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Minnesota Session Laws - 1995, Regular Session
Key: (1) language to be deleted (2) new language
CHAPTER 207-S.F.No. 1110
An act relating to human services; including
provisions for human services administration; life
skills and self-sufficiency; childrens' programs;
economic self-sufficiency; medical assistance and
general assistance medicare; long-term care; community
mental health and regional treatment centers; health
department; child support enforcement; department of
human services flexibility reforms; appropriating
money; amending Minnesota Statutes 1994, sections
14.03, subdivision 3; 16B.08, subdivision 5; 62A.045;
62A.046; 62A.048; 62A.27; 62N.381, subdivisions 2, 3,
and 4; 144.0721, by adding subdivisions; 144.0723,
subdivisions 1, 2, 3, 4, and 6; 144.122; 144.226,
subdivision 1; 144.56, by adding a subdivision;
144.562, subdivision 2; 144.702, subdivision 2;
144.801, subdivisions 3 and 5; 144.802; 144.803;
144.804; 144.806; 144.807; 144.808; 144.809; 144.8091;
144.8093; 144.8095; 144A.071, subdivisions 2, 3, 4a,
and by adding a subdivision; 144A.073, subdivisions 1,
2, 3, 4, 5, 8, and by adding a subdivision; 144A.31,
subdivision 2a; 144A.33, subdivision 3; 144A.43,
subdivision 3; 144A.47; 144B.01, subdivision 5;
144C.01, subdivision 2; 144C.05, subdivision 1;
144C.07; 144C.08; 144C.09, subdivision 2; 144C.10;
145A.15; 147.01, subdivision 6; 148.921, subdivision
2; 157.03; 171.07, by adding a subdivision; 198.003,
subdivisions 3 and 4; 245.041; 245.4871, subdivisions
12, 33a, and by adding a subdivision; 245.4873,
subdivisions 2 and 6; 245.4874; 245.4875, subdivision
2, and by adding a subdivision; 245.4878; 245.4882,
subdivision 5; 245.4885, subdivision 2; 245.4886, by
adding a subdivision; 245.492, subdivisions 2, 6, 9,
and 23; 245.493, subdivision 2; 245.4932, subdivisions
1, 2, 3, and 4; 245.494, subdivisions 1, 2, and 3;
245.495; 245.496, subdivision 3, and by adding a
subdivision; 245.825; 245A.02, by adding a
subdivision; 245A.03, subdivision 2a; 245A.04,
subdivisions 3, 3b, 7, and 9; 245A.06, subdivisions 2,
4, and by adding a subdivision; 245A.07, subdivision
3; 245A.09, by adding subdivisions; 245A.14,
subdivisions 6 and 7; 246.18, subdivision 4, and by
adding a subdivision; 246.23, subdivision 2; 246.56,
by adding a subdivision; 252.27, subdivisions 1, 1a,
2a, and by adding subdivisions; 252.275, subdivisions
3, 4, and 8; 252.292, subdivision 4; 252.46,
subdivisions 1, 3, 6, 17, and by adding subdivisions;
253B.091; 254A.17, subdivision 3; 254B.02, subdivision
1; 254B.05, subdivisions 1 and 4; 256.014, subdivision
1; 256.015, subdivisions 1, 2, and 7; 256.025,
subdivisions 1, 2, and 3; 256.026; 256.034,
subdivision 1; 256.045, subdivisions 3, 4, 4a, and 5;
256.12, subdivision 14; 256.73, subdivisions 2 and 3a;
256.736, subdivisions 3 and 13; 256.74, subdivision 1,
and by adding a subdivision; 256.76, subdivision 1;
256.8711; 256.9353, subdivision 8; 256.9365; 256.9657,
subdivisions 3 and 4; 256.9685, subdivision 1b, and by
adding subdivisions; 256.969, subdivisions 1, 2b, 9,
10, 16, and by adding subdivisions; 256.975, by adding
a subdivision; 256.98, subdivisions 1 and 8; 256.983,
subdivision 4; 256B.042, subdivision 2; 256B.055,
subdivision 12; 256B.056, subdivision 4, and by adding
a subdivision; 256B.0575; 256B.059, subdivisions 1, 3,
and 5; 256B.0595, subdivisions 1, 2, 3, and 4;
256B.06, subdivision 4; 256B.0625, subdivisions 5, 8,
8a, 13, 13a, 17, 18, 19a, 37, and by adding
subdivisions; 256B.0627, subdivisions 1, 2, 4, and 5;
256B.0628, subdivision 2, and by adding a subdivision;
256B.0641, subdivision 1; 256B.0911, subdivisions 2,
2a, 3, 4, and 7; 256B.0913, subdivisions 4, 5, 8, 12,
14, and by adding subdivisions; 256B.0915,
subdivisions 2, 3, 5, and by adding subdivisions;
256B.092, subdivision 4, and by adding a subdivision;
256B.093, subdivisions 1, 2, 3, and by adding a
subdivision; 256B.15, subdivisions 1a, 2, and by
adding a subdivision; 256B.19, subdivisions 1b, 1c,
and 1d; 256B.27, subdivision 2a; 256B.431,
subdivisions 2b, 2j, 15, 17, 23, and by adding a
subdivision; 256B.432, subdivisions 1, 2, 3, 5, and 6;
256B.49, subdivision 1, and by adding subdivisions;
256B.501, subdivisions 1, 3, 3c, 3g, 8, and by adding
subdivisions; 256B.69, subdivisions 4, 5, 6, 9, and by
adding subdivisions; 256D.02, subdivision 5; 256D.03,
subdivisions 3, 3b, and 4; 256D.05, subdivision 7;
256D.36, subdivision 1; 256D.385; 256D.405,
subdivision 3; 256D.425, subdivision 1, and by adding
a subdivision; 256D.435, subdivisions 1, 3, 4, 5, 6,
and by adding a subdivision; 256D.44, subdivisions 1,
2, 3, 4, 5, and 6; 256D.45, subdivision 1; 256D.46,
subdivisions 1 and 2; 256D.48, subdivision 1; 256E.08,
subdivision 6; 256E.115; 256F.01; 256F.02; 256F.03,
subdivision 5, and by adding a subdivision; 256F.04,
subdivisions 1 and 2; 256F.05, subdivisions 2, 3, 4,
5, 7, 8, and by adding a subdivision; 256F.06,
subdivisions 1, 2, and 4; 256F.09; 256H.01,
subdivisions 9 and 12; 256H.02; 256H.03, subdivisions
1, 2a, 4, 6, and by adding a subdivision; 256H.05,
subdivision 6; 256H.08; 256H.11, subdivision 1;
256H.12, subdivisions 1, 3, and by adding a
subdivision; 256H.15, subdivision 1; 256H.18; 256H.20,
subdivision 3a; 256I.03, subdivision 5, and by adding
a subdivision; 256I.04, subdivisions 2b and 3;
256I.05, subdivisions 1, 1a, and 5; 256I.06,
subdivisions 2 and 6; 257.3571, subdivision 1;
257.3572; 257.3577, subdivision 1; 257.55, subdivision
1; 257.57, subdivision 2; 257.62, subdivisions 1, 5,
and 6; 257.64, subdivision 3; 257.69, subdivisions 1
and 2; 393.07, subdivisions 5 and 10; 393.12; 447.32,
subdivision 5; 501B.89, subdivision 1, and by adding a
subdivision; 518.171, subdivisions 1, 3, 4, 5, 7, and
8; 518.611, subdivisions 2 and 4; 518.613, subdivision
7; 518.615, subdivision 3; 524.6-207; 550.37,
subdivision 14; and Laws 1993, First Special Session
chapter 1, article 7, section 51, subdivision 5; and
article 8, section 30, subdivision 2; proposing coding
for new law in Minnesota Statutes, chapters 144; 145;
157; 214; 245; 245A; 256; and 256B; proposing coding
for new law as Minnesota Statutes, chapters 144D; and
144E; repealing Minnesota Statutes 1994, sections
38.161; 38.162; 62C.141; 62C.143; 62D.106; 62E.04,
subdivisions 9 and 10; 144.8097; 144A.31, subdivisions
2b, 4, 5, 6, and 7; 157.01; 157.02; 157.031; 157.04;
157.045; 157.05; 157.08; 157.12; 157.13; 157.14;
245.492, subdivision 20; 245.825, subdivision 2;
245.98, subdivision 3; 252.275, subdivisions 4a and
10; 256.851; 256D.35, subdivisions 14 and 19; 256D.36,
subdivision 1a; 256D.37; 256D.425, subdivision 3;
256D.435, subdivisions 2, 7, 8, 9, and 10; 256D.44,
subdivision 7; 256E.06, subdivisions 12 and 13;
256F.05, subdivisions 2a and 4a; 256F.06, subdivision
3; 256F.09, subdivision 4; and 256H.03, subdivisions 2
and 5.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
APPROPRIATIONS
Section 1. [HEALTH AND 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 "1996" and "1997" where
used in this article, mean that the appropriation or
appropriations listed under them are available for the fiscal
year ending June 30, 1996, or June 30, 1997, respectively.
Where a dollar amount appears in parentheses, it means a
reduction of an appropriation.
SUMMARY BY FUND
APPROPRIATIONS BIENNIAL
1996 1997 TOTAL
General $2,402,943,000 $2,598,629,000 $5,001,572,000
Local Government
Trust Fund 50,499,000 -0- 50,499,000
State Government
Special Revenue 24,853,000 24,830,000 49,683,000
Metropolitan Landfill
Contingency Action Fund 193,000 193,000 386,000
Trunk Highway 1,513,000 1,513,000 3,026,000
Special Revenue 8,000 8,000 16,000
TOTAL 2,480,009,000 2,625,173,000 5,105,182,000
APPROPRIATIONS
Available for the Year
Ending June 30
1996 1997
Sec. 2. COMMISSIONER OF
HUMAN SERVICES
Subdivision 1. Total
Appropriation 2,395,537,000 2,540,250,000
Summary by Fund
General 2,345,038,000 2,540,250,000
Local Government
Trust Fund 50,499,000 -0-
Subd. 2. Finance and Management
General
20,126,000 21,396,000
[RECEIPTS FOR SYSTEMS PROJECTS.]
Appropriations and federal receipts for
information system projects for MAXIS,
electronic benefit system, social
services information system, child
support enforcement, and Minnesota
medicaid information system (MMIS II)
must be deposited in the state system
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.
[COMMUNICATION COSTS.] The commissioner
shall continue to operate the
department of human services
communication systems account
established in Laws 1993, First Special
Session chapter 1, article 1, section
2, subdivision 2, to manage shared
communication costs necessary for the
operation of the programs the
commissioner supervises. 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 may
accept on behalf of the state any gift,
bequest, devise, or personal property
of any kind or money tendered to the
state for any lawful purpose pertaining
to the communication activities of the
department. Any money so received must
be deposited in the department of human
services 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.
[ISSUANCE OPERATIONS CENTER.] Payments
to the commissioner from other
governmental units and private
enterprises for (1) services performed
by the issuance operations center or (2)
reports generated by the payment and
eligibility systems must be deposited
in the state systems account authorized
in Minnesota Statutes, section
256.014. These payments are
appropriated to the commissioner for
the operation of the issuance center or
system, in accordance with Minnesota
Statutes, section 256.014.
[SOCIAL SERVICES INFORMATION PROJECT.]
If the commissioner proceeds with the
development and implementation of the
social services information system
(SSIS), the commissioner shall report
annually by February 1 on the status of
the project to the chairs of the house
health and human services committee and
of the senate health care and family
services committees. This report must
include an explanation of the linkages
between the SSIS and the MAXIS and MMIS
computer systems. The SSIS project
must not result in an increase in the
permanent staff of the department of
human services.
[PRINTING COSTS.] In order to reduce
printing costs, the commissioner shall
solicit bids for printing from inmate
work programs operated by the
department of corrections.
Subd. 3. Life Skills
Self-Sufficiency
114,755,000 120,918,000
Summary by Fund
General 64,256,000 120,918,000
Local Government
Trust 50,499,000 -0-
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) Semi-Independent Living
Services (SILS) Grants
4,766,000 4,819,000
(b) Chemical Dependency
Consolidated Treatment
41,230,000 45,080,000
(c) Deaf and Hard of Hearing
Services Grants
501,000 501,000
(d) Community Social Services Grants
51,476,000 52,902,000
Summary by Fund
General 977,000 52,902,000
Local Government
Trust 50,499,000 -0-
[CSSA APPROPRIATION.] The increased
appropriation available in fiscal year
1996 and thereafter must be used to
increase each county's aid
proportionately over the aid received
in calendar year 1994.
(e) Consumer Support
125,000 1,832,000
(f) Developmental Disabilities
Family Support Grants
1,599,000 1,074,000
(g) Aging Ombudsman
166,000 166,000
(h) Aging Grants
4,103,000 4,103,000
(i) American Indian Chemical
Dependency Grants and Chemical
Dependency Special Grants
2,265,000 2,265,000
(j) Chemical Dependency
Consolidated Treatment - Nonentitled
2,100,000 2,100,000
(k) Administration and Other Grants
6,424,000 6,076,000
[CROSS-CULTURAL TRAINING.] Of this
appropriation, $50,000 each year is for
cross-cultural training for deaf and
hard of hearing children and their
families and is available only upon the
receipt of $25,000 each year in
nonstate matching funds.
[INDIAN ELDERS.] The Minnesota board on
aging shall provide staff out of the
available appropriation to support the
Indian elders coordinator position.
[USE OF MENTAL HEALTH COLLABORATIVE
FUNDS.] Once a children's mental health
collaborative has been formed, the
commissioner may provide and a
collaborative may receive funding for
two years for planning and
implementation purposes. This does not
preclude existing collaboratives from
getting additional start-up funds.
[CHEMICAL DEPENDENCY RATE FREEZE.]
Beginning January 1, 1996, rates for
chemical dependency treatment services
provided according to Minnesota
Statutes, chapter 254B, shall be the
same as those rates negotiated
according to Minnesota Statutes,
section 254B.03, subdivision 1,
paragraph (b), and effective January 1,
1995. Rates for vendors under
Minnesota Statutes, chapter 254B, who
are enrolled after January 1, 1995,
shall not be higher than the statewide
average rate for vendors licensed at
the same level of care. Counties and
providers shall not negotiate an
increase in rates between January 1,
1995, and December 31, 1997.
[SILS TRANSFER.] (a) For the purpose of
transferring certain persons from the
semi-independent living services (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 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 9525.2140, if the services
remain nonresidential as defined in
Minnesota Statutes, section 245A.02,
subdivision 10. For the purposes 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.
(b) Contingent upon continuing 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 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.
[NEW ICF/MR.] For the fiscal year
ending June 30, 1996, a newly
constructed or newly established
intermediate care facility for persons
with mental retardation 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 to 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.
[ICF/MR RECEIVERSHIP.] For the fiscal
year ending June 30, 1996, if a
facility which is in receivership under
Minnesota Statutes, section 245A.12 or
245A.13, is sold to an unrelated
organization: (a) the facility shall
be considered a newly established
facility for rate setting purposes,
notwithstanding any provisions to the
contrary in Minnesota Statutes, section
256B.501, subdivision 11; 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.
[GRH TO CSSA TRANSFER.] For the fiscal
year ending June 30, 1995, the
commissioner may transfer funds from
the group residential housing (GRH)
account to county community social
services act (CSSA) grants to provide
continuous funding for persons no
longer eligible for GRH payments for
the following reasons: they reside in
a setting with only a semi-independent
living services license; or they reside
in family foster care settings and have
become ineligible for GRH difficulty of
care payments due to receipt of mental
retardation/related conditions waivered
services. The amount to be transferred
must not exceed the amount of GRH
payments for actual residents in the
affected GRH settings during the fiscal
year 1995. The amount transferred is
to be added to the affected county's
CSSA base. This paragraph is effective
the day following final enactment.
[COUNTY MAINTENANCE-MEALS-AGING.] 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 1995.
Subd. 4. Children's Program 19,860,000 21,453,000
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) Children's Trust Fund Grants
247,000 247,000
(b) Families With Children
Services Grants and Administration
1,718,000 1,710,000
(c) Family Service Collaborative Grants
1,000,000 1,500,000
(d) Family Preservation, Family Support,
and Child Protection Grants
8,573,000 8,573,000
(e) Subsidized Adoption Grants
5,587,000 6,688,000
(f) Other Families with Children
Services Grants
2,735,000 2,735,000
[FAMILY SERVICES COLLABORATIVE.] Plans
for the expenditure of funds for family
services collaboratives must be
approved by the children's cabinet
according to criteria in Minnesota
Statutes, section 121.8355. Money
appropriated for these purposes may be
expended in either year of the
biennium. Money appropriated for
family services collaboratives is also
available for start-up funds under
Minnesota Statutes, section 245.492,
subdivision 19, for children's mental
health collaboratives.
[HOME CHOICE PROGRAM.] Of this
appropriation, $75,000 each year must
be used as a grant to the metropolitan
council to support the housing and
related counseling component of the
home choice program.
[FOSTER CARE.] Foster care, as defined
in Minnesota Statutes, section 260.015,
subdivision 7, is not a community
social service as defined in Minnesota
Statutes, section 256E.03, subdivision
2, paragraph (a). This paragraph is
effective the day following final
enactment.
[NEW CHANCE.] 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.
[HIPPY CARRY FORWARD.] $50,000 in
unexpended money appropriated in fiscal
year 1995 for the Home Instruction
Program for Preschool Youngsters
(HIPPY) in Laws 1994, chapter 636,
article 1, section 11, does not cancel
but is available for the same purposes
for fiscal year 1996.
[COMMUNITY COLLABORATIVE MATCHING
GRANT.] Of the funds appropriated for
family services collaboratives, $75,000
in fiscal year 1996 shall be used for
the commissioner of human services to
provide a matching grant for community
collaborative projects for children and
youth developed by a regional
organization established under
Minnesota Statutes, section 116N.08, to
receive rural development challenge
grants. The regional organization must
include a broad cross-section of public
and private sector community
representatives to develop programs,
services or facilities to address
specific community needs of children
and youth. The regional organization
must also provide a two-to-one match of
nonstate dollars for this grant.
[INDIAN CHILD WELFARE GRANTS.] $100,000
is appropriated from the general fund
to the commissioner of human services
for the purposes of providing
compliance grants to an Indian child
welfare defense corporation, pursuant
to Minnesota Statutes, section
257.3571, subdivision 2a, to be
available until June 30, 1997.
Subd. 5. Economic Self-Sufficiency
General
317,950,000 321,696,000
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) STRIDE Grants
8,939,000 8,211,000
(b) AFDC Grants
143,568,000 146,772,000
(c) General Assistance Grants
45,707,000 45,009,000
(d) Work Readiness Grants
1,573,000 -0-
(e) Minnesota Supplemental Aid
22,493,000 25,757,000
(f) Minnesota Family Investment
Plan (MFIP) Grants
21,307,000 15,150,000
(g) Child-Care Fund Entitlement Grants
17,208,000 19,780,000
(h) Child Support Enforcement Grants
9,785,000 9,785,000
(i) Child Care Fund - Nonentitled
15,526,000 19,751,000
(j) Administration and Other Grants
31,844,000 31,481,000
[FOOD STAMP EMPLOYMENT AND TRAINING.]
Federal food stamp employment and
training funds are appropriated to the
commissioner to reimburse counties for
food stamp employment and training
expenditures.
[STATE TAKEOVER ACCELERATION.]
Notwithstanding Minnesota Statutes,
section 256.025, $800,000 of the funds
appropriated for fiscal year 1996 under
Minnesota Statutes, section 256.026,
shall be used to reimburse the county
share of project STRIDE case management
and work readiness employment and
training services for the first six
months of calendar year 1995.
[CASH BENEFITS IN ADVANCE.] The
commissioner, with the advance approval
of the commissioner of finance, is
authorized to issue cash assistance
benefits up to two days before the
first day of each month, including two
days before the start of each state
fiscal year. Of the money appropriated
for the aid to families with dependent
children program for fiscal year 1996,
$12,000,000 is available in fiscal year
1995. If that amount is insufficient
for the costs incurred, an additional
amount of the fiscal year 1996
appropriation as needed may be
transferred with the advance approval
of the commissioner of finance. This
paragraph is effective the day
following final enactment.
[MFIP TRANSFER.] Unexpended money
appropriated for the Minnesota family
investment plan in fiscal year 1996
does not cancel but is available for
those purposes in fiscal year 1997.
[PATERNITY ESTABLISHMENT.] Federal
matching funds from the hospital
acknowledgment reimbursement program
may be retained by the commissioner to
establish paternity in child support
cases. These federal matching funds
are appropriated to the commissioner
and must be used for education and
public information concerning paternity
establishment and the prevention of
nonmarital births.
[CHILD SUPPORT INCENTIVES.] The
commissioner may transfer money
appropriated for child support
enforcement county performance
incentives for fiscal years 1996 and
1997 between county performance
incentive accounts. Unexpended money
in fiscal year 1996 does not cancel but
is available for county performance
incentives in fiscal year 1997.
[MINNESOTA PARENTS' FAIR SHARE.]
Unexpended money appropriated for
Minnesota parents' fair share in fiscal
year 1996 does not cancel but is
available to the commissioner for this
program in fiscal year 1997.
[GA/AFDC TO SSI CONVERSION.] The
commissioner may contract with a
private entity to convert general
assistance and AFDC recipients to the
federal Supplemental Security Income
program. The contract shall pay only
for cases successfully converted, at a
rate to be negotiated by the
commissioner.
[GA STANDARD.] The commissioner shall
set the monthly standard of assistance
for general assistance units consisting
of an adult recipient who is childless
and unmarried or living apart from his
or her parents or a legal guardian at
$203.
[AFDC SUPPLEMENTARY GRANTS.] 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.
[WORK READINESS ELIMINATION.]
Notwithstanding Minnesota Statutes,
section 256.025, $1,573,000 of the
funds appropriated for fiscal year 1996
under Minnesota Statutes, section
256.026, must be used to reimburse the
county share of work readiness grants
for the first six months of calendar
year 1995.
[FEDERAL WELFARE REFORM.]
Notwithstanding the provisions of
Minnesota Statutes, section 256.011 or
any other law to the contrary, the
commissioner of human services may not
implement changes in human services
block grants and entitlement programs
mandated by the 104th Congress, without
authorization by the Minnesota
Legislature.
Subd. 6. Health Care
General
1,668,242,000 1,794,408,000
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) Group Residential Housing Grants
48,284,000 54,776,000
(b) MA Long-Term Care Facilities
540,531,000 556,857,000
(c) MA Long-Term Care Waivers
and Home Care
202,821,000 217,781,000
(d) MA Managed Care and
Fee-for-Service
581,671,000 659,554,000
(e) General Assistance Medical Care
224,007,000 230,400,000
(f) Alternative Care
37,251,000 41,053,000
(g) Medicaid Management
Information System
10,657,000 10,657,000
(h) Administration and Other Grants
23,020,000 23,330,000
[PREADMISSION SCREENING TRANSFER.]
Effective the day following final
enactment, up to $40,000 of the
appropriation for preadmission
screening and alternative care for
fiscal year 1995 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.
[ICF/MR AND NURSING FACILITY
INFLATION.] 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, 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.
[ICF/MR RATE EXEMPTIONS.] For the rate
year beginning October 1, 1995, the
commissioner shall exempt ICF/MR
facilities from reductions to the
payment rates under Minnesota Statutes,
section 256B.501, subdivision 5b, if
the facility: (1) has had a settle-up
payment rate established in the
reporting year preceding the rate year
for a one-time rate adjustment; (2) is
a newly established facility; (3) is an
A to B licensure conversion project
under the reimbursement rule; (4) has a
payment rate subject to a community
conversion project under Minnesota
Statutes, section 252.292; or (5) has a
payment rate established under
Minnesota Statutes, section 245A.12 or
245A.13. The commissioner shall
consider these exceptions in the
promulgation of permanent rules for
payment rates to be effective on or
after October 1, 1996.
[MINNESOTACARE PHARMACY.]
Notwithstanding the amendments in this
act to Minnesota Statutes, section
256B.0625, subdivision 13, the pharmacy
dispensing fee in the MinnesotaCare
program shall be $4.10.
[ALTERNATIVE CARE TRANSFER.] Any money
allocated to the alternative care
program that is not spent for the
purposes indicated does not cancel but
shall be transferred to the medical
assistance account.
[RATABLE REDUCTION.] For services
rendered on or after July 1, 1995, the
commissioner shall ratably reduce
general assistance medical care
payments for all services except
pharmacy services by 4.0 percent.
[INFLATIONARY FORECAST ERRORS.] The
commissioner shall adjust the medical
assistance hospital cost index under
Minnesota Statutes, section 256.969,
subdivision 1, for admissions occurring
on or after July 1, 1995, to recover
payments under both medical assistance
and general assistance medical care
made to hospitals in prior years in
which projected inflation exceeded
actual inflation. The adjustment shall
be determined by the commissioner and
established at a level sufficient to
recover the difference between
projected inflation and actual
inflation for rate years 1990 to 1992
by June 30, 1997.
[PREADMISSION SCREENING RATE.] The
preadmission screening payment to all
counties shall continue at the payment
amount in effect for fiscal year 1995.
[PAS/AC APPROPRIATION.] The
commissioner may expend the money
appropriated for preadmission screening
and the alternative care program for
these purposes in either year of the
biennium.
[SAIL TRANSFER.] Appropriations for
administrative costs associated with
the senior's agenda