii) prepare a plan to phase out the
non-MinnesotaCare surcharges by June 30, 1995.
Sec. 133. [ALTERNATIVE CARE PROGRAM PILOT PROJECTS.]
Subdivision 1. [PROJECT PURPOSE.] (a) By September 1,
1993, the commissioner of human services shall select up to six
pilot projects for the alternative care program. The purpose of
the pilot projects is to simplify program administration and
reduce documentation, increase service flexibility, and more
clearly identify program outcomes. The pilot projects must
begin January 1, 1994, and expire June 30, 1995.
(b) Projects must be selected based on their ability to
improve client outcomes, broaden service choices, and reduce
average per client costs and administrative costs. If
sufficient satisfactory applications are received, the
commissioner shall approve three projects in the seven-county
metropolitan area and three projects outside the metropolitan
area. If sufficient satisfactory applications are not received,
more than three projects may be approved in either the
metropolitan or nonmetropolitan areas. Up to two projects may
include SAIL counties.
Subd. 2. [TERMS.] A county or counties may apply to
participate in the pilot project by submitting to the
commissioner an amendment to the biennial plan that identifies
measurable outcomes to be achieved under the pilot project.
Participating counties shall determine the types of services to
be reimbursed with alternative care program grant funds and any
individual client reimbursement limits. Participating counties
shall determine the payment rates for all services under the
pilot project. Participating counties will maintain their
average monthly alternative care expenditures per client at
their calendar 1993 averages adjusted for any overall increase
in the case mix complexity of their caseload. A county may
spend up to five percent of grant funds for needed client
services that are not listed under Minnesota Statutes, section
256B.0913, subdivision 5. The average expenditure per client in
a pilot project must not exceed 75 percent of the statewide
individual average nursing home costs.
Subd. 3. [DOCUMENTATION.] Beginning January 1, 1994, a
county or counties participating in a pilot project shall not
submit invoices for processing through the medical assistance
management information system (MMIS) or other individual client
service and reimbursement data for services delivered after
December 31, 1993. A pilot project county must provide to the
commissioner the minimum client-specific characteristics
required to make nursing facility occupancy and alternative care
program cost forecasts and the minimum client-specific data
necessary for long-term care planning and alternative care pilot
project evaluation. The client-specific characteristics must be
submitted to the commissioner quarterly. The commissioner shall
minimize the reporting required from counties.
Subd. 4. [FUNDING.] On March 1, 1994, and monthly
thereafter until June 30, 1994, the commissioner shall issue to
counties participating in the pilot projects an amount of money
equal to one-sixth of each county's unexpended allocation of
base and targeted alternative care appropriations under
Minnesota Statutes, section 256B.0913, subdivisions 10 and 11.
On July 1, 1994, and monthly thereafter, the commissioner shall
issue an amount of money equal to one-twelfth of the fiscal year
1994 allocation. Additional targeted funds may be allocated
based on the criteria established in Minnesota Statutes, section
256B.0913, to the extent that money is available. Targeted
funds will be equally distributed over the remaining months of
the fiscal year. Counties participating in the pilot projects
must submit to the commissioner quarterly expenditure reports
and reconcile the actual expenditure on September 1, 1995.
Subd. 5. [REPORT.] The commissioner must evaluate the
pilot projects and report findings to the legislature by
February 1, 1995. The report must evaluate client outcomes and
service utilization, total spending and average per client
costs, administrative cost reductions, changes in the types of
services provided, and any border problems with contiguous
nonpilot counties.
Sec. 134. [REPEALER.]
Minnesota Statutes 1992, section 252.478 is repealed.
Sec. 135. [EFFECTIVE DATES.]
Subdivision 1. Sections 7, 28, and 45 are effective the
day following final enactment. Sections 12 and 131 are
effective the day following final enactment.
Subd. 2. Section 127 is effective the day following final
enactment.
Subd. 3. Section 126 is effective the day following final
enactment.
Subd. 4. Section 35 is effective for transfers made for
less than fair market value on or after July 1, 1993, or after
the effective date of any applicable federal waivers, whichever
is later, except that those portions of section 35 that may be
implemented without federal waivers are effective for transfers
made for less than fair market value on or after July 1, 1993.
Subd. 5. Section 32 is effective retroactive to October 1,
1992.
Subd. 6. Section 61, paragraph (c), is effective upon the
receipt by the commissioner of human services of the requested
waiver from the secretary of human services, for persons
screened for admission to a nursing facility on or after the
date the waiver is received.
Subd. 7. Sections 6 and 129 are effective the day
following final enactment and apply to cases pending or brought
on or after their effective date.
Subd. 8. Section 42 is effective retroactive to July 1,
1992.
Subd. 9. The definition of total premium revenue in
section 15, paragraph (b), applies to all health maintenance
organization surcharges effective October 1, 1992.
ARTICLE 6
FAMILY SELF-SUFFICIENCY
AND CHILD SUPPORT ENFORCEMENT
Section 1. Minnesota Statutes 1992, section 144.215,
subdivision 3, is amended to read:
Subd. 3. [FATHER'S NAME; CHILD'S NAME.] In any case in
which paternity of a child is determined by a court of competent
jurisdiction, or upon compliance with the provisions of a
declaration of parentage is executed under section 257.55,
subdivision 1, clause (e) 257.34, or a recognition of parentage
is executed under section 257.75, the name of the father shall
be entered on the birth certificate. If the order of the court
declares the name of the child, it shall also be entered on the
birth certificate. If the order of the court does not declare
the name of the child, or there is no court order, then upon the
request of both parents in writing, the surname of the child
shall be that of the father.
Sec. 2. Minnesota Statutes 1992, section 144.215, is
amended by adding a subdivision to read:
Subd. 4. [SOCIAL SECURITY NUMBER REGISTRATION.] (a)
Parents of a child born within this state shall give their
social security numbers to the office of vital statistics at the
time of filing the birth certificate, but the numbers shall not
appear on the certificate.
(b) The social security numbers are classified as private
data, as defined in section 13.02, subdivision 12, on
individuals, but the office of vital statistics shall provide
the social security number to the public authority responsible
for child support services upon request by the public authority
for use in the establishment of parentage and the enforcement of
child support obligations.
Sec. 3. Minnesota Statutes 1992, section 256.032,
subdivision 11, is amended to read:
Subd. 11. [SIGNIFICANT CHANGE.] "Significant change" means
a change in income available to the family so that the sum of
the income and the grant for the current month would be less
than the transitional standard as defined in subdivision
13 decline in gross income of 38 percent or more from the income
used to determine the grant for the current month.
Sec. 4. Minnesota Statutes 1992, section 256.73,
subdivision 2, is amended to read:
Subd. 2. [ALLOWANCE BARRED BY OWNERSHIP OF PROPERTY.]
Ownership by an assistance unit of property as follows is a bar
to any allowance under sections 256.72 to 256.87:
(1) The value of real property other than the homestead,
which when combined with other assets exceeds the limits of
paragraph (2), unless the assistance unit is making a good faith
effort to sell the nonexcludable real property. The time period
for disposal must not exceed nine consecutive months and. The
assistance unit shall execute must sign an agreement to dispose
of the property and to repay assistance received during the nine
months up to that would not have been paid had the property been
sold at the beginning of such period, but not to exceed the
amount of the net sale proceeds. The payment must be made when
the property is sold family has five working days from the date
it realizes cash from the sale of the property to repay the
overpayment. If the property is not sold within the required
time or the assistance unit becomes ineligible for any
reason the entire amount received during the nine months is an
overpayment and subject to recovery during the nine-month
period, the amount payable under the agreement will not be
determined and recovery will not begin until the property is in
fact sold. If the property is intentionally sold at less than
fair market value or if a good faith effort to sell the property
is not being made, the overpayment amount shall be computed
using the fair market value determined at the beginning of the
nine-month period. For the purposes of this section,
"homestead" means the home that is owned by, and is the usual
residence of, the child, relative, or other member of the
assistance unit together with the surrounding property which is
not separated from the home by intervening property owned by
others. "Usual residence" includes the home from which the
child, relative, or other members of the assistance unit is
temporarily absent due to an employability development plan
approved by the local human service agency, which includes
education, training, or job search within the state but outside
of the immediate geographic area. Public rights-of-way, such as
roads which run through the surrounding property and separate it
from the home, will not affect the exemption of the property; or
(2) Personal property of an equity value in excess of
$1,000 for the entire assistance unit, exclusive of personal
property used as the home, one motor vehicle of an equity value
not exceeding $1,500 or the entire equity value of a motor
vehicle determined to be necessary for the operation of a
self-employment business, one burial plot for each member of the
assistance unit, one prepaid burial contract with an equity
value of no more than $1,000 for each member of the assistance
unit, clothing and necessary household furniture and equipment
and other basic maintenance items essential for daily living, in
accordance with rules promulgated by and standards established
by the commissioner of human services.
Sec. 5. Minnesota Statutes 1992, section 256.73,
subdivision 3a, is amended to read:
Subd. 3a. [PERSONS INELIGIBLE.] No assistance shall be
given under sections 256.72 to 256.87:
(1) on behalf of any person who is receiving supplemental
security income under title XVI of the Social Security Act
unless permitted by federal regulations;
(2) for any month in which the assistance unit's gross
income, without application of deductions or disregards, exceeds
185 percent of the standard of need for a family of the same
size and composition; except that the earnings of a dependent
child who is a full-time student may be disregarded for six
calendar months per calendar year and the earnings of a
dependent child who is a full-time student that are derived from
the jobs training and partnership act (JTPA) may be disregarded
for six calendar months per calendar year. These two earnings
disregards cannot be combined to allow more than a total of six
months per calendar year when the earned income of a full-time
student is derived from participation in a program under the
JTPA. If a stepparent's income is taken into account in
determining need, the disregards specified in section 256.74,
subdivision 1a, shall be applied to determine income available
to the assistance unit before calculating the unit's gross
income for purposes of this paragraph;
(3) to any assistance unit for any month in which any
caretaker relative with whom the child is living is, on the last
day of that month, participating in a strike;
(4) on behalf of any other individual in the assistance
unit, nor shall the individual's needs be taken into account for
any month in which, on the last day of the month, the individual
is participating in a strike;
(5) on behalf of any individual who is the principal earner
in an assistance unit whose eligibility is based on the
unemployment of a parent when the principal earner, without good
cause, fails or refuses to accept employment, or to register
with a public employment office, unless the principal earner is
exempt from these work requirements.
Sec. 6. Minnesota Statutes 1992, section 256.73,
subdivision 5, is amended to read:
Subd. 5. [AID FOR UNBORN CHILDREN PREGNANT WOMEN.] (a) For
the purposes of sections 256.72 to 256.87, assistance payments
shall be made during the final three months of pregnancy to a
pregnant woman who has with no other children but who otherwise
qualifies for assistance except for medical assistance payments
which shall be made at the time that pregnancy is confirmed by a
physician if the pregnant woman has no other children and
otherwise qualifies for assistance as provided in sections
256B.055 and 256B.056 who are receiving assistance. It must be
medically verified that the unborn child is expected to be born
in the month the payment is made or within the three-month
period following the month of payment. Eligibility must be
determined as if the unborn child had been born and was living
with her, considering the needs, income, and resources of all
individuals in the filing unit. If eligibility exists for this
fictional unit, the pregnant woman is eligible and her payment
amount is determined based solely on her needs, income,
including deemed income, and resources. No payments shall be
made for the needs of the unborn or for any special needs
occasioned by the pregnancy except as provided in clause
paragraph (b). The commissioner of human services shall
promulgate, pursuant to the administrative procedures act, rules
to implement this subdivision.
(b) The commissioner may, according to rules, make payments
for the purpose of meeting special needs occasioned by or
resulting from pregnancy both for a pregnant woman with no other
children receiving assistance as well as for a pregnant woman
receiving assistance as provided in sections 256.72 to 256.87.
The special needs payments shall be dependent upon the needs of
the pregnant woman and the resources allocated to the county by
the commissioner and shall be limited to payments for medically
recognized special or supplemental diet needs and the purchase
of a crib and necessary clothing for the future needs of the
unborn child at birth. The commissioner shall, according to
rules, make payments for medically necessary prenatal care of
the pregnant woman and the unborn child.
Sec. 7. Minnesota Statutes 1992, section 256.73,
subdivision 8, is amended to read:
Subd. 8. [RECOVERY OF OVERPAYMENTS.] (a) If an amount of
aid to families with dependent children assistance is paid to a
recipient in excess of the payment due, it shall be recoverable
by the county agency. The agency shall give written notice to
the recipient of its intention to recover the overpayment.
(b) When an overpayment occurs, the county agency shall
recover the overpayment from a current recipient by reducing the
amount of aid payable to the assistance unit of which the
recipient is a member for one or more monthly assistance
payments until the overpayment is repaid. For any month in
which an overpayment must be recovered, recoupment may be made
by reducing the grant but only if the reduced assistance
payment, together with the assistance unit's total income after
deducting work expenses as allowed under section 256.74,
subdivision 1, clauses (3) and (4), equals at least 95 percent
of the standard of need for the assistance unit, except that if
the overpayment is due solely to agency error, this total after
deducting allowable work expenses must equal at least 99 percent
of the standard of need. Notwithstanding the preceding
sentence, beginning on the date on which the commissioner
implements a computerized client eligibility and information
system in one or more counties, All county agencies in the state
shall reduce the assistance payment by three percent of the
assistance unit's standard of need or the amount of the monthly
payment, whichever is less, for all overpayments whether or not
the overpayment is due solely to agency error. If the
overpayment is due solely to having wrongfully obtained
assistance, whether based on a court order, the finding of an
administrative fraud disqualification hearing or a waiver of
such a hearing, or a confession of judgment containing an
admission of an intentional program violation, the amount of
this reduction shall be ten percent. In cases when there is
both an overpayment and underpayment, the county agency shall
offset one against the other in correcting the payment.
(c) Overpayments may also be voluntarily repaid, in part or
in full, by the individual, in addition to the above aid
reductions, until the total amount of the overpayment is repaid.
(d) The county agency shall make reasonable efforts to
recover overpayments to persons no longer on assistance in
accordance with standards adopted in rule by the commissioner of
human services. The county agency need not attempt to recover
overpayments of less than $35 paid to an individual no longer on
assistance if the individual does not receive assistance again
within three years, unless the individual has been convicted of
fraud under section 256.98.
Sec. 8. [256.734] [WAIVER OF AFDC BARRIERS TO EMPLOYMENT.]
Subdivision 1. [REQUEST.] (a) The commissioner of human
services shall seek from the United States Department of Health
and Human Services a waiver of the existing requirements of the
AFDC program as described below, in order to eliminate barriers
to employment for AFDC recipients.
(b) The commissioner shall seek a waiver to set the maximum
equity value of a licensed motor vehicle which can be excluded
as a resource under United States Code, title 42, section
602(a)(7)(B), at $4,500 because of the need of AFDC recipients
for reliable transportation to participate in education, work,
and training to become economically self-sufficient.
(c) The commissioner shall seek a waiver of the counting of
the earned income of dependent children and minor caretakers who
are attending school at least half time, in order to encourage
them to save at least part of their earnings for future
education or employment needs. Savings set aside in a separate
account under this paragraph shall be excluded from the AFDC
resource limits in Code of Federal Regulations, title 45,
section 233.20(a)(3).
Subd. 2. [IMPLEMENTATION.] If approval from the Department
of Health and Human Services indicates that the requested
program changes are cost neutral to the federal government and
the state, the commissioner shall implement the program changes
authorized by this section promptly. If approval indicates that
the program changes are not cost neutral, the commissioner shall
report the costs to the 1994 legislature and delay
implementation until such time as an appropriation to cover
additional costs becomes available.
Subd. 3. [EVALUATION.] If the federal waiver is granted,
the commissioner shall evaluate the program changes according to
federal waiver requirements and submit a report to the
legislature within a time frame consistent with the evaluation
criteria that are established.
Sec. 9. Minnesota Statutes 1992, section 256.736,
subdivision 10, is amended to read:
Subd. 10. [COUNTY DUTIES.] (a) To the extent of available
state appropriations, county boards shall:
(1) refer all mandatory and eligible volunteer caretakers
required to register permitted to participate under subdivision
3 3a to an employment and training service provider for
participation in employment and training services;
(2) identify to the employment and training service
provider caretakers who fall into the targeted groups the target
group of which the referred caretaker is a member;
(3) provide all caretakers with an orientation which meets
the requirements in subdivisions 10a and 10b;
(4) work with the employment and training service provider
to encourage voluntary participation by caretakers in the
targeted target groups;
(5) work with the employment and training service provider
to collect data as required by the commissioner;
(6) to the extent permissible under federal law, require
all caretakers coming into the AFDC program to attend
orientation;
(7) encourage nontargeted nontarget caretakers to develop a
plan to obtain self-sufficiency;
(8) notify the commissioner of the caretakers required to
participate in employment and training services;
(9) inform appropriate caretakers of opportunities
available through the head start program and encourage
caretakers to have their children screened for enrollment in the
program where appropriate;
(10) provide transportation assistance using available
funds to caretakers who participate in employment and training
programs;
(11) ensure that orientation, job search, services to
custodial parents under the age of 20, educational activities
and work experience for AFDC-UP families, and case management
services are made available to appropriate caretakers under this
section, except that payment for case management services is
governed by subdivision 13;
(12) explain in its local service unit plan under section
268.88 how it will ensure that targeted target caretakers
determined to be in need of social services are provided with
such social services. The plan must specify how the case
manager and the county social service workers will ensure
delivery of needed services;
(13) to the extent allowed by federal laws and regulations,
provide a job search program as defined in subdivision 14 and at
least one of the following employment and training services:, a
community work experience program (CWEP) as defined in section
256.737, grant diversion as defined in section 256.739, and
on-the-job training as defined in section 256.738, or. A county
may also provide another work and training program approved by
the commissioner and the secretary of the United States
Department of Health and Human Services. Planning and approval
for employment and training services listed in this clause must
be obtained through submission of the local service unit plan as
specified under section 268.88. Each county is urged to adopt
grant diversion as the second program required under this clause
A county is not required to provide a community work experience
program if the county agency is successful in placing at least
40 percent of the monthly average of all caretakers who are
subject to the job search requirements of subdivision 14 in
grant diversion or on-the-job training program;
(14) prior to participation, provide an assessment of each
AFDC recipient who is required or volunteers to participate in
an approved employment and training service. The assessment
must include an evaluation of the participant's (i) educational,
child care, and other supportive service needs; (ii) skills and
prior work experience; and (iii) ability to secure and retain a
job which, when wages are added to child support, will support
the participant's family. The assessment must also include a
review of the results of the early and periodic screening,
diagnosis and treatment (EPSDT) screening and preschool
screening under chapter 123, if available; the participant's
family circumstances; and, in the case of a custodial parent
under the age of 18, a review of the effect of a child's
development and educational needs on the parent's ability to
participate in the program;
(15) develop an employability development plan for each
recipient for whom an assessment is required under clause (14)
which: (i) reflects the assessment required by clause (14); (ii)
takes into consideration the recipient's physical capacity,
skills, experience, health and safety, family responsibilities,
place of residence, proficiency, child care and other supportive
service needs; (iii) is based on available resources and local
employment opportunities; (iv) specifies the services to be
provided by the employment and training service provider; (v)
specifies the activities the recipient will participate in,
including the worksite to which the caretaker will be assigned,
if the caretaker is subject to the requirements of section
256.737, subdivision 2; (vi) specifies necessary supportive
services such as child care; (vii) to the extent possible,
reflects the preferences of the participant; and (viii)
specifies the recipient's long-term employment goal which shall
lead to self-sufficiency; and
(16) obtain the written or oral concurrence of the
appropriate exclusive bargaining representatives with respect to
job duties covered under collective bargaining agreements to
assure that no work assignment under this section or sections
256.737, 256.738, and 256.739 results in: (i) termination,
layoff, or reduction of the work hours of an employee for the
purpose of hiring an individual under this section or sections
256.737, 256.738, and 256.739; (ii) the hiring of an individual
if any other person is on layoff from the same or a
substantially equivalent job; (iii) any infringement of the
promotional opportunities of any currently employed individual;
(iv) the impairment of existing contracts for services or
collective bargaining agreements; or (v) except for on-the-job
training under section 256.738, a participant filling an
established unfilled position vacancy.; and
(17) assess each caretaker in an AFDC-UP family who is
under age 25, has not completed high school or a high school
equivalency program, and who would otherwise be required to
participate in a work experience placement under section 256.737
to determine if an appropriate secondary education option is
available for the caretaker. If an appropriate secondary
education option is determined to be available for the
caretaker, the caretaker must, in lieu of participating in work
experience, enroll in and meet the educational program's
participation and attendance requirements. "Secondary
education" for this paragraph means high school education or
education designed to prepare a person to qualify for a high
school equivalency certificate, basic and remedial education,
and English as a second language education. A caretaker
required to participate in secondary education who, without good
cause, fails to participate shall be subject to the provisions
of subdivision 4a and the sanction provisions of subdivision 4,
clause (6). For purposes of this clause, "good cause" means the
inability to obtain licensed or legal nonlicensed child care
services needed to enable the caretaker to attend, inability to
obtain transportation needed to attend, illness or incapacity of
the caretaker or another member of the household which requires
the caretaker to be present in the home, or being employed for
more than 30 hours per week.
(b) Funds available under this subdivision may not be used
to assist, promote, or deter union organizing.
(c) A county board may provide other employment and
training services that it considers necessary to help caretakers
obtain self-sufficiency.
(d) Notwithstanding section 256G.07, when a targeted target
caretaker relocates to another county to implement the
provisions of the caretaker's case management contract or other
written employability development plan approved by the county
human service agency, its case manager or employment and
training service provider, the county that approved the plan is
responsible for the costs of case management and other services
required to carry out the plan, including employment and
training services. The county agency's responsibility for the
costs ends when all plan obligations have been met, when the
caretaker loses AFDC eligibility for at least 30 days, or when
approval of the plan is withdrawn for a reason stated in the
plan, whichever occurs first. Responsibility for the costs of
child care must be determined under chapter 256H. A county
human service agency may pay for the costs of case management,
child care, and other services required in an approved
employability development plan when the nontargeted nontarget
caretaker relocates to another county or when a targeted target
caretaker again becomes eligible for AFDC after having been
ineligible for at least 30 days.
Sec. 10. Minnesota Statutes 1992, section 256.736,
subdivision 10a, is amended to read:
Subd. 10a. [ORIENTATION.] (a) Each county agency must
provide an orientation to all caretakers within its jurisdiction
who are determined eligible for AFDC on or after July 1, 1989,
and who are required to attend an orientation. The county
agency shall require attendance at orientation of all caretakers
except in the time limits described in this paragraph:
(1) caretakers who are exempt from registration under
subdivision 3 within 60 days of being determined eligible for
AFDC for caretakers with a continued absence or incapacitated
parent basis of eligibility; and or
(2) caretakers who are not within 30 days of being
determined eligible for AFDC for caretakers with an unemployed
parent basis of eligibility.
(b) Caretakers are required to attend an in-person
orientation if the caretaker is a member of one of the groups
listed in subdivision 3a, paragraph (a), and who are either
responsible for the care of an incapacitated person or a
dependent child under the age of six or enrolled at least half
time in any recognized school, training program, or institution
of higher learning unless the caretaker is exempt from
registration under subdivision 3 and the caretaker's exemption
basis will not expire within 60 days of being determined
eligible for AFDC, or the caretaker is enrolled at least half
time in any recognized school, training program, or institution
of higher learning and the in-person orientation cannot be
scheduled at a time that does not interfere with the caretaker's
school or training schedule. The county agency shall require
attendance at orientation of caretakers described in subdivision
3a, paragraph (b) or (c), if they become the commissioner
determines that the groups are eligible for participation in
employment and training services.
(b) Except as provided in paragraph (e), (c) The
orientation must consist of a presentation that informs
caretakers of:
(1) the identity, location, and phone numbers of employment
and training and support services available in the county;
(2) the types and locations of child care services
available through the county agency that are accessible to
enable a caretaker to participate in educational programs or
employment and training services;
(3) the child care resource and referral program designated
by the commissioner providing education and assistance to select
child care services and a referral to the child care resource
and referral when assistance is requested;
(4) the obligations of the county agency and service
providers under contract to the county agency;
(5) the rights, responsibilities, and obligations of
participants;
(6) the grounds for exemption from mandatory employment and
training services or educational requirements;
(7) the consequences for failure to participate in
mandatory services or requirements;
(8) the method of entering educational programs or
employment and training services available through the county;
(9) the availability and the benefits of the early and
periodic, screening, diagnosis and treatment (EPSDT) program and
preschool screening under chapter 123;
(10) their eligibility for transition year child care
assistance when they lose eligibility for AFDC due to their
earnings; and
(11) their eligibility for extended medical assistance when
they lose eligibility for AFDC due to their earnings; and
(12) the availability and benefits of the Head Start
program.
(c) (d) Orientation must encourage recipients to view AFDC
as a temporary program providing grants and services to
individuals who set goals and develop strategies for supporting
their families without AFDC assistance. The content of the
orientation must not imply that a recipient's eligibility for
AFDC is time limited. Orientation may be provided through
audio-visual methods, but the caretaker must be given an
opportunity for face-to-face interaction with staff of the
county agency or the entity providing the orientation, and an
opportunity to express the desire to participate in educational
programs and employment and training services offered through
the county agency.
(d) (e) County agencies shall not require caretakers to
attend orientation for more than three hours during any period
of 12 continuous months. The county agency shall also arrange
for or provide needed transportation and child care to enable
caretakers to attend.
(e) Orientation for caretakers not eligible for
participation in employment and training services under the
provisions of subdivision 3a, paragraphs (a) and (b), shall
present information only on those employment, training, and
support services available to those caretakers, and information
on clauses (2), (3), (9), (10), and (11) of paragraph (a) and
all of paragraph (c), and may not last more than two hours. The
county or, under contract, the county's employment and training
service provider shall mail written orientation materials
containing the information specified in paragraph (c), clauses
(1) to (3) and (8) to (12), to each caretaker exempt from
attending an in-person orientation or who has good cause for
failure to attend after at least two dates for their orientation
have been scheduled. The county or the county's employment and
training service provider shall follow up with a phone call or
in writing within two weeks after mailing the material.
(f) Persons required to attend orientation must be informed
of the penalties for failure to attend orientation, support
services to enable the person to attend, what constitutes good
cause for failure to attend, and rights to appeal. Persons
required to attend orientation must be offered a choice of at
least two dates for their first scheduled orientation. No
person may be sanctioned for failure to attend orientation until
after a second failure to attend.
(g) Good cause for failure to attend an in-person
orientation exists when a caretaker cannot attend because of:
(1) temporary illness or injury of the caretaker or of a
member of the caretaker's family that prevents the caretaker
from attending an orientation during the hours when the
orientation is offered;
(2) a judicial proceeding that requires the caretaker's
presence in court during the hours when orientation is
scheduled; or
(3) a nonmedical emergency that prevents the caretaker from
attending an orientation during the hours when orientation is
offered. "Emergency" for the purposes of this paragraph means a
sudden, unexpected occurrence or situation of a serious or
urgent nature that requires immediate action.
(h) Caretakers must receive a second orientation only when:
(1) there has been a 30-day break in AFDC eligibility; and
(2) the caretaker has not attended an orientation within
the previous 12-month period, excluding the month of
reapplication for AFDC.
Sec. 11. Minnesota Statutes 1992, section 256.736,
subdivision 14, is amended to read:
Subd. 14. [JOB SEARCH.] (a) The commissioner of human
services shall Each county agency must establish and operate a
job search program as provided under Public Law Number
100-485 this section. Unless exempt, the principal wage earner
in an AFDC-UP assistance unit must be referred to and begin
participation in the job search program within 30 days of being
determined eligible for AFDC, and must begin participation
within four months of being determined eligible. If the
principal wage earner is exempt from participation in job
search, the other caretaker must be referred to and begin
participation in the job search program within 30 days of being
determined eligible for AFDC. The principal wage earner or the
other caretaker is exempt from job search participation if:
(1) the caretaker is already participating in another
approved employment and training service;
(2) the caretaker's employability plan specifies other
activities;
(3) the caretaker is exempt from registration under
subdivision 3; or
(4) the caretaker is unable to secure employment due to
inability to communicate in the English language, is
participating in an English as a second language course, and is
making satisfactory progress towards completion of the course.
If an English as a second language course is not available to
the caretaker, the caretaker is exempt from participation until
a course becomes available (2) the caretaker is under age 25,
has not completed a high school diploma or an equivalent
program, and is participating in a secondary education program
as defined in subdivision 10, paragraph (a), clause (17), which
is approved by the employment and training service provider in
the employability development plan.
(b) The job search program must provide the following
services:
(1) an initial period of up to four consecutive weeks of
job search activities for no less than 20 hours per week but not
more than 32 hours per week. The employment and training
service provider shall specify for each participating caretaker
the number of weeks and hours of job search to be conducted and
shall report to the county board agency if the caretaker fails
to cooperate with the job search requirement; and
(2) an additional period of job search following the first
period at the discretion of the employment and training service
provider. The total of these two periods of job search may not
exceed eight weeks for any 12 consecutive month period beginning
with the month of application.
(c) The job search program may provide services to
non-AFDC-UP caretakers.
(d) After completion of job search requirements in this
section, nonexempt caretakers shall be placed in and must
participate in and cooperate with the work experience program
under section 256.737, the on-the-job training program under
section 256.738, or the grant diversion program under section
256.739. Caretakers must be offered placement in a grant
diversion or on-the-job training program, if either such
employment is available, before being required to participate in
a community work experience program under section 256.737.
Sec. 12. Minnesota Statutes 1992, section 256.736,
subdivision 16, is amended to read:
Subd. 16. [ALLOCATION AND USE OF MONEY.] (a) State money
appropriated for employment and training services under this
section must be allocated to counties as specified in paragraphs
(b) to (i) (j).
(b) For purposes of this section subdivision, "targeted
caretaker" means a recipient who:
(1) is a custodial parent under the age of 24 who: (i) has
not completed a high school education and at the time of
application for AFDC is not enrolled in high school or in a high
school equivalency program; or (ii) had little or no work
experience in the preceding year;
(2) is a member of a family in which the youngest child is
within two years of being ineligible for AFDC due to age; or
(3) has received 36 months or more of AFDC over the last 60
months.
(c) One hundred percent of the money appropriated for case
management services as described in subdivision 11 must be
allocated to counties based on the average number of cases in
each county described in clause (1). Money appropriated for
employment and training services as described in subdivision 1a,
paragraph (d), other than case management services, must be
allocated to counties as follows:
(1) Forty percent of the state money must be allocated
based on the average number of cases receiving AFDC in the
county which either have been open for 36 or more consecutive
months or have a caretaker who is under age 24 and who has no
high school or general equivalency diploma. The average number
of cases must be based on counts of these cases as of March 31,
June 30, September 30, and December 31 of the previous year.
(2) Twenty percent of the state money must be allocated
based on the average number of cases receiving AFDC in the
county which are not counted under clause (1). The average
number of cases must be based on counts of cases as of March 31,
June 30, September 30, and December 31 of the previous year.
(3) Twenty-five percent of the state money must be
allocated based on the average monthly number of assistance
units in the county receiving AFDC-UP for the period ending
December 31 of the previous year.
(4) Fifteen percent of the state money must be allocated at
the discretion of the commissioner based on participation levels
for targeted target group members in each county.
(d) No more than 15 percent of the money allocated under
paragraph (b) and no more than 15 percent of the money allocated
under paragraph (c) may be used for administrative activities.
(e) At least 55 percent of the money allocated to counties
under paragraph (c) must be used for employment and training
services for caretakers in the targeted target groups, and up to
45 percent of the money may be used for employment and training
services for nontargeted nontarget caretakers. One hundred
percent of the money allocated to counties for case management
services must be used to provide those services to caretakers in
the targeted target groups.
(f) Money appropriated to cover the nonfederal share of
costs for bilingual case management services to refugees for the
employment and training programs under this section are
allocated to counties based on each county's proportion of the
total statewide number of AFDC refugee cases. However, counties
with less than one percent of the statewide number of AFDC
refugee cases do not receive an allocation.
(g) Counties and, the department of jobs and training, and
entities under contract with either the department of jobs and
training or the department of human services for provision of
Project STRIDE related services shall bill the commissioner of
human services for any expenditures incurred by the county, the
county's employment and training service provider, or the
department of jobs and training that may be reimbursed by
federal money. The commissioner of human services shall bill
the United States Department of Health and Human Services and
the United States Department of Agriculture for the
reimbursement and appropriate the reimbursed money to the
county, the department of jobs and training, or employment and
training service provider that submitted the original bill. The
reimbursed money must be used to expand employment and training
services.
(h) The commissioner of human services shall review county
expenditures of case management and employment and training
block grant money at the end of the fourth third quarter of the
biennium and each quarter after that, and may reallocate
unencumbered or unexpended money allocated under this section to
those counties that can demonstrate a need for additional
money. Reallocation of funds must be based on the formula set
forth in paragraph (a), excluding the counties that have not
demonstrated a need for additional funds.
(i) The county agency may continue to provide case
management and supportive services to a participant for up to 90
days after the participant loses AFDC eligibility and may
continue providing a specific employment and training service
for the duration of that service to a participant if funds for
the service are obligated or expended prior to the participant
losing AFDC eligibility.
(j) One hundred percent of the money appropriated for an
unemployed parent work experience program under section 256.737
must be allocated to counties based on the average monthly
number of assistance units in the county receiving AFDC-UP for
the period ending December 31 of the previous year.
Sec. 13. Minnesota Statutes 1992, section 256.736, is
amended by adding a subdivision to read:
Subd. 19. [EVALUATION.] In order to evaluate the services
provided under this section, the commissioner may randomly
assign no more than 2,500 families to a control group. Families
assigned to the control group shall not participate in services
under this section, except that families participating in
services under this section at the time they are assigned to the
control group may continue such participation. Recipients
assigned to the control group who are included under subdivision
3a, paragraph (a), shall be guaranteed child care assistance
under chapter 256H for an educational plan authorized by the
county. Once assigned to the control group, a family must
remain in that group for the duration of the evaluation period.
The evaluation period shall coincide with the demonstration
authorized in section 256.031, subdivision 3.
Sec. 14. [256.7366] [FEDERAL WAIVER.]
The commissioner of human services shall make changes in
the state plan and seek waivers or demonstration authority
needed to minimize the barriers to effective and efficient use
of grant diversion under section 256.739 as a method of placing
AFDC recipients in suitable employment. The commissioner shall
implement the federally approved changes as soon as possible.
Sec. 15. Minnesota Statutes 1992, section 256.737,
subdivision 1, is amended to read:
Subdivision 1. [ESTABLISHMENT AND PURPOSE.] In order that
persons receiving aid under this chapter may be assisted in
achieving self-sufficiency by enhancing their employability
through meaningful work experience and training and the
development of job search skills, the commissioner of human
services shall continue the pilot community work experience
demonstration programs that were approved by January 1, 1984.
The commissioner may establish additional community work
experience programs in as many counties as necessary to comply
with the participation requirements of the Family Support Act of
1988, Public Law Number 100-485. Programs established on or
after July 1, 1989, must be operated on a volunteer basis and
must be operated according to the Family Support Act of 1988,
Public Law Number 100-485. To the degree required by federal
law or regulation, each county agency must establish and operate
a community work experience program to assist nonexempt
caretakers in AFDC-UP households achieve self-sufficiency by
enhancing their employability through participation in
meaningful work experience and training, the development of job
search skills and the development of marketable job skills.
This subdivision does not apply to AFDC recipients participating
in the Minnesota family investment plan under sections 256.031
to 256.0361.
Sec. 16. Minnesota Statutes 1992, section 256.737,
subdivision 1a, is amended to read:
Subd. 1a. [COMMISSIONER'S DUTIES.] The commissioner shall:
(a) assist counties in the design and implementation of these
programs; (b) promulgate, in accordance with chapter 14,
emergency rules necessary for the implementation of this
section, except that the time restrictions of section 14.35
shall not apply and the rules may be in effect until June 30,
1993, unless superseded by permanent rules; (c) seek any federal
waivers necessary for proper implementation of this section in
accordance with federal law; and (d) prohibit the use of
participants in the programs to do work that was part or all of
the duties or responsibilities of an authorized public employee
bargaining unit position established as of January 1, 1989 1993.
The exclusive bargaining representative shall be notified no
less than 14 days in advance of any placement by the community
work experience program. Written or oral concurrence with
respect to job duties of persons placed under the community work
experience program shall be obtained from the appropriate
exclusive bargaining representative within seven days. The
appropriate oversight committee shall be given monthly lists of
all job placements under a community work experience program.
Sec. 17. Minnesota Statutes 1992, section 256.737,
subdivision 2, is amended to read:
Subd. 2. [PROGRAM REQUIREMENTS.] (a) Programs Worksites
developed under this section are limited to projects that serve
a useful public service such as: health, social service,
environmental protection, education, urban and rural development
and redevelopment, welfare, recreation, public facilities,
public safety, community service, services to aged or disabled
citizens, and child care. To the extent possible, the prior
training, skills, and experience of a recipient must be used in
making appropriate work experience assignments.
(b) As a condition to placing a person receiving aid to
families with dependent children in a program under this
subdivision, the county agency shall first provide the recipient
the opportunity to participate in the following services:
(1) for placement in suitable subsidized or unsubsidized
employment through participation in job search under section
256.736, subdivision 14; or
(2) basic educational or vocational or occupational
training for an identifiable job opportunity for placement in
suitable employment through participation in on-the-job training
under section 256.738 or grant diversion under section 256.739,
if such employment is available.
(c) A recipient who has completed a caretaker referred to
job search under section 256.736, subdivision 14, and who is
unable has failed to secure suitable employment, and who is not
enrolled in an approved training program may must participate in
a community work experience program.
(d) The county agency shall limit the maximum number of
hours any participant under this section may work in any month
to:
(1) for counties operating an approved mandatory community
work experience program as of January 1, 1993, who elect this
method for countywide operations, a number equal to the amount
of the aid to families with dependent children payable to the
family divided by the greater of the federal minimum wage or the
applicable state minimum wage; or
(2) for all other counties, a caretaker must participate in
any week 20 hours with no less than 16 hours spent participating
in a work experience placement and no more than four of the
hours spent in alternate activities as described in the
caretaker's employability development plan. Placement in a work
experience worksite must be based on the assessment required
under section 256.736 and the caretaker's employability
development plan. Caretakers participating under this clause
may be allowed excused absences from the assigned job site of up
to eight hours per month. For the purposes of this clause,
"excused absence" means absence due to temporary illness or
injury of the caretaker or a member of the caretaker's family,
the unavailability of licensed child care or transportation
needed to participate in the work experience placement, a job
interview, or a nonmedical emergency. For purposes of this
clause, "emergency" has the meaning given it in section 256.736,
subdivision 10a, paragraph (g).
(e) After a participant has been assigned to a position
under this section paragraph (d), clause (1), for nine months,
the participant may not continue in that assignment unless the
maximum number of hours a participant works is no greater than
the amount of the aid to families with dependent children
payable with respect to the family divided by the higher of (1)
the federal minimum wage or the applicable state minimum wage,
whichever is greater, or (2) the rate of pay for individuals
employed in the same or similar occupations by the same employer
at the same site.
(f) After each six months of a recipient's participation in
an assignment, and at the conclusion of each assignment under
this section, the county agency shall reassess and revise, as
appropriate, each participant's employability development plan.
(g) Structured, supervised volunteer work with an agency or
organization which is monitored by the county service provider
may, with the approval of the commissioner of jobs and training,
be used as a work experience placement.
Sec. 18. Minnesota Statutes 1992, section 256.737, is
amended by adding a subdivision to read:
Subd. 3. [EXEMPTIONS.] A caretaker is exempt from
participation in a work experience placement under this section
if the caretaker is exempt from participation in job search
under section 256.736, subdivision 14, or the caretaker is
suitably employed in a grant diversion or an on-the-job training
placement. Caretakers who, as of October 1, 1993, are
participating in an education or training activity approved
under a Project STRIDE employability development plan are exempt
from participation in a work experience placement until July 1,
1994.
Sec. 19. Minnesota Statutes 1992, section 256.737, is
amended by adding a subdivision to read:
Subd. 4. [GOOD CAUSE.] A caretaker shall have good cause
for failure to cooperate if:
(1) the worksite participation adversely affects the
caretaker's physical or mental health as verified by a
physician, licensed or certified psychologist, physical
therapist, vocational expert, or by other sound medical
evidence; or
(2) the caretaker does not possess the skill or knowledge
required for the work.
Sec. 20. Minnesota Statutes 1992, section 256.737, is
amended by adding a subdivision to read:
Subd. 5. [FAILURE TO COMPLY.] A caretaker required to
participate under this section who has failed without good cause
to participate shall be provided with notices, appeal
opportunities, and offered a conciliation conference under the
provisions of section 256.736, subdivision 4a, and shall be
subject to the sanction provisions of section 256.736,
subdivision 4, clause (6).
Sec. 21. Minnesota Statutes 1992, section 256.737, is
amended by adding a subdivision to read:
Subd. 6. [FEDERAL REQUIREMENTS.] If the Family Support Act
of 1988, Public Law Number 100-485, is revised or if federal
implementation of that law is revised so that Minnesota is no
longer obligated to operate a mandatory work experience program
for AFDC-UP families, the commissioner shall operate the work
experience program under this section as a volunteer program,
and shall utilize the funding authorized for work experience to
improve and expand the availability of other employment and
training services authorized under this section.
Sec. 22. Minnesota Statutes 1992, section 256.74,
subdivision 1, is amended to read:
Subdivision 1. [AMOUNT.] The amount of assistance which
shall be granted to or on behalf of any dependent child and
mother or other needy eligible relative caring for the dependent
child shall be determined by the county agency in accordance
with rules promulgated by the commissioner and shall be
sufficient, when added to all other income and support available
to the child, to provide the child with a reasonable subsistence
compatible with decency and health. The amount shall be based
on the method of budgeting required in Public Law Number 97-35,
section 2315, United States Code, title 42, section 602, as
amended and federal regulations at Code of Federal Regulations,
title 45, section 233. Nonrecurring lump sum income received by
an assistance unit AFDC family must be budgeted in the normal
retrospective cycle. The number of months of ineligibility is
determined by dividing the amount of the lump sum income and all
other When the family's income, after application of the
applicable disregards, by exceeds the standard of need standard
for the assistance unit family because of receipt of earned or
unearned lump sum income, the family will be ineligible for the
full number of months derived by dividing the sum of the lump
sum income and other income by the monthly need standard for a
family of that size. An amount Any income remaining after
from this calculation is income in the first month following the
period of eligibility ineligibility. If the total monthly
income including the lump sum income is larger than the standard
of need for a single month The first month of ineligibility is
the payment month that corresponds with the budget month in
which the lump sum income was received. For purposes of
applying the lump sum provision, family includes those persons
defined in the Code of Federal Regulations, title 45, section
233.20(a)(3)(ii)(F). A period of ineligibility must be
shortened when the standard of need increases and the amount the
family would have received also changes, an amount is documented
as stolen, an amount is unavailable because a member of the
family left the household with that amount and has not returned,
an amount is paid by the family during the period of
ineligibility to cover a cost that would otherwise qualify for
emergency assistance, or the family incurs and pays for medical
expenses which would have been covered by medical assistance if
eligibility existed. In making its determination the county
agency shall disregard the following from family income:
(1) all the earned income of each dependent child applying
for AFDC if the child is a full-time student and all of the
earned income of each dependent child receiving aid to families
with dependent children AFDC who is a full-time student or is a
part-time student, and who is not a full-time employee,. A
student is one who is attending a school, college, or
university, or a course of vocational or technical training
designed to fit students for gainful employment as well as and
includes a participant in the Job Corps program under the Job
Training Partnership Act (JTPA). The county agency shall also
disregard all the earned income derived from the job training
and partnership act (JTPA) for a of each dependent child for
applying for or receiving AFDC when the income is derived from a
program carried out under JTPA, except that disregard of earned
income may not exceed six calendar months per calendar year,
together with unearned income derived from the job training and
partnership act;
(2) all educational grants and loans;
(3) the first $90 of each individual's earned income. For
self-employed persons, the expenses directly related to
producing goods and services and without which the goods and
services could not be produced shall be disregarded pursuant to
rules promulgated by the commissioner;
(4) thirty dollars plus one-third of each individual's
earned income for individuals found otherwise eligible to
receive aid or who have received aid in one of the four months
before the month of application. With respect to any month, the
county welfare agency shall not disregard under this clause any
earned income of any person who has: (a) reduced earned income
without good cause within 30 days preceding any month in which
an assistance payment is made; (b) refused without good cause to
accept an offer of suitable employment; (c) left employment or
reduced earnings without good cause and applied for assistance
so as to be able later to return to employment with the
advantage of the income disregard; or (d) failed without good
cause to make a timely report of earned income in accordance
with rules promulgated by the commissioner of human services.
Persons who are already employed and who apply for assistance
shall have their needs computed with full account taken of their
earned and other income. If earned and other income of the
family is less than need, as determined on the basis of public
assistance standards, the county agency shall determine the
amount of the grant by applying the disregard of income
provisions. The county agency shall not disregard earned income
for persons in a family if the total monthly earned and other
income exceeds their needs, unless for any one of the four
preceding months their needs were met in whole or in part by a
grant payment. The disregard of $30 and one-third of earned
income in this clause shall be applied to the individual's
income for a period not to exceed four consecutive months. Any
month in which the individual loses this disregard because of
the provisions of subclauses (a) to (d) shall be considered as
one of the four months. An additional $30 work incentive must
be available for an eight-month period beginning in the month
following the last month of the combined $30 and one-third work
incentive. This period must be in effect whether or not the
person has earned income or is eligible for AFDC. To again
qualify for the earned income disregards under this clause, the
individual must not be a recipient of aid for a period of 12
consecutive months. When an assistance unit becomes ineligible
for aid due to the fact that these disregards are no longer
applied to income, the assistance unit shall be eligible for
medical assistance benefits for a 12-month period beginning with
the first month of AFDC ineligibility;
(5) an amount equal to the actual expenditures for the care
of each dependent child or incapacitated individual living in
the same home and receiving aid, not to exceed: (a) $175 for
each individual age two and older, and $200 for each individual
under the age of two, when the family member whose needs are
included in the eligibility determination is employed for 30 or
more hours per week; or (b) $174 for each individual age two or
older, and $199 for each individual under the age of two, when
the family member whose needs are included in the eligibility
determination is not employed throughout the month or when
employment is less than 30 hours per week. The dependent care
disregard must be applied after all other disregards under this
subdivision have been applied;
(6) the first $50 per assistance unit of the monthly
support obligation collected by the support and recovery (IV-D)
unit. The first $50 of periodic support payments collected by
the public authority responsible for child support enforcement
from a person with a legal obligation to pay support for a
member of the assistance unit must be paid to the assistance
unit within 15 days after the end of the month in which the
collection of the periodic support payments occurred and must be
disregarded when determining the amount of assistance. A review
of a payment decision under this clause must be requested within
30 days after receiving the notice of collection of assigned
support or within 90 days after receiving the notice if good
cause can be shown for not making the request within the 30-day
limit;
(7) that portion of an insurance settlement earmarked and
used to pay medical expenses, funeral and burial costs, or to
repair or replace insured property; and
(8) all earned income tax credit payments received by the
family as a refund of federal income taxes or made as advance
payments by an employer.
All payments made pursuant to a court order for the support
of children not living in the assistance unit's household shall
be disregarded from the income of the person with the legal
obligation to pay support, provided that, if there has been a
change in the financial circumstances of the person with the
legal obligation to pay support since the support order was
entered, the person with the legal obligation to pay support has
petitioned for a modification of the support order.
Sec. 23. Minnesota Statutes 1992, section 256.78, is
amended to read:
256.78 [ASSISTANCE GRANTS RECONSIDERED.]
All assistance granted under sections 256.72 to 256.87
shall be reconsidered as frequently as may be required by the
rules of the state agency. After such further investigation as
the county agency may deem necessary or the state agency may
require, the amount of assistance may be changed or assistance
may be entirely withdrawn if the state or county agency find
that the child's circumstances have altered sufficiently to
warrant such action. The period of ineligibility for AFDC which
results when an assistance unit receives lump sum income must be
reduced when:
(1) the assistance unit's standard of need increases due to
changes in state law or due to changes in the size or
composition of the assistance unit, so that the amount of aid
the assistance unit would have received would have increased had
it not become ineligible;
(2) the lump sum income, or a portion of it becomes
unavailable to the assistance unit due to expenditures to avoid
a life-threatening circumstance, theft, or dissipation which is
beyond the family's control by a member of the family who is no
longer part of the assistance unit when the lump sum income is
not used to meet the needs of members of the assistance unit; or
(3) the assistance unit incurs and pays medical expenses
for care and services specified in sections 256B.02, subdivision
8, and 256B.0625.
The county agency may for cause at any time revoke, modify,
or suspend any order for assistance previously made. When
assistance is thus revoked, modified, or suspended the county
agency shall at once report to the state agency such decision
together with supporting evidence required by the rules of the
state agency. All such decisions shall be subject to appeal and
review by the state agency as provided in section 256.045.
Sec. 24. Minnesota Statutes 1992, section 256.983,
subdivision 3, is amended to read:
Subd. 3. [DEPARTMENT RESPONSIBILITIES.] The commissioner
shall establish training programs which shall be attended by all
investigative and supervisory staff of the involved county
agencies. The commissioner shall also develop the necessary
operational guidelines, forms, and reporting mechanisms, which
shall be used by the involved county agencies. An individual's
application or redetermination form shall include an
authorization for release by the individual to obtain
documentation for any information on that form which is involved
in a fraud prevention investigation. The authorization for
release would be effective until six months after public
assistance benefits have ceased.
Sec. 25. Minnesota Statutes 1992, section 256B.056,
subdivision 1a, is amended to read:
Subd. 1a. [INCOME AND ASSETS GENERALLY.] Unless
specifically required by state law or rule or federal law or
regulation, the methodologies used in counting income and assets
to determine eligibility for medical assistance shall be as
follows: (a) for persons whose eligibility category is based on
blindness, disability, or age of 65 or more years, the
methodologies for the supplemental security income program shall
be used; and (b), except that payments made pursuant to a court
order for the support of children shall be excluded from income
in an amount not to exceed the difference between the applicable
income standard used in the state's medical assistance program
for aged, blind, and disabled persons and the applicable income
standard used in the state's medical assistance program for
families with children. Exclusion of court-ordered child
support payments is subject to the condition that if there has
been a change in the financial circumstances of the person with
the legal obligation to pay support since the support order was
entered, the person with the legal obligation to pay support has
petitioned for modification of the support order. For families
and children, which includes all other eligibility categories,
the methodologies for the aid to families with dependent
children program under section 256.73 shall be used. For these
purposes, a "methodology" does not include an asset or income
standard, or accounting method, or method of determining
effective dates.
Sec. 26. Minnesota Statutes 1992, section 256D.01,
subdivision 1a, is amended to read:
Subd. 1a. [STANDARDS.] (a) A principal objective in
providing general assistance is to provide for persons
ineligible for federal programs who are unable to provide for
themselves. The minimum standard of assistance determines the
total amount of the general assistance grant without separate
standards for shelter, utilities, or other needs.
(b) The commissioner shall set the standard of assistance
for an assistance unit consisting of an adult recipient who is
childless and unmarried or living apart from children and spouse
and who does not live with a parent or parents or a legal
custodian. When the other standards specified in this
subdivision increase, this standard must also be increased by
the same percentage.
(c) For an assistance unit consisting of a single adult who
lives with a parent or parents, the general assistance standard
of assistance is the amount that the aid to families with
dependent children standard of assistance would increase if the
recipient were added as an additional minor child to an
assistance unit consisting of the recipient's parent and all of
that parent's family members, except that the standard may not
exceed the standard for a general assistance recipient living
alone. Benefits received by a responsible relative of the
assistance unit under the supplemental security income program,
a workers' compensation program, the Minnesota supplemental aid
program, or any other program based on the responsible
relative's disability, and any benefits received by a
responsible relative of the assistance unit under the social
security retirement program, may not be counted in the
determination of eligibility or benefit level for the assistance
unit. Except as provided below, the assistance unit is
ineligible for general assistance if the available resources or
the countable income of the assistance unit and the parent or
parents with whom the assistance unit lives are such that a
family consisting of the assistance unit's parent or parents,
the parent or parents' other family members and the assistance
unit as the only or additional minor child would be financially
ineligible for general assistance. For the purposes of
calculating the countable income of the assistance unit's parent
or parents, the calculation methods, income deductions,
exclusions, and disregards used when calculating the countable
income for a single adult or childless couple must be used.
(d) For an assistance unit consisting of a childless
couple, the standards of assistance are the same as the first
and second adult standards of the aid to families with dependent
children program. If one member of the couple is not included
in the general assistance grant, the standard of assistance for
the other is the second adult standard of the aid to families
with dependent children program.
(e) For an assistance unit consisting of all members of a
family, the standards of assistance are the same as the
standards of assistance that apply to a family under the aid to
families with dependent children program if that family had the
same number of parents and children as the assistance unit under
general assistance and if all members of that family were
eligible for the aid to families with dependent children
program. If one or more members of the family are not included
in the assistance unit for general assistance, the standards of
assistance for the remaining members are the same as the
standards of assistance that apply to an assistance unit
composed of the entire family, less the standards of assistance
for a family of the same number of parents and children as those
members of the family who are not in the assistance unit for
general assistance. In no case shall the standard for family
members who are in the assistance unit for general assistance,
when combined with the standard for family members who are not
in the general assistance unit, total more than the standard for
the entire family if all members were in an AFDC assistance
unit. A child may not be excluded from the assistance unit
unless income intended for its benefit is received from a
federally aided categorical assistance program or supplemental
security income. The income of a child who is excluded from the
assistance unit may not be counted in the determination of
eligibility or benefit level for the assistance unit.
(f) An assistance unit consisting of one or more members of
a family must have its grant determined using the policies and
procedures of the aid to families with dependent children
program, except that, until June 30, 1995, in cases where a
county agency has developed or approved a case plan that
includes reunification with the children, foster care
maintenance payments made under state or local law for a child
who is temporarily absent from the assistance unit must not be
considered income to the child and the payments must not be
counted in the determination of the eligibility or benefit level
of the assistance unit. However Otherwise, the standard of
assistance must be determined according to paragraph (e),; the
first $50 of total child support received by an assistance unit
in a month must be excluded and the balance counted as unearned
income,; and nonrecurring lump sums received by the family must
be considered income in the month received and a resource in the
following months.
Sec. 27. Minnesota Statutes 1992, section 256D.02,
subdivision 5, is amended to read:
Subd. 5. "Family" means the applicant or recipient and the
following persons who reside with the applicant or recipient:
(1) the applicant's spouse;
(2) any minor child of whom the applicant is a parent,
stepparent, or legal custodian, and that child's minor siblings,
including half-siblings and stepsiblings;
(3) the other parent of the applicant's minor child or
children together with that parent's minor children, and, if
that parent is a minor, his or her parents, stepparents, legal
guardians, and minor siblings; and
(4) if the applicant or recipient is a minor, the minor's
parents, stepparents, or legal guardians, and any other minor
children for whom those parents, stepparents, or legal guardians
are financially responsible.
A minor child who is temporarily absent from the
applicant's or recipient's home due to placement in foster care
paid for from state or local funds, but who is expected to
return within six months of the month of departure, is
considered to be residing with the applicant or recipient.
A "family" must contain at least one minor child and at
least one of that child's natural or adoptive parents,
stepparents, or legal custodians.
Sec. 28. Minnesota Statutes 1992, section 256D.03,
subdivision 3, is amended to read:
Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.]
(a) General assistance medical care may be paid for any person
who is not eligible for medical assistance under chapter 256B,
including eligibility for medical assistance based on a
spend-down of excess income according to section 256B.056,
subdivision 5, and:
(1) who is receiving assistance under section 256D.05 or
256D.051; or
(2)(i) who is a resident of Minnesota; and whose equity in
assets is not in excess of $1,000 per assistance unit. Exempt
assets, the reduction of excess assets, and the waiver of excess
assets must conform to the medical assistance program in chapter
256B, with the following exception: the maximum amount of
undistributed funds in a trust that could be distributed to or
on behalf of the beneficiary by the trustee, assuming the full
exercise of the trustee's discretion under the terms of the
trust, must be applied toward the asset maximum; and
(ii) who has countable income not in excess of the
assistance standards established in section 256B.056,
subdivision 4, or whose excess income is spent down pursuant to
section 256B.056, subdivision 5, using a six-month budget
period, except that a one-month budget period must be used for
recipients residing in a long-term care facility. The method
for calculating earned income disregards and deductions for a
person who resides with a dependent child under age 21 shall be
as specified in section 256.74, subdivision 1. However, if a
disregard of $30 and one-third of the remainder described in
section 256.74, subdivision 1, clause (4), has been applied to
the wage earner's income, the disregard shall not be applied
again until the wage earner's income has not been considered in
an eligibility determination for general assistance, general
assistance medical care, medical assistance, or aid to families
with dependent children for 12 consecutive months. The earned
income and work expense deductions for a person who does not
reside with a dependent child under age 21 shall be the same as
the method used to determine eligibility for a person under
section 256D.06, subdivision 1, except the disregard of the
first $50 of earned income is not allowed; or
(3) who would be eligible for medical assistance except
that the person resides in a facility that is determined by the
commissioner or the federal health care financing administration
to be an institution for mental diseases.
(b) Eligibility is available for the month of application,
and for three months prior to application if the person was
eligible in those prior months. A redetermination of
eligibility must occur every 12 months.
(c) General assistance medical care is not available for a
person in a correctional facility unless the person is detained
by law for less than one year in a county correctional or
detention facility as a person accused or convicted of a crime,
or admitted as an inpatient to a hospital on a criminal hold
order, and the person is a recipient of general assistance
medical care at the time the person is detained by law or
admitted on a criminal hold order and as long as the person
continues to meet other eligibility requirements of this
subdivision.
(d) General assistance medical care is not available for
applicants or recipients who do not cooperate with the county
agency to meet the requirements of medical assistance.
(e) In determining the amount of assets of an individual,
there shall be included any asset or interest in an asset,
including an asset excluded under paragraph (a), that was given
away, sold, or disposed of for less than fair market value
within the 30 months preceding application for general
assistance medical care or during the period of eligibility.
Any transfer described in this paragraph shall be presumed to
have been for the purpose of establishing eligibility for
general assistance medical care, unless the individual furnishes
convincing evidence to establish that the transaction was
exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair
market value at the time it was given away, sold, or disposed
of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility,
including partial months, shall be calculated by dividing the
uncompensated transfer amount by the average monthly per person
payment made by the medical assistance program to skilled
nursing facilities for the previous calendar year. The
individual shall remain ineligible until this fixed period has
expired. The period of ineligibility may exceed 30 months, and
a reapplication for benefits after 30 months from the date of
the transfer shall not result in eligibility unless and until
the period of ineligibility has expired. The period of
ineligibility begins in the month the transfer was reported to
the county agency, or if the transfer was not reported, the
month in which the county agency discovered the transfer,
whichever comes first. For applicants, the period of
ineligibility begins on the date of the first approved
application.
(f)(1) Beginning October 1, 1993, an undocumented alien or
a nonimmigrant is ineligible for general assistance medical care
other than emergency services. For purposes of this
subdivision, a nonimmigrant is an individual in one or more of
the classes listed in United States Code, title 8, section
1101(a)(15), and an undocumented alien is an individual who
resides in the United States without the approval or
acquiescence of the Immigration and Naturalization Service.
(2) This subdivision does not apply to a child under age
18, to a Cuban or Haitian entrant as defined in Public Law
Number 96-422, section 501(e)(1) or (2)(a), or to an alien who
is aged, blind, or disabled as defined in United States Code,
title 42, section 1382c(a)(1).
(3) For purposes of paragraph (f), "emergency services" has
the meaning given in Code of Federal Regulations, title 42,
section 440.255(b)(1).
Sec. 29. Minnesota Statutes 1992, section 256D.04, is
amended to read:
256D.04 [DUTIES OF THE COMMISSIONER.]
In addition to any other duties imposed by law, the
commissioner shall:
(1) Supervise according to section 256.01 the
administration of general assistance and general assistance
medical care by county agencies as provided in sections 256D.01
to 256D.21;
(2) Promulgate uniform rules consistent with law for
carrying out and enforcing the provisions of sections 256D.01 to
256D.21, including section 256D.05, subdivision 3, and section
256.01, subdivision 2, paragraph (16), to the end that general
assistance may be administered as uniformly as possible
throughout the state; rules shall be furnished immediately to
all county agencies and other interested persons; in
promulgating rules, the provisions of sections 14.001 to 14.69,
shall apply;
(3) Allocate money appropriated for general assistance and
general assistance medical care to county agencies as provided
in section 256D.03, subdivisions 2 and 3;
(4) Accept and supervise the disbursement of any funds that
may be provided by the federal government or from other sources
for use in this state for general assistance and general
assistance medical care;
(5) Cooperate with other agencies including any agency of
the United States or of another state in all matters concerning
the powers and duties of the commissioner under sections 256D.01
to 256D.21;
(6) Cooperate to the fullest extent with other public
agencies empowered by law to provide vocational training,
rehabilitation, or similar services;
(7) Gather and study current information and report at
least annually to the governor and legislature on the nature and
need for general assistance and general assistance medical care,
the amounts expended under the supervision of each county
agency, and the activities of each county agency and publish
such reports for the information of the public; and
(8) Specify requirements for general assistance and general
assistance medical care reports, including fiscal reports,
according to section 256.01, subdivision 2, paragraph (17); and
(9) Ensure that every notice of eligibility for general
assistance or work readiness includes a notice that women who
are pregnant may be eligible for medical assistance benefits.
Sec. 30. Minnesota Statutes 1992, section 256D.05, is
amended by adding a subdivision to read:
Subd. 8. [PERSONS INELIGIBLE.] (a) Beginning October 1,
1993, an undocumented alien or a nonimmigrant is ineligible for
work readiness and general assistance benefits. For purposes of
this subdivision, a nonimmigrant is an individual in one or more
of the classes listed in United States Code, title 8, section
1101(a)(15), and an undocumented alien is an individual who
resides in the United States without the approval or
acquiescence of the Immigration and Naturalization Service.
(b) This subdivision does not apply to a child under age
18, to a Cuban or Haitian entrant as defined in Public Law
Number 96-422, section 501(e)(1) or (2)(a), or to an alien who
is aged, blind, or disabled as defined in United States Code,
title 42, section 1382c(a)(1).
Sec. 31. Minnesota Statutes 1992, section 256D.051,
subdivision 1, is amended to read:
Subdivision 1. [WORK REGISTRATION.] (a) Except as provided
in this subdivision, persons who are residents of the state and
whose income and resources are less than the standard of
assistance established by the commissioner, but who are not
categorically eligible under section 256D.05, subdivision 1, are
eligible for the work readiness program for a maximum period of
six calendar months during any 12 consecutive calendar month
period, subject to the provisions of paragraph (d), subdivision
3, and section 256D.052, subdivision 4. The person's
eligibility period begins on the first day of the calendar month
following the date of application for assistance or following
the date all eligibility factors are met, whichever is later;
however, the person may voluntarily continue to participate in
work readiness services for up to three additional consecutive
months immediately following the last month of benefits to
complete the provisions of the person's employability
development plan. After July 1, 1992, if orientation is
available within three weeks after the date eligibility is
determined, initial payment will not be made until the
registrant attends orientation to the work readiness program.
Prior to terminating work readiness assistance the county agency
must provide advice on the person's eligibility for general
assistance medical care and must assess the person's eligibility
for general assistance under section 256D.05 to the extent
possible, using information in the case file, and determine the
person's eligibility for general assistance. A determination
that the person is not eligible for general assistance must be
stated in the notice of termination of work readiness benefits.
(b) Persons, families, and married couples who are not
state residents but who are otherwise eligible for work
readiness assistance may receive emergency assistance to meet
emergency needs.
(c) Except for family members who must participate in work
readiness services under the provisions of section 256D.05,
subdivision 1, clause (14) (15), any person who would be defined
for purposes of the food stamp program as being enrolled or
participating at least half-time in an institution of higher
education or a post-secondary program is ineligible for the work
readiness program. Post-secondary education does not include
the following programs: (1) high school equivalency; (2) adult
basic education; (3) English as a second language; (4) literacy
training; and (5) skill-specific technical training that has a
course of study of less than three months, that is not paid for
using work readiness funds, and that is specified in the work
readiness employability development plan developed with the
recipient prior to the recipient beginning the training course.
(d) Notwithstanding the provisions of sections 256.045 and
256D.10, during the pendency of an appeal, work readiness
payments and services shall not continue to a person who appeals
the termination of benefits due to exhaustion of the period of
eligibility specified in paragraph (a) or (d).
Sec. 32. Minnesota Statutes 1992, section 256D.051,
subdivision 6, is amended to read:
Subd. 6. [SERVICE COSTS.] The commissioner shall reimburse
92 percent of county agency expenditures for providing work
readiness services including direct participation expenses and
administrative costs, except as provided in section 256.017.
State work readiness funds shall be used only to pay the county
agency's and work readiness service provider's actual costs of
providing participant support services, direct program services,
and program administrative costs for persons who participate in
work readiness services. Beginning January 1, 1991, the average
reimbursable cost per recipient must not exceed $283 annually.
Beginning July 1, 1991, the average annual reimbursable cost for
providing work readiness services to a recipient for whom an
individualized employability development plan is not completed
must not exceed $60 for the work readiness services, and $223
for necessary recipient support services such as transportation
or child care needed to participate in work readiness services.
If an individualized employability development plan has been
completed, the average annual reimbursable cost for providing
work readiness services must not exceed $283, except that the
total annual average reimbursable cost shall not exceed $804 for
recipients who participate in a pilot project work experience
program under section 56, for all services and costs necessary
to implement the plan, including the costs of training,
employment search assistance, placement, work experience,
on-the-job training, other appropriate activities, the
administrative and program costs incurred in providing these
services, and necessary recipient support services such as
tools, clothing, and transportation needed to participate in
work readiness services. Beginning July 1, 1991, the state will
reimburse counties, up to the limit of state appropriations,
according to the payment schedule in section 256.025 for the
county share of costs incurred under this subdivision on or
after January 1, 1991. Payment to counties under this
subdivision is subject to the provisions of section 256.017.
Sec. 33. Minnesota Statutes 1992, section 257.54, is
amended to read:
257.54 [HOW PARENT AND CHILD RELATIONSHIP ESTABLISHED.]
The parent and child relationship between a child and
(a) the biological mother may be established by proof of
her having given birth to the child, or under sections 257.51 to
257.74 or section 257.75;
(b) the biological father may be established under sections
257.51 to 257.74 or section 257.75; or
(c) an adoptive parent may be established by proof of
adoption.
Sec. 34. Minnesota Statutes 1992, section 257.541, is
amended to read:
257.541 [CUSTODY AND VISITATION OF CHILDREN BORN OUTSIDE OF
MARRIAGE.]
Subdivision 1. [MOTHER'S RIGHT TO CUSTODY.] The biological
mother of a child born to a mother who was not married to the
child's father neither when the child was born nor when the
child was conceived has sole custody of the child until
paternity has been established under sections 257.51 to 257.74,
or until custody is determined in a separate proceeding under
section 518.156.
Subd. 2. [FATHER'S RIGHT TO VISITATION AND CUSTODY.] (a)
If paternity has been acknowledged under section 257.34 and
paternity has been established under sections 257.51 to 257.74,
the father's rights of visitation or custody are determined
under sections 518.17 and 518.175.
(b) If paternity has not been acknowledged under section
257.34 and paternity has been established under sections 257.51
to 257.74, the biological father may petition for rights of
visitation or custody in the paternity proceeding or in a
separate proceeding under section 518.156.
Subd. 3. [FATHER'S RIGHT TO VISITATION AND CUSTODY;
RECOGNITION OF PATERNITY.] If paternity has been recognized
under section 257.75, the father may petition for rights of
visitation or custody in an independent action under section
518.156. The proceeding must be treated as an initial
determination of custody under section 518.17. The provisions
of chapter 518 apply with respect to the granting of custody and
visitation. These proceedings may not be combined with any
proceeding under chapter 518B.
Sec. 35. Minnesota Statutes 1992, section 257.55,
subdivision 1, is amended to read:
Subdivision 1. [PRESUMPTION.] A man is presumed to be the
biological father of a child if:
(a) He and the child's biological mother are or have been
married to each other and the child is born during the marriage,
or within 280 days after the marriage is terminated by death,
annulment, declaration of invalidity, dissolution, or divorce,
or after a decree of legal separation is entered by a court;
(b) Before the child's birth, he and the child's biological
mother have attempted to marry each other by a marriage
solemnized in apparent compliance with law, although the
attempted marriage is or could be declared void, voidable, or
otherwise invalid, and,
(1) if the attempted marriage could be declared invalid
only by a court, the child is born during the attempted
marriage, or within 280 days after its termination by death,
annulment, declaration of invalidity, dissolution or divorce; or
(2) if the attempted marriage is invalid without a court
order, the child is born within 280 days after the termination
of cohabitation;
(c) After the child's birth, he and the child's biological
mother have married, or attempted to marry, each other by a
marriage solemnized in apparent compliance with law, although
the attempted marriage is or could be declared void, voidable,
or otherwise invalid, and,
(1) he has acknowledged his paternity of the child in
writing filed with the state registrar of vital statistics;
(2) with his consent, he is named as the child's father on
the child's birth certificate; or
(3) he is obligated to support the child under a written
voluntary promise or by court order;
(d) While the child is under the age of majority, he
receives the child into his home and openly holds out the child
as his biological child; or
(e) He and the child's biological mother acknowledge his
paternity of the child in a writing signed by both of them under
section 257.34 and filed with the state registrar of vital
statistics. If another man is presumed under this clause to be
the child's father, acknowledgment may be effected only with the
written consent of the presumed father or after the presumption
has been rebutted.;
(f) Evidence of statistical probability of paternity based
on blood testing establishes that the likelihood that the man he
is the father of the child, calculated with a prior probability
of no more than 0.5 (50 percent), is 99 percent or greater;
(g) He and the child's biological mother have executed a
recognition of parentage in accordance with section 257.75 and
another man is presumed to be the father under this subdivision;
or
(h) He and the child's biological mother have executed a
recognition of parentage in accordance with section 257.75 and
another man and the child's mother have executed a recognition
of parentage in accordance with section 257.75.
Sec. 36. Minnesota Statutes 1992, section 257.57,
subdivision 2, is amended to read:
Subd. 2. The child, the mother, or personal representative
of the child, the public authority chargeable by law with the
support of the child, the personal representative or a parent of
the mother if the mother has died or is a minor, a man alleged
or alleging himself to be the father, or the personal
representative or a parent of the alleged father if the alleged
father has died or is a minor may bring an action:
(1) at any time for the purpose of declaring the existence
of the father and child relationship presumed under section
257.55, subdivision 1, clause (d), (e), or (f), (g), or (h), or
the nonexistence of the father and child relationship presumed
under clause (d) of that subdivision;
(2) for the purpose of declaring the nonexistence of the
father and child relationship presumed under section 257.55,
subdivision 1, clause (e) or (g), only if the action is brought
within three years after the date of the execution of the
declaration or recognition of parentage; or
(3) for the purpose of declaring the nonexistence of the
father and child relationship presumed under section 257.55,
subdivision 1, paragraph (f), only if the action is brought
within three years after the party bringing the action, or the
party's attorney of record, has been provided the blood test
results.
Sec. 37. Minnesota Statutes 1992, section 257.59,
subdivision 3, is amended to read:
Subd. 3. The action may be brought in the county in which
the child or the alleged father defendant resides or is found
or, if the father defendant is deceased, in which proceedings
for probate of his the defendant's estate have been or could be
commenced.
Sec. 38. Minnesota Statutes 1992, section 257.73,
subdivision 1, is amended to read:
Subdivision 1. Upon compliance with the provisions of
section 257.55, subdivision 1, clause (e), 257.75, or upon order
of a court of this state or upon request of a court of another
state, the local registrar of vital statistics shall prepare a
new certificate of birth consistent with the acknowledgment or
the findings of the court and shall substitute the new
certificate for the original certificate of birth.
Sec. 39. Minnesota Statutes 1992, section 257.74,
subdivision 1, is amended to read:
Subdivision 1. If a mother relinquishes or proposes to
relinquish for adoption a child who has
(a) a presumed father under section 257.55, subdivision 1,
(b) a father whose relationship to the child has been
determined by a court or established under section 257.75, or
(c) a father as to whom the child is a legitimate child
under prior law of this state or under the law of another
jurisdiction, the father shall be given notice of the adoption
proceeding as provided in section 259.26.
Sec. 40. [257.75] [RECOGNITION OF PARENTAGE.]
Subdivision 1. [RECOGNITION BY PARENTS.] The mother and
father of a child born to a mother who was not married to the
child's father nor to any other man when the child was conceived
nor when the child was born may, in a writing signed by both of
them before a notary public and filed with the state registrar
of vital statistics, state and acknowledge under oath that they
are the biological parents of the child and wish to be
recognized as the biological parents. The recognition must be
in the form prepared by the commissioner of human services under
subdivision 5.
Subd. 2. [REVOCATION OF RECOGNITION.] A recognition may be
revoked in a writing signed by the mother or father before a
notary public and filed with the state registrar of vital
statistics within 30 days after the recognition is executed.
Upon receipt of a revocation of the recognition of parentage,
the state registrar of vital statistics shall forward a copy of
the revocation to the nonrevoking parent.
Subd. 3. [EFFECT OF RECOGNITION.] Subject to subdivision 2
and section 257.55, subdivision 1, paragraph (g) or (h), the
recognition has the force and effect of a judgment or order
determining the existence of the parent and child relationship
under section 257.66. If the conditions in section 257.55,
subdivision 1, paragraph (g) or (h), exist, the recognition
creates only a presumption of paternity for purposes of sections
257.51 to 257.74. Until an order is entered granting custody to
another, the mother has sole custody. The recognition is:
(1) a basis for bringing an action to award custody or
visitation rights to either parent, establishing a child support
obligation, ordering a contribution by a parent under section
256.87, or ordering a contribution to the reasonable expenses of
the mother's pregnancy and confinement, as provided under
section 257.66, subdivision 3;
(2) determinative for all other purposes related to the
existence of the parent and child relationship; and
(3) entitled to full faith and credit in other
jurisdictions.
Subd. 4. [ACTION TO VACATE RECOGNITION.] An action to
vacate a recognition of paternity may be brought by the mother,
father, or child. A mother or father must bring the action
within one year of the execution of the recognition or within
six months after discovery of evidence in support of the action,
whichever is later. A child must bring an action to vacate
within six months of discovery of evidence, in support of the
action or within one year of reaching the age of majority,
whichever is later. If the court finds a prima facie basis for
vacating the recognition, the court shall order the child,
mother, and father to submit to blood tests. If the court
issues an order for the taking of blood tests, the court shall
require the party seeking to vacate the recognition to make
advance payment for the costs of the blood tests. If the party
fails to pay for the costs of the blood tests, the court shall
dismiss the action to vacate with prejudice. The court may also
order the party seeking to vacate the recognition to pay the
other party's reasonable attorney fees, costs, and
disbursements. If the results of the blood tests establish that
the man who executed the recognition is not the father, the
court shall vacate the recognition. The court shall terminate
the obligation of a party to pay ongoing child support based on
the recognition. A modification of child support based on a
recognition may be made retroactive with respect to any period
during which the moving party has pending a motion to vacate the
recognition but only from the date of service of notice of the
motion on the responding party.
Subd. 5. [RECOGNITION FORM.] The commissioner of human
services shall prepare a form for the recognition of parentage
under this section. In preparing the form, the commissioner
shall consult with the individuals specified in subdivision 6.
The recognition form must be drafted so that the force and
effect of the recognition and the benefits and responsibilities
of establishing paternity are clear and understandable. The
form must include a notice regarding the finality of a
recognition and the revocation procedure under subdivision 2.
The form must include a provision for each parent to verify that
the parent has read or viewed the educational materials prepared
by the commissioner of human services describing the recognition
of paternity. Each parent must receive a copy of the
recognition.
Subd. 6. [PATERNITY EDUCATIONAL MATERIALS.] The
commissioner of human services shall prepare educational
materials for new and prospective parents that describe the
benefits and effects of establishing paternity. The materials
must include a description and comparison of the procedures for
establishment of paternity through a recognition of parentage
under this section and an adjudication of paternity under
sections 257.51 to 257.74. The commissioner shall consider the
use of innovative audio or visual approaches to the presentation
of the materials to facilitate understanding and presentation.
In preparing the materials, the commissioner shall consult with
child advocates and support workers, battered women's advocates,
social service providers, educators, attorneys, hospital
representatives, and people who work with parents in making
decisions related to paternity. The commissioner shall consult
with representatives of communities of color. On and after
January 1, 1994, the commissioner shall make the materials
available without cost to hospitals, requesting agencies, and
other persons for distribution to new parents.
Subd. 7. [HOSPITAL DISTRIBUTION OF EDUCATIONAL MATERIALS;
RECOGNITION FORM.] Hospitals that provide obstetric services
shall distribute the educational materials and recognition of
parentage forms prepared by the commissioner of human services
to new parents and shall assist parents in understanding the
recognition of parentage form. On and after January 1, 1994,
hospitals may not distribute the declaration of parentage forms.
Subd. 8. [NOTICE.] If the state registrar of vital
statistics receives more than one recognition of parentage for
the same child, the registrar shall notify both signatories on
each recognition that the recognition is no longer final and
that each man has only a presumption of paternity under section
257.55, subdivision 1.
Sec. 41. Minnesota Statutes 1992, section 388.23,
subdivision 1, is amended to read:
Subdivision 1. [AUTHORITY.] The county attorney, or any
deputy or assistant county attorney whom the county attorney
authorizes in writing, has the authority to subpoena and require
the production of any records of telephone companies, cellular
phone companies, paging companies, electric companies, gas
companies, water utilities, chemical suppliers, hotels and
motels, airlines, buses, taxis, and other entities engaged in
the business of transporting people, and freight companies,
warehousing companies, package delivery companies, and other
entities engaged in the businesses of transport, storage, or
delivery, and records of the existence of safe deposit box
account numbers and customer savings and checking account
numbers maintained by financial institutions and safe deposit
companies, insurance records relating to the monetary payment or
settlement of claims, and wage and employment records of an
applicant or recipient of public assistance who is the subject
of a welfare fraud investigation relating to eligibility
information for public assistance programs. Subpoenas may only
be issued for records that are relevant to an ongoing legitimate
law enforcement investigation or welfare fraud investigation and
there is probable cause that a crime has been committed. This
provision applies only to the records of business entities and
does not extend to private individuals or their dwellings.
Subpoenas may only be served by peace officers as defined by
section 626.84, subdivision 1, paragraph (c).
Sec. 42. Minnesota Statutes 1992, section 393.07,
subdivision 10, is amended to read:
Subd. 10. [FEDERAL FOOD STAMP PROGRAM.] (a) The county
welfare board shall establish and administer the food stamp
program pursuant to rules of the commissioner of human services,
the supervision of the commissioner as specified in section
256.01, and all federal laws and regulations. The commissioner
of human services shall monitor food stamp program delivery on
an ongoing basis to ensure that each county complies with
federal laws and regulations. Program requirements to be
monitored include, but are not limited to, number of
applications, number of approvals, number of cases pending,
length of time required to process each application and deliver
benefits, number of applicants eligible for expedited issuance,
length of time required to process and deliver expedited
issuance, number of terminations and reasons for terminations,
client profiles by age, household composition and income level
and sources, and the use of phone certification and home
visits. The commissioner shall determine the county-by-county
and statewide participation rate.
(b) On July 1 of each year, the commissioner of human
services shall determine a statewide and county-by-county food
stamp program participation rate. The commissioner may
designate a different agency to administer the food stamp
program in a county if the agency administering the program
fails to increase the food stamp program participation rate
among families or eligible individuals, or comply with all
federal laws and regulations governing the food stamp program.
The commissioner shall review agency performance annually to
determine compliance with this paragraph.
(c) A person who commits any of the following acts has
violated section 256.98 or 609.821, or both, and is subject to
both the criminal and civil penalties provided under that
section those sections:
(1) Obtains or attempts to obtain, or aids or abets any
person to obtain by means of a willfully false statement or
representation, or intentional concealment of a material fact,
food stamps to which the person is not entitled or in an amount
greater than that to which that person is entitled; or
(2) Presents or causes to be presented, coupons for payment
or redemption knowing them to have been received, transferred or
used in a manner contrary to existing state or federal law; or
(3) Willfully uses, possesses, or transfers food stamp
coupons or authorization to purchase cards in any manner
contrary to existing state or federal law, rules, or
regulations; or
(4) Buys or sells food stamp coupons, authorization to
purchase cards or other assistance transaction devices for cash
or consideration other than eligible food.
(d) A peace officer or welfare fraud investigator may
confiscate food stamps, authorization to purchase cards, or
other assistance transaction devices found in the possession of
any person who is neither a recipient of the food stamp program
nor otherwise authorized to possess and use such materials.
Confiscated property shall be disposed of as the commissioner
may direct and consistent with state and federal food stamp
law. The confiscated property must be retained for a period of
not less than 30 days to allow any affected person to appeal the
confiscation under section 256.045.
Sec. 43. Minnesota Statutes 1992, section 518.156,
subdivision 1, is amended to read:
Subdivision 1. In a court of this state which has
jurisdiction to decide child custody matters, a child custody
proceeding is commenced:
(a) by a parent
(1) by filing a petition for dissolution or legal
separation; or
(2) where a decree of dissolution or legal separation has
been entered or where none is sought, or when paternity has been
recognized under section 257.75, by filing a petition or motion
seeking custody or visitation of the child in the county where
the child is permanently resident or where the child is found or
where an earlier order for custody of the child has been
entered; or
(b) by a person other than a parent, where a decree of
dissolution or legal separation has been entered or where none
is sought by filing a petition or motion seeking custody or
visitation of the child in the county where the child is
permanently resident or where the child is found or where an
earlier order for custody of the child has been entered. A
person seeking visitation pursuant to this paragraph must
qualify under one of the provisions of section 257.022.
Sec. 44. Minnesota Statutes 1992, section 518.551,
subdivision 5, is amended to read:
Subd. 5. [NOTICE TO PUBLIC AUTHORITY; GUIDELINES.] (a) The
petitioner shall notify the public authority of all proceedings
for dissolution, legal separation, determination of parentage or
for the custody of a child, if either party is receiving aid to
families with dependent children or applies for it subsequent to
the commencement of the proceeding. After receipt of the
notice, the court shall set child support as provided in this
subdivision. The court may order either or both parents owing a
duty of support to a child of the marriage to pay an amount
reasonable or necessary for the child's support, without regard
to marital misconduct. The court shall approve a child support
stipulation of the parties if each party is represented by
independent counsel, unless the stipulation does not meet the
conditions of paragraph (h). In other cases the court shall
determine and order child support in a specific dollar amount in
accordance with the guidelines and the other factors set forth
in paragraph (b) and any departure therefrom. The court may
also order the obligor to pay child support in the form of a
percentage share of the obligor's net bonuses, commissions, or
other forms of compensation, in addition to, or if the obligor
receives no base pay, in lieu of, an order for a specific dollar
amount.
The court shall derive a specific dollar amount by
multiplying the obligor's net income by the percentage indicated
by the following guidelines:
Net Income Per Number of Children
Month of Obligor
1 2 3 4 5 6 7 or
more
$400 and Below Order based on the ability of the
obligor to provide support
at these income levels, or at higher
levels, if the obligor has
the earning ability.
$401 - 500 14% 17% 20% 22% 24% 26% 28%
$501 - 550 15% 18% 21% 24% 26% 28% 30%
$551 - 600 16% 19% 22% 25% 28% 30% 32%
$601 - 650 17% 21% 24% 27% 29% 32% 34%
$651 - 700 18% 22% 25% 28% 31% 34% 36%
$701 - 750 19% 23% 27% 30% 33% 36% 38%
$751 - 800 20% 24% 28% 31% 35% 38% 40%
$801 - 850 21% 25% 29% 33% 36% 40% 42%
$851 - 900 22% 27% 31% 34% 38% 41% 44%
$901 - 950 23% 28% 32% 36% 40% 43% 46%
$951 - 1000 24% 29% 34% 38% 41% 45% 48%
$1001- 4000 25% 30% 35% 39% 43% 47% 50%
Guidelines for support for an obligor with a monthly income
of $4,001 or more shall be the same dollar amounts as provided
for in the guidelines for an obligor with a monthly income of
$4,000.
Net Income defined as:
Total monthly
income less *(i) Federal Income Tax
*(ii) State Income Tax
(iii) Social Security
Deductions
(iv) Reasonable
Pension Deductions
*Standard
Deductions apply- (v) Union Dues
use of tax tables (vi) Cost of Dependent Health
recommended Insurance Coverage
(vii) Cost of Individual or Group
Health/Hospitalization
Coverage or an
Amount for Actual
Medical Expenses
(viii) A Child Support or
Maintenance Order that is
Currently Being Paid.
"Net income" does not include:
(1) the income of the obligor's spouse, but does include
in-kind payments received by the obligor in the course of
employment, self-employment, or operation of a business if the
payments reduce the obligor's living expenses; or
(2) compensation received by a party for employment in
excess of a 40-hour work week, provided that:
(i) support is nonetheless ordered in an amount at least
equal to the guidelines amount based on income not excluded
under this clause; and
(ii) the party demonstrates, and the court finds, that:
(A) the excess employment began after the filing of the
petition for dissolution;
(B) the excess employment reflects an increase in the work
schedule or hours worked over that of the two years immediately
preceding the filing of the petition;
(C) the excess employment is voluntary and not a condition
of employment;
(D) the excess employment is in the nature of additional,
part-time or overtime employment compensable by the hour or
fraction of an hour; and
(E) the party's compensation structure has not been changed
for the purpose of affecting a support or maintenance obligation.
(b) In addition to the child support guidelines, the court
shall take into consideration the following factors in setting
or modifying child support:
(1) all earnings, income, and resources of the parents,
including real and personal property, but excluding income from
excess employment of the obligor or obligee that meets the
criteria of paragraph (a), clause (2)(ii);
(2) the financial needs and resources, physical and
emotional condition, and educational needs of the child or
children to be supported;
(3) the standards of living the child would have enjoyed
had the marriage not been dissolved, but recognizing that the
parents now have separate households;
(4) the amount of the aid to families with dependent
children grant for the child or children;
(5) which parent receives the income taxation dependency
exemption and what financial benefit the parent receives from
it; and
(6) the parents' debts as provided in paragraph (c); and
(7) the obligor's receipt of assistance under sections
256.72 to 256.87 or 256B.01 to 256B.40.
(c) In establishing or modifying a support obligation, the
court may consider debts owed to private creditors, but only if:
(1) the right to support has not been assigned under
section 256.74;
(2) the court determines that the debt was reasonably
incurred for necessary support of the child or parent or for the
necessary generation of income. If the debt was incurred for
the necessary generation of income, the court shall consider
only the amount of debt that is essential to the continuing
generation of income; and
(3) the party requesting a departure produces a sworn
schedule of the debts, with supporting documentation, showing
goods or services purchased, the recipient of them, the amount
of the original debt, the outstanding balance, the monthly
payment, and the number of months until the debt will be fully
paid.
(d) Any schedule prepared under paragraph (c), clause (3),
shall contain a statement that the debt will be fully paid after
the number of months shown in the schedule, barring emergencies
beyond the party's control.
(e) Any further departure below the guidelines that is
based on a consideration of debts owed to private creditors
shall not exceed 18 months in duration, after which the support
shall increase automatically to the level ordered by the court.
Nothing in this section shall be construed to prohibit one or
more step increases in support to reflect debt retirement during
the 18-month period.
(f) Where payment of debt is ordered pursuant to this
section, the payment shall be ordered to be in the nature of
child support.
(g) Nothing shall preclude the court from receiving
evidence on the above factors to determine if the guidelines
should be exceeded or modified in a particular case.
(h) The guidelines in this subdivision are a rebuttable
presumption and shall be used in all cases when establishing or
modifying child support. If the court does not deviate from the
guidelines, the court shall make written findings concerning the
amount of the obligor's income used as the basis for the
guidelines calculation and any other significant evidentiary
factors affecting the determination of child support. If the
court deviates from the guidelines, the court shall make written
findings giving the amount of support calculated under the
guidelines, the reasons for the deviation, and shall
specifically address the criteria in paragraph (b) and how the
deviation serves the best interest of the child. The provisions
of this paragraph apply whether or not the parties are each
represented by independent counsel and have entered into a
written agreement. The court shall review stipulations
presented to it for conformity to the guidelines and the court
is not required to conduct a hearing, but the parties shall
provide the documentation of earnings required under subdivision
5b.
Sec. 45. Minnesota Statutes 1992, section 518.611,
subdivision 1, is amended to read:
Subdivision 1. [ORDER.] Whenever an obligation for support
of a dependent child or maintenance of a spouse, or both, is
determined and ordered by a court of this state, the amount of
child support or maintenance as determined by court order must
be withheld from the income, regardless of source, of the person
obligated to pay the support or maintenance. Every order for
maintenance or support must include:
(1) the obligor's social security number and date of birth
and the name and address of the obligor's employer or other
payor of funds; and
(2) provisions for the obligor to keep the public authority
informed of the name and address of the obligor's current
employer or payor of funds, and whether the obligor has access
to employment-related health insurance coverage and, if so, the
health insurance policy information.
Sec. 46. Minnesota Statutes 1992, section 518.611,
subdivision 2, is amended to read:
Subd. 2. [CONDITIONS OF INCOME WITHHOLDING.] (a)
Withholding shall result whenever when:
(1) the obligor requests it in writing to the public
authority;
(2) the custodial parent requests it by making a motion to
the court; or
(3) the obligor fails to make the maintenance or support
payments, and the following conditions are met:
(1) (i) the obligor is at least 30 days in arrears;
(2) (ii) the obligee or the public authority serves written
notice of income withholding, showing arrearage, on the obligor
at least 15 days before service of the notice of income
withholding and a copy of the court's order on the payor of
funds;
(3) (iii) within the 15-day period, the obligor fails to
move the court to deny withholding on the grounds that an
arrearage of at least 30 days does not exist as of the date of
the notice of income withholding, or on other grounds limited to
mistakes of fact, and, ex parte, to stay service on the payor of
funds until the motion to deny withholding is heard;
(4) (iv) the obligee or the public authority serves a copy
of the notice of income withholding, a copy of the court's order
or notice of order, and the provisions of this section on the
payor of funds; and
(5) (v) the obligee serves on the public authority a copy
of the notice of income withholding, a copy of the court's
order, an application, and the fee to use the public authority's
collection services.
For those persons not applying for the public authority's IV-D
services, a monthly service fee of $15 must be charged to the
obligor in addition to the amount of child support ordered by
the court and withheld through automatic income withholding, or
for persons applying for the public authority's IV-D services,
the service fee under section 518.551, subdivision 7, applies.
The county agency shall explain to affected persons the services
available and encourage the applicant to apply for IV-D services.
(b) To pay the arrearage specified in the notice of income
withholding, the employer or payor of funds shall withhold from
the obligor's income an additional amount equal to 20 percent of
the monthly child support or maintenance obligation until the
arrearage is paid.
(c) The obligor may, at any time, waive the written notice
required by this subdivision.
(d) The obligor may move the court, under section 518.64,
to modify the order respecting the amount of maintenance or
support.
(e) (d) Every order for support or maintenance shall
provide for a conspicuous notice of the provisions of this
subdivision. An order without this notice remains subject to
this subdivision.
(f) (e) Absent a court order to the contrary, if an
arrearage exists at the time an order for ongoing support or
maintenance would otherwise terminate, income withholding shall
continue in effect in an amount equal to the former support or
maintenance obligation plus an additional amount equal to 20
percent of the monthly child support obligation, until all
arrears have been paid in full.
Sec. 47. Minnesota Statutes 1992, section 518.611,
subdivision 6, is amended to read:
Subd. 6. [PRIORITY.] An order for withholding under this
section or execution or garnishment upon a judgment for child
support arrearages or preadjudicated expenses shall have
priority over an attachment, execution, garnishment, or wage
assignment and shall not be subject to the statutory limitations
on amounts levied against the income of the obligor. Amounts
withheld from an employee's income must not exceed the maximum
permitted under the Consumer Credit Protection Act, United
States Code, title 15, section 1673(b)(2). If there is more
than one withholding order on a single employee, the employer
shall put them into effect, giving priority first to amounts
currently due and not in arrears and then to other amounts, in
the sequence in which the withholding orders were received up to
the maximum allowed in the Consumer Credit Protection Act. the
payor of funds shall comply with all of the orders to the extent
that the total amount withheld from the payor's income does not
exceed the limits imposed under the Consumer Credit Protection
Act, giving priority to amounts designated in each order as
current support as follows:
(1) If the total of the amounts designated in the orders as
current support exceeds the amount available for income
withholding, the payor of funds shall allocate to each order an
amount for current support equal to the amount designated in
that order as current support, divided by the total of the
amounts designated in the orders as current support, multiplied
by the amount of the income available for income withholding;
and
(2) If the total of the amounts designated in the orders as
current support does not exceed the amount available for income
withholding, the payor of funds shall pay the amounts designated
as current support, and shall allocate to each order an amount
for past due support equal to the amount designated in that
order as past due support, divided by the total of the amounts
designated in the orders as past due support, multiplied by the
amount of income remaining available for income withholding
after the payment of current support.
Notwithstanding any law to the contrary, funds from income
sources included in section 518.54, subdivision 6, whether
periodic or lump sum, are not exempt from attachment or
execution upon a judgment for child support arrearages.
Sec. 48. Minnesota Statutes 1992, section 518.611, is
amended by adding a subdivision to read:
Subd. 12. [INTERSTATE INCOME WITHHOLDING.] Upon receipt of
an order for support entered in another state, with the
specified documentation from an authorized agency, the public
authority shall implement income withholding under subdivision
2. If the obligor requests a hearing under subdivision 3 to
contest withholding, the court administrator shall enter the
order. Entry of the order shall not confer jurisdiction on the
courts or administrative agencies of this state for any purpose
other than contesting implementation of income withholding.
Sec. 49. Minnesota Statutes 1992, section 518.613,
subdivision 2, is amended to read:
Subd. 2. [ORDER; COLLECTION SERVICES.] Every order for
child support must include the obligor's social security number
and date of birth and the name and address of the obligor's
employer or other payor of funds. In addition, every order must
contain provisions requiring the obligor to keep the public
authority informed of the name and address of the obligor's
current employer, or other payor of funds and whether the
obligor has access to employment-related health insurance
coverage and, if so, the health insurance policy information.
Upon entry of the order for support or maintenance, the court
shall mail a copy of the court's automatic income withholding
order and the provisions of section 518.611 and this section to
the obligor's employer or other payor of funds and to the public
authority responsible for child support enforcement. An obligee
who is not a recipient of public assistance shall must decide to
either apply for the IV-D collection services of the public
authority or obtain income withholding only services when an
order for support is entered unless the requirements of this
section have been waived under subdivision 7. No later than
January 1, 1990, The supreme court shall develop a standard
automatic income withholding form to be used by all Minnesota
courts. This form shall be made a part of any order for support
or decree by reference.
Sec. 50. Minnesota Statutes 1992, section 518.613,
subdivision 3, is amended to read:
Subd. 3. [WITHHOLDING.] The employer or other payor shall
withhold and forward the child support or maintenance ordered in
the manner and within the time limits provided in section
518.611. Amounts received from employers or other payors under
this section by the public agency responsible for child support
enforcement that are in excess of public assistance received by
the obligee must be remitted to the obligee. The public agency
must remit payments to the obligee at least once monthly on a
standard payment date set by the agency. A county in which this
section applies may contract for services to carry out the
provisions of this section.
Sec. 51. Minnesota Statutes 1992, section 518.613,
subdivision 4, is amended to read:
Subd. 4. [APPLICATION.] On and after August 1, 1989, this
section applies in a county selected under Laws 1987, chapter
403, article 3, section 93, and in a county that chooses to have
this section apply by resolution of a majority vote of its
county board. On and after November 1, 1990, this section
applies to all child support and maintenance obligations that
are initially ordered or modified on and after November 1, 1990,
and that are being enforced by the public authority. Effective
January 1, 1994, this section applies to all child support and
maintenance obligations ordered or modified by the court. Those
persons not applying for the public authority's IV-D services
must pay a monthly service fee of $15. The fee will be charged
to the obligor in addition to the amount of the child support
which was ordered by the court. Persons applying for the public
authority's IV-D services will pay the service fee under section
518.551, subdivision 7.
Sec. 52. Minnesota Statutes 1992, section 518.64,
subdivision 2, is amended to read:
Subd. 2. [MODIFICATION.] (a) The terms of an order
respecting maintenance or support may be modified upon a showing
of one or more of the following: (1) substantially increased or
decreased earnings of a party; (2) substantially increased or
decreased need of a party or the child or children that are the
subject of these proceedings; (3) receipt of assistance under
sections 256.72 to 256.87 or 256B.01 to 256B.40; or (4) a change
in the cost of living for either party as measured by the
federal bureau of statistics, any of which makes the terms
unreasonable and unfair.
The terms of a current support order shall be rebuttably
presumed to be unreasonable and unfair if the application of the
child support guidelines in section 518.551, subdivision 5, to
the current circumstances of the parties results in a calculated
court order that is at least 20 percent and at least $50 per
month higher or lower than the current support order.
(b) On a motion for modification of maintenance, including
a motion for the extension of the duration of a maintenance
award, the court shall apply, in addition to all other relevant
factors, the factors for an award of maintenance under section
518.552 that exist at the time of the motion. On a motion for
modification of support, the court:
(1) shall apply section 518.551, subdivision 5, and shall
not consider the financial circumstances of each party's spouse,
if any; and
(2) shall not consider compensation received by a party for
employment in excess of a 40-hour work week, provided that the
party demonstrates, and the court finds, that:
(i) the excess employment began after entry of the existing
support order;
(ii) the excess employment is voluntary and not a condition
of employment;
(iii) the excess employment is in the nature of additional,
part-time employment, or overtime employment compensable by the
hour or fractions of an hour;
(iv) the party's compensation structure has not been
changed for the purpose of affecting a support or maintenance
obligation;
(v) in the case of an obligor, current child support
payments are at least equal to the guidelines amount based on
income not excluded under this clause; and
(vi) in the case of an obligor who is in arrears in child
support payments to the obligee, any net income from excess
employment must be used to pay the arrearages until the
arrearages are paid in full.
(c) A modification of support or maintenance may be made
retroactive only with respect to any period during which the
petitioning party has pending a motion for modification but only
from the date of service of notice of the motion on the
responding party and on the public authority if public
assistance is being furnished or the county attorney is the
attorney of record. However, modification may be applied to an
earlier period if the court makes express findings that the
party seeking modification was precluded from serving a motion
by reason of a significant physical or mental disability, a
material misrepresentation of another party, or fraud upon the
court and that the party seeking modification, when no longer
precluded, promptly served a motion.
(d) Except for an award of the right of occupancy of the
homestead, provided in section 518.63, all divisions of real and
personal property provided by section 518.58 shall be final, and
may be revoked or modified only where the court finds the
existence of conditions that justify reopening a judgment under
the laws of this state, including motions under section 518.145,
subdivision 2. The court may impose a lien or charge on the
divided property at any time while the property, or subsequently
acquired property, is owned by the parties or either of them,
for the payment of maintenance or support money, or may
sequester the property as is provided by section 518.24.
(e) The court need not hold an evidentiary hearing on a
motion for modification of maintenance or support.
(f) Section 518.14 shall govern the award of attorney fees
for motions brought under this subdivision.
Sec. 53. Minnesota Statutes 1992, section 609.821,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITIONS.] For the purposes of this
section, the following terms have the meanings given them:
(a) "Financial transaction card" means any instrument or
device, whether known as a credit card, credit plate, charge
plate, courtesy card, bank services card, banking card, check
guarantee card, debit card, electronic benefit system (EBS)
card, electronic benefit transfer (EBT) card, assistance
transaction card, or by any other name, issued with or without
fee by an issuer for the use of the cardholder in obtaining
credit, money, goods, services, public assistance benefits, or
anything else of value, and includes the account or
identification number or symbol of a financial transaction card.
(b) "Cardholder" means a person in whose name a card is
issued.
(c) "Issuer" means a person or, firm, or governmental
agency, or a duly authorized agent or designee, that issues a
financial transaction card.
(d) "Property" includes money, goods, services, public
assistance benefit, or anything else of value.
(e) "Public assistance benefit" means any money, goods or
services, or anything else of value, issued under chapters 256,
256B, 256D, or section 393.07, subdivision 10.
Sec. 54. Minnesota Statutes 1992, section 609.821,
subdivision 2, is amended to read:
Subd. 2. [VIOLATIONS; PENALTIES.] A person who does any of
the following commits financial transaction card fraud:
(1) without the consent of the cardholder, and knowing that
the cardholder has not given consent, uses or attempts to use a
card to obtain the property of another, or a public assistance
benefit issued for the use of another;
(2) uses or attempts to use a card knowing it to be forged,
false, fictitious, or obtained in violation of clause (6);
(3) sells or transfers a card knowing that the cardholder
and issuer have not authorized the person to whom the card is
sold or transferred to use the card, or that the card is forged,
false, fictitious, or was obtained in violation of clause (6);
(4) without a legitimate business purpose, and without the
consent of the cardholders, receives or possesses, with intent
to use, or with intent to sell or transfer in violation of
clause (3), two or more cards issued in the name of another, or
two or more cards knowing the cards to be forged, false,
fictitious, or obtained in violation of clause (6);
(5) being authorized by an issuer to furnish money, goods,
services, or anything else of value, knowingly and with an
intent to defraud the issuer or the cardholder:
(i) furnishes money, goods, services, or anything else of
value upon presentation of a financial transaction card knowing
it to be forged, expired, or revoked, or knowing that it is
presented by a person without authority to use the card; or
(ii) represents in writing to the issuer that the person
has furnished money, goods, services, or anything else of value
which has not in fact been furnished;
(6) upon applying for a financial transaction card to an
issuer, or for a public assistance benefit which is distributed
by means of a financial transaction card:
(i) knowingly gives a false name or occupation; or
(ii) knowingly and substantially overvalues assets or
substantially undervalues indebtedness for the purpose of
inducing the issuer to issue a financial transaction card; or
(iii) knowingly makes a false statement or representation
for the purpose of inducing an issuer to issue a financial
transaction card used to obtain a public assistance benefit;
(7) with intent to defraud, falsely notifies the issuer or
any other person of a theft, loss, disappearance, or nonreceipt
of a financial transaction card; or
(8) without the consent of the cardholder and knowing that
the cardholder has not given consent, falsely alters, makes, or
signs any written document pertaining to a card transaction to
obtain or attempt to obtain the property of another.
Sec. 55. [PILOT PROJECT; WORK EXPERIENCE COMPONENT OF WORK
READINESS.]
Subdivision 1. [DUTIES OF COMMISSIONER.] The commissioner
of human services may establish a pilot project to implement the
work experience component in subdivision 2 for persons
participating in work readiness. The commissioner may select
one county within the seven-county metropolitan area and one or
more counties outside the seven-county metropolitan area to
participate in the pilot project. The commissioner may grant
waivers to any county, whether or not it is selected, to
establish and implement a comprehensive work readiness pilot
project. The commissioner shall allocate a proportionate number
of participant slots to each pilot county based on the amount of
funding available and the estimated per participant cost. Pilot
counties shall assign recipients to participate in the project
who have no recent work experience or local work reference on a
first-come, first-served basis, or who the county determines
will benefit from the work experience component by improving
their employability. Recipients assigned to project
participation shall be eligible for work readiness benefits and
services for a maximum period of eight months during any
12-consecutive-calendar-month period rather than the six-month
period specified in Minnesota Statutes, section 256D.051,
subdivision 1. The work experience pilot project may not begin
before January 1, 1994. The funds for the project are limited
to the amount appropriated by the legislature.
Subd. 2. [WORK EXPERIENCE COMPONENT.] (a) The purpose of
the pilot project is to develop a work experience component that
helps recipients achieve self-sufficiency.
(b) Recipients selected to participate in the pilot project
must cooperate with all work readiness requirements, including
the requirement to participate in a work experience component.
Work readiness recipients who would be required to participate
in the work experience component for less than eight hours per
month under the provisions of paragraph (d), or who are
attending high school, or who are functionally illiterate and
participating in literacy training, and family general
assistance recipients who are required to participate in work
readiness services under Minnesota Statutes, section 256D.05,
subdivision 1, clause (15), may not participate in the pilot
project and must instead participate in standard work readiness
employment and training services.
(c) Selected recipients shall be referred to the work
experience component at the end of their third month of work
readiness eligibility and must participate in the component
until the recipient finds suitable employment or until work
readiness benefits terminate. Permanent suitable employment
offered through grant diversion under Minnesota Statutes,
section 256D.09, subdivision 3, during this time period shall
substitute for work experience participation. The participant's
employability development plan must specify the type of work
experience position the recipient will be placed in, the
beginning date of mandatory participation in work experience,
and identify other services necessary to help the participant
become employed, including the requirement to participate for a
minimum of eight hours per week in job search activities if the
participant is not suitably employed.
(d) Each project recipient is required to participate in a
work experience job placement for that number of hours
calculated by dividing the assistance unit's work readiness
assistance payment by the state minimum wage. The county shall
provide for a participant's support services costs of
transportation, child care, and other work related expenses
incurred in order to participate in the work experience activity.
(e) The county shall assign work to the participant that
the participant is able to perform. Work experience positions
may be developed with public and private nonprofit employers.
Structured, supervised volunteer work with an agency or
organization which is monitored by the county service provider
may be used as a work experience placement. The county must
provide workers' compensation or other comparable protection for
a work experience participant. A participant is not eligible
for unemployment compensation, and is not an employee of the
state of Minnesota within the meaning of Minnesota Statutes,
section 43A.02, subdivision 2. The commissioner of jobs and
training shall assist in the design and implementation of the
work experience program.
(f) An eligible employer may not terminate, lay off, or
reduce the regular working hours of an employee for the purpose
of hiring an individual with money available under this
program. An eligible employer may not hire an individual with
money available through this program if any other person is on
layoff from the same or substantially equivalent job or to fill
an established vacant position. Written or oral concurrence
shall be obtained from the appropriate exclusive bargaining
representative with respect to job duties covered under
collective bargaining agreements.
(g) Recipients assigned to a work experience placement must
participate and cooperate in the placement and meet all work
readiness requirements. The county shall terminate assistance
payments provided under this section as specified in Minnesota
Statutes, section 256D.051, subdivision 1a, for a nonexempt
recipient who refuses without good cause to participate in a
work experience placement.
(h) The commissioner shall provide a report to the
legislature on the operation of the pilot project by March 1,
1995.
Subd. 3. [EXPIRATION DATE.] The pilot projects established
under this section terminate on June 30, 1995.
Sec. 56. [REPEALER.]
Minnesota Statutes 1992, section 256.985 is repealed.
Sec. 57. [EFFECTIVE DATES.]
Subdivision 1. Section 40, subdivisions 5 and 6, is
effective the day following final enactment. All other
subdivisions in section 40 are effective January 1, 1994.
Subd. 2. Sections 53 and 54 are effective for crimes
committed on or after July 1, 1993.
Subd. 3. Sections 7 and 9 to 21 are effective October 1,
1993.
Subd. 4. Sections 1, 33 to 39, and 47 are effective
January 1, 1994.
ARTICLE 7
REGIONAL TREATMENT CENTERS
AND MENTAL HEALTH ADMINISTRATION
Section 1. [245.037] [LEASES FOR REGIONAL TREATMENT CENTER
AND STATE NURSING HOME PROPERTY.]
Notwithstanding any law to the contrary, money collected as
rent under section 16B.24, subdivision 5, for state property at
any of the regional treatment centers or state nursing home
facilities administered by the commissioner of human services is
dedicated to the regional treatment center or state nursing home
from which it is generated. Any balance remaining at the end of
the fiscal year shall not cancel and is available until expended.
Sec. 2. Minnesota Statutes 1992, section 245.462,
subdivision 4, is amended to read:
Subd. 4. [CASE MANAGER.] "Case manager" means an
individual employed by the county or other entity authorized by
the county board to provide case management services specified
in section 245.4711. A case manager must have a bachelor's
degree in one of the behavioral sciences or related fields from
an accredited college or university and have at least 2,000
hours of supervised experience in the delivery of services to
adults with mental illness, must be skilled in the process of
identifying and assessing a wide range of client needs, and must
be knowledgeable about local community resources and how to use
those resources for the benefit of the client. The case manager
shall meet in person with a mental health professional at least
once each month to obtain clinical supervision of the case
manager's activities. Case managers with a bachelor's degree
but without 2,000 hours of supervised experience in the delivery
of services to adults with mental illness must complete 40 hours
of training approved by the commissioner of human services in
case management skills and in the characteristics and needs of
adults with serious and persistent mental illness and must
receive clinical supervision regarding individual service
delivery from a mental health professional at least once each
week until the requirement of 2,000 hours of supervised
experience is met. Clinical supervision must be documented in
the client record.
Until June 30, 1991 1996, a refugee who does not have the
qualifications specified in this subdivision may provide case
management services to adult refugees with serious and
persistent mental illness who are members of the same ethnic
group as the case manager if the person: (1) is actively
pursuing credits toward the completion of a bachelor's degree in
one of the behavioral sciences or a related field from an
accredited college or university; (2) completes 40 hours of
training as specified in this subdivision; and (3) receives
clinical supervision at least once a week until the requirements
of obtaining a bachelor's degree and 2,000 hours of supervised
experience are met.
Sec. 3. Minnesota Statutes 1992, section 245.462,
subdivision 20, is amended to read:
Subd. 20. [MENTAL ILLNESS.] (a) "Mental illness" means an
organic disorder of the brain or a clinically significant
disorder of thought, mood, perception, orientation, memory, or
behavior that is listed in the clinical manual of the
International Classification of Diseases (ICD-9-CM), current
edition, code range 290.0 to 302.99 or 306.0 to 316.0 or the
corresponding code in the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders (DSM-MD),
current edition, Axes I, II, or III, and that seriously limits a
person's capacity to function in primary aspects of daily living
such as personal relations, living arrangements, work, and
recreation.
(b) An "adult with acute mental illness" means an adult who
has a mental illness that is serious enough to require prompt
intervention.
(c) For purposes of case management and community support
services, a "person with serious and persistent mental illness"
means an adult who has a mental illness and meets at least one
of the following criteria:
(1) the adult has undergone two or more episodes of
inpatient care for a mental illness within the preceding 24
months;
(2) the adult has experienced a continuous psychiatric
hospitalization or residential treatment exceeding six months'
duration within the preceding 12 months;
(3) the adult:
(i) has a diagnosis of schizophrenia, bipolar disorder,
major depression, or borderline personality disorder;
(ii) indicates a significant impairment in functioning; and
(iii) has a written opinion from a mental health
professional, in the last three years, stating that the adult is
reasonably likely to have future episodes requiring inpatient or
residential treatment, of a frequency described in clause (1) or
(2), unless an ongoing case management or community support
services program is are provided; or
(4) the adult has, in the last three years, been committed
by a court as a mentally ill person under chapter 253B, or the
adult's commitment has been stayed or continued; or
(5) the adult (i) was eligible under clauses (1) to (4),
but the specified time period has expired or the adult was
eligible as a child under section 245.4871, subdivision 6; and
(ii) has a written opinion from a mental health professional, in
the last three years, stating that the adult is reasonably
likely to have future episodes requiring inpatient or
residential treatment, of a frequency described in clause (1) or
(2), unless ongoing case management or community support
services are provided.
Sec. 4. Minnesota Statutes 1992, section 245.464,
subdivision 1, is amended to read:
Subdivision 1. [COORDINATION.] The commissioner shall
supervise the development and coordination of locally available
adult mental health services by the county boards in a manner
consistent with sections 245.461 to 245.486. The commissioner
shall coordinate locally available services with those services
available from the regional treatment center serving the area
including state-operated services offered at sites outside of
the regional treatment centers. The commissioner shall review
the adult mental health component of the community social
services plan developed by county boards as specified in section
245.463 and provide technical assistance to county boards in
developing and maintaining locally available mental health
services. The commissioner shall monitor the county board's
progress in developing its full system capacity and quality
through ongoing review of the county board's adult mental health
component of the community social services plan and other
information as required by sections 245.461 to 245.486.
Sec. 5. Minnesota Statutes 1992, section 245.466,
subdivision 1, is amended to read:
Subdivision 1. [DEVELOPMENT OF SERVICES.] The county board
in each county is responsible for using all available resources
to develop and coordinate a system of locally available and
affordable adult mental health services. The county board may
provide some or all of the mental health services and activities
specified in subdivision 2 directly through a county agency or
under contracts with other individuals or agencies. A county or
counties may enter into an agreement with a regional treatment
center under section 246.57 or with any state facility or
program as defined in section 246.50, subdivision 3, to enable
the county or counties to provide the treatment services in
subdivision 2. Services provided through an agreement between a
county and a regional treatment center must meet the same
requirements as services from other service providers. County
boards shall demonstrate their continuous progress toward full
implementation of sections 245.461 to 245.486 during the period
July 1, 1987, to January 1, 1990. County boards must develop
fully each of the treatment services and management activities
prescribed by sections 245.461 to 245.486 by January 1, 1990,
according to the priorities established in section 245.464 and
the adult mental health component of the community social
services plan approved by the commissioner under section 245.478.
Sec. 6. Minnesota Statutes 1992, section 245.474, is
amended to read:
245.474 [REGIONAL TREATMENT CENTER INPATIENT SERVICES.]
Subdivision 1. [AVAILABILITY OF REGIONAL TREATMENT CENTER
INPATIENT SERVICES.] By July 1, 1987, the commissioner shall
make sufficient regional treatment center inpatient services
available to adults with mental illness throughout the state who
need this level of care. Inpatient services may be provided
either on the regional treatment center campus or at any state
facility or program as defined in section 246.50, subdivision 3.
Services must be as close to the patient's county of residence
as possible. Regional treatment centers are responsible to:
(1) provide acute care inpatient hospitalization;
(2) stabilize the medical and mental health condition of
the adult requiring the admission;
(3) improve functioning to the point where discharge to
community-based mental health services is possible;
(4) strengthen family and community support; and
(5) facilitate appropriate discharge and referrals for
follow-up mental health care in the community.
Subd. 2. [QUALITY OF SERVICE.] The commissioner shall
biennially determine the needs of all adults with mental illness
who are served by regional treatment centers or at any state
facility or program as defined in section 246.50, subdivision 3,
by administering a client-based evaluation system. The
client-based evaluation system must include at least the
following independent measurements: behavioral development
assessment; habilitation program assessment; medical needs
assessment; maladaptive behavioral assessment; and vocational
behavior assessment. The commissioner shall propose staff
ratios to the legislature for the mental health and support
units in regional treatment centers as indicated by the results
of the client-based evaluation system and the types of
state-operated services needed. The proposed staffing ratios
shall include professional, nursing, direct care, medical,
clerical, and support staff based on the client-based evaluation
system. The commissioner shall recompute staffing ratios and
recommendations on a biennial basis.
Subd. 3. [TRANSITION TO COMMUNITY.] Regional treatment
centers must plan for and assist clients in making a transition
from regional treatment centers and other inpatient facilities
or programs, as defined in section 246.50, subdivision 3, to
other community-based services. In coordination with the
client's case manager, if any, regional treatment centers must
also arrange for appropriate follow-up care in the community
during the transition period. Before a client is discharged,
the regional treatment center must notify the client's case
manager, so that the case manager can monitor and coordinate the
transition and arrangements for the client's appropriate
follow-up care in the community.
Sec. 7. Minnesota Statutes 1992, section 245.484, is
amended to read:
245.484 [RULES.]
The commissioner shall adopt emergency rules to govern
implementation of case management services for eligible children
in section 245.4881 and professional home-based family treatment
services for medical assistance eligible children, in section
245.4884, subdivision 3, by January 1, 1992, and must adopt
permanent rules by January 1, 1993.
The commissioner shall adopt permanent rules as necessary
to carry out sections 245.461 to 245.486 and 245.487 to
245.4888. The commissioner shall reassign agency staff as
necessary to meet this deadline.
By January 1, 1993 1994, the commissioner shall adopt
permanent rules specifying program requirements for family
community support services.
Sec. 8. Minnesota Statutes 1992, section 245.4871,
subdivision 4, is amended to read:
Subd. 4. [CASE MANAGER.] (a) "Case manager" means an
individual employed by the county or other entity authorized by
the county board to provide case management services specified
in subdivision 3 for the child with severe emotional disturbance
and the child's family. A case manager must have experience and
training in working with children.
(b) A case manager must:
(1) have at least a bachelor's degree in one of the
behavioral sciences or a related field from an accredited
college or university;
(2) have at least 2,000 hours of supervised experience in
the delivery of mental health services to children;
(3) have experience and training in identifying and
assessing a wide range of children's needs; and
(4) be knowledgeable about local community resources and
how to use those resources for the benefit of children and their
families.
(c) The case manager may be a member of any professional
discipline that is part of the local system of care for children
established by the county board.
(d) The case manager must meet in person with a mental
health professional at least once each month to obtain clinical
supervision.
(e) Case managers with a bachelor's degree but without
2,000 hours of supervised experience in the delivery of mental
health services to children with emotional disturbance must:
(1) begin 40 hours of training approved by the commissioner
of human services in case management skills and in the
characteristics and needs of children with severe emotional
disturbance before beginning to provide case management
services; and
(2) receive clinical supervision regarding individual
service delivery from a mental health professional at least once
each week until the requirement of 2,000 hours of experience is
met.
(f) Clinical supervision must be documented in the child's
record. When the case manager is not a mental health
professional, the county board must provide or contract for
needed clinical supervision.
(g) The county board must ensure that the case manager has
the freedom to access and coordinate the services within the
local system of care that are needed by the child.
(h) Until June 30, 1991 1996, a refugee who does not have
the qualifications specified in this subdivision may provide
case management services to child refugees with severe emotional
disturbance of the same ethnic group as the refugee if the
person:
(1) is actively pursuing credits toward the completion of a
bachelor's degree in one of the behavioral sciences or related
fields at an accredited college or university;
(2) completes 40 hours of training as specified in this
subdivision; and
(3) receives clinical supervision at least once a week
until the requirements of obtaining a bachelor's degree and
2,000 hours of supervised experience are met.
Sec. 9. Minnesota Statutes 1992, section 245.4873,
subdivision 2, is amended to read:
Subd. 2. [STATE LEVEL; COORDINATION.] The state
coordinating council consists of the commissioners or designees
of commissioners of the departments of human services, health,
education, state planning, and corrections, and a representative
of the Minnesota district judges association juvenile committee,
in conjunction with the commissioner of commerce or a designee
of the commissioner, and the director or designee of the
director of the office of strategic and long-range planning.
The members of the council shall annually alternate chairing the
council beginning with the commissioner of human services and
proceeding in the order as listed in this subdivision. The
council shall meet at least quarterly to:
(1) educate each agency about the policies, procedures,
funding, and services for children with emotional disturbances
of all agencies represented;
(2) develop mechanisms for interagency coordination on
behalf of children with emotional disturbances;
(3) identify barriers including policies and procedures
within all agencies represented that interfere with delivery of
mental health services for children;
(4) recommend policy and procedural changes needed to
improve development and delivery of mental health services for
children in the agency or agencies they represent;
(5) identify mechanisms for better use of federal and state
funding in the delivery of mental health services for children;
and
(6) until February 15, 1992, prepare an annual report on
the policy and procedural changes needed to implement a
coordinated, effective, and cost-efficient children's mental
health delivery system.
This report shall be submitted to the legislature and the
state mental health advisory council annually as part of the
report required under section 245.487, subdivision 4. The
report shall include information from each department
represented on:
(1) the number of children in each department's system who
require mental health services;
(2) the number of children in each system who receive
mental health services;
(3) how mental health services for children are funded
within each system;
(4) how mental health services for children could be
coordinated to provide more effectively appropriate mental
health services for children; and
(5) recommendations for the provision of early screening
and identification of mental illness in each system perform the
duties required under sections 245.494 to 245.496.
Sec. 10. Minnesota Statutes 1992, section 245.4882,
subdivision 5, is amended to read:
Subd. 5. [SPECIALIZED RESIDENTIAL TREATMENT SERVICES.] The
commissioner of human services shall establish or contract
for continue efforts to further interagency collaboration to
develop a comprehensive system of services, including family
community support and specialized residential treatment services
for children. The services shall be designed for children with
emotional disturbance who exhibit violent or destructive
behavior and for whom local treatment services are not feasible
due to the small number of children statewide who need the
services and the specialized nature of the services required.
The services shall be located in community settings. If no
appropriate services are available in Minnesota or within the
geographical area in which the residents of the county normally
do business, the commissioner is responsible, effective July 1,
1995, for 50 percent of the nonfederal costs of out-of-state
treatment of children for whom no appropriate resources are
available in Minnesota. Counties are eligible to receive
enhanced state funding under this section only if they have
established juvenile screening teams under section 260.151,
subdivision 3, and if the out-of-state treatment has been
approved by the commissioner. By January 1, 1995, the
commissioners of human services and corrections shall jointly
develop a plan, including a financing strategy, for increasing
the in-state availability of treatment within a secure setting.
By July 1, 1994, the commissioner of human services shall also:
(1) conduct a study and develop a plan to meet the needs of
children with both a developmental disability and severe
emotional disturbance; and
(2) study the feasibility of expanding medical assistance
coverage to include specialized residential treatment for the
children described in this subdivision.
Sec. 11. [245.491] [CITATION; DECLARATION OF PURPOSE.]
Subdivision 1. [CITATION.] Sections 245.491 to 245.496 may
be cited as "the children's mental health integrated fund."
Subd. 2. [PURPOSE.] The legislature finds that children
with emotional or behavioral disturbances or who are at risk of
suffering such disturbances often require services from multiple
service systems including mental health, social services,
education, corrections, juvenile court, health, and jobs and
training. In order to better meet the needs of these children,
it is the intent of the legislature to establish an integrated
children's mental health service system that:
(1) allows local service decision makers to draw funding
from a single local source so that funds follow clients and
eliminates the need to match clients, funds, services, and
provider eligibilities;
(2) creates a local pool of state, local, and private funds
to procure a greater medical assistance federal financial
participation;
(3) improves the efficiency of use of existing resources;
(4) minimizes or eliminates the incentives for cost and
risk shifting; and
(5) increases the incentives for earlier identification and
intervention.
The children's mental health integrated fund established under
sections 245.491 to 245.496 must be used to develop and support
this integrated mental health service system. In developing
this integrated service system, it is not the intent of the
legislature to limit any rights available to children and their
families through existing federal and state laws.
Sec. 12. [245.492] [DEFINITIONS.]
Subdivision 1. [DEFINITIONS.] The definitions in this
section apply to sections 245.491 to 245.496.
Subd. 2. [BASE LEVEL FUNDING.] "Base level funding" means
funding received from state, federal, or local sources and
expended across the local system of care in fiscal year 1993 for
children's mental health services or for special education
services for children with emotional or behavioral disturbances.
In subsequent years, base level funding may be adjusted to
reflect decreases in the numbers of children in the target
population.
Subd. 3. [CHILDREN WITH EMOTIONAL OR BEHAVIORAL
DISTURBANCES.] "Children with emotional or behavioral
disturbances" includes children with emotional disturbances as
defined in section 245.4871, subdivision 15, and children with
emotional or behavioral disorders as defined in Minnesota Rules,
part 3525.1329, subpart 1.
Subd. 4. [FAMILY.] "Family" has the definition provided in
section 245.4871, subdivision 16.
Subd. 5. [FAMILY COMMUNITY SUPPORT SERVICES.] "Family
community support services" has the definition provided in
section 245.4871, subdivision 17.
Subd. 6. [INITIAL TARGET POPULATION.] "Initial target
population" means a population of children that the local
children's mental health collaborative agrees to serve in the
start-up phase and who meet the criteria for the target
population. The initial target population may be less than the
target population.
Subd. 7. [INTEGRATED FUND.] "Integrated fund" is a pool of
both public and private local, state, and federal resources,
consolidated at the local level, to accomplish locally agreed
upon service goals for the target population. The fund is used
to help the local children's mental health collaborative to
serve the mental health needs of children in the target
population by allowing the local children's mental health
collaboratives to develop and implement an integrated service
system.
Subd. 8. [INTEGRATED FUND TASK FORCE.] "The integrated
fund task force" means the statewide task force established in
Laws 1991, chapter 292, article 6, section 57.
Subd. 9. [INTEGRATED SERVICE SYSTEM.] "Integrated service
system" means a coordinated set of procedures established by the
local children's mental health collaborative for coordinating
services and actions across categorical systems and agencies
that results in:
(1) integrated funding;
(2) improved outreach, early identification, and
intervention across systems;
(3) strong collaboration between parents and professionals
in identifying children in the target population facilitating
access to the integrated system, and coordinating care and
services for these children;
(4) a coordinated assessment process across systems that
determines which children need multiagency care coordination and
wraparound services;
(5) multiagency plan of care; and
(6) wraparound services.
Services provided by the integrated service system must meet the
requirements set out in sections 245.487 to 245.4887. Children
served by the integrated service system must be economically and
culturally representative of children in the service delivery
area.
Subd. 10. [INTERAGENCY EARLY INTERVENTION COMMITTEE.]
"Interagency early intervention committee" refers to the
committee established under section 120.17, subdivision 12.
Subd. 11. [LOCAL CHILDREN'S ADVISORY COUNCIL.] "Local
children's advisory council" refers to the council established
under section 245.4875, subdivision 5.
Subd. 12. [LOCAL CHILDREN'S MENTAL HEALTH COLLABORATIVE.]
"Local children's mental health collaborative" or "collaborative"
means an entity formed by the agreement of representatives of
the local system of care including mental health services,
social services, correctional services, education services,
health services, and vocational services for the purpose of
developing and governing an integrated service system. A local
coordinating council, a community transition interagency
committee as defined in section 120.17, subdivision 16, or an
interagency early intervention committee may serve as a local
children's mental health collaborative if its representatives
are capable of carrying out the duties of the local children's
mental health collaborative set out in sections 245.491 to
245.496. Where a local coordinating council is not the local
children's mental health collaborative, the local children's
mental health collaborative must work closely with the local
coordinating council in designing the integrated service system.
Subd. 13. [LOCAL COORDINATING COUNCIL.] "Local
coordinating council" refers to the council established under
section 245.4875, subdivision 6.
Subd. 14. [LOCAL SYSTEM OF CARE.] "Local system of care"
has the definition provided in section 245.4871, subdivision 24.
Subd. 15. [MENTAL HEALTH SERVICES.] "Mental health
services" has the definition provided in section 245.4871,
subdivision 28.
Subd. 16. [MULTIAGENCY PLAN OF CARE.] "Multiagency plan of
care" means a written plan of intervention and integrated
services developed by a multiagency team in conjunction with the
child and family based on their unique strengths and needs as
determined by a multiagency assessment. The plan must outline
measurable client outcomes and specific services needed to
attain these outcomes, the agencies responsible for providing
the specified services, funding responsibilities, timelines, the
judicial or administrative procedures needed to implement the
plan of care, the agencies responsible for initiating these
procedures and designate one person with lead responsibility for
overseeing implementation of the plan.
Subd. 17. [RESPITE CARE.] "Respite care" is planned
routine care to support the continued residence of a child with
emotional or behavioral disturbance with the child's family or
long-term primary caretaker.
Subd. 18. [SERVICE DELIVERY AREA.] "Service delivery area"
means the geographic area to be served by the local children's
mental health collaborative and must include at a minimum a part
of a county and school district or a special education
cooperative.
Subd. 19. [START-UP FUNDS.] "Start-up funds" means the
funds available to assist a local children's mental health
collaborative in planning and implementing the integrated
service system for children in the target population, in setting
up a local integrated fund, and in developing procedures for
enhancing federal financial participation.
Subd. 20. [STATE COORDINATING COUNCIL.] "State
coordinating council" means the council established under
section 245.4873, subdivision 2.
Subd. 21. [TARGET POPULATION.] "Target population" means
children up to age 18 with an emotional or behavioral
disturbance or who are at risk of suffering an emotional or
behavioral disturbance as evidenced by a behavior or condition
that affects the child's ability to function in a primary aspect
of daily living including personal relations, living
arrangements, work, school, and recreation, and a child who can
benefit from:
(1) multiagency service coordination and wraparound
services; or
(2) informal coordination of traditional mental health
services provided on a temporary basis.
Children between the ages of 18 and 21 who meet these
criteria may be included in the target population at the option
of the local children's mental health collaborative.
Subd. 22. [THERAPEUTIC SUPPORT OF FOSTER
CARE.] "Therapeutic support of foster care" has the definition
provided in section 245.4871, subdivision 34.
Subd. 23. [WRAPAROUND SERVICES.] "Wraparound services" are
alternative, flexible, coordinated, and highly individualized
services that are based on a multiagency plan of care. These
services are designed to build on the strengths and respond to
the needs identified in the child's multiagency assessment and
to improve the child's ability to function in the home, school,
and community. Wraparound services may include, but are not
limited to, residential services, respite services, services
that assist the child or family in enrolling in or participating
in recreational activities, assistance in purchasing otherwise
unavailable items or services important to maintain a specific
child in the family, and services that assist the child to
participate in more traditional services and programs.
Sec. 13. [245.493] [LOCAL LEVEL COORDINATION.]
Subdivision 1. [REQUIREMENTS TO QUALIFY AS A LOCAL
CHILDREN'S MENTAL HEALTH COLLABORATIVE.] In order to qualify as
a local children's mental health collaborative and be eligible
to receive start-up funds, the representatives of the local
system of care, or at a minimum one county, one school district
or special education cooperative, and one mental health entity
must agree to the following:
(1) to establish a local children's mental health
collaborative and develop an integrated service system; and
(2) to commit resources to providing services through the
local children's mental health collaborative.
Subd. 2. [GENERAL DUTIES OF THE LOCAL CHILDREN'S MENTAL
HEALTH COLLABORATIVES.] Each local children's mental health
collaborative must:
(1) identify a service delivery area and an initial target
population within that service delivery area. The initial
target population must be economically and culturally
representative of children in the service delivery area to be
served by the local children's mental health collaborative. The
size of the initial target population must also be economically
viable for the service delivery area;
(2) seek to maximize federal revenues available to serve
children in the target population by designating local
expenditures for mental health services that can be matched with
federal dollars;
(3) in consultation with the local children's advisory
council and the local coordinating council, if it is not the
local children's mental health collaborative, design, develop,
and ensure implementation of an integrated service system and
develop interagency agreements necessary to implement the
system;
(4) expand membership to include representatives of other
services in the local system of care including prepaid health
plans under contract with the commissioner of human services to
serve the mental health needs of children and families;
(5) create or designate a management structure for fiscal
and clinical responsibility and outcome evaluation;
(6) spend funds generated by the local children's mental
health collaborative as required in sections 245.491 to 245.496;
and
(7) explore methods and recommend changes needed at the
state level to reduce duplication and promote coordination of
services including the use of uniform forms for reporting,
billing, and planning of services.
Sec. 14. [245.4931] [INTEGRATED LOCAL SERVICE SYSTEM.]
The integrated service system established by the local
children's mental health collaborative must:
(1) include a process for communicating to agencies in the
local system of care eligibility criteria for services received
through the local children's mental health collaborative and a
process for determining eligibility. The process shall place
strong emphasis on outreach to families, respecting the family
role in identifying children in need, and valuing families as
partners;
(2) include measurable outcomes, timelines for evaluating
progress, and mechanisms for quality assurance and appeals;
(3) involve the family, and where appropriate the
individual child, in developing multiagency service plans to the
extent required in sections 120.17, subdivision 3a; 245.4871,
subdivision 21; 245.4881, subdivision 4; 253B.03, subdivision 7;
257.071, subdivision 1; and 260.191, subdivision 1e;
(4) meet all standards and provide all mental health
services as required in sections 245.487 to 245.4888, and ensure
that the services provided are culturally appropriate;
(5) spend funds generated by the local children's mental
health collaborative as required in sections 245.491 to 245.496;
(6) encourage public-private partnerships to increase
efficiency, reduce redundancy, and promote quality of care; and
(7) ensure that, if the county participant of the local
children's mental health collaborative is also a provider of
child welfare targeted case management as authorized by the 1993
legislature, then federal reimbursement received by the county
for child welfare targeted case management provided to children
served by the local children's mental health collaborative must
be directed to the integrated fund.
Sec. 15. [245.4932] [REVENUE ENHANCEMENT; AUTHORITY AND
RESPONSIBILITIES.]
Subdivision 1. [PROVIDER RESPONSIBILITIES.] The children's
mental health collaborative shall have the following authority
and responsibilities regarding federal revenue enhancement:
(1) the collaborative shall designate a lead county or
other qualified entity as the fiscal agency for reporting,
claiming, and receiving payments;
(2) the collaborative or lead county may enter into
subcontracts with other counties, school districts, special
education cooperatives, municipalities, and other public and
nonprofit entities for purposes of identifying and claiming
eligible expenditures to enhance federal reimbursement;
(3) the collaborative must continue the base level of
expenditures for services for children with emotional or
behavioral disturbances and their families from any state,
county, federal, or other public or private funding source
which, in the absence of the new federal reimbursement earned
under sections 245.491 to 245.496, would have been available for
those services. The base year for purposes of this subdivision
shall be the accounting period closest to state fiscal year
1993;
(4) the collaborative or lead county must develop and
maintain an accounting and financial management system adequate
to support all claims for federal reimbursement, including a
clear audit trail and any provisions specified in the contract;
(5) the collaborative shall pay the nonfederal share of the
medical assistance costs for services designated by the
collaborative;
(6) the lead county or other qualified entity may not use
federal funds or local funds designated as matching for other
federal funds to provide the nonfederal share of medical
assistance.
Subd. 2. [COMMISSIONER'S RESPONSIBILITIES.] (1)
Notwithstanding sections 256B.19, subdivision 1, and 256B.0625,
the commissioner shall be required to amend the state medical
assistance plan to include as covered services eligible for
medical assistance reimbursement, those services eligible for
reimbursement under federal law or waiver, which a collaborative
elects to provide and for which the collaborative elects to pay
the nonfederal share of the medical assistance costs.
(2) The commissioner may suspend, reduce, or terminate the
federal reimbursement to a provider that does not meet the
requirements of sections 245.493 to 245.496.
(3) The commissioner shall recover from the collaborative
any federal fiscal disallowances or sanctions for audit
exceptions directly attributable to the collaborative's actions
or the proportional share if federal fiscal disallowances or
sanctions are based on a statewide random sample.
Subd. 3. [PAYMENTS.] Notwithstanding section 256.025,
subdivision 2, payments under sections 245.493 to 245.496 to
providers for wraparound service expenditures and expenditures
for other services for which the collaborative elects to pay the
nonfederal share of medical assistance shall only be made of
federal earnings from services provided under sections 245.493
to 245.496.
Subd. 4. [CENTRALIZED DISBURSEMENT OF MEDICAL ASSISTANCE
PAYMENTS.] Notwithstanding section 256B.041, and except for
family community support services and therapeutic support of
foster care, county payments for the cost of wraparound services
and other services for which the collaborative elects to pay the
nonfederal share, for reimbursement under medical assistance,
shall not be made to the state treasurer. For purposes of
wraparound services under sections 245.493 to 245.496, the
centralized disbursement of payments to providers under section
256B.041 consists only of federal earnings from services
provided under sections 245.493 to 245.496.
Sec. 16. [245.494] [STATE LEVEL COORDINATION.]
Subdivision 1. [STATE COORDINATING COUNCIL.] The state
coordinating council, in consultation with the integrated fund
task force, shall:
(1) assist local children's mental health collaboratives in
meeting the requirements of sections 245.491 to 245.496, by
seeking consultation and technical assistance from national
experts and coordinating presentations and assistance from these
experts to local children's mental health collaboratives;
(2) assist local children's mental health collaboratives in
identifying an economically viable initial target population;
(3) develop methods to reduce duplication and promote
coordinated services including uniform forms for reporting,
billing, and planning of services;
(4) by September 1, 1994, develop a model multiagency plan
of care that can be used by local children's mental health
collaboratives in place of an individual education plan,
individual family community support plan, individual family
support plan, and an individual treatment plan;
(5) assist in the implementation and operation of local
children's mental health collaboratives by facilitating the
integration of funds, coordination of services, and measurement
of results, and by providing other assistance as needed;
(6) by July 1, 1993, develop a procedure for awarding
start-up funds. Development of this procedure shall be exempt
from chapter 14;
(7) develop procedures and provide technical assistance to
allow local children's mental health collaboratives to integrate
resources for children's mental health services with other
resources available to serve children in the target population
in order to maximize federal participation and improve
efficiency of funding;
(8) ensure that local children's mental health
collaboratives and the services received through these
collaboratives meet the requirements set out in sections 245.491
to 245.496;
(9) identify base level funding from state and federal
sources across systems;
(10) explore ways to access additional federal funds and
enhance revenues available to address the needs of the target
population;
(11) develop a mechanism for identifying the state share of
funding for services to children in the target population and
for making these funds available on a per capita basis for
services provided through the local children's mental health
collaborative to children in the target population. Each year
beginning January 1, 1994, forecast the growth in the state
share and increase funding for local children's mental health
collaboratives accordingly;
(12) identify barriers to integrated service systems that
arise from data practices and make recommendations including
legislative changes needed in the data practices act to address
these barriers; and
(13) annually review the expenditures of local children's
mental health collaboratives to ensure that funding for services
provided to the target population continues from sources other
than the federal funds earned under sections 245.491 to 245.496
and that federal funds earned are spent consistent with sections
245.491 to 245.496.
Subd. 2. [STATE COORDINATING COUNCIL REPORT.] Each year,
beginning February 1, 1995, the state coordinating council must
submit a report to the legislature on the status of the local
children's mental health collaboratives. The report must
include the number of local children's mental health
collaboratives, the amount and type of resources committed to
local children's mental health collaboratives, the additional
federal revenue received as a result of local children's mental
health collaboratives, the services provided, the number of
children served, outcome indicators, the identification of
barriers to additional collaboratives and funding integration,
and recommendations for further improving service coordination
and funding integration.
Subd. 3. [DUTIES OF THE COMMISSIONER OF HUMAN SERVICES.]
The commissioner of human services, in consultation with the
integrated fund task force, shall:
(1) beginning January 1, 1994, in areas where a local
children's mental health collaborative has been established,
based on an independent actuarial analysis, separate all medical
assistance, general assistance medical care, and MinnesotaCare
resources devoted to mental health services for children and
their families including inpatient, outpatient, medication
management, services under the rehabilitation option, and
related physician services from the total health capitation from
prepaid plans, including plans established under section
256B.69, for the target population as identified in section
245.492, subdivision 21, and develop guidelines for managing
these mental health benefits that will require all contractors
to:
(i) provide mental health services eligible for medical
assistance reimbursement;
(ii) meet performance standards established by the
commissioner of human services including providing services
consistent with the requirements and standards set out in
sections 245.487 to 245.4888 and 245.491 to 245.496;
(iii) provide the commissioner of human services with data
consistent with that collected under sections 245.487 to
245.4888; and
(iv) in service delivery areas where there is a local
children's mental health collaborative for the target population
defined by local children's mental health collaborative:
(A) participate in the local children's mental health
collaborative;
(B) commit resources to the integrated fund that are
actuarially equivalent to resources received for the target
population being served by local children's mental health
collaboratives; and
(C) meet the requirements and the performance standards
developed for local children's mental health collaboratives;
(2) ensure that any prepaid health plan that is operating
within the jurisdiction of a local children's mental health
collaborative and that is able to meet all the requirements
under section 245.494, subdivision 3, paragraph (1), items (i)
to (iv), shall have 60 days from the date of receipt of written
notice of the establishment of the collaborative to decide
whether it will participate in the local children's mental
health collaborative; the prepaid health plan shall notify the
collaborative and the commissioner of its decision to
participate;
(3) develop a mechanism for integrating medical assistance
resources for mental health service with resources for general
assistance medical care, MinnesotaCare, and any other state and
local resources available for services for children and develop
a procedure for making these resources available for use by a
local children's mental health collaborative;
(4) gather data needed to manage mental health care
including evaluation data and data necessary to establish a
separate capitation rate for children's mental health services
if that option is selected;
(5) by January 1, 1994, develop a model contract for
providers of mental health managed care that meets the
requirements set out in sections 245.491 to 245.496 and 256B.69,
and utilize this contract for all subsequent awards, and before
January 1, 1995, the commissioner of human services shall not
enter into or extend any contract for any prepaid plan that
would impede the implementation of sections 245.491 to 245.496;
(6) develop revenue enhancement or rebate mechanisms and
procedures to certify expenditures made through local children's
mental health collaboratives for services including
administration and outreach that may be eligible for federal
financial participation under medical assistance, including
expenses for administration, and other federal programs;
(7) ensure that new contracts and extensions or
modifications to existing contracts under section 256B.69 do not
impede implementation of sections 245.491 to 245.496;
(8) provide technical assistance to help local children's
mental health collaboratives certify local expenditures for
federal financial participation, using due diligence in order to
meet implementation timelines for sections 245.491 to 245.496
and recommend necessary legislation to enhance federal revenue,
provide clinical and management flexibility, and otherwise meet
the goals of local children's mental health collaboratives and
request necessary state plan amendments to maximize the
availability of medical assistance for activities undertaken by
the local children's mental health collaborative;
(9) take all steps necessary to secure medical assistance
reimbursement under the rehabilitation option for family
community support services and therapeutic support of foster
care, and for residential treatment and wraparound services when
these services are provided through a local children's mental
health collaborative;
(10) provide a mechanism to identify separately the
reimbursement to a county for child welfare targeted case
management provided to children served by the local
collaborative for purposes of subsequent transfer by the county
to the integrated fund; and
(11) where interested and qualified contractors are
available, finalize contracts within 180 days of receipt of
written notification of the establishment of a local children's
mental health collaborative.
Subd. 4. [RULEMAKING.] The commissioners of human
services, health, and corrections, and the state board of
education shall adopt or amend rules as necessary to implement
sections 245.491 to 245.496.
Subd. 5. [RULE MODIFICATION.] By January 15, 1994, the
commissioner shall report to the legislature the extent to which
claims for federal reimbursement for case management as set out
in Minnesota Rules, parts 9520.0900 to 9520.0926 and 9505.0322,
as they pertain to mental health case management are consistent
with the number of children eligible to receive this service.
The report shall also identify how the commissioner intends to
increase the numbers of eligible children receiving this
service, including recommendations for modifying rules or
statutes to improve access to this service and to reduce
barriers to its provision.
In developing these recommendations, the commissioner shall:
(1) review experience and consider alternatives to the
reporting and claiming requirements, such as the rate of
reimbursement, the claiming unit of time, and documenting and
reporting procedures set out in Minnesota Rules, parts 9520.0900
to 9520.0926 and 9505.0322, as they pertain to mental health
case management;
(2) consider experience gained from implementation of child
welfare targeted case management;
(3) determine how to adjust the reimbursement rate to
reflect reductions in caseload size;
(4) determine how to ensure that provision of targeted
child welfare case management does not preclude an eligible
child's right, or limit access, to case management services for
children with severe emotional disturbance as set out in
Minnesota Rules, parts 9520.0900 to 9520.0926 and 9505.0322, as
they pertain to mental health case management;
(5) determine how to include cost and time data collection
for contracted providers for rate setting, claims, and
reimbursement purposes;
(6) evaluate the need for cost control measures where there
is no county share; and
(7) determine how multiagency teams may share the
reimbursement.
The commissioner shall conduct a study of the cost of
county staff providing case management services under Minnesota
Rules, parts 9520.0900 to 9520.0926 and 9505.0322, as they
pertain to mental health case management. If the average cost
of providing case management services to children with severe
emotional disturbance is determined by the commissioner to be
greater than the average cost of providing child welfare
targeted case management, the commissioner shall ensure that a
higher reimbursement rate is provided for case management
services under Minnesota Rules, parts 9520.0900 to 9520.0926 and
9505.0322, to children with severe emotional disturbance. The
total medical assistance funds expended for this service in the
biennium ending in state fiscal year 1995 shall not exceed the
amount projected in the state Medicaid forecast for case
management for children with serious emotional disturbances.
Sec. 17. [245.495] [ADDITIONAL FEDERAL REVENUES.]
(a) Each local children's mental health collaborative shall
report expenditures eligible for federal reimbursement in a
manner prescribed by the commissioner of human services under
section 256.01, subdivision 2, clause (17). The commissioner of
human services shall pay all funds earned by each local
children's mental health collaborative to the collaborative.
Each local children's mental health collaborative must use these
funds to expand the initial target population or to develop or
provide mental health services through the local integrated
service system to children in the target population. Funds may
not be used to supplant funding for services to children in the
target population.
For purposes of this section, "mental health services" are
community-based, nonresidential services, which may include
respite care, that are identified in the child's multiagency
plan of care.
(b) The commissioner may set aside a portion of the federal
funds earned under this section to repay the special revenue
maximization account under section 256.01, subdivision 2, clause
(15). The set-aside must not exceed five percent of the federal
reimbursement earned by collaboratives and repayment is limited
to:
(1) the costs of developing and implementing sections
245.491 to 245.496, including the costs of technical assistance
from the departments of human services, education, health, and
corrections to implement the children's mental health integrated
fund;
(2) programming the information systems; and
(3) any lost federal revenue for the central office claim
directly caused by the implementation of these sections.
(c) Any unexpended funds from the set-aside described in
paragraph (b) shall be distributed to counties according to
section 245.496, subdivision 2.
Sec. 18. [245.496] [IMPLEMENTATION.]
Subdivision 1. [APPLICATIONS FOR START-UP FUNDS FOR LOCAL
CHILDREN'S MENTAL HEALTH COLLABORATIVES.] By July 1, 1993, the
commissioner of human services shall publish the procedures for
awarding start-up funds. Applications for local children's
mental health collaboratives shall be obtained through the
commissioner of human services and submitted to the state
coordinating council. The application must state the amount of
start-up funds requested by the local children's mental health
collaborative and how the local children's mental health
collaborative intends on using these funds.
Subd. 2. [DISTRIBUTION OF START-UP FUNDS.] By October 1,
1993, the state coordinating council must ensure distribution of
start-up funds to local children's mental health collaboratives
that meet the requirements established in section 245.493 and
whose applications have been approved by the council. The
remaining appropriation for start-up funds shall be distributed
by February 1, 1994. If the number of applications received
exceed the number of local children's mental health
collaboratives that can be funded, the funds must be
geographically distributed across the state and balanced between
the seven county metro area and the rest of the state.
Preference must be given to collaboratives that include the
juvenile court and correctional systems, multiple school
districts, or other multiple government entities from the local
system of care. In rural areas, preference must also be given
to local children's mental health collaboratives that include
multiple counties.
Subd. 3. [SUBMISSION AND APPROVAL OF LOCAL COLLABORATIVE
PROPOSALS FOR INTEGRATED SYSTEMS.] By December 31, 1994, a local
children's mental health collaborative that received start-up
funds must submit to the state coordinating council its proposal
for creating and funding an integrated service system for
children in the target population. Within 60 days of receiving
the local collaborative proposal the state coordinating council
must review the proposal and notify the local children's mental
health collaborative as to whether or not the proposal has been
approved. If the proposal is not approved, the state
coordinating council must indicate changes needed to receive
approval.
Sec. 19. Minnesota Statutes 1992, section 245.652,
subdivision 1, is amended to read:
Subdivision 1. [PURPOSE.] The regional treatment centers
shall provide services designed to end a person's reliance on
chemical use or a person's chemical abuse and increase effective
and chemical-free functioning. Clinically effective programs
must be provided in accordance with section 246.64. Services
may be offered on the regional center campus or at sites
elsewhere in the catchment area served by the regional treatment
center.
Sec. 20. Minnesota Statutes 1992, section 245.652,
subdivision 4, is amended to read:
Subd. 4. [SYSTEM LOCATIONS.] Programs shall be located in
Anoka, Brainerd, Fergus Falls, Moose Lake, St. Peter, and
Willmar and may be offered at other selected sites.
Sec. 21. Minnesota Statutes 1992, section 245.73,
subdivision 2, is amended to read:
Subd. 2. [APPLICATION; CRITERIA.] County boards may submit
an application and budget for use of the money in the form
specified by the commissioner. The commissioner shall make
grants only to counties whose applications and budgets are
approved by the commissioner for residential programs for adults
with mental illness to meet licensing requirements pursuant to
sections 245A.01 to 245A.16. State funds received by a county
pursuant to this section shall be used only for direct service
costs. Both direct service and other costs, including but not
limited to renovation, construction or rent of buildings,
purchase or lease of vehicles or equipment as required for
licensure as a residential program for adults with mental
illness under sections 245A.01 to 245A.16, may be paid out of
the matching funds required under subdivision 3. Neither the
state funds nor the matching funds These grants shall not be
used for room and board costs. For calendar year 1994 and
subsequent years, the commissioner shall allocate the money
appropriated under this section on a calendar year basis.
Sec. 22. Minnesota Statutes 1992, section 245.73,
subdivision 3, is amended to read:
Subd. 3. [FORMULA.] Grants made pursuant to this section
shall finance 75 to 100 percent of the county's costs of
expanding or providing services for adult mentally ill persons
in residential facilities as provided in subdivision 2.
Sec. 23. Minnesota Statutes 1992, section 245.73, is
amended by adding a subdivision to read:
Subd. 5. [TRANSFER OF FUNDS.] The commissioner may
transfer money from adult mental health residential program
grants to community support program grants under section 256E.12
if the county requests such a transfer and if the commissioner
determines the transfer will help adults with mental illness to
remain and function in their own communities. The commissioner
shall consider past utilization of the residential program in
determining which counties to include in the transferred fund.
Sec. 24. Minnesota Statutes 1992, section 246.0135, is
amended to read:
246.0135 [OPERATION OF REGIONAL TREATMENT CENTERS.]
(a) The commissioner of human services is prohibited from
closing any regional treatment center or state-operated nursing
home or any program at any of the regional treatment centers or
state-operated nursing homes, without specific legislative
authorization. For persons with mental retardation or related
conditions who move from one regional treatment center to
another regional treatment center, the provisions of section
256B.092, subdivision 10, must be followed for both the
discharge from one regional treatment center and admission to
another regional treatment center, except that the move is not
subject to the consensus requirement of section 256B.092,
subdivision 10, paragraph (b).
(b) Prior to closing or downsizing a regional treatment
center, the commissioner of human services shall be responsible
for assuring that community-based alternatives developed in
response are adequate to meet the program needs identified by
each county within the catchment area and do not require
additional local county property tax expenditures.
(c) The nonfederal share of the cost of alternative
treatment or care developed as the result of the closure of a
regional treatment center, including costs associated with
fulfillment of responsibilities under chapter 253B shall be paid
from state funds appropriated for purposes specified in section
246.013.
(d) Counties in the catchment area of a regional treatment
center which has been closed or downsized may not at any time be
required to pay a greater cost of care for alternative care and
treatment than the county share set by the commissioner for the
cost of care provided by regional treatment centers.
(e) The commissioner may not divert state funds used for
providing for care or treatment of persons residing in a
regional treatment center for purposes unrelated to the care and
treatment of such persons.
Sec. 25. Minnesota Statutes 1992, section 246.02,
subdivision 2, is amended to read:
Subd. 2. The commissioner of human services shall act with
the advice of the medical policy directional committee on mental
health in the appointment and removal of the chief executive
officers of the following institutions: Anoka-Metro Regional
Treatment Center, Ah-Gwah-Ching Center, Fergus Falls Regional
Treatment Center, Moose Lake Regional Treatment Center, Oak
Terrace Nursing Home, Rochester State Hospital, St. Peter
Regional Treatment Center and Minnesota Security Hospital,
Willmar Regional Treatment Center, Faribault Regional Center,
Cambridge Regional Human Services Center, and Brainerd Regional
Human Services Center, and until June 30, 1995, Moose Lake
Regional Treatment Center, and after June 30, 1995, Minnesota
Psychopathic Personality Treatment Center.
Sec. 26. Minnesota Statutes 1992, section 246.151,
subdivision 1, is amended to read:
Subdivision 1. [COMPENSATION.] Notwithstanding any law to
the contrary, the commissioners of human services and veterans
affairs are authorized to provide for the payment to patients or
residents of state institutions under their management and
control of such pecuniary compensation as they may deem
proper, required by the United States Department of Labor.
Payment of subminimum wages shall meet all requirements of
United States Department of Labor Regulations, Code of Federal
Regulations, title 29, part 525. The amount of compensation to
depend depends upon the quality and character of the work
performed as determined by the commissioner and the chief
executive officer, but in no case less than 25 percent of the
minimum wage established pursuant to section 177.24.
Sec. 27. [246B.01] [MINNESOTA PSYCHOPATHIC PERSONALITY
TREATMENT CENTER; DEFINITIONS.]
Subdivision 1. [APPLICABILITY.] The definitions in this
section apply to this chapter.
Subd. 2. [COMMISSIONER.] "Commissioner" means the
commissioner of human services or the commissioner's designee.
Subd. 3. [PSYCHOPATHIC PERSONALITY.] "Psychopathic
personality" has the meaning given in section 526.09.
Sec. 28. [246B.02] [ESTABLISHMENT OF MINNESOTA
PSYCHOPATHIC PERSONALITY TREATMENT CENTER.]
The commissioner of human services shall establish and
maintain a secure facility located in Moose Lake. The facility
shall be known as the Minnesota Psychopathic Personality
Treatment Center. The facility shall provide care and treatment
to 100 persons committed by the courts as psychopathic
personalities, or persons admitted there with the consent of the
commissioner of human services.
Sec. 29. [246B.03] [LICENSURE.]
The commissioner of human services shall apply to the
commissioner of health to license the Minnesota Psychopathic
Personality Treatment Center as a supervised living facility
with applicable program licensing standards.
Sec. 30. [246B.04] [RULES; EVALUATION.]
The commissioner of human services shall adopt rules to
govern the operation, maintenance, and licensure of the program
established at the Minnesota Psychopathic Personality Treatment
Center for persons committed as a psychopathic personality. The
commissioner shall establish an evaluation process to measure
outcomes and behavioral changes as a result of treatment
compared with incarceration without treatment, to determine the
value, if any, of treatment in protecting the public.
Sec. 31. Minnesota Statutes 1992, section 252.025,
subdivision 4, is amended to read:
Subd. 4. [STATE-PROVIDED SERVICES.] (a) It is the policy
of the state to capitalize and recapitalize the regional
treatment centers as necessary to prevent depreciation and
obsolescence of physical facilities and to ensure they retain
the physical capability to provide residential programs.
Consistent with that policy and with section 252.50, and within
the limits of appropriations made available for this purpose,
the commissioner may establish, by June 30, 1991, the following
state-operated, community-based programs for the least
vulnerable regional treatment center residents: at Brainerd
regional services center, two residential programs and two day
programs; at Cambridge regional treatment center, four
residential programs and two day programs; at Faribault regional
treatment center, ten residential programs and six day programs;
at Fergus Falls regional treatment center, two residential
programs and one day program; at Moose Lake regional treatment
center, four residential programs and two day programs; and at
Willmar regional treatment center, two residential programs and
one day program.
(b) By January 15, 1991, the commissioner shall report to
the legislature a plan to provide continued regional treatment
center capacity and state-operated, community-based residential
and day programs for persons with developmental disabilities at
Brainerd, Cambridge, Faribault, Fergus Falls, Moose Lake, St.
Peter, and Willmar, as follows:
(1) by July 1, 1998, continued regional treatment center
capacity to serve 350 persons with developmental disabilities as
follows: at Brainerd, 80 persons; at Cambridge, 12 persons; at
Faribault, 110 persons; at Fergus Falls, 60 persons; at Moose
Lake, 12 persons; at St. Peter, 35 persons; at Willmar, 25
persons; and up to 16 crisis beds in the Twin Cities
metropolitan area; and
(2) by July 1, 1999, continued regional treatment center
capacity to serve 254 persons with developmental disabilities as
follows: at Brainerd, 57 persons; at Cambridge, 12 persons; at
Faribault, 80 persons; at Fergus Falls, 35 persons; at Moose
Lake, 12 persons; at St. Peter, 30 persons; at Willmar, 12
persons, and up to 16 crisis beds in the Twin Cities
metropolitan area. In addition, the plan shall provide for the
capacity to provide residential services to 570 persons with
developmental disabilities in 95 state-operated, community-based
residential programs.
The commissioner is subject to a mandamus action under
chapter 586 for any failure to comply with the provisions of
this subdivision.
Sec. 32. Minnesota Statutes 1992, section 252.025, is
amended by adding a subdivision to read:
Subd. 5. [SERVICES FOR DEVELOPMENTALLY DISABLED PERSONS:
MOOSE LAKE REGIONAL TREATMENT CENTER CATCHMENT AREA.]
Notwithstanding subdivision 4, the commissioner shall develop in
the Moose Lake regional treatment center catchment area for
persons with developmental disabilities at least 12 beds in
state-operated waivered homes, eight state-operated crisis beds,
one state-operated day training and habilitation facility, and
21 beds in other community settings. These services must be
established by October 1, 1993, to serve persons relocated from
the Moose Lake regional treatment center.
These services shall be in addition to any state-operated,
community services and day treatment centers in operation in the
Moose Lake catchment area during state fiscal year 1993.
Sec. 33. Minnesota Statutes 1992, section 252.025, is
amended by adding a subdivision to read:
Subd. 6. [DEVELOPMENT OF STATE-OPERATED
SERVICES.] Notwithstanding subdivision 4, during the biennium
ending June 30, 1995, the commissioner shall establish the
following services for persons with developmental disabilities:
(1) by June 30, 1994, eight state-operated, community-based
waivered homes located anywhere in the state for 32 persons and
two state-operated day training and habilitation facilities for
persons leaving regional treatment centers as a result of
downsizing;
(2) by June 30, 1994, 16 state-operated, community-based
waivered homes at Faribault for 64 persons, four state-operated
day training and habilitation facilities, and 38 beds in
community settings for persons leaving the Faribault regional
treatment center;
(3) by June 30, 1995, 78 beds in private community settings
for persons leaving the Faribault regional treatment center;
(4) by June 30, 1995, eight state-operated crisis beds in
the Faribault regional treatment center catchment area;
(5) by June 30, 1994, private community-based beds located
anywhere in the state to achieve a net reduction of 93 persons
leaving regional treatment centers as a result of downsizing;
and
(6) by June 30, 1995, nine state-operated waivered homes
for 36 persons and two state-operated day training and
habilitation facilities for persons leaving regional treatment
centers as a result of downsizing, and sufficient beds in
private community settings to achieve a net reduction of 84 beds
in regional treatment centers.
Sec. 34. Minnesota Statutes 1992, section 252.50, is
amended by adding a subdivision to read:
Subd. 2a. [USE OF ENHANCED WAIVERED SERVICES FUNDS.] The
commissioner may, within the limits of appropriations made
available for this purpose, use enhanced waivered services funds
under the home- and community-based waiver for persons with
mental retardation or related conditions to move to
state-operated community programs and to private facilities.
Sec. 35. Minnesota Statutes 1992, section 253.015,
subdivision 1, is amended to read:
Subdivision 1. [STATE HOSPITALS FOR PERSONS WITH MENTAL
ILLNESS.] The state hospitals located at Anoka, Brainerd, Fergus
Falls, Moose Lake, St. Peter, and Willmar, and Moose Lake until
June 30, 1995, shall constitute the state hospitals for persons
with mental illness, and shall be maintained under the general
management of the commissioner of human services. The
commissioner of human services shall determine to what state
hospital persons with mental illness shall be committed from
each county and notify the probate judge thereof, and of changes
made from time to time. The chief executive officer of each
hospital for persons with mental illness shall be known as the
chief executive officer.
Sec. 36. Minnesota Statutes 1992, section 253.015, is
amended by adding a subdivision to read:
Subd. 3. [SERVICES FOR PERSONS WITH MENTAL ILLNESS FROM
MOOSE LAKE REGIONAL TREATMENT CENTER.] (a) The commissioner
shall develop the following services in the Moose Lake catchment
area for patients with mental illness relocated from the Moose
Lake regional treatment center and must promote a mix of
state-operated and private services to include the following:
(1) by September 1, 1994, services in community nursing
facilities for 45 patients with mental illness;
(2) by December 1, 1994, 24 state-operated community
service slots, which may be a combination of residential and
crisis services, designed to serve persons with mental illness
and at least 75 percent of these state-operated community
service slots shall be residential services;
(3) by December 1, 1994, 16 service slots in other
community settings; and
(4) by December 1, 1994, 25 inpatient psychiatric beds in
community hospitals for adult patients who are acutely ill,
particularly those under judicial commitment.
(b) By October 1, 1994, 15 inpatient acute care
state-operated psychiatric beds in the Moose Lake catchment
area;
(c) By July 1, 1995, the commissioner shall establish 60
beds at Brainerd regional human services center to serve persons
with mental illness being relocated from the Moose Lake regional
treatment center.
Sec. 37. Minnesota Statutes 1992, section 253.015, is
amended by adding a subdivision to read:
Subd. 4. [SERVICES FOR PERSONS WITH TRAUMATIC BRAIN
INJURY.] By June 30, 1994, the commissioner shall develop 15
beds at Brainerd regional human services center for persons with
traumatic brain injury, including patients relocated from the
Moose Lake regional treatment center.
Sec. 38. Minnesota Statutes 1992, section 253.202, is
amended to read:
253.202 [MANAGEMENT.]
Notwithstanding the provisions of section 253.201, or any
other law to the contrary, the Minnesota Security Hospital shall
be under the administrative management of a hospital
administrator, to be appointed by the commissioner of human
services, who shall be a graduate of an accredited college
giving a course leading to a degree in hospital administration,
and the commissioner of human services, by rule, shall designate
such colleges which in the commissioner's opinion give an
accredited course in hospital administration. The
administrative management of the Minnesota Security Hospital
shall not continue under the management of the superintendent of
the St. Peter regional treatment center. In addition to a
hospital administrator, the commissioner of human services may
appoint a licensed doctor of medicine as chief of the medical
staff and the doctor shall be in charge of all medical care,
treatment, rehabilitation, and research. This section is
effective on July 1, 1963.
Sec. 39. Minnesota Statutes 1992, section 254.04, is
amended to read:
254.04 [TREATMENT OF INEBRIATES CHEMICALLY DEPENDENT
PERSONS.]
The commissioner of human services is hereby authorized to
continue the treatment of inebriates chemically dependent
persons at the state hospital farm for inebriates Ah-Gwah-Ching
and at the regional treatment centers located at Anoka,
Brainerd, Fergus Falls, Moose Lake, St. Peter, and Willmar as
now provided by law, and in addition thereto the commissioner is
authorized to provide for the treatment of inebriates at the
Moose Lake regional treatment center, but no inebriate shall be
committed for treatment to either facility except as may be
authorized and permitted by the commissioner of human services.
During the year ending June 30, 1994, the commissioner shall
relocate, in the catchment area served by the Moose Lake
regional treatment center, two state-operated off-campus
programs designed to serve patients who are relocated from the
Moose Lake regional treatment center. One program shall be a
35-bed program for women who are chemically dependent; the other
shall be a 25-bed program for men who are chemically dependent.
The facility space housing the Liberalis chemical dependency
program (building C-35) and the men's chemical dependency
program (4th floor main) may not be vacated until suitable
off-campus space for the women's chemical dependency program of
35 beds and the men's chemical dependency program of 25 beds is
located and clients and staff are relocated.
Sec. 40. Minnesota Statutes 1992, section 254.05, is
amended to read:
254.05 [DESIGNATION OF STATE HOSPITALS.]
The state hospital for the insane located at Anoka shall
hereafter be known and designated as the Anoka-metro regional
treatment center; the state hospital for the insane located at
Hastings shall hereafter be known and designated as the Hastings
state hospital; the state hospital for the insane and the
hospital farm for inebriates located at Willmar shall hereafter
be known and designated as the Willmar regional treatment
center; until June 30, 1995, the state hospital for the insane
located at Moose Lake shall hereafter be known and designated as
the Moose Lake regional treatment center; after June 30, 1995,
the newly established state facility at Moose Lake shall be
known and designated as the Minnesota psychopathic personality
treatment center; the state hospital for the insane located at
Fergus Falls shall hereafter be known and designated as the
Fergus Falls regional treatment center; the state hospital for
the insane located at Rochester shall hereafter be known and
designated as the Rochester state hospital; and the state
hospital for the insane located at St. Peter shall hereafter be
known and designated as the St. Peter regional treatment
center. Each of the foregoing state hospitals shall also be
known by the name of regional center at the discretion of the
commissioner of human services. The terms "human services" or
"treatment" may be included in the designation.
Sec. 41. Minnesota Statutes 1992, section 256B.0625,
subdivision 20, is amended to read:
Subd. 20. [MENTAL ILLNESS CASE MANAGEMENT.] (a) To the
extent authorized by rule of the state agency, medical
assistance covers case management services to persons with
serious and persistent mental illness or subject to federal
approval, children with severe emotional disturbance. Entities
meeting program standards set out in rules governing family
community support services as defined in section 245.4871,
subdivision 17, are eligible for medical assistance
reimbursement for case management services for children with
severe emotional disturbance when these services meet the
program standards in Minnesota Rules, parts 9520.0900 to
9520.0926 and 9505.0322, excluding subpart 6.
(b) In counties where fewer than 50 percent of children
estimated to be eligible under medical assistance to receive
case management services for children with severe emotional
disturbance actually receive these services in state fiscal year
1995, community mental health centers serving those counties,
entities meeting program standards in Minnesota Rules, parts
9520.0570 to 9520.0870, and other entities authorized by the
commissioner are eligible for medical assistance reimbursement
for case management services for children with severe emotional
disturbance when these services meet the program standards in
Minnesota Rules, parts 9520.0900 to 9520.0926 and 9505.0322,
excluding subpart 6.
Sec. 42. Minnesota Statutes 1992, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 36. [FAMILY COMMUNITY SUPPORT SERVICES.] Medical
assistance covers family community support services as defined
in section 245.4871, subdivision 17.
Sec. 43. Minnesota Statutes 1992, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 37. [THERAPEUTIC SUPPORT OF FOSTER CARE.] Medical
assistance covers therapeutic support of foster care as defined
in section 245.4871, subdivision 34.
Sec. 44. Minnesota Statutes 1992, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 38. [WRAPAROUND SERVICES.] Medical assistance covers
wraparound services as defined in section 245.492, subdivision
20, that are provided through a local children's mental health
collaborative, as that entity is defined in section 245.492,
subdivision 11.
Sec. 45. Laws 1991, chapter 292, article 6, section 54, is
amended to read:
Sec. 54. [RULE REVISION.]
The commissioner must revise Minnesota Rules, parts
9545.0900 to 9545.1090, which govern facilities that provide
residential services for children with emotional handicaps. The
rule revisions must be adopted within 12 months of the effective
date of this section by January 1, 1994.
Sec. 46. Laws 1991, chapter 292, article 6, section 57,
subdivision 1, is amended to read:
Subdivision 1. [STATEWIDE TASK FORCE.] The commissioner of
human services shall convene a task force to study the
feasibility of establishing an integrated children's mental
health fund. The task force shall consist of mental health
professionals, county social services personnel, service
providers, advocates, and parents of children who have
experienced episodes of emotional disturbance. The task force
shall also include representatives of the children's mental
health subcommittee of the state advisory council and local
coordinating councils established under Minnesota Statutes,
sections 245.487 to 245.4887. The task force shall include the
commissioners of education, health, and human services; two
members of the senate; and two members of the house of
representatives. The task force shall examine all possible
county, state, and federal sources of funds for children's
mental health with a view to designing an integrated children's
mental health fund, improving methods of coordinating and
maximizing all funding sources, and increasing federal funding.
Programs to be examined shall include, but not be limited to,
the following: medical assistance, title IV-E of the social
security act, title XX social service programs, chemical
dependency programs, education and special education programs,
and, for children with a dual diagnosis, programs for the
developmentally disabled. The task force may consult with
experts in the field, as necessary. The task force shall make a
preliminary report and recommendations on local coordination of
funding sources by January 1, 1992, to facilitate the
development of local protocols and procedures under subdivision
2. The task force shall submit a final report to the
legislature by January 1, 1993, with its findings and
recommendations. By January 1, 1994, the task force shall
provide a report to the legislature with recommendations of the
task force for promoting integrated funding and services for
children's mental health. The report must include the following
recommendations: (1) how to phase in all delivery systems,
including the juvenile court and correctional systems; (2) how
to expand the initial target population so that the state
eventually has a statewide integrated children's mental health
service system that integrates funding regardless of source for
children with emotional or behavioral disturbances or those at
risk of suffering such disturbances; (3) proposed outcome
measures for local children's mental health collaboratives; and
(4) any necessary legislative changes in the data practices act.
The task force shall continue through June 30, 1995, and shall
advise and assist the state coordinating council and local
children's mental health collaboratives as required in Minnesota
Statutes, sections 245.491 to 245.496.
Sec. 47. Laws 1991, chapter 292, article 6, section 57,
subdivision 3, is amended to read:
Subd. 3. [FINAL REPORT.] By February 15, 1993, the
commissioner of human services shall provide a report to the
legislature that describes the reports and recommendations of
the statewide task force under subdivision 1 and of the local
coordinating councils under subdivision 2, and provides the
commissioner's recommendations for legislation or other needed
changes.
Sec. 48. [ADULT MENTAL HEALTH SERVICES AND FUNDING.]
Subdivision 1. [STATEWIDE TASK FORCE.] The commissioner of
human services shall convene a task force to study and make
recommendations concerning adult mental health services and
funding. The task force shall consist of the commissioners of
health, jobs and training, corrections, and commerce, the
director of the housing finance agency, two members of the house
of representatives, and two members of the senate. The task
force shall also include persons diagnosed with mental illness,
family members of persons diagnosed with mental illness, mental
health professionals, county social services personnel, public
and private service providers, advocates for persons with mental
illness, and representatives of the state advisory council
established under Minnesota Statutes, section 245.697, and of
the local advisory council established under Minnesota Statutes,
section 245.466, subdivision 5. The task force must also
include public employee representatives from each of the state
regional treatment centers that treat adults with mental
illness, the division of rehabilitative services, and county
public employee bargaining units whose members serve adults with
mental illness. Public employee representatives must be
selected by their exclusive representatives. The commissioner
of human services shall contract with a facilitator-mediator
chosen by agreement of the members of the task force. The task
force shall examine all possible county, state, and federal
sources of funds for adult mental health with a view to
improving methods of coordinating services and maximizing all
funding sources and community support services, and increasing
federal funding. Programs to be examined shall include, but not
be limited to, the following: medical assistance, title XX
social services programs, jobs and training programs,
corrections programs, and housing programs. The task force may
consult with experts in the field, as necessary. The task force
shall make a preliminary report and recommendations on
coordination of services and funding sources by January 1, 1994,
to facilitate the development of local protocols and procedures
under subdivision 2. The task force shall submit a final report
to the legislature by January 1, 1995, with its findings and
recommendations. Once this report has been submitted, the task
force will expire.
Subd. 2. [DEVELOPMENT OF LOCAL PROTOCOLS AND
PROCEDURES.] (a) By January 1, 1994, each local adult mental
health advisory council established under Minnesota Statutes,
section 245.466, subdivision 5, may establish a task force to
develop recommended protocols and procedures that will ensure
that the planning, case management, and delivery of services for
adults with severe mental illness are coordinated and make the
most efficient and effective use of available funding. The task
force must include, at a minimum, representatives of county
medical assistance and mental health staff and representatives
of state and county public employee bargaining units. The
protocols and procedures must be designed to:
(1) ensure that services to adults are adequately funded to
meet the adult's needs;
(2) ensure that planning for services, case management,
service delivery, and payment for services involves coordination
of all affected agencies, providers, and funding sources; and
(3) maximize available funding by making full use of all
available funding, including medical assistance.
(b) By June 1, 1994, each council may make recommendations
to the statewide task force established under subdivision 1
regarding the feasibility and desirability of existing or
proposed methods of service delivery and funding sources to
ensure that services are tailored to the specific needs of each
adult and to allow where feasible greater flexibility in paying
for services.
(c) By June 1, 1994, each local advisory council may report
to the commissioner of human services the council's findings and
the recommended protocols and procedures. The council may also
recommend legislative changes or rule changes that will improve
local coordination and further maximize available funding.
Subd. 3. [FINAL REPORT.] By February 15, 1995, the
commissioner of human services shall provide a report to the
legislature that describes the reports and recommendations of
the statewide task force under subdivision 1 and of the local
advisory councils under subdivision 2, and provides the
commissioner's recommendations for legislation or other needed
changes.
Sec. 49. [MENTAL HEALTH SERVICES DELIVERY SYSTEM PILOT
PROJECT IN DAKOTA COUNTY.]
Subdivision 1. [AUTHORIZATION FOR CONTINUATION OF PILOT
PROJECT.] (a) The previously authorized mental health services
delivery system pilot project in Dakota county shall be
continued for a two-year period commencing on July 1, 1993, and
ending on June 30, 1995.
(b) Dakota county shall receive a grant from the department
of human services in the amount of $50,000 per year to pay
related expenses associated with the pilot project during fiscal
years 1994 and 1995.
Subd. 2. [AUTHORIZATION FOR INTEGRATED FUNDING OF
STATE-SUPPORTED MENTAL HEALTH SERVICES.] (a) The commissioner of
human services shall establish an adult mental health services
integrated fund for Dakota county to permit flexibility in
expenditures based on local needs with local control.
(b) The revenues and expenditures included in the
integrated fund shall be as follows:
(1) residential services funds administered under Minnesota
Rules, parts 9535.2000 to 9535.3000, in an amount to be
determined by mutual agreement between Dakota county and the
commissioner of human services after an examination of the
county's historical utilization of Minnesota Rules, parts
9520.0500 to 9520.0690, facilities located both within and
outside of the county;
(2) community support services funds administered under
Minnesota Rules, parts 9535.1700 to 9535.1760;
(3) Anoka alternatives grant funds;
(4) housing support services grant funds;
(5) OBRA grant funds; and
(6) crisis foster homes grant funds.
(c) As part of the pilot project, Dakota county may study
the feasibility of adding medical assistance, general
assistance, general assistance medical care, and Minnesota
supplemental aid to the integrated fund. The commissioner of
human services, with the express consent of the Dakota county
board of commissioners, may add medical assistance, general
assistance, general assistance medical care, and Minnesota
supplemental aid to the integrated fund.
(d) Dakota county must provide the commissioner of human
services with timely and pertinent information about the
county's adult mental health service delivery system through the
following methods:
(1) submission of community social services act plans and
plan amendments;
(2) submission of social service expenditure and grant
reconciliation reports, based on a coding format to be
determined by mutual agreement between the county and the
commissioner;
(3) compliance with the community mental health reporting
system and with other state reporting systems necessary for the
production of comprehensive statewide information;
(4) submission of the data on clients, services, costs,
providers, human resources, and outcomes that the state needs in
order to compile information on a statewide basis; and
(5) participation in semiannual meetings convened by the
commissioner for the purpose of reviewing Dakota county's adult
mental health program and assessing the impact of integrated
funding.
(e) The commissioner of human services shall waive or
modify any administrative rules, regulations, or guidelines
which are incompatible with the implementation of the integrated
fund.
(f) The integrated fund may be subject to the following
conditions and understandings.
(1) Dakota county may apply for any new or expanded mental
health service funds which may become available in the future,
on an equal basis with other counties.
(2) The integrated fund may be adjusted at least biennially
to reflect any increase in the population of Dakota county,
using a method to be determined by mutual agreement between the
county and the commissioner of human services.
(3) If the level of state funding for mental health
services in other counties is adjusted upward or downward, an
adjustment at the equivalent rate shall be made to Dakota
county's integrated fund, to the extent that the adjustment made
elsewhere applies to the revenue and expenditure categories
included in the integrated fund.
(4) Payments to Dakota county for the integrated fund shall
be made in 12 equal installments per year at the beginning of
each month, or by another method to be determined by mutual
agreement between the county and the commissioner of human
services.
(5) The commissioner of human services shall exempt Dakota
county from fiscal and other sanctions for noncompliance with
any requirements in state rules, regulations, or guidelines
which are incompatible with the implementation of the integrated
fund.
(6) The integrated fund may be discontinued for any reason
by the Dakota county board of commissioners or the commissioner
of human services, after 90 days' written notice to the other
party.
(7) If the integrated fund is discontinued, any expenses
incurred by Dakota county in order to resume full compliance
with state rules, regulations, and guidelines, shall be covered
by the state, to the extent allowed by rules and appropriation
funding.
(8) The integrated fund shall be established on July 1,
1993, or later by mutual agreement between the county and the
commissioner of human services.
(9) If any of the revenues included in the integrated fund
are federal in origin, any federal requirements for the use and
reporting of those funds shall remain in force, unless such
requirements are waived or modified by the appropriate federal
agency.
Sec. 50. [REPEALER, COUNTY GRANTS, FEDERAL BLOCK GRANTS.]
Minnesota Statutes 1992, sections 245.711 and 245.712, are
repealed.
Sec. 51. [EFFECTIVE DATES.]
Subdivision 1. Section 49 is effective July 1, 1993.
Subd. 2. Section 10 is effective July 1, 1993.
Subd. 3. Sections 16, subdivision 1, clause (6), and 18,
subdivision 1, are effective the day following final enactment.
Subd. 4. Section 41, paragraph (b), is effective October
1, 1995.
Subd. 5. Sections 42 and 43 are effective October 1, 1994.
Subd. 6. Section 44 is effective January 1, 1994.
ARTICLE 8
GROUP RESIDENTIAL HOUSING
Section 1. Minnesota Statutes 1992, section 256.025,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITIONS.] (a) For purposes of this
section, the following terms have the meanings given them.
(b) "Base amount" means the calendar year 1990 county share
of county agency expenditures for all of the programs specified
in subdivision 2, except for the programs in subdivision 2,
clauses (4), (7), and (13). The 1990 base amount for
subdivision 2, clause (4), shall be reduced by one-seventh for
each county, and the 1990 base amount for subdivision 2, clause
(7) shall be reduced by seven-tenths for each county, and those
amounts in total shall be the 1990 base amount for group
residential housing in subdivision 2, clause (13).
(c) "County agency expenditure" means the total expenditure
or cost incurred by the county of financial responsibility for
the benefits and services for each of the programs specified in
subdivision 2. The term includes the federal, state, and county
share of costs for programs in which there is federal financial
participation. For programs in which there is no federal
financial participation, the term includes the state and county
share of costs. The term excludes county administrative costs,
unless otherwise specified.
(d) "Nonfederal share" means the sum of state and county
shares of costs of the programs specified in subdivision 2.
(e) The "county share of county agency expenditures growth
amount" is the amount by which the county share of county agency
expenditures in calendar years 1991 to 2000 has increased over
the base amount.
Sec. 2. Minnesota Statutes 1992, section 256.025,
subdivision 2, is amended to read:
Subd. 2. [COVERED PROGRAMS AND SERVICES.] The procedures
in this section govern payment of county agency expenditures for
benefits and services distributed under the following programs:
(1) aid to families with dependent children under sections
256.82, subdivision 1, and 256.935, subdivision 1;
(2) medical assistance under sections 256B.041, subdivision
5, and 256B.19, subdivision 1;
(3) general assistance medical care under section 256D.03,
subdivision 6;
(4) general assistance under section 256D.03, subdivision
2;
(5) work readiness under section 256D.03, subdivision 2;
(6) emergency assistance under section 256.871, subdivision
6;
(7) Minnesota supplemental aid under section 256D.36,
subdivision 1;
(8) preadmission screening and alternative care grants;
(9) work readiness services under section 256D.051;
(10) case management services under section 256.736,
subdivision 13;
(11) general assistance claims processing, medical
transportation and related costs; and
(12) medical assistance, medical transportation and related
costs; and
(13) group residential housing under section 256I.05,
subdivision 8, transferred from programs in clauses (4) and (7).
Sec. 3. Minnesota Statutes 1992, section 256D.03,
subdivision 3, is amended to read:
Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.]
(a) General assistance medical care may be paid for any person
who is not eligible for medical assistance under chapter 256B,
including eligibility for medical assistance based on a
spend-down of excess income according to section 256B.056,
subdivision 5, and:
(1) who is receiving assistance under section 256D.05 or
256D.051, or who is having a payment made on the person's behalf
under sections 256I.01 to 256I.06; or
(2)(i) who is a resident of Minnesota; and whose equity in
assets is not in excess of $1,000 per assistance unit. Exempt
assets, the reduction of excess assets, and the waiver of excess
assets must conform to the medical assistance program in chapter
256B, with the following exception: the maximum amount of
undistributed funds in a trust that could be distributed to or
on behalf of the beneficiary by the trustee, assuming the full
exercise of the trustee's discretion under the terms of the
trust, must be applied toward the asset maximum; and
(ii) who has countable income not in excess of the
assistance standards established in section 256B.056,
subdivision 4, or whose excess income is spent down pursuant to
section 256B.056, subdivision 5, using a six-month budget
period, except that a one-month budget period must be used for
recipients residing in a long-term care facility. The method
for calculating earned income disregards and deductions for a
person who resides with a dependent child under age 21 shall be
as specified in section 256.74, subdivision 1. However, if a
disregard of $30 and one-third of the remainder described in
section 256.74, subdivision 1, clause (4), has been applied to
the wage earner's income, the disregard shall not be applied
again until the wage earner's income has not been considered in
an eligibility determination for general assistance, general
assistance medical care, medical assistance, or aid to families
with dependent children for 12 consecutive months. The earned
income and work expense deductions for a person who does not
reside with a dependent child under age 21 shall be the same as
the method used to determine eligibility for a person under
section 256D.06, subdivision 1, except the disregard of the
first $50 of earned income is not allowed; or
(3) who would be eligible for medical assistance except
that the person resides in a facility that is determined by the
commissioner or the federal health care financing administration
to be an institution for mental diseases.
(b) Eligibility is available for the month of application,
and for three months prior to application if the person was
eligible in those prior months. A redetermination of
eligibility must occur every 12 months.
(c) General assistance medical care is not available for a
person in a correctional facility unless the person is detained
by law for less than one year in a county correctional or
detention facility as a person accused or convicted of a crime,
or admitted as an inpatient to a hospital on a criminal hold
order, and the person is a recipient of general assistance
medical care at the time the person is detained by law or
admitted on a criminal hold order and as long as the person
continues to meet other eligibility requirements of this
subdivision.
(d) General assistance medical care is not available for
applicants or recipients who do not cooperate with the county
agency to meet the requirements of medical assistance.
(e) In determining the amount of assets of an individual,
there shall be included any asset or interest in an asset,
including an asset excluded under paragraph (a), that was given
away, sold, or disposed of for less than fair market value
within the 30 months preceding application for general
assistance medical care or during the period of eligibility.
Any transfer described in this paragraph shall be presumed to
have been for the purpose of establishing eligibility for
general assistance medical care, unless the individual furnishes
convincing evidence to establish that the transaction was
exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair
market value at the time it was given away, sold, or disposed
of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility,
including partial months, shall be calculated by dividing the
uncompensated transfer amount by the average monthly per person
payment made by the medical assistance program to skilled
nursing facilities for the previous calendar year. The
individual shall remain ineligible until this fixed period has
expired. The period of ineligibility may exceed 30 months, and
a reapplication for benefits after 30 months from the date of
the transfer shall not result in eligibility unless and until
the period of ineligibility has expired. The period of
ineligibility begins in the month the transfer was reported to
the county agency, or if the transfer was not reported, the
month in which the county agency discovered the transfer,
whichever comes first. For applicants, the period of
ineligibility begins on the date of the first approved
application.
Sec. 4. Minnesota Statutes 1992, section 256D.35,
subdivision 3a, is amended to read:
Subd. 3a. [ASSISTANCE UNIT.] "Assistance unit" means the
individual applicant or recipient or an eligible applicant
married couple or recipient married couple who live together.
Sec. 5. Minnesota Statutes 1992, section 256D.44,
subdivision 2, is amended to read:
Subd. 2. [STANDARD OF ASSISTANCE FOR SHELTER.] The state
standard of assistance for shelter provides for the recipient's
shelter costs. The monthly state standard of assistance for
shelter must be determined according to paragraphs (a)
to (c) (f).
(a) If the an applicant or recipient does not reside with
another person or persons, the state standard of assistance is
the actual cost for shelter items or $124, whichever is less.
(b) If the recipient resides with another person, the state
standard of assistance is the actual costs for shelter items or
$93, whichever is less. If an applicant married couple or
recipient married couple, who live together, does not reside
with others, the state standard of assistance is the actual cost
for shelter items or $186, whichever is less.
(c) Actual shelter costs for applicants or recipients are
determined by dividing the total monthly shelter costs by the
number of persons who share the residence. If an applicant or
recipient resides with another person or persons, the state
standard of assistance is the actual cost for shelter items or
$93, whichever is less.
(d) If an applicant married couple or recipient married
couple, who live together, resides with others, the state
standard of assistance is the actual cost for shelter items or
$124, whichever is less.
(e) Actual shelter costs for applicants or recipients, who
reside with others, are determined by dividing the total monthly
shelter costs by the number of persons who share the residence.
(f) Married couples, living together and receiving MSA on
January 1, 1994, and whose eligibility has not been terminated
for a full calendar month, are exempt from the standards in
paragraphs (b) and (d).
Sec. 6. Minnesota Statutes 1992, section 256D.44,
subdivision 3, is amended to read:
Subd. 3. [STANDARD OF ASSISTANCE FOR BASIC NEEDS.] The
state standard of assistance for basic needs provides for the
applicant's or recipient's maintenance needs, other than actual
shelter costs. Except as provided in subdivision 4, the monthly
state standard of assistance for basic needs is as follows:
(a) For If an applicant or recipient who does not reside
with another person or persons, the state standard of assistance
is $305 $371.
(b) For an individual who resides with another person or
persons, the state standard of assistance is $242. If an
applicant married couple or recipient married couple who live
together, does not reside with others, the state standard of
assistance is $557.
(c) If an applicant or recipient resides with another
person or persons, the state standard of assistance is $286.
(d) If an applicant married couple or recipient married
couple who live together, resides with others, the state
standard of assistance is $371.
(e) Married couples, living together and receiving MSA on
January 1, 1994, and whose eligibility has not been terminated a
full calendar month, are exempt from the standards in paragraphs
(b) and (d).
Sec. 7. Minnesota Statutes 1992, section 256I.01, is
amended to read:
256I.01 [CITATION.]
Sections 256I.01 to 256I.06 shall be cited as the "group
residential housing rate act."
Sec. 8. Minnesota Statutes 1992, section 256I.02, is
amended to read:
256I.02 [PURPOSE.]
The group residential housing rate act establishes a
comprehensive system of rates and payments for persons who
reside in a group residence and who meet the eligibility
criteria of the general assistance program under sections
256D.01 to 256D.21, or the Minnesota supplemental aid program
under sections 256D.33 to 256D.54 under section 256I.04,
subdivision 1.
Sec. 9. Minnesota Statutes 1992, section 256I.03,
subdivision 2, is amended to read:
Subd. 2. [GROUP RESIDENTIAL HOUSING RATE.] "Group
residential housing rate" means a monthly rate set for shelter,
fuel, food, utilities, household supplies, and other costs
necessary to provide room and board for eligible individuals
eligible for general assistance under sections 256D.01 to
256D.21 or supplemental aid under sections 256D.33 to 256D.54.
Group residential housing rate does not include payments for
foster care for children who are not blind, child welfare
services, medical care, dental care, hospitalization, nursing
care, drugs or medical supplies, program costs, or other social
services. However, the group residential housing rate for
recipients living in residences in section 256I.05, subdivision
2, paragraph (c), clause (2), includes all items covered by that
residence's medical assistance per diem rate. The rate is
negotiated by the county agency or the state according to the
provisions of sections 256I.01 to 256I.06.
Sec. 10. Minnesota Statutes 1992, section 256I.03,
subdivision 3, is amended to read:
Subd. 3. [GROUP RESIDENTIAL HOUSING.] "Group residential
housing" means a group living situation that provides at a
minimum room and board to unrelated persons who meet the
eligibility requirements of section 256I.04. This definition
includes foster care settings for a single adult. To receive
payment for a group residence rate, the residence must be
licensed by either the department of health or human services
and must comply with applicable laws and rules establishing
standards for health, safety, and licensure. Secure crisis
shelters for battered women and their children designated by the
department of corrections are not group residences under this
chapter meet the requirements under section 256I.04, subdivision
2a.
Sec. 11. Minnesota Statutes 1992, section 256I.03, is
amended by adding a subdivision to read:
Subd. 5. [MSA EQUIVALENT RATE.] "MSA equivalent rate"
means an amount equal to the total of:
(1) the combined maximum shelter and basic needs standards
for MSA recipients living alone specified in section 256D.44,
subdivisions 2, paragraph (a); and 3, paragraph (a); plus
(2) for persons who are not eligible to receive food stamps
due to living arrangement, the maximum allotment authorized by
the federal Food Stamp Program for a single individual which is
in effect on the first day of July each year; less
(3) the personal needs allowance authorized for medical
assistance recipients under section 256B.35.
The MSA equivalent rate is to be adjusted on the first day
of July each year to reflect changes in any of the component
rates under clauses (1) to (3).
Sec. 12. Minnesota Statutes 1992, section 256I.03, is
amended by adding a subdivision to read:
Subd. 6. [MEDICAL ASSISTANCE ROOM AND BOARD RATE.]
"Medical assistance room and board rate" means an amount equal
to the medical assistance income standard for a single
individual living alone in the community less the medical
assistance personal needs allowance under section 256B.35. For
the purposes of this section, the amount of the group
residential housing rate that exceeds the medical assistance
room and board rate is considered a remedial care cost. A
remedial care cost may be used to meet a spend down obligation
under section 256B.056, subdivision 5. The medical assistance
room and board rate is to be adjusted on the first day of
January of each year.
Sec. 13. Minnesota Statutes 1992, section 256I.04,
subdivision 1, is amended to read:
Subdivision 1. [INDIVIDUAL ELIGIBILITY REQUIREMENTS.] To
be eligible for a group residential housing payment, the
individual must be eligible for general assistance under
sections 256D.01 to 256D.21, or supplemental aid under sections
256D.33 to 256D.54. If the individual is in the group residence
due to illness or incapacity, the individual must be in the
residence under a plan developed or approved by the county
agency. Residence in other group residences must be approved by
the county agency. An individual is eligible for and entitled to
a group residential housing payment to be made on the
individual's behalf if the county agency has approved the
individual's residence in a group residential housing setting
and the individual meets the requirements in paragraph (a) or
(b).
(a) The individual is aged, blind, or is over 18 years of
age and disabled as determined under the criteria used by the
title II program of the Social Security Act, and meets the
resource restrictions and standards of the supplemental security
income program, and the individual's countable income after
deducting the exclusions and disregards of the SSI program and
the medical assistance personal needs allowance under section
256B.35 is less than the monthly rate specified in the county
agency's agreement with the provider of group residential
housing in which the individual resides.
(b) The individual's resources are less than the standards
specified by section 256D.08, and the individual's countable
income as determined under sections 256D.01 to 256D.21, less the
medical assistance personal needs allowance under section
256B.35 is less than the monthly rate specified in the county
agency's agreement with the provider of group residential
housing in which the individual resides.
Sec. 14. Minnesota Statutes 1992, section 256I.04, is
amended by adding a subdivision to read:
Subd. 1a. [COUNTY APPROVAL.] A county agency may not
approve a group residential housing payment for an individual in
any setting with a rate in excess of the MSA equivalent rate for
more than 30 days in a calendar year unless the county agency
has developed or approved a plan for the individual which
specifies that:
(1) the individual has an illness or incapacity which
prevents the person from living independently in the community;
and
(2) the individual's illness or incapacity requires the
services which are available in the group residence.
Sec. 15. Minnesota Statutes 1992, section 256I.04, is
amended by adding a subdivision to read:
Subd. 1b. [OPTIONAL STATE SUPPLEMENTS TO SSI.] Group
residential housing payments made on behalf of persons eligible
under subdivision 1, paragraph (a), are optional state
supplements to the SSI program.
Sec. 16. Minnesota Statutes 1992, section 256I.04, is
amended by adding a subdivision to read:
Subd. 1c. [INTERIM ASSISTANCE.] Group residential housing
payments made on behalf of persons eligible under subdivision 1,
paragraph (b), are considered interim assistance payments to
applicants for the federal SSI program.
Sec. 17. Minnesota Statutes 1992, section 256I.04,
subdivision 2, is amended to read:
Subd. 2. [DATE OF ELIGIBILITY.] For a person living in a
group residence who is eligible for general assistance under
sections 256D.01 to 256D.21, payment shall be made from the date
a signed application form is received by the county agency or
the date the applicant meets all eligibility factors, whichever
is later. For a person living in a group residence who is
eligible for supplemental aid under sections 256D.33 to 256D.54,
payment shall be made from the first of the month in which an
approved application is received by a county agency. An
individual who has met the eligibility requirements of
subdivision 1, shall have a group residential housing payment
made on the individual's behalf from the first day of the month
in which a signed application form is received by a county
agency, or the first day of the month in which all eligibility
factors have been met, whichever is later.
Sec. 18. Minnesota Statutes 1992, section 256I.04, is
amended by adding a subdivision to read:
Subd. 2a. [LICENSE REQUIRED.] A county agency may not
enter into an agreement with an establishment to provide group
residential housing unless:
(1) the establishment is licensed by the department of
health as a hotel and restaurant; a board and lodging
establishment; a residential care home; a boarding care home
before March 1, 1985; or a supervised living facility, and the
service provider for residents of the facility is licensed under
chapter 245A; or
(2) the residence is licensed by the commissioner of human
services under Minnesota Rules, parts 9555.5050 to 9555.6265, or
certified by a county human services agency prior to July 1,
1992, using the standards under Minnesota Rules, parts 9555.5050
to 9555.6265.
The requirements under clauses (1) and (2) do not apply to
establishments exempt from state licensure because they are
located on Indian reservations and subject to tribal health and
safety requirements.
Sec. 19. Minnesota Statutes 1992, section 256I.04, is
amended by adding a subdivision to read:
Subd. 2b. [GROUP RESIDENTIAL HOUSING AGREEMENTS.]
Agreements between county agencies and providers of group
residential housing must be in writing and must specify the name
and address under which the establishment subject to the
agreement does business and under which the establishment, or
service provider, if different from the group residential
housing establishment, is licensed by the department of health
or the department of human services; the address of the location
or locations at which group residential housing is provided
under this agreement; the per diem and monthly rates that are to
be paid from group residential housing funds for each eligible
resident at each location; the number of beds at each location
which are subject to the group residential housing agreement;
and a statement that the agreement is subject to the provisions
of sections 256I.01 to 256I.06 and subject to any changes to
those sections.
Sec. 20. Minnesota Statutes 1992, section 256I.04, is
amended by adding a subdivision to read:
Subd. 2c. [CRISIS SHELTERS.] Secure crisis shelters for
battered women and their children designated by the Minnesota
department of corrections are not group residences under this
chapter.
Sec. 21. Minnesota Statutes 1992, section 256I.04,
subdivision 3, is amended to read:
Subd. 3. [MORATORIUM ON THE DEVELOPMENT OF GROUP
RESIDENTIAL HOUSING BEDS.] (a) County agencies shall not enter
into agreements for new general assistance or Minnesota
supplemental aid group residence residential housing beds
except: (1) for adult foster homes licensed by the commissioner
of human services under Minnesota Rules, parts 9555.5105 to
9555.6265 for group residential housing establishments meeting
the requirements of subdivision 2a, clause (2); (2)
for facilities group residential housing establishments licensed
under Minnesota Rules, parts 9525.0215 to 9525.0355, provided
the facility is needed to meet the census reduction targets for
persons with mental retardation or related conditions at
regional treatment centers; (3) to ensure compliance with the
federal Omnibus Budget Reconciliation Act alternative
disposition plan requirements for inappropriately placed persons
with mental retardation or related conditions or mental illness;
or (4) up to 80 beds in a single, specialized facility located
in Hennepin county that will provide housing for chronic
inebriates who are repetitive users of detoxification centers
and are refused placement in emergency shelters because of their
state of intoxication. Planning for the specialized facility
must have been initiated before July 1, 1991, in anticipation of
receiving a grant from the housing finance agency under section
462A.05, subdivision 20a, paragraph (b).
(b) A county agency may enter into a group residential
housing agreement for beds in addition to those currently
covered under a group residential housing agreement if the
additional beds are only a replacement of beds which have been
made available due to closure of a setting, a change of
licensure or certification which removes the beds from group
residential housing payment, or as a result of the downsizing of
a group residential housing setting. The transfer of available
beds from one county to another can only occur by the agreement
of both counties.
(c) Group residential housing beds which become available
as a result of downsizing settings which have a license issued
under Minnesota Rules, parts 9520.0500 to 9520.0690, must be
permanently removed from the group residential housing census
and not replaced.
Sec. 22. Minnesota Statutes 1992, section 256I.05,
subdivision 1, is amended to read:
Subdivision 1. [MONTHLY MAXIMUM RATES.] (a) Monthly
payments for room and board rates negotiated by a county agency,
or set by the department under rules developed pursuant to
subdivision 6, on behalf of for a recipient living in a group
residence residential housing must be paid at the rates in
effect on June 30, 1991, not to exceed $966.37 for a group
residence that entered into an initial group residential housing
agreement with a county agency before June 1, 1989 the MSA
equivalent rate specified under section 256I.03, subdivision 5,
with the exception that a county agency may negotiate a room and
board rate that exceeds the MSA equivalent rate by up to $426.37
for recipients of waiver services under title XIX of the Social
Security Act. This exception is subject to the following
conditions:
(1) that the secretary of health and human services has not
approved a state request to include room and board costs which
exceed the MSA equivalent rate in an individual's set of waiver
services under title XIX of the Social Security Act; or
(2) that the secretary of health and human services has
approved the inclusion of room and board costs which exceed the
MSA equivalent rate, but in an amount that is insufficient to
cover costs which are included in a group residential housing
agreement in effect on June 30, 1994, and the amount of the rate
that is above the MSA equivalent rate has been approved by the
commissioner. The county agency may at any time negotiate a
lower payment room and board rate than the rate that would
otherwise be paid under this subdivision.
(b) The maximum monthly rate for an establishment that
enters into an initial group residential housing agreement with
a county agency on or after June 1, 1989, may not exceed 90
percent of the maximum rate established under subdivision 1.
This is effective until June 30, 1994.
Sec. 23. Minnesota Statutes 1992, section 256I.05,
subdivision 1a, is amended to read:
Subd. 1a. [LOWER MAXIMUM SUPPLEMENTARY RATES.] (a) The
maximum monthly rate for a general assistance or Minnesota
supplemental aid group residence that enters into an initial
group residential housing agreement with a county agency on or
after June 1, 1989, may not exceed 90 percent of the maximum
rate established under subdivision 1. This is effective until
June 30, 1993, or until the statewide system authorized under
subdivision 6 is established, whichever occurs first.
(b) The maximum monthly rate for a general assistance or
Minnesota supplemental aid group residence that is neither
licensed by nor registered with the Minnesota department of
health, or licensed by the department of human services, to
provide programs or services in addition to room and board is an
amount equal to the total of:
(1) the combined maximum shelter and basic needs standards
for Minnesota supplemental aid recipients living alone specified
in section 256D.44, subdivisions 2, paragraph (a), and 3,
paragraph (a); plus
(2) for persons who are not eligible to receive food stamps
due to living arrangements, the maximum allotment authorized by
the federal food stamp program for a single individual which is
in effect on the first day of July each year; less
(3) the personal needs allowance authorized for medical
assistance recipients under section 256B.35. In addition to the
room and board rate specified in subdivision 1, the county
agency may negotiate a payment not to exceed $426.37 for other
services necessary to provide room and board provided by the
group residence if the residence is licensed by or registered by
the department of health, or licensed by the department of human
services to provide services in addition to room and board, and
if the recipient of services is not also concurrently receiving
services under a home and community-based waiver under title XIX
of the Social Security Act or residing in a setting which
receives funding under Minnesota Rules, parts 9535.2000 to
9535.3000. The registration and licensure requirement does not
apply to establishments which are exempt from state licensure
because they are located on Indian reservations and for which
the tribe has prescribed health and safety requirements.
Service payments under this section may be prohibited under
rules to prevent the supplanting of federal funds with state
funds. The commissioner shall pursue the feasibility of
obtaining the approval of the secretary of health and human
services to provide home and community-based waiver services
under title XIX of the Social Security Act for residents who are
not eligible for an existing home and community-based waiver due
to a primary diagnosis of mental illness or chemical dependency,
and shall apply for a waiver if it is determined to be cost
effective.
Sec. 24. Minnesota Statutes 1992, section 256I.05, is
amended by adding a subdivision to read:
Subd. 1c. [RATE INCREASES.] A county agency may not
increase the rates negotiated for group residential housing
above those in effect on June 30, 1993, except:
(a) A county may increase the rates for group residential
housing settings to the MSA equivalent rate for those settings
whose current rate is below the MSA equivalent rate.
(b) A county agency may increase the rates for residents in
adult foster care whose difficulty of care has increased. The
total group residential housing rate for these residents must
not exceed the maximum rate specified in subdivisions 1 and 1a.
County agencies must not include nor increase group residential
housing difficulty of care rates for adults in foster care whose
difficulty of care is eligible for funding by home and
community-based waiver programs under title XIX of the Social
Security Act.
(c) The room and board rates will be increased each year
when the MSA equivalent rate is adjusted for SSI cost-of-living
increases by the amount of the annual SSI increase, less the
amount of the increase in the medical assistance personal needs
allowance under section 256B.35.
(d) When a group residential housing rate is used to pay
for an individual's room and board, or other costs necessary to
provide room and board, the rate payable to the residence must
continue for up to 18 calendar days per incident that the person
is temporarily absent from the residence, not to exceed 60 days
in a calendar year, if the absence or absences have received the
prior approval of the county agency's social service staff.
Prior approval is not required for emergency absences due to
crisis, illness or injury.
(e) For facilities meeting substantial change criteria
within the prior year. Substantial change criteria exists if
the group residential housing establishment experiences a 25
percent increase or decrease in the total number of its beds, if
the net cost of capital additions or improvements is in excess
of 15 percent of the current market value of the residence, or
if the residence physically moves, or changes its licensure, and
incurs a resulting increase in operation and property costs.
(f) Until June 30, 1994, a county agency may increase by up
to five percent the total rate paid for recipients of assistance
under sections 256D.01 to 256D.21 or 256D.33 to 256D.54 who
reside in residences that are licensed by the commissioner of
health as a boarding care home, but are not certified for the
purposes of the medical assistance program. However, an
increase under this clause must not exceed an amount equivalent
to 65 percent of the 1991 medical assistance reimbursement rate
for nursing home resident class A, in the geographic grouping in
which the facility is located, as established under Minnesota
Rules, parts 9549.0050 to 9549.0058.
Sec. 25. Minnesota Statutes 1992, section 256I.05,
subdivision 2, is amended to read:
Subd. 2. [MONTHLY RATES; EXEMPTIONS.] (a) The maximum
group residential housing rate does not apply to a residence
that on August 1, 1984, was licensed by the commissioner of
health only as a boarding care home, certified by the
commissioner of health as an intermediate care facility, and
licensed by the commissioner of human services under Minnesota
Rules, parts 9520.0500 to 9520.0690.
(b) The maximum group residential housing rate does not
apply to a residence that on August 1, 1984, was licensed by the
commissioner of human services under Minnesota Rules, parts
9525.0520 to 9525.0660, but funded as a group residence under
general assistance or Minnesota supplemental aid.
Sec. 26. Minnesota Statutes 1992, section 256I.05,
subdivision 8, is amended to read:
Subd. 8. [STATE PARTICIPATION.] For a resident of a group
residence who is eligible for general assistance under sections
256D.01 to 256D.21 section 256I.04, subdivision 1, paragraph
(b), state participation in the group residential housing rate
payment is determined according to section 256D.03, subdivision
2. For a resident of a group residence who is eligible under
sections 256D.33 to 256D.54 section 256I.04, subdivision 1,
paragraph (a), state participation in the group residential
housing rate is determined according to section 256D.36.
Sec. 27. Minnesota Statutes 1992, section 256I.06, is
amended to read:
256I.06 [PAYMENT METHODS.]
When a group residential housing rate is used to pay the
room and board costs of a person eligible under sections 256D.01
to 256D.21, the Monthly payment may Subdivision 1. [MONTHLY
PAYMENTS.] Monthly payments made on an individual's behalf for
group residential housing must be issued as a voucher or vendor
payment. When a group residential housing rate is used to pay
the room and board costs of a person eligible under sections
256D.33 to 256D.54, payments must be made to the recipient. If
a recipient is not able to manage the recipient's finances, a
representative payee must be appointed.
Subd. 2. [TIME OF PAYMENT.] A county agency may make
payments to a group residence in advance for an individual whose
stay in the group residence is expected to last beyond the
calendar month for which the payment is made and who does not
expect to receive countable earned income during the month for
which the payment is made. Group residential housing payments
made by a county agency on behalf of an individual who is not
expected to remain in the group residence beyond the month for
which payment is made must be made subsequent to the
individual's departure from the group residence. Group
residential housing payments made by a county agency on behalf
of an individual with earned income must be made subsequent to
receipt of a monthly household report form.
Subd. 3. [FILING OF APPLICATION.] The county agency must
immediately provide an application form to any person requesting
group residential housing. Application for group residential
housing must be in writing on a form prescribed by the
commissioner. The county agency must determine an applicant's
eligibility for group residential housing as soon as the
required verifications are received by the county agency and
within 30 days after a signed application is received by the
county agency for the aged or blind or within 60 days for the
disabled.
Subd. 4. [VERIFICATION.] The county agency must request,
and applicants and recipients must provide and verify, all
information necessary to determine initial and continuing
eligibility and group residential housing payment amounts. If
necessary, the county agency shall assist the applicant or
recipient in obtaining verifications. If the applicant or
recipient refuses or fails without good cause to provide the
information or verification, the county agency shall deny or
terminate eligibility for group residential housing payments.
Subd. 5. [REDETERMINATION OF ELIGIBILITY.] The eligibility
of each recipient must be redetermined at least once every 12
months.
Subd. 6. [REPORTS.] Recipients must report changes in
circumstances that affect eligibility or group residential
housing payment amounts within ten days of the change.
Recipients with earned income must complete a monthly household
report form. If the report form is not received before the end
of the month in which it is due, the county agency must
terminate eligibility for group residential housing payments.
The termination shall be effective on the first day of the month
following the month in which the report was due. If a complete
report is received within the month eligibility was terminated,
the individual is considered to have continued an application
for group residential housing payment effective the first day of
the month the eligibility was terminated.
Subd. 7. [DETERMINATION OF RATES.] The county in which a
group residence is located will determine the amount of group
residential housing rate to be paid on behalf of an individual
in the group residence regardless of the individual's county of
financial responsibility.
Subd. 8. [AMOUNT OF GROUP RESIDENTIAL HOUSING
PAYMENT.] The amount of a group residential housing payment to
be made on behalf of an eligible individual is determined by
subtracting the individual's countable income under section
256I.04, subdivision 1, for a whole calendar month from the
group residential housing charge for that same month. The group
residential housing charge is determined by multiplying the
group residential housing rate times the period of time the
individual was a resident or temporarily absent under section
256I.05, subdivision 1c, paragraph (d).
Sec. 28. [TRANSFER OF GROUP RESIDENTIAL HOUSING FUNDS.]
Upon federal approval of payment under the home and
community-based waiver provisions for room and board costs in
addition to the MSA equivalent rate defined in Minnesota
Statutes, section 256I.03, the commissioner of human services
shall transfer anticipated group residential housing
expenditures to the medical assistance account to meet the
nonfederal share requirement of funding these additional costs
as home and community-based services. Any transfer of group
residential housing funds to the medical assistance account
shall correspond to the increase in the waiver rates resulting
from medical assistance payment for unusual room and board costs
in excess of the MSA equivalent rate.
Sec. 29. [REPEALER.]
Minnesota Statutes 1992, sections 256I.03, subdivision 4;
256I.05, subdivisions 4, 9, and 10; and 256I.051, are repealed.
Sec. 30. [EFFECTIVE DATES.]
Subdivision 1. Section 25 is effective July 1, 1994.
Subd. 2. Sections 1 to 3, 8, 9, 13 to 17, 22, 23, and 26
to 29 are effective July 1, 1994, contingent upon federal
recognition that group residential housing payments qualify as
optional state supplement payments to the supplemental security
income program under title XVI of the Social Security Act and
confer categorical eligibility for medical assistance under the
state plan for medical assistance.
Subd. 3. Sections 4 to 6 are effective January 1, 1994.
Subd. 4. Implementation of section 12 is contingent upon
approval by the Secretary of Health and Human Services of the
definition and procedure contained in that section.
ARTICLE 9
HEALTH DEPARTMENT
Section 1. [115C.082] [LEAD FUND.]
Subdivision 1. [FUND ESTABLISHED.] A lead fund is created
in the state treasury. The fund consists of all revenue
deposited in the fund under sections 115C.081 and 297E.01,
subdivision 11, and all other money and interest made available
to the fund by law.
Subd. 2. [USES OF FUND.] (a) Money in the lead fund may be
appropriated for:
(1) all lead programs administered by the commissioner of
jobs and training;
(2) all lead activities and programs administered by the
commissioner of health; and
(3) all lead programs administered by the commissioner of
the housing finance agency.
(b) Money in the lead fund must be annually distributed for
lead abatement as follows:
(1) 25 percent to the commissioner of health for lead
activities and programs including contracting with community
health boards;
(2) ten percent to the housing development fund for lead
programs; and
(3) the remainder to the commissioner of jobs and training
for lead abatement programs.
(c) In expending funds under this program, the commissioner
of health shall abide by the following requirements:
(1) no funds shall be spent for lead screening unless the
board of health or grantee meets the center for disease control
proficiency requirements and the analytical requirements
specified in section 144.873, subdivision 3. The commissioner
may make grants that include providing the appropriate
analytical equipment in order to meet this condition;
(2) no money shall be provided to boards of health who
issue abatement orders inconsistent with the rules promulgated
under section 144.878; and
(3) before issuing a contract to boards of health, outside
a city of the first class, the commissioner of health shall
evaluate the need and cost effectiveness of contracting for
sanitarian and public health nurse services to determine whether
the contract grant should be with an individual board of health,
or a group of boards of health, or whether services should be
delivered by the commissioner. Nothing in this provision is
designed to restrict grants for lead education or lead screening.
Sec. 2. Minnesota Statutes 1992, section 116.76,
subdivision 14, is amended to read:
Subd. 14. [PATHOLOGICAL WASTE.] "Pathological waste" means
human tissues and body parts removed accidentally or during
surgery or autopsy intended for disposal. Pathological waste
does not include teeth.
Sec. 3. Minnesota Statutes 1992, section 116.78,
subdivision 4, is amended to read:
Subd. 4. [SHARPS.] Sharps, except those generated from a
household or from a farm operation or agricultural business:
(1) must be placed in puncture-resistant containers;
(2) may not be compacted or mixed with other waste material
whether or not the sharps are decontaminated unless it is part
of an infectious waste decontamination process approved by the
commissioner of health or the commissioner of the pollution
control agency that will prevent exposure during transportation
and disposal; and
(3) may not be disposed of at refuse-derived fuel
facilities or at other facilities where waste is hand sorted.
Sec. 4. Minnesota Statutes 1992, section 116.78,
subdivision 7, is amended to read:
Subd. 7. [COMPACTION AND MIXTURE WITH OTHER WASTES.]
Infectious waste may not be compacted or mixed with other waste
materials prior to incineration or disposal. Compaction is
acceptable if it is part of an infectious waste system, approved
by the commissioner of health or the commissioner of the
pollution control agency, that is designed to prevent exposure
during storage, transportation, and disposal.
Sec. 5. Minnesota Statutes 1992, section 116.79,
subdivision 1, is amended to read:
Subdivision 1. [PREPARATION OF MANAGEMENT PLANS.] (a) To
the extent applicable to the facility, a person in charge of a
facility that generates, stores, decontaminates, incinerates, or
disposes of infectious or pathological waste must prepare a
management plan for the infectious or pathological waste handled
by the facility. A person may prepare a common management plan
for all generating facilities owned and operated by the person.
If a single plan is prepared to cover multiple facilities, the
plan must identify common policy and procedures for the
facilities and any management procedures that are facility
specific. The plan must identify each generating facility
covered by the plan. A management plan must list all
physicians, dentists, chiropractors, podiatrists, veterinarians,
certified nurse practitioners, certified nurse midwives, or
physician assistants, employed by, under contract to, or working
at the generating facilities, except hospitals or laboratories.
A management plan from a hospital must list the number of
licensed beds and from a laboratory must list the number of
generating employees.
(b) The management plan must describe, to the extent the
information is applicable to the facility:
(1) the type of infectious waste and pathological waste
that the person generates or handles;
(2) the segregation, packaging, labeling, collection,
storage, and transportation procedures for the infectious waste
or pathological waste that will be followed;
(3) the decontamination or disposal methods for the
infectious or pathological waste that will be used;
(4) the transporters and disposal facilities that will be
used for the infectious waste;
(5) the steps that will be taken to minimize the exposure
of employees to infectious agents throughout the process of
disposing of infectious or pathological wastes; and
(6) the name of the individual responsible for the
management of the infectious waste or pathological waste.
(c) The management plan must be kept at the facility.
(d) To the extent applicable to the facility, management
plans must be accompanied by a statement of the quantity of
infectious and pathological waste generated, decontaminated,
stored, incinerated, or disposed of at the facility during the
previous two-year period. Quantities shall be reported in
gallons or pounds. The commissioner of health shall prepare a
summary of the quantities of infectious and pathological waste
generated, by facility type.
(e) A management plan must be updated and resubmitted at
least once every two years.
Sec. 6. Minnesota Statutes 1992, section 116.79,
subdivision 4, is amended to read:
Subd. 4. [PLANS FOR STORAGE, DECONTAMINATION,
INCINERATION, AND DISPOSAL FACILITIES.] (a) A person who stores,
incinerates, or decontaminates infectious or pathological waste,
other than at the facility where the waste was generated, or a
person who incinerates or disposes of infectious or pathological
waste on site, must submit a copy of the management plan to the
commissioner of the pollution control agency with a fee of
$225. The fee must be deposited in the state treasury and
credited to the general fund. A person who incinerates on site
must submit an attachment to the generator's management plan
detailing the incineration operation.
(b) The commissioner shall review the plans and may require
a plan to be modified within 180 days after the plan is
submitted if the commissioner determines that the plan is not
consistent with state or federal law or that the plan is not
adequate to minimize exposure of persons to the waste.
Sec. 7. Minnesota Statutes 1992, section 116.80,
subdivision 1, is amended to read:
Subdivision 1. [TRANSFER OF INFECTIOUS WASTE.] (a) A
generator may not transfer infectious waste to a commercial
transporter unless the transporter is registered with the
commissioner.
(b) A transporter may not deliver infectious waste to a
facility prohibited to accept the waste.
(c) A person who is registered to transport infectious
waste may not refuse waste generated from a facility that is
properly packaged and labeled as "infectious waste.".
Sec. 8. Minnesota Statutes 1992, section 116.80,
subdivision 2, is amended to read:
Subd. 2. [PREPARATION OF MANAGEMENT PLANS.] (a) A
commercial transporter in charge of a business that transports
infectious waste must prepare a management plan for the
infectious waste handled by the commercial transporter.
(b) The management plan must describe, to the extent the
information is applicable to the commercial transporter:
(1) the type of infectious waste that the commercial
transporter handles;
(2) the transportation procedures for the infectious waste
that will be followed;
(3) the disposal facilities that will be used for the
infectious waste;
(4) the steps that will be taken to minimize the exposure
of employees to infectious agents throughout the process of
transporting and disposing of infectious waste; and
(5) the name of the individual responsible for the
transportation and management of the infectious waste.
(c) The management plan must be kept at the commercial
transporter's principal place of business.
(d) Management plans must be accompanied by a statement of
the quantity of infectious waste transported during the previous
two-year period. Quantities shall be reported in gallons or
pounds.
(e) A management plan must be updated and resubmitted at
least once every two years.
(f) The commissioner shall review the plans and may require
a plan to be modified within 180 days after the plan is
submitted if the commissioner determines that the plan is not
consistent with state or federal law or that the plan is not
adequate to minimize exposure of persons to the waste.
Sec. 9. Minnesota Statutes 1992, section 116.81,
subdivision 1, is amended to read:
Subdivision 1. [AGENCY RULES.] The agency, in consultation
with the commissioner of health, may adopt rules to implement
sections 116.76 to 116.82. The agency has primary
responsibility for rules relating to transportation of
infectious waste and facilities storing, transporting,
decontaminating, incinerating, and disposing of infectious
waste. The agency, before adopting rules affecting animals or
research animal waste, must consult the commissioner of
agriculture and the board of animal health.
Sec. 10. Minnesota Statutes 1992, section 116.82,
subdivision 3, is amended to read:
Subd. 3. [LOCAL ENFORCEMENT.] Sections 116.76 to 116.81
may be enforced by a county by delegation of enforcement
authority granted to the commissioner of health and the agency
in section 116.83. Separate enforcement actions may not be
brought by a state agency and a county for the same violations.
The state or county may not bring an action that is being
enforced by the federal Office of Safety and Health
Administration.
Sec. 11. Minnesota Statutes 1992, section 116.83,
subdivision 1, is amended to read:
Subdivision 1. [STATE RESPONSIBILITIES ENFORCEMENT
AUTHORITY.] The agency or the commissioner of health may enforce
sections 116.76 to 116.81. The commissioner of health is
primarily responsible for enforcement involving generators. The
agency is primarily responsible for enforcement involving other
persons subject to sections 116.76 to 116.81.
Sec. 12. Minnesota Statutes 1992, section 116.83,
subdivision 3, is amended to read:
Subd. 3. [ACCESS TO INFORMATION AND PROPERTY.] Subject to
section 144.651, the commissioner of the pollution control
agency or the commissioner of health may on presentation of
credentials, during regular business hours:
(1) examine and copy any books, records, memoranda, or data
that is related to compliance with sections 116.76 to 116.81;
and
(2) enter public or private property regulated by sections
116.76 to 116.81 for the purpose of taking an action authorized
by this section including obtaining information and conducting
investigations.
Sec. 13. [116.87] [DEFINITIONS.]
Subdivision 1. [RESIDENTIAL LEAD PAINT WASTE.]
"Residential lead paint waste" means waste produced by removing
lead paint from the interior or exterior structure or the ground
surface of a residence. Residential lead paint waste does not
include:
(1) lead paint waste removed with the aid of any chemical
paint stripper; or
(2) lead paint waste that is mixed with water and that
contains any free liquid.
Subd. 2. [RESIDENCE.] The term "residence" has the meaning
given in rules adopted under sections 144.871 to 144.879.
Sec. 14. [116.875] [AUTHORIZED MANAGEMENT METHODS.]
Subdivision 1. [DISPOSAL.] Notwithstanding any other law,
a person who disposes of residential lead paint waste in the
state may dispose of the waste at:
(1) a land disposal facility that meets the requirements of
Minnesota Rules, chapter 7045;
(2) a facility that meets the requirements for a new mixed
municipal solid waste land disposal facility under Minnesota
Rules, chapter 7035 that began operation after January 1, 1989;
(3) a demolition debris land disposal facility equipped
with a clay or artificial liner and leachate collection system;
or
(4) a solid waste incinerator ash landfill if disposal is
approved by the commissioner in accordance with agency rules.
Subd. 2. [MANAGEMENT RESPONSIBILITY; NOT TRANSFERABLE TO
OCCUPANT.] (a) A person whose activities produce residential
lead paint waste is responsible for the management and proper
disposal of the waste.
(b) When residential lead paint waste is produced by
activities of a person other than the occupant of the residence
from which the waste is removed, the person shall not leave the
residential lead paint waste at that residence and shall not
transfer responsibility for managing or disposing of the waste
to the occupant.
Subd. 3. [WASTE PRODUCED BY OCCUPANT.] Residential lead
paint waste produced by activities of the occupant of the
residence from which the waste is removed must be managed as
provided by law for household hazardous waste.
Subd. 4. [DEMOLITION DEBRIS.] Residential lead paint waste
attached to woodwork, walls, or other elements removed from the
structure of a residence that constitute demolition debris may
be disposed of at any permitted demolition debris land disposal
facility.
Sec. 15. [116.88] [PROHIBITED METHODS OF MANAGEMENT.]
Subdivision 1. [UNLINED LANDFILLS.] Except as provided in
section 116.875, subdivision 4, no person shall dispose of
residential lead paint waste at an unlined land disposal
facility.
Subd. 2. [INCINERATION.] No person shall send or accept
residential lead paint waste for incineration by a mixed
municipal solid waste incinerator.
Sec. 16. [116.885] [RECYCLING AND TREATMENT.]
Nothing in sections 116.87 to 116.89 is intended to prevent
or discourage treatment or recycling of residential lead paint
waste. The commissioner shall encourage treatment and recycling
of residential lead paint waste.
Sec. 17. [116.89] [ENFORCEMENT.]
Subdivision 1. [RULES.] The Minnesota pollution control
agency may adopt rules necessary to implement and enforce the
provisions of sections 116.87 to 116.885, including rules to
regulate the transportation, storage, disposal, and other
management of residential lead paint waste after the waste
leaves the site where it was produced.
Subd. 2. [LICENSE REVOCATION.] In addition to enforcement
by the Minnesota pollution control agency, the commissioner of
health may revoke the license of an abatement contractor that
violates any provision of sections 116.87 to 116.885 or the
rules adopted under subdivision 1.
Sec. 18. Minnesota Statutes 1992, section 144.122, is
amended to read:
144.122 [LICENSE AND PERMIT FEES.]
(a) The state commissioner of health, by rule, may
prescribe reasonable procedures and fees for filing with the
commissioner as prescribed by statute and for the issuance of
original and renewal permits, licenses, registrations, and
certifications issued under authority of the commissioner. The
expiration dates of the various licenses, permits,
registrations, and certifications as prescribed by the rules
shall be plainly marked thereon. Fees may include application
and examination fees and a penalty fee for renewal applications
submitted after the expiration date of the previously issued
permit, license, registration, and certification. The
commissioner may also prescribe, by rule, reduced fees for
permits, licenses, registrations, and certifications when the
application therefor is submitted during the last three months
of the permit, license, registration, or certification period.
Fees proposed to be prescribed in the rules shall be first
approved by the department of finance. All fees proposed to be
prescribed in rules shall be reasonable. The fees shall be in
an amount so that the total fees collected by the commissioner
will, where practical, approximate the cost to the commissioner
in administering the program. All fees collected shall be
deposited in the state treasury and credited to the general
state government special revenue fund unless otherwise
specifically appropriated by law for specific purposes.
(b) The commissioner may charge a fee for voluntary
certification of medical laboratories and environmental
laboratories, and for environmental and medical laboratory
services provided by the department, without complying with
paragraph (a) or chapter 14. Fees charged for environment and
medical laboratory services provided by the department must be
approximately equal to the costs of providing the services.
(c) The commissioner may develop a schedule of fees for
diagnostic evaluations conducted at clinics held by the services
for children with handicaps program. All receipts generated by
the program are annually appropriated to the commissioner for
use in the maternal and child health program.
(d) The commissioner, for fiscal years 1993 and beyond,
shall set license fees for hospitals and nursing homes that are
not boarding care homes at a level sufficient to recover, over a
two-year period, the deficit associated with the collection of
license fees from these facilities. The license fees for these
facilities shall be set at the following levels:
Joint Commission on Accreditation of Healthcare
Organizations (JCAHO hospitals) $2,142
Non-JCAHO hospitals $2,228 plus $138 per bed
Nursing home $324 plus $76 per bed
For fiscal years 1993 and beyond, the commissioner shall
set license fees for outpatient surgical centers, boarding care
homes, and supervised living facilities at a level sufficient to
recover, over a four-year period, the deficit associated with
the collection of license fees from these facilities. The
license fees for these facilities shall be set at the following
levels:
Outpatient surgical centers $1,645
Boarding care homes $249 plus $58 per bed
Supervised living facilities $249 plus $58 per bed.
Sec. 19. Minnesota Statutes 1992, section 144.123,
subdivision 1, is amended to read:
Subdivision 1. [WHO MUST PAY.] Except for the limitation
contained in this section, the commissioner of health shall
charge a handling fee for each specimen submitted to the
department of health for analysis for diagnostic purposes by any
hospital, private laboratory, private clinic, or physician. No
fee shall be charged to any entity which receives direct or
indirect financial assistance from state or federal funds
administered by the department of health, including any public
health department, nonprofit community clinic, venereal disease
clinic, family planning clinic, or similar entity. The
commissioner of health may establish by rule other exceptions to
the handling fee as may be necessary to gather information for
epidemiologic purposes. All fees collected pursuant to this
section shall be deposited in the state treasury and credited to
the general state government special revenue fund.
Sec. 20. Minnesota Statutes 1992, section 144.226,
subdivision 2, is amended to read:
Subd. 2. [FEES TO GENERAL STATE GOVERNMENT SPECIAL REVENUE
FUND.] Fees collected under this section by the state registrar
shall be deposited to the general state government special
revenue fund.
Sec. 21. Minnesota Statutes 1992, section 144.3831,
subdivision 2, is amended to read:
Subd. 2. [COLLECTION AND PAYMENT OF FEE.] The public water
supply described in subdivision 1 shall:
(1) collect the fees assessed on its service connections;
(2) pay the department of revenue an amount equivalent to
the fees based on the total number of service connections. The
service connections for each public water supply described in
subdivision 1 shall be verified every four years by the
department of health; and
(3) pay one-fourth of the total yearly fee to the
department of revenue each calendar quarter. The first
quarterly payment is due on or before September 30, 1992. In
lieu of quarterly payments, a public water supply described in
subdivision 1 with fewer than 50 service connections may make a
single annual payment by June 30 each year, starting in 1993.
The fees payable to the department of revenue shall be deposited
in the state treasury as nondedicated general state government
special revenue fund revenues.
Sec. 22. Minnesota Statutes 1992, section 144.802,
subdivision 1, is amended to read:
Subdivision 1. [LICENSES; CONTENTS, CHANGES, AND
TRANSFERS.] No natural person, partnership, association,
corporation or unit of government may operate an ambulance
service within this state unless it possesses a valid license to
do so issued by the commissioner. The license shall specify the
base of operations, primary service area, and the type or types
of ambulance service for which the licensee is licensed. The
licensee shall obtain a new license if it wishes to establish a
new base of operation, or to expand its primary service area, or
to provide a new type or types of service. A license, or the
ownership of a licensed ambulance service, may be transferred
only after the approval of the commissioner, based upon a
finding that the proposed licensee or proposed new owner of a
licensed ambulance service meets or will meet the requirements
of section 144.804. If the proposed transfer would result in a
change in or addition of a new base of operations, expansion of
the service's primary service area, or provision of a new type
or types of ambulance service, the commissioner shall require
the prospective licensee or owner to comply with subdivision 3.
The commissioner may approve the license or ownership transfer
prior to completion of the application process described in
subdivision 3 upon obtaining written assurances from the
proposed licensee or proposed new owner that no change in the
service's base of operations, expansion of the service's primary
service area, or provision of a new type or types of ambulance
service will occur during the processing of the application.
The cost of licenses shall be in an amount prescribed by the
commissioner pursuant to section 144.122. Licenses shall expire
and be renewed as prescribed by the commissioner pursuant to
section 144.122. Fees collected shall be deposited to the trunk
highway fund.
Sec. 23. Minnesota Statutes 1992, section 144.8091,
subdivision 1, is amended to read:
Subdivision 1. [REPAYMENT FOR VOLUNTEER TRAINING.] Any
political subdivision, or nonprofit hospital or nonprofit
corporation operating a licensed ambulance service shall be
reimbursed by the commissioner for the necessary expense of the
initial training of a volunteer ambulance attendant upon
successful completion by the attendant of a basic emergency care
course, or a continuing education course for basic emergency
care, or both, which has been approved by the commissioner,
pursuant to section 144.804. Reimbursement may include tuition,
transportation, food, lodging, hourly payment for the time spent
in the training course, and other necessary expenditures, except
that in no instance shall a volunteer ambulance attendant be
reimbursed more than $350 $450 for successful completion of a
basic course, and $140 $225 for successful completion of a
continuing education course.
Sec. 24. Minnesota Statutes 1992, section 144.871,
subdivision 2, is amended to read:
Subd. 2. [ABATEMENT.] "Abatement" means removal of,
replacement of, or encapsulation of deteriorated paint, bare
soil, dust, drinking water, or other lead-containing materials
that are or may become readily accessible during the lead
abatement process and pose an immediate threat of actual lead
exposure to people.
Sec. 25. Minnesota Statutes 1992, section 144.871,
subdivision 6, is amended to read:
Subd. 6. [ELEVATED BLOOD LEAD LEVEL.] "Elevated blood lead
level" in a child no more than six years old before the sixth
birthday or in a pregnant woman means a blood lead level that
exceeds the federal Centers for Disease Control guidelines for
preventing lead poisoning in young children, unless the
commissioner finds that a lower concentration is necessary to
protect public health.
Sec. 26. Minnesota Statutes 1992, section 144.871,
subdivision 7a, is amended to read:
Subd. 7a. [HIGH RISK FOR TOXIC LEAD EXPOSURE.] "High risk
for toxic lead exposure" means either a census tract that meets
one or more of the following criteria:
(1) that a census tract where elevated blood lead levels
have been diagnosed in a population of children or pregnant
women;
(2) without blood lead data, that a population of children
or pregnant women resides in:
(i) a census tract with many residential structures known
to have or suspected of having deteriorated lead-based paint; or
(ii) (3) a census tract with a median soil lead
concentration greater than 100 parts per million for any sample
collected according to Minnesota Rules, part 4761.0400, subpart
8, and rules adopted under section 144.878; or
(3) the priorities adopted by the commissioner under
section 144.878, subdivision 2, shall apply to this subdivision.
Sec. 27. Minnesota Statutes 1992, section 144.871,
subdivision 7b, is amended to read:
Subd. 7b. [PRIMARY PREVENTION FOR TOXIC LEAD EXPOSURE.]
"Primary prevention for toxic lead exposure" means performance
of swab team services, encapsulation, and removal and
replacement abatement, including lead cleanup and health
education, before children develop elevated blood lead
levels. includes any or all of the following:
(1) education of the general public in populations where
children under six years of age and pregnant women have been
identified with blood lead levels greater than nine micrograms
per deciliter;
(2) education for property owners and renters concerning
in-place management of potential lead hazards to create
lead-safe housing;
(3) in-place management of potential lead hazards using
swab team services or property owner or renter lead abatement
activities; and
(4) encapsulation, and removal and replacement abatement
where necessary to make the residence lead safe.
Sec. 28. Minnesota Statutes 1992, section 144.871, is
amended by adding a subdivision to read:
Subd. 7c. [LEAD INSPECTOR.] "Lead inspector" means a
person who has successfully completed a training course in
investigation of residences for possible sources of lead
exposure and who is licensed by the commissioner under section
144.877 to perform this activity.
Sec. 29. Minnesota Statutes 1992, section 144.871, is
amended by adding a subdivision to read:
Subd. 7d. [PERSON.] "Person" has the meaning given in
section 103I.005, subdivision 16.
Sec. 30. Minnesota Statutes 1992, section 144.871,
subdivision 9, is amended to read:
Subd. 9. [SWAB TEAM.] "Swab team" means a person or
persons who implement in-place management of lead exposure
sources, which includes. Swab team services include any or all
of the following:
(1) covering or replacing bare soil that has a lead
concentration of 100 parts per million, and establishing safe
exterior play and garden areas; removing lead dust by washing,
vacuuming, and cleaning the interior of residential property;
(2) other means that immediately protect children who
engage in mouthing or pica behavior from lead sources, including
cleanup and health education, advice and assistance to help a
family locate and move to a temporary lead-safe residence while
abatement is being completed, or to help a family locate and
move to alternate lead-safe housing when abatement is not
completed by the property owner, and any other assistance
necessary to meet the family's immediate needs as a result of
the relocation;
(3) removing loose paint and paint chips and installing
guards to protect intact paint; and
(3) removing lead dust by washing, vacuuming, and cleaning
the interior of residential property including carpets; and
(4) other means, including cleanup and health education,
that immediately protect children who engage in mouthing or pica
behavior from lead sources covering or replacing bare soil that
has a lead concentration of 100 parts per million, and
establishing safe exterior play and garden areas.
Sec. 31. Minnesota Statutes 1992, section 144.871, is
amended by adding a subdivision to read:
Subd. 10. [VENOUS BLOOD SAMPLE.] "Venous blood sample"
means a quantity of blood drawn from a vein.
Sec. 32. Minnesota Statutes 1992, section 144.872,
subdivision 2, is amended to read:
Subd. 2. [HOME ASSESSMENTS.] (a) The commissioner shall,
within available federal or state appropriations, contract with
boards of health, who may determine priority for responding to
cases of elevated blood lead levels, to conduct assessments to
determine sources of lead contamination in the residences of
pregnant women whose blood lead levels are at least ten
micrograms per deciliter and of children whose blood lead levels
are at least 20 micrograms per deciliter or whose blood lead
levels persist in the range of 15 to 19 micrograms per deciliter
for 90 days after initial identification to the board of health
or the commissioner. Assessments must be conducted within five
working days of the board of health receiving notice that the
criteria in this subdivision have been met. The commissioner or
boards of health must be notified of all violations of standards
under section 144.878, subdivision 2, that are identified during
a home assessment.
(b) The commissioner or boards of health must identify the
known addresses for the previous 12 months of the child or
pregnant woman with elevated blood lead levels and notify the
property owners at those addresses. The commissioner may also
collect information on the race, sex, and family income of
children and pregnant women with elevated blood lead levels.
(c) Within the limits of appropriations, a board of health
shall conduct home assessments for children and pregnant women
whose confirmed blood lead levels are in the range of ten to 19
micrograms per deciliter.
(d) The commissioner shall also provide educational
materials on all sources of lead to boards of health to provide
education on ways of reducing the danger of lead contamination.
The commissioner may provide laboratory or field lead testing
equipment to a board of health or may reimburse a board of
health for direct costs associated with assessments.
Sec. 33. Minnesota Statutes 1992, section 144.872,
subdivision 3, is amended to read:
Subd. 3. [SAFE HOUSING.] The commissioner shall, within
the limits of available appropriations, contract with boards of
health for safe housing to be used in meeting relocation
requirements in section 144.874, subdivision 4. The
commissioner shall, within available federal or state
appropriations, award grants to boards of health for the
purposes of paying housing and relocation costs under section
144.874, subdivision 4.
Sec. 34. Minnesota Statutes 1992, section 144.872,
subdivision 4, is amended to read:
Subd. 4. [LEAD CLEANUP EQUIPMENT AND MATERIAL GRANTS.] (a)
Within the limits of available state or federal appropriations,
funds shall be made available under a grant program to nonprofit
community-based organizations in areas at high risk for toxic
lead exposure. Grantees shall use the money to purchase lead
cleanup equipment and educational materials, and to pay for
training for staff and volunteers for lead abatement
certification. Grantees may work with licensed lead abatement
contractors and certified trainers in order to meet the
requirements of this program receive training necessary for
certification under section 144.876, subdivision 1. Lead
cleanup equipment shall include: high efficiency particle
accumulator and wet vacuum cleaners, drop cloths, secure
containers, respirators, scrapers, dust and particle containment
material, and other cleanup and containment materials to remove
loose paint and plaster, patch loose paint and plaster, control
household dust, wax floors, clean carpets and sidewalks, and
cover bare soil.
(b) Upon certification, the grantees grantee's staff and
volunteers may make equipment and educational materials
available to residents and property owners and instruct them on
the proper use. Equipment shall be made available to low-income
households on a priority basis at no fee, and other households
on a sliding fee scale. Equipment shall not be made available
to any person, licensed lead abatement contractor, or certified
trainer who charges or intends to charge a fee for services
performed using equipment or materials purchased by a nonprofit
community-based organization through a grant obtained under this
subdivision.
Sec. 35. Minnesota Statutes 1992, section 144.872, is
amended by adding a subdivision to read:
Subd. 5. [SWAB TEAMS.] Boards of health may determine
priority for responding to cases of elevated blood lead levels.
Sec. 36. Minnesota Statutes 1992, section 144.873, is
amended to read:
144.873 [REPORTING OF MEDICAL AND ENVIRONMENTAL SAMPLE
ANALYSES.]
Subdivision 1. [REPORT REQUIRED.] Medical laboratories
performing blood lead analyses must report to the commissioner
finger stick and venipuncture blood lead results and the method
used to obtain these results. Boards of health must report to
the commissioner the results of analyses from residential
samples of paint, soil, dust, and drinking water. The
commissioner shall require the date of the test, and the current
address and birthdate of the patient, and other related
information from medical laboratories and boards of health as
may be needed to monitor and evaluate blood lead levels in the
public. If a clinic or physician sends a blood lead test to a
medical laboratory outside of Minnesota, that clinic or
physician must meet the reporting requirements under this
subdivision.
Subd. 2. [TEST OF CHILDREN IN HIGH RISK AREAS.] Within
limits of available state and federal appropriations, the
commissioner shall promote and subsidize a blood lead test of
all children under six years of age before the sixth birthday
who live in all areas of high risk for toxic lead exposure that
are currently known or subsequently identified. Within the
limits of available appropriations, the commissioner shall
conduct surveys, especially soil assessments larger than a
residence, as defined by the commissioner, to determine probable
sources of lead exposure in greater Minnesota communities where
a case of elevated blood lead levels has been reported.
Surveys conducted under this subdivision must consist of
evaluating census tracts to determine whether or not they are at
high risk for toxic lead exposure. The evaluation shall consist
of a priority response determination under section 144.878,
subdivision 2a. In making this evaluation, the commissioner
shall:
(1) conduct a soil survey in the manner provided for under
Minnesota Rules, part 4761.0400, subpart 8; and
(2) evaluate housing quality, if data is available.
The commissioner may also conduct a blood lead screening of
children under six years of age within the census tract.
Subd. 3. [STATEWIDE LEAD SCREENING.] Statewide lead
screening by blood lead assays in conjunction with routine blood
tests analyzed by laboratories that meet the center for disease
control laboratory proficiency standards, by atomic absorption
equipment, or other equipment with equivalent or better accuracy
shall be advocated used by boards of health.
Sec. 37. Minnesota Statutes 1992, section 144.874,
subdivision 1, is amended to read:
Subdivision 1. [RESIDENCE ASSESSMENT.] (a) A board of
health must conduct a timely assessment of a residence and all
common areas, if the residence is located in a building with two
or more residential units, within five working days of receiving
notification that the criteria in this subdivision have been
met, as confirmed by lead analysis of a venous blood sample, to
determine sources of lead exposure if:
(1) a pregnant woman in the residence is identified as
having a blood lead level of at least ten micrograms of lead per
deciliter of whole blood;
(2) a child in the residence is identified as having a
blood lead level at or above 20 micrograms per deciliter; or
(3) a child in the residence is identified as having a
blood lead level that persists in the range of 15 to 19
micrograms per deciliter for 90 days after initial
identification.
(b) Within the limits of available state and federal
appropriations, a board of health shall also conduct home
assessments for children whose confirmed blood lead levels are
in the range of ten to 19 micrograms per deciliter. A board of
health may assess a residence even if none of the three criteria
in this subdivision are met.
(c) If a child regularly spends several hours per day at
one or more other sites such as another residence, such as or a
residential or commercial child care facility, the board of
health must also assess the other residence sites. The board of
health shall have one additional day to complete the assessment
for each additional site.
(b) (d) The board of health must conduct the residential
assessment according to rules adopted by the commissioner
according to under section 144.878. A board of health must have
residence assessments performed by lead inspectors licensed by
the commissioner according to rules adopted under section
144.878. A board of health may observe the performance of lead
abatement in progress and may enforce the provisions of sections
144.871 to 144.879 under section 144.8781. The staff complement
of the department of health shall be increased by two full-time
equivalent positions who shall be lead inspectors.
Sec. 38. Minnesota Statutes 1992, section 144.874,
subdivision 2, is amended to read:
Subd. 2. [RESIDENTIAL LEAD ASSESSMENT GUIDE.] (a) The
commissioner of health shall develop or purchase a residential
lead assessment guide that enables parents and other caregivers
to assess the possible lead sources present and that
suggests lead abatement actions. The guide must provide
information on safe abatement and disposal methods, sources of
equipment, and telephone numbers for additional information to
enable the persons to either perform the abatement or to
intelligently select an abatement contractor. In addition, the
guide must:
(1) meet the requirements of Minnesota laws and rules;
(2) be understandable at not more than an eighth grade
reading level;
(3) include information on all necessary safety precautions
for all lead source cleanup; and
(4) be the best available educational material.
(b) A board of health must provide the residential lead
assessment guide at no cost to:
(1) parents and other caregivers of children who are
identified as having blood lead levels of at least ten
micrograms per deciliter; and
(2) all property owners and occupants who are issued
housing code orders requiring disruption abatement of lead
sources, and all occupants of those residences.
(c) A board of health must provide the residential lead
assessment guide on request to owners or tenants occupants of
residential property within the jurisdiction of the board of
health.
Sec. 39. Minnesota Statutes 1992, section 144.874,
subdivision 3, is amended to read:
Subd. 3. [SWAB TEAMS; LEAD ASSESSMENT; LEAD ABATEMENT
ORDERS.] A board of health must order a property owner to
perform abatement on a lead source that exceeds a standard
adopted according to section 144.878 at the residence of a child
with an elevated blood lead level or a pregnant woman with a
blood lead level of at least ten micrograms per deciliter. Lead
abatement orders must require that any source of damage, such as
leaking roofs, plumbing, and windows, must be repaired or
replaced, as needed, to prevent damage to lead-containing
interior surfaces. The board of health is not required to pay
for lead abatement. With each lead abatement order, the board
of health must coordinate with swab team abatement and provide a
residential lead abatement guide.
Sec. 40. Minnesota Statutes 1992, section 144.874, is
amended by adding a subdivision to read:
Subd. 3a. [SWAB TEAM SERVICES.] After issuing abatement
orders for a residence of a child or pregnant women with
elevated blood lead levels, the commissioner or a board of
health must send a swab team within five working days to the
residence to perform swab team services as defined in section
144.871, subdivision 9. If the commissioner or board of health
provides swab team services after an assessment, but before the
issuance of an abatement order, swab team services do not need
to be repeated after the issuance of an abatement order. Swab
team services are not considered completed until the
reassessment required under subdivision 6 shows no violation of
one or more of the standards under section 144.878, subdivision
2. If assessments and abatement orders are conducted at times
when weather or soil conditions do not permit the assessment or
abatement of lead in soil, the residences shall have their soil
assessed and abated, if necessary, at the first opportunity that
weather and soil conditions allow.
Sec. 41. Minnesota Statutes 1992, section 144.874,
subdivision 4, is amended to read:
Subd. 4. [RELOCATION OF RESIDENTS.] (a) A board of health
must ensure that residents are relocated from rooms or dwellings
during abatement that generates leaded dust, such as removal or
disruption of lead-based paint or plaster that contains lead.
Residents must be allowed to return to the residence or dwelling
after completion of abatement. A board of health shall use
grant funds under section 144.872, subdivision 3, in cooperation
with local housing agencies, to pay for moving costs and rent
for a temporary residence for any low-income resident
temporarily relocated during lead abatement, not to exceed $250
per household. For purposes of this section, "low-income
resident" means any resident whose gross household income is at
or below 185 percent of the federal poverty level.
(b) Any resident of rental property who is notified by the
board of health to vacate the premises during lead abatement
notwithstanding any rental agreement or lease provisions:
(1) shall not be required to pay rent due the landlord for
the period of time the tenant must vacate the premises; and
(2) may elect to immediately terminate the tenancy
effective on the date the tenant vacates the premises for lead
abatement, and shall not be liable for any further rent or other
charges due under the terms of the tenancy.
(c) A landlord of rental property in which tenants must
vacate the premises during lead abatement must:
(1) allow a tenant to return to the dwelling after lead
abatement and retesting, as required under subdivision 6, is
completed unless the tenant has elected to terminate the tenancy
under paragraph (b); and
(2) return any security deposit due under section 504.20 to
any tenant who terminates tenancy under paragraph (b) within
five days of the date the tenant vacates the unit.
Sec. 42. Minnesota Statutes 1992, section 144.874,
subdivision 5, is amended to read:
Subd. 5. [WARNING NOTICE; FINE.] A warning notice must be
posted on all entrances to properties for which an order to
abate a lead source has been issued by a board of health. This
A person who unlawfully removes a warning notice posted under
this section may be subject to a fine up to $250. The warning
notice must be at least 8-1/2 by 11 inches in size and must
include the following language, or substantially similar
language:
(a) "This property contains dangerous amounts of lead to
which children under age six and pregnant women should not be
exposed."
(b) "It is unlawful to remove or deface this warning. This
warning may be removed only upon the direction of the board of
health."
(c) "Persons who remove or deface this warning are subject
to a $250 fine. This warning may be removed only upon the
direction of the board of health."
Sec. 43. Minnesota Statutes 1992, section 144.874,
subdivision 6, is amended to read:
Subd. 6. [SERVICES AND RETESTING REQUIRED.] After
completion of swab team services and the abatement as
ordered, including any repairs ordered by a local housing or
building inspector, the board of health must retest the
residence to assure the violations no longer exist. The board
of health is not required to test a residence after lead
abatement that was not ordered by the board of health.
Sec. 44. Minnesota Statutes 1992, section 144.874,
subdivision 9, is amended to read:
Subd. 9. [PRIMARY PREVENTION.] Although children who are
found to already have elevated blood lead levels must have the
highest priority for intervention, the commissioner shall pursue
primary prevention of lead poisoning for toxic lead exposure
within the limits of appropriations.
Sec. 45. Minnesota Statutes 1992, section 144.874, is
amended by adding a subdivision to read:
Subd. 11a. [LEAD ABATEMENT DIRECTIVES.] In order to
achieve statewide consistency in the application of lead
abatement standards, the commissioner shall issue program
directives that interpret the application of rules under section
144.878 in ambiguous or unusual lead abatement situations.
These directives are guidelines to local boards of health. The
commissioner shall periodically review the evaluation of lead
abatement orders and the program directives to determine if the
rules under section 144.878 need to be amended to reflect new
understanding of lead abatement practices and methods.
Sec. 46. Minnesota Statutes 1992, section 144.876, is
amended by adding a subdivision to read:
Subd. 4. [NOTICE OF ABATEMENT.] At least five days before
starting work at each lead abatement worksite, a lead abatement
contractor shall give written notice to the commissioner and the
board of health.
Sec. 47. [144.877] [LEAD INSPECTORS; LICENSING.]
Subdivision 1. [LICENSE REQUIRED.] A lead inspector must
obtain a license within 180 days of the effective date of this
section and must renew it annually. The license must be readily
available at assessment sites for inspection by the commissioner
or by staff of a board of health with jurisdiction over a work
site. A license cannot be transferred.
Subd. 2. [LICENSE APPLICATION.] An application for license
or license renewal must be on a form provided by the
commissioner and must include:
(1) a $50 nonrefundable fee, in the form of a check;
(2) evidence that the applicant has successfully completed
a lead inspector training course approved in subdivision 6, or
has, within the previous 180 days, successfully completed an
initial lead inspection training course.
The fee required in this subdivision is waived for an
employee of a board of health.
Subd. 3. [LICENSE RENEWAL.] A license is valid for one
year from the issuance date unless the commissioner revokes it.
An applicant must successfully complete either an initial lead
inspection training course or an annual refresher lead
inspection training course to apply for license renewal.
Subd. 4. [LICENSE REPLACEMENT.] A licensed lead inspector
may obtain a replacement license by reapplying for a license. A
replacement expires on the same date as the original license. A
nonrefundable $25 fee is required with each replacement
application.
Subd. 5. [DENIAL OF LICENSE APPLICATION.] The commissioner
may deny an application, revoke, or impose limitations or
conditions on a license, if the applicant or licensed lead
inspector:
(1) violates rules adopted under sections 144.871 to
144.879;
(2) submits an application that is incomplete, inaccurate,
or lacks the required fee, or submits an invalid check;
(3) obtains a license, certificate, or approval through
error, fraud, or cheating;
(4) provides false or fraudulent information on forms;
(5) aids or allows an unlicensed or uncertified person to
engage in activities for which a license or certificate is
required;
(6) endangers public health or safety;
(7) has been convicted during the previous five years of a
felony or gross misdemeanor related to residential lead
assessment or residential lead abatement; or
(8) has been convicted during the previous five years of a
violation of section 270.72, 325F.69, or 325F.71.
An application for licensure that has been denied may be
resubmitted when the reasons for denial have been corrected. A
person whose license is revoked may not apply for a license
within one year of the date of revocation. After one year, the
application requirements must be followed by an applicant for a
license, certificate, or course approval. An applicant who
submits an approvable application within 60 days of initial
denial is not required to pay a second fee.
Subd. 6. [APPROVAL OF LEAD INSPECTION COURSE.] A lead
inspection course sponsored by the United States Environmental
Protection Agency is an approved course for the purpose of this
section.
Subd. 7. [LEAD INSPECTION; RULES.] The commissioner may
adopt rules to implement this section. The commissioner may
also approve lead inspector courses offered by groups other than
those approved by the United States Environmental Protection
Agency and shall charge a fee to cover the costs of approving
courses.
Sec. 48. Minnesota Statutes 1992, section 144.878,
subdivision 2, is amended to read:
Subd. 2. [LEAD STANDARDS AND ABATEMENT METHODS.] (a) The
commissioner shall adopt rules establishing standards and
abatement methods for lead in paint, dust, and drinking water in
a manner that protects public health and the environment for all
residences, including residences also used for a commercial
purpose. The commissioner shall adopt priorities for providing
abatement services to areas defined to be at high risk for toxic
lead exposure. In adopting priorities, the commission shall
consider the number of children and pregnant women diagnosed
with elevated blood lead levels and the median concentration of
lead in the soil. The commissioner shall give priority to areas
having the largest population of children and pregnant women
having elevated blood lead levels, areas with the highest median
soil lead concentration, and areas where it has been determined
that there are large numbers of residences that have
deteriorating paint. The commissioner shall differentiate
between intact paint and deteriorating paint. The commissioner
and political subdivisions shall require abatement of intact
paint only if the commissioner or political subdivision finds
that the intact paint is on a chewable or lead-dust producing
surface that is a known source or reasonably expected to be a
source of actual lead exposure to a specific person. In
adopting rules under this subdivision, the commissioner shall
require the best available technology for lead abatement
methods, paint stabilization, and repainting.
(b) The commissioner of health shall adopt standards and
abatement methods for lead in bare soil on playgrounds and
residential property in a manner to protect public health and
the environment. The commissioner shall adopt a maximum
standard of 100 parts of lead per million in bare soil, unless
it is proven that a different standard provides greater
protection of public health.
(c) The commissioner of the pollution control agency shall
adopt rules to ensure that removal of exterior lead-based
coatings from residential property by abrasive blasting methods
and disposal of any hazardous waste are is conducted in a manner
that protects public health and the environment.
(d) All standards adopted under this subdivision must
provide adequate reasonable margins of safety that are
consistent with a detailed review of scientific evidence and an
emphasis on overprotection rather than underprotection when the
scientific evidence is ambiguous. The rules must apply to any
individual performing or ordering the performance of lead
abatement.
(e) No unit of local government may have an ordinance or
regulation governing lead abatement methods for lead in paint,
dust, or soil for residences and residential land that require a
different lead abatement method than the lead abatement
standards established under sections 144.871 to 144.879.
Sec. 49. Minnesota Statutes 1992, section 144.878,
subdivision 2a, is amended to read:
Subd. 2a. [PRIORITIES FOR RESPONSE ACTION.] By January 1,
1988, The commissioner of health must adopt new rules
establishing the a priority list of census tracts at high risk
for toxic lead exposure for primary prevention response actions.
The rules must consider the potential for children's contact
with the soil and the existing level of lead in the soil and may
consider the relative risk to the public health, the size of the
population at risk, and blood lead levels of resident
populations. In establishing the list, the commissioner shall
award points under this subdivision to each census tract on
which information is available. The priority for primary
prevention response actions in census tracts at high risk for
toxic lead exposure shall be based on the cumulative points
awarded to each census tract. A greater number of points means
a higher priority. If a tie occurs in the number of points,
priority shall be given to the census tract with the higher
percentage of population with blood lead levels greater than ten
micrograms of lead per deciliter. All local governmental units
and boards of health shall follow the priorities under this
subdivision. The commissioner shall revise and update the
priority list at least every five years. Points shall be
awarded to each census tract for each criteria, considered
independently, defined in section 144.871, subdivision 7a.
Points shall be awarded as follows:
(a) In a census tract where at least 20 children have been
screened in the last five years, one point shall be awarded for
each five percent of children who were under six years old at
the time they were screened for lead in blood and whose blood
lead level exceeds ten micrograms of lead per deciliter. An
additional point shall be awarded if one percent of the children
had blood levels greater than 20 micrograms per deciliter of
blood. Two points shall be awarded to a census tract, where the
blood lead screening has been inadequate, that is contiguous
with a census tract where more than ten percent of the children
under six years of age have blood lead levels exceeding ten
micrograms per deciliter.
(b) One point shall be awarded for every five percent of
housing that is defined as dilapidated or deteriorated by the
planning department or similar agency of the city in which the
housing is located. Where data is available by neighborhood or
section within a city, the percent of dilapidated or
deteriorated housing shall apply equally to each census tract
within the neighborhood or section.
(c) One point shall be awarded for every 100 parts per
million of lead soil, based on the median soil lead values of
foundation soil samples, calculated on 100 parts per million
intervals, or fraction thereof. For the cities of St. Paul and
Minneapolis, the commissioner shall use the June 1988 census
tract version of the houseside map entitled "Distribution of
Household Lead Content of Soil Dust in the Twin Cities,"
prepared by the center for urban and regional affairs. Where
the map displays a census tract that is crossed by two or more
intervals, the commissioner shall make a reasoned determination
of the median foundation soil lead value for that tract. Values
for census tracts may be updated by surveying the tract
according to the procedures under Minnesota Rules, part
4761.0400, subpart 8.
Sec. 50. Minnesota Statutes 1992, section 144.878,
subdivision 5, is amended to read:
Subd. 5. [LEAD ABATEMENT CONTRACTORS AND EMPLOYEES.] The
commissioner shall adopt rules to license lead abatement
contractors, to certify employees of lead abatement contractors
who perform abatement, and to certify lead abatement trainers
who provide lead abatement training for contractors, employees,
or other lead abatement trainers. The rules must include
standards and procedures for on-the-job training for swab teams.
A person who performs painting, renovation, rehabilitation,
remodeling, or other residential work that is not lead abatement
need not be a licensed lead abatement contractor. By July 1,
1994, a person who performs work that removes intact paint on
residences built before February 27, 1978, must determine
whether lead sources are present and whether the planned work
would be lead abatement as defined in section 144.871,
subdivision 2. This determination may be made by quantitative
chemical analysis, X-ray fluorescence analyzer, or chemical spot
test using sodium rhodizonate. If lead sources are identified,
the work must be performed by a licensed lead abatement
contractor. An owner of an owner-occupied residence with one or
two units is not subject to the requirements under this
subdivision. All lead abatement training must include a
hands-on component and instruction on the health effects of lead
exposure, the use of personal protective equipment, workplace
hazards and safety problems, abatement methods and work
practices, decontamination procedures, cleanup and waste
disposal procedures, lead monitoring and testing methods, and
legal rights and responsibilities. The commissioner shall adopt
rules to approve lead abatement training courses and to charge a
fee for approval. At least 30 days before publishing initial
notice of proposed rules under this subdivision on the licensing
of lead abatement contractors, the commissioner shall submit the
rules to the chairs of the health and human services committees
in the house of representatives and the senate, and to any
legislative committee on licensing created by the legislature.
Sec. 51. [144.8781] [ENFORCEMENT.]
Subdivision 1. [CEASE AND DESIST ORDER.] (a) The
commissioner may issue an order requiring a person to cease lead
abatement if the commissioner determines that a condition exists
that poses an immediate danger to the public health. For
purposes of this subdivision, an immediate danger to the public
health exists if the commissioner determines that:
(1) lead abatement is being performed in a manner that
violates applicable state or federal law or related rules;
(2) the person performing lead abatement is not currently
licensed or certified as required by rules adopted under
sections 144.871 to 144.879; or
(3) the lead abatement contractor has not given prior
written notice required by section 144.876 to the commissioner
and board of health.
(b) An order to cease lead abatement is effective for a
maximum of 60 days. Following issuance of the order, the
commissioner shall provide the contractor or individual with an
opportunity for a hearing under the contested case provisions of
chapter 14. Within ten days of the hearing, the commissioner
shall decide whether to rescind, modify, or reissue the previous
order. A modified or reissued order is effective for a maximum
of 60 days from the date of modification or reissuance.
Subd. 2. [ORDER FOR CORRECTIVE ACTION.] (a) The
commissioner may issue an order requiring a person violating
sections 144.871 to 144.879 or a rule adopted under sections
144.871 to 144.879 to take the corrective action the
commissioner determines will accomplish the purpose of the
project and prevent future violation. The order for corrective
action shall state the conditions that constitute the violation,
the specific statute or rule violated, and the time by which the
violation must be corrected.
(b) If the person believes that the information contained
in the commissioner's order for corrective action is in error,
the person may ask the commissioner to reconsider the parts of
the order that are alleged to be in error. The request must be
in writing, delivered to the commissioner by certified mail
within five working days of receipt of the order, and:
(1) specify which parts of the order for corrective action
are alleged to be in error;
(2) explain why they are in error; and
(3) provide documentation to support the allegation of
error.
The commissioner shall respond to a request made under this
subdivision within 15 working days after receipt of the request.
A request for reconsideration does not stay the order for
corrective action but the commissioner may provide additional
time to comply with the order after reviewing the request. The
commissioner's disposition of a request for reconsideration is
final.
Subd. 3. [INJUNCTIVE RELIEF.] In addition to any other
remedy provided by law, the commissioner may bring an action for
injunctive relief in the district court in Ramsey county or, at
the commissioner's discretion, in the district court in the
county in which the lead abatement is being undertaken, to halt
the work or an activity connected with it. A temporary
restraining order or other injunctive relief may be granted by
the court if continuation of the lead abatement or an activity
connected with it would result in an imminent risk of harm to
any person.
Subd. 4. [PENALTIES.] (a) A person who violates any of the
requirements of sections 144.871 to 144.879 or any requirement,
rule, or order issued under this section is subject to a civil
penalty of not more than $5,000 per day of violation. Penalties
may be recovered in a civil action in the name of the state
brought by the attorney general.
(b) The commissioner may issue an order assessing a penalty
of not more than $5,000 per violation to any person who violates
any of the requirements of sections 144.871 to 144.879 or any
requirement, rule, or order issued under this section. A person
subject to an administrative penalty order may request a
contested case hearing under chapter 14 within 20 days from date
of receipt of the penalty order. If the penalty order is not
contested within 20 days of receipt, it becomes final and may
not be contested.
(c) The amount of penalty shall be based on the past
history of violations, the severity of violation, the
culpability of the person, and other relevant factors.
(d) Penalties assessed under sections 144.871 to 144.879
shall be paid to the commissioner for deposit in the general
fund. Unpaid penalties shall be increased to 125 percent of the
original assessed amount if not paid within 60 days after the
penalty order becomes final. After 60 days, interest shall
accrue on the unpaid penalty balance at the rate established in
section 549.09.
Subd. 5. [MISDEMEANOR PENALTY.] A person is guilty of a
misdemeanor and may be sentenced to payment of a fine of not
more than $700, imprisonment for not more than 30 days, or both,
for each violation if that person:
(1) hinders or delays the commissioner or the
commissioner's authorized representative in the performance of
the duty to enforce sections 144.871 to 144.879;
(2) undertakes lead abatement without a current, valid
license;
(3) refuses to make a license or certificate accessible to
either the commissioner or the commissioner's authorized
representative;
(4) employs a person to do lead abatement who does not have
a valid certificate;
(5) fails to report lead abatement as required by section
144.876; or
(6) makes a false material statement related to a license,
certificate, report, or other documents required under sections
144.871 to 144.879.
Subd. 6. [DISCRIMINATION.] A person who discriminates
against or otherwise sanctions an employee who complains to or
cooperates with the commissioner in administering sections
144.871 to 144.879 is guilty of a misdemeanor.
Sec. 52. Minnesota Statutes 1992, section 144.98,
subdivision 5, is amended to read:
Subd. 5. [LABORATORY CERTIFICATION ACCOUNT STATE
GOVERNMENT SPECIAL REVENUE FUND.] There is an account in the
special revenue fund called the laboratory certification
account. Fees collected under this section and appropriations
for the purposes of this section must be deposited in
the laboratory certification account. Money in the laboratory
certification account is annually appropriated to the
commissioner of health to administer this section state
government special revenue fund.
Sec. 53. Minnesota Statutes 1992, section 144A.04,
subdivision 7, is amended to read:
Subd. 7. [MINIMUM NURSING STAFF REQUIREMENT.]
Notwithstanding the provisions of Minnesota Rules, part
4655.5600, the minimum staffing standard for nursing personnel
in certified nursing homes is as follows:
(a) The minimum number of hours of nursing personnel to be
provided in a nursing home is the greater of two hours per
resident per 24 hours or 0.95 hours per standardized resident
day.
(b) For purposes of this subdivision, "hours of nursing
personnel" means the paid, on-duty, productive nursing hours of
all nurses and nursing assistants, calculated on the basis of
any given 24-hour period. "Productive nursing hours" means all
on-duty hours during which nurses and nursing assistants are
engaged in nursing duties. Examples of nursing duties may be
found in Minnesota Rules, parts 4655.5900, 4655.6100, and
4655.6400. Not included are vacations, holidays, sick leave,
in-service classroom training, or lunches. Also not included
are the nonproductive nursing hours of the in-service training
director. In homes with more than 60 licensed beds, the hours
of the director of nursing are excluded. "Standardized resident
day" means the sum of the number of residents in each case mix
class multiplied by the case mix weight for that resident class,
as found in Minnesota Rules, part 9549.0059, subpart 2,
calculated on the basis of a facility's census for any given
day. For the purpose of determining a facility's census, the
commissioner of health shall exclude the resident days claimed
by the facility for resident therapeutic leave or bed hold days.
(c) Calculation of nursing hours per standardized resident
day is performed by dividing total hours of nursing personnel
for a given period by the total of standardized resident days
for that same period.
(d) A nursing home that is issued a notice of noncompliance
under section 144A.10, subdivision 5, for a violation of this
subdivision, shall be assessed a civil fine of $300 for each day
of noncompliance, subject to section 144A.10, subdivisions 7 and
8.
Sec. 54. [144C.01] [AMBULANCE SERVICE PERSONNEL LONGEVITY
AWARD AND INCENTIVE PROGRAM.]
Subdivision 1. [ESTABLISHMENT.] An ambulance service
personnel longevity award and incentive program is established.
The program is intended to recognize the service rendered to
state and local government and the citizens of Minnesota by
qualified ambulance service personnel, and to reward qualified
ambulance service personnel for significant contributions to
state and local government and to the public. The purpose of
the ambulance service personnel longevity award and incentive
trust is to accumulate resources to allow for the payment of
longevity awards to qualified ambulance service personnel upon
the completion of a substantial ambulance service career.
Subd. 2. [ADMINISTRATION.] (a) Unless paragraph (c)
applies, consistent with the responsibilities of the state board
of investment and the various ambulance services, the ambulance
service personnel longevity award and incentive program must be
administered by the commissioner of health. The administrative
responsibilities of the commissioner of health for the program
relate solely to the record keeping, award application, and
award payment functions. The state board of investment is
responsible for the investment of the ambulance service
personnel longevity award and incentive trust. The applicable
ambulance service is responsible for determining, consistent
with this chapter, who is a qualified ambulance service person,
what constitutes a year of credited ambulance service, what
constitutes sufficient documentation of a year of prior service,
and for submission of all necessary data to the commissioner of
health in a manner consistent with this chapter. Determinations
of an ambulance service are final.
(b) The commissioner of health may administer the
commissioner's assigned responsibilities regarding the program
directly or may retain a qualified governmental or
nongovernmental plan administrator under contract to administer
those responsibilities regarding the program. A contract with a
qualified plan administrator must be the result of an open
competitive bidding process and must be reopened for competitive
bidding at least once during every five-year period after the
effective date of this section.
(c) The commissioner of employee relations shall review the
options within state government for the most appropriate
administration of pension plans or similar arrangements for
emergency service personnel and recommend to the governor the
most appropriate future pension plan or nonpension plan
administrative arrangement for this chapter. If the governor
concurs in the recommendation, the governor shall transfer the
future administrative responsibilities relating to this chapter
to that administrative agency.
Sec. 55. [144C.02] [PROGRAM ELIGIBILITY; QUALIFIED
AMBULANCE SERVICE PERSONNEL.]
(a) Persons eligible to participate in the ambulance
service personnel longevity award and incentive program are
qualified ambulance service personnel.
(b) Qualified ambulance service personnel are ambulance
attendants, ambulance drivers, and ambulance service medical
directors or medical advisors who meet the following
requirements:
(1) employment of the person by or provision by the person
of service to an ambulance service that is licensed as such by
the state of Minnesota and that provides ambulance services that
are generally available to the public and are free of unfair
discriminatory practices under chapter 363;
(2) performance by the person during the 12 months ending
as of the immediately previous June 30 of all or a predominant
portion of the person's services in the state of Minnesota or on
behalf of Minnesota residents, as verified by August 1 annually
in an affidavit from the chief administrative officer of the
ambulance service;
(3) current certification of the person during the 12
months ending as of the immediately previous June 30 by the
Minnesota department of health as an ambulance attendant,
ambulance driver, or ambulance service medical director or
medical advisor under section 144.804, and supporting rules, and
current active ambulance service employment or service provision
status of the person, as verified by August 1 annually in an
affidavit from the chief administrative officer of the ambulance
service; and
(4) conformance by the person with the definition of the
phrase "volunteer ambulance attendant" under section 144.8091,
subdivision 2, except that for the salary limit specified in
that provision there must be substituted, for purposes of this
section only, a limit of $3,000 for calendar year 1993, and
$3,000 multiplied by the cumulative percentage increase in the
national Consumer Price Index, all items, for urban wage earners
and clerical workers, as published by the federal Department of
Labor, Bureau of Labor Statistics, since December 31, 1993, and
for an ambulance service medical director, conformance based
solely on the person's hourly stipends or salary for service as
a medical director.
(c) The term "active ambulance service employment or
service provision status" means being in good standing with and
on the active roster of the ambulance service making the
certification.
(d) The maximum period of ambulance service employment or
service provision for which a person may receive credit towards
an award under this chapter, including prior service credit
under section 144C.07, subdivision 2, paragraph (c), is 20 years.
(e) For a person who is employed by or provides service to
more than one ambulance service concurrently during any period
during the 12-month period, credit towards an award under this
chapter is limited to one ambulance service during any period.
The creditable period is with the ambulance service for which
the person undertakes the greatest portion of employment or
service hours.
Sec. 56. [144C.03] [AMBULANCE SERVICE PERSONNEL LONGEVITY
AWARD AND INCENTIVE TRUST; TRUST ACCOUNT.]
Subdivision 1. [TRUST.] There is established an ambulance
service personnel longevity award and incentive trust.
Subd. 2. [TRUST ACCOUNT.] There is established in the
general fund an ambulance service personnel longevity award and
incentive trust account. The trust account must be credited
with appropriations for that purpose, and investment earnings on
those accumulated proceeds. The assets and income of the trust
account must be held and managed by the commissioner of finance
and the state board of investment for the benefit of the state
of Minnesota and its general creditors.
Subd. 3. [PRIORITY OF CLAIMS.] The state of Minnesota
intends that this program, trust, and trust account not
constitute a separate fund for any legal purpose, including the
federal Internal Revenue Code, as amended, and the federal
Employee Retirement Income Security Act of 1974, as amended.
Qualified ambulance service personnel have only an unsecured
promise of the state of Minnesota to pay a longevity award upon
meeting entitlement requirements set forth in section 144C.08,
and qualified ambulance service personnel meeting those
entitlement requirements have the status of general unsecured
creditors with respect to an ambulance service personnel
longevity award, if and when awarded.
Sec. 57. [144C.05] [DISTRIBUTIONS FROM ACCOUNT.]
Subdivision 1. [AWARD PAYMENTS.] (a) The commissioner of
health or the commissioner's designee under section 144C.01,
subdivision 2, shall pay ambulance service personnel longevity
awards to qualified ambulance service personnel determined to be
entitled to an award under section 144C.08 by the commissioner
based on the submissions by the various ambulance services.
Amounts necessary to pay the ambulance service personnel
longevity award are appropriated from the ambulance service
personnel longevity award and incentive trust account to the
commissioner of health.
(b) If the state of Minnesota is unable to meet its
financial obligations as they become due, the commissioner of
health shall undertake all necessary steps to discontinue paying
ambulance service personnel longevity awards until the state of
Minnesota is again able to meet its financial obligations as
they become due.
Subd. 2. [GENERAL CREDITORS OF THE STATE.] The trust
account is at all times subject to a levy under an execution of
any general creditor of the state of Minnesota, and if no other
funds are available to satisfy that levy, the levy has priority
for payment from the trust account before any ambulance service
personnel longevity award.
Sec. 58. [144C.06] [TRUST ACCOUNT INVESTMENT.]
The trust account must be invested by the state board of
investment, as provided in section 11A.20.
Sec. 59. [144C.07] [CREDITING QUALIFIED AMBULANCE
PERSONNEL SERVICE.]
Subdivision 1. [SEPARATE RECORD KEEPING.] The commissioner
of health or the commissioner's designee under section 144C.01,
subdivision 2, shall maintain a separate record of potential
award accumulations for each qualified ambulance service person
under subdivision 2.
Subd. 2. [POTENTIAL ALLOCATIONS.] (a) On September 1,
annually, the commissioner of health or the commissioner's
designee under section 144C.01, subdivision 2, shall determine
the amount of the allocation of the prior year's accumulation to
each qualified ambulance service person. The prior year's net
investment gain or loss under paragraph (b) must be allocated
and that year's appropriation, after deduction of administrative
expenses, also must be allocated.
(b) The difference in the market value of the assets of the
ambulance service personnel longevity award and incentive trust
account as of the immediately previous June 30 and the June 30
occurring 12 months earlier must be reported on or before August
15 by the state board of investment. The market value gain or
loss must be expressed as a percentage of the total potential
award accumulations as of the immediately previous June 30, and
that positive or negative percentage must be applied to increase
or decrease the recorded potential award accumulation of each
qualified ambulance service person.
(c) The appropriation for this purpose, after deduction of
administrative expenses, must be divided by the total number of
additional ambulance service personnel years of service
recognized since the last allocation or 1,000 years of service,
whichever is greater. A qualified ambulance service person must
be credited with a year of service if the person is certified by
the chief administrative officer of the ambulance service as
having rendered active ambulance service during the 12 months
ending as of the immediately previous June 30. If the person
has rendered prior active ambulance service, the person must be
additionally credited with one-fifth of a year of service for
each year of active ambulance service rendered before June 30,
1993, but not to exceed in any year one additional year of
service or to exceed in total five years of prior service.
Prior active ambulance service means employment by or the
provision of service to a licensed ambulance service before June
30, 1993, as determined by the person's current ambulance
service based on records provided by the person that were
contemporaneous to the service. The prior ambulance service
must be reported on or before August 15 to the commissioner of
health in an affidavit from the chief administrative officer of
the ambulance service.
Sec. 60. [144C.08] [AMBULANCE SERVICE PERSONNEL LONGEVITY
AWARD.]
(a) A qualified ambulance service person who has terminated
active ambulance service, who has at least five years of
credited ambulance service, who is at least 50 years old, and
who is among the 400 persons with the greatest amount of
credited ambulance service applying for a longevity award during
that year, is entitled, upon application, to an ambulance
service personnel longevity award. An applicant whose
application is not approved because of the limit on the number
of annual awards may apply in a subsequent year.
(b) If a qualified ambulance service person who meets the
age and service requirements specified in paragraph (a) dies
before applying for a longevity award, the estate of the
decedent is entitled, upon application, to the decedent's
ambulance service personnel longevity award, without reference
to the limit on the number of annual awards.
(c) An ambulance service personnel longevity award is the
total amount of the person's accumulations indicated in the
person's separate record under section 144C.07 as of the August
15 preceding the application. The amount is payable only in a
lump sum.
(d) Applications for an ambulance service personnel
longevity award must be received by the commissioner of health
or the commissioner's designee under section 144C.01,
subdivision 2, by August 15, annually. Ambulance service
personnel longevity awards are payable only as of the last
business day in October annually.
Sec. 61. [144C.09] [EFFECT OF CHANGES.]
Subdivision 1. [MODIFICATIONS.] The ambulance service
personnel longevity award and incentive program is a gratuity
established by the state of Minnesota and may be modified by
subsequent legislative enactment at any time without creating
any cause of action for any ambulance service personnel related
to the program as a result. No provision of this act and no
subsequent amendment may be interpreted as causing or resulting
in the program to be funded for federal Internal Revenue Code or
federal Employee Retirement Income Security Act of 1974
purposes, or as causing or resulting in any contributions to or
investment income earned by the ambulance service personnel
longevity award and incentive trust account to be subject to
federal income tax to ambulance service personnel or their
beneficiaries before actual receipt of a longevity award under
section 144C.08.
Subd. 2. [NONASSIGNABILITY.] No entitlement or claim of a
qualified ambulance service person or the person's beneficiary
to an ambulance service personnel longevity award is assignable,
or subject to garnishment, attachment, execution, levy, or legal
process of any kind, except as provided in section 518.58,
518.581, or 518.611. The commissioner of health may not
recognize any attempted transfer, assignment, or pledge of an
ambulance service personnel longevity award.
Subd. 3. [PUBLIC EMPLOYEE STATUS.] Recognizing the
important public function performed by ambulance service
personnel, only for purposes of this act and the receipt of a
state sponsored gratuity in the form of an ambulance service
personnel longevity award, all qualified ambulance service
personnel are considered to be public employees.
Sec. 62. [144C.10] [SCOPE OF ADMINISTRATIVE DUTIES.]
For purposes of administering the award and incentive
program, the commissioner of health cannot hear appeals, direct
ambulance services to take any specific actions, investigate or
take action on individual complaints, or otherwise act on
information beyond that submitted by the licensed ambulance
services.
Sec. 63. Minnesota Statutes 1992, section 149.04, is
amended to read:
149.04 [RENEWAL OF LICENSE.]
Any license may be renewed from time to time and shall be
in force after such renewal for a period specified by the state
commissioner of health upon the payment of a renewal fee in an
amount prescribed by the commissioner pursuant to section
144.122.
All fees received under this chapter shall be paid by the
state commissioner of health to the credit of the general state
government special revenue fund in the state treasury. The
salaries of the necessary employees of the commissioner, the per
diem of the inspectors and examiners, their expenses, and all
incidental expenses of the commissioner in carrying out the
provisions of this chapter shall be paid from the appropriations
made to the state commissioner of health, but no expense or
claim shall be incurred or paid in excess of the amount received
from the fees herein provided.
Sec. 64. Minnesota Statutes 1992, section 157.045, is
amended to read:
157.045 [INCREASE IN FEES.]
For licenses issued for 1989 and succeeding years, the
commissioner of health shall increase license fees for
facilities licensed under this chapter and chapter 327 to a
level sufficient to recover all expenses related to the
licensing, inspection, and enforcement activities prescribed in
those chapters. In calculating the fee increase, the
commissioner shall include the salaries and expenses of 5.5 new
positions required to meet the inspection frequency prescribed
in section 157.04. Fees collected must be deposited in the
special revenue account state government special revenue fund.
Sec. 65. Minnesota Statutes 1992, section 198.34, is
amended to read:
198.34 [DEPOSIT OF RECEIPTS.]
Federal money received by the board for the care of
veterans in a veterans home, after being credited to a federal
receipt account, must be transferred to the general revenue fund
in the state treasury must be deposited into a dedicated account
in the state treasury and is appropriated to the veterans homes
board of directors for the operational needs of the veterans
homes and the board of directors. Money paid to the board by a
veteran or by another person on behalf of a veteran for care in
a veterans home must be deposited in the state treasury and
credited to the general fund in a dedicated account and is
appropriated to the veterans homes board of directors for the
operational needs of the veterans homes and the board of
directors.
Sec. 66. [198.36] [VETERANS HOME; FERGUS FALLS.]
Subdivision 1. [ESTABLISHMENT.] The board shall establish
a veterans home in Fergus Falls to provide at least 60 beds for
skilled nursing care in conformance with licensing rules of the
department of health.
Subd. 2. [FUNDING.] The home must be purchased or built
with funds, 65 percent of which must be provided by the federal
government, and 35 percent by other nonstate sources, including
local units of government, veterans' organizations, and
corporations or other business entities.
Subd. 3. [SUPPORT SERVICES.] Upon request, the department
of human services shall arrange for the extension of support
services to the veterans home in Fergus Falls including, but not
limited to, the provision of utilities, and kitchen and laundry
services.
Sec. 67. Minnesota Statutes 1992, section 214.04,
subdivision 1, is amended to read:
Subdivision 1. [SERVICES PROVIDED.] The commissioner of
administration with respect to the board of electricity, the
commissioner of education with respect to the board of teaching,
the commissioner of public safety with respect to the board of
private detective and protective agent services, and the board
of peace officer standards and training, and the commissioner of
revenue with respect to the board of assessors, shall provide
suitable offices and other space, joint conference and hearing
facilities, examination rooms, and the following administrative
support services: purchasing service, accounting service,
advisory personnel services, consulting services relating to
evaluation procedures and techniques, data processing,
duplicating, mailing services, automated printing of license
renewals, and such other similar services of a housekeeping
nature as are generally available to other agencies of state
government. Investigative services shall be provided the boards
by employees of the office of attorney general. The
commissioner of health with respect to the health-related
licensing boards and shall provide mailing and office supply
services and may provide other facilities and services listed in
this subdivision at a central location upon request of the
health-related licensing boards. The chair of the department
commissioner of commerce with respect to the remaining
non-health-related licensing boards shall provide the above
facilities and services at a central location for
the health-related and remaining non-health-related licensing
boards. The legal and investigative services for the boards
shall be provided by employees of the attorney general assigned
to the departments servicing the boards. Notwithstanding the
foregoing, the attorney general shall not be precluded by this
section from assigning other attorneys to service a board if
necessary in order to insure competent and consistent legal
representation. Persons providing legal and investigative
services shall to the extent practicable provide the services on
a regular basis to the same board or boards.
Sec. 68. Minnesota Statutes 1992, section 214.06,
subdivision 1, is amended to read:
Subdivision 1. [FEE ADJUSTMENT.] Notwithstanding any law
to the contrary, the commissioner of health as authorized by
section 214.13, all health-related licensing boards and all
non-health-related licensing boards shall by rule, with the
approval of the commissioner of finance, adjust any fee which
the commissioner of health or the board is empowered to assess a
sufficient amount so that the total fees collected by each board
will as closely as possible equal anticipated expenditures
during the fiscal biennium, as provided in section 16A.128. For
members of an occupation registered after July 1, 1984, by the
commissioner of health under the provisions of section 214.13,
the fee established must include an amount necessary to recover,
over a five-year period, the commissioner's direct expenditures
for adoption of the rules providing for registration of members
of the occupation. All fees received shall be deposited in the
state treasury. Fees received by the commissioner of health or
health-related licensing boards must be credited to the health
occupations licensing account in the state government special
revenue fund.
Sec. 69. Minnesota Statutes 1992, section 214.06, is
amended by adding a subdivision to read:
Subd. 3. [HEALTH-RELATED LICENSING BOARDS.]
Notwithstanding section 14.22, subdivision 1, clause (3), a
public hearing is not required to be held when the
health-related licensing boards need to raise fees to cover
anticipated expenditures in a biennium. The notice of intention
to adopt the rules, as required under section 14.22, must state
that no hearing will be held.
Sec. 70. [214.103] [HEALTH-RELATED LICENSING BOARDS;
COMPLAINTS; INVESTIGATION AND HEARING.]
Subdivision 1. [APPLICATION.] For purposes of this
section, "board" means "health-related licensing board" and does
not include non-health-related licensing boards. Nothing in
this section supersedes section 214.10, subdivisions 2a, 3, 8,
and 9, as they apply to the health-related licensing boards.
Subd. 2. [RECEIPT OF COMPLAINT.] The boards shall receive
and resolve complaints or other communications, whether oral or
written, against regulated persons. Before resolving an oral
complaint, the executive director or a board member designated
by the board to review complaints may require the complainant to
state the complaint in writing. The executive director or the
designated board member shall determine whether the complaint
alleges or implies a violation of a statute or rule which the
board is empowered to enforce. The executive director or the
designated board member may consult with the designee of the
attorney general as to a board's jurisdiction over a complaint.
If the executive director or the designated board member
determines that it is necessary, the executive director may seek
additional information to determine whether the complaint is
jurisdictional or to clarify the nature of the allegations by
obtaining records or other written material, obtaining a
handwriting sample from the regulated person, clarifying the
alleged facts with the complainant, and requesting a written
response from the subject of the complaint.
Subd. 3. [REFERRAL TO OTHER AGENCIES.] The executive
director shall forward to another governmental agency any
complaints received by the board which do not relate to the
board's jurisdiction but which relate to matters within the
jurisdiction of another governmental agency. The agency shall
advise the executive director of the disposition of the
complaint. A complaint or other information received by another
governmental agency relating to a statute or rule which a board
is empowered to enforce must be forwarded to the executive
director of the board to be processed in accordance with this
section.
Subd. 4. [ROLE OF THE ATTORNEY GENERAL.] The executive
director or the designated board member shall forward a
complaint and any additional information to the designee of the
attorney general when the executive director or the designated
board member determines that a complaint is jurisdictional and
(1) requires investigation before the executive director or the
designated board member may resolve the complaint; (2) that
attempts at resolution for disciplinary action or the initiation
of a contested case hearing is appropriate; (3) that an
agreement for corrective action is warranted; or (4) that the
complaint should be dismissed, consistent with subdivision 8.
Subd. 5. [INVESTIGATION BY ATTORNEY GENERAL.] If the
executive director or the designated board member determines
that investigation is necessary before resolving the complaint,
the executive director shall forward the complaint and any
additional information to the designee of the attorney general.
The designee of the attorney general shall evaluate the
communications forwarded and investigate as appropriate. The
designee of the attorney general may also investigate any other
complaint forwarded under subdivision 3 when the designee of the
attorney general determines that investigation is necessary. In
the process of evaluation and investigation, the designee shall
consult with or seek the assistance of the executive director or
the designated board member. The designee may also consult with
or seek the assistance of other qualified persons who are not
members of the board who the designee believes will materially
aid in the process of evaluation or investigation. Upon
completion of the investigation, the designee shall forward the
investigative report to the executive director.
Subd. 6. [ATTEMPTS AT RESOLUTION.] (a) At any time after
receipt of a complaint, the executive director or the designated
board member may attempt to resolve the complaint with the
regulated person. The available means for resolution include a
conference or any other written or oral communication with the
regulated person. A conference may be held for the purposes of
investigation, negotiation, education, or conciliation. The
results of attempts at resolution with the regulated person may
include a recommendation to the board for disciplinary action,
an agreement between the executive director or the designated
board member and the regulated person for corrective action, or
the dismissal of a complaint. If attempts at resolution are not
in the public interest or are not satisfactory to the executive
director or the designated board member, then the executive
director or the designated board member may initiate a contested
case hearing.
(1) The designee of the attorney general shall represent
the board in all attempts at resolution which the executive
director or the designated board member anticipate may result in
disciplinary action. The available remedies for disciplinary
action by consent with the regulated person are those listed in
section 214.108, subdivision 4. A stipulation between the
executive director or the designated board member and the
regulated person shall be presented to the board for the board's
consideration. An approved stipulation and resulting order
shall become public data.
(2) The designee of the attorney general shall represent
the board upon the request of the executive director or the
designated board member in all attempts at resolution which the
executive director or the designated board member anticipate may
result in corrective action. Any agreement between the
executive director or the designated board member and the
regulated person for corrective action shall be in writing and
shall be reviewed by the designee of the attorney general prior
to its execution. The agreement for corrective action shall
provide for dismissal of the complaint upon successful
completion by the regulated person of the corrective action.
(b) Upon receipt of a complaint alleging sexual contact or
sexual conduct with a client, the board must forward the
complaint to the designee of the attorney general for an
investigation. If, after it is investigated, the complaint
appears to provide a basis for disciplinary action, the board
shall resolve the complaint by disciplinary action or initiate a
contested case hearing. Notwithstanding paragraph (a), clause
(2), a board may not take corrective action or dismiss a
complaint alleging sexual contact or sexual conduct with a
client unless, in the opinion of the executive director, the
designated board member, and the designee of the attorney
general, there is insufficient evidence to justify disciplinary
action.
Subd. 7. [CONTESTED CASE HEARING.] If the executive
director or the designated board member determines that attempts
at resolution of a complaint are not in the public interest or
are not satisfactory to the executive director or the designated
board member, the executive director or the designated board
member, after consultation with the designee of the attorney
general, may initiate a contested case hearing under chapter
14. The designated board member or any board member who was
consulted during the course of an investigation may participate
at the contested case hearing. A designated or consulted board
member may not deliberate or vote in any proceeding before the
board pertaining to the case.
Subd. 8. [DISMISSAL OF A COMPLAINT.] A complaint may not
be dismissed without the concurrence of two board members. The
designee of the attorney general must review before dismissal
any complaints which allege any violation of chapter 609, any
conduct which would be required to be reported under section
626.556 or 626.557, any sexual contact or sexual conduct with a
client, any violation of a federal law, any actual or potential
inability to practice the regulated profession or occupation by
reason of illness, use of alcohol, drugs, chemicals, or any
other materials, or as a result of any mental or physical
condition, any violation of state medical assistance laws, or
any disciplinary action related to credentialing in another
jurisdiction or country which was based on the same or related
conduct specified in this subdivision.
Subd. 9. [INFORMATION TO COMPLAINANT.] A board shall
furnish to a person who made a complaint a description of the
actions of the board relating to the complaint.
Subd. 10. [PROHIBITED PARTICIPATION BY BOARD MEMBER.] A
board member who has actual bias or a current or former direct
financial or professional connection with a regulated person may
not vote in board actions relating to the regulated person.
Sec. 71. Minnesota Statutes 1992, section 256B.0625,
subdivision 14, is amended to read:
Subd. 14. [DIAGNOSTIC, SCREENING, AND PREVENTIVE
SERVICES.] (a) Medical assistance covers diagnostic, screening,
and preventive services.
(b) "Preventive services" include services related to
pregnancy, including services for those conditions which may
complicate a pregnancy and which may be available to a pregnant
woman determined to be at risk of poor pregnancy outcome.
Preventive services available to a woman at risk of poor
pregnancy outcome may differ in an amount, duration, or scope
from those available to other individuals eligible for medical
assistance.
(c) "Screening services" include, but are not limited to,
blood lead tests.
Sec. 72. Minnesota Statutes 1992, section 326.44, is
amended to read:
326.44 [FEES PAID TO GENERAL STATE GOVERNMENT SPECIAL
REVENUE FUND.]
All fees received under sections 326.37 to 326.45 shall be
deposited by the state commissioner of health to the credit of
the general state government special revenue fund in the state
treasury. The salaries of the necessary employees of the
commissioner and the per diem of the inspectors and examiners
hereinbefore provided, their expenses and all incidental
expenses of the commissioner in carrying out the provisions of
sections 326.37 to 326.45, shall be paid, from the
appropriations made to the state commissioner of health, but no
expense or claim shall be incurred or paid in excess of the
amount received from the fees herein provided.
Sec. 73. Minnesota Statutes 1992, section 326.75,
subdivision 4, is amended to read:
Subd. 4. [DEPOSIT OF FEES.] Fees collected under this
section shall be deposited in the general state government
special revenue fund.
Sec. 74. Minnesota Statutes 1992, section 462A.03,
subdivision 15, is amended to read:
Subd. 15. [REHABILITATION.] "Rehabilitation" means the
repair, reconstruction, or improvement of existing residential
housing with the object of making such residential housing
decent, safe, sanitary and more desirable to live in, of greater
market value or in conformance with state, county, or city
health, housing, building, fire prevention, and housing
maintenance codes, and lead and other public standards
applicable to housing, as determined by the agency.
Sec. 75. [REPEALER.]
Subdivision 1. [LEAD ABATEMENT.] Minnesota Statutes 1992,
sections 144.8721; 144.874, subdivision 10; and 144.878,
subdivision 2a, are repealed.
Subd. 2. [INFECTIOUS WASTE.] Minnesota Statutes 1992,
sections 116.76, subdivision 7; 116.79, subdivision 3; 116.81,
subdivision 2; and 116.83, subdivision 2, are repealed.
Minnesota Rules, parts 4622.0100; 4622.0300; 4622.0400;
4622.0600; 4622.0700; 4622.0900; 4622.1000; 4622.1050;
4622.1100; 4622.1150; and 4622.1200, are repealed.
Subd. 3. [MENTAL HEALTH PRACTICE EXPENSES.] Minnesota
Statutes 1992, section 148B.72, is repealed effective June 30,
1993.
Subd. 4. [ADVISORY COUNCIL.] Minnesota Statutes 1992,
section 214.141, is repealed.
Sec. 76. [EFFECTIVE DATE.]
Sections 1, 13 to 17, 24 to 51, 71, 74, and 75, subdivision
1, are effective the day following final enactment. Section 60
is effective July 1, 1995.
Presented to the governor May 27, 1993
Signed by the governor May 27, 1993, 4:22 p.m.
Official Publication of the State of Minnesota
Revisor of Statutes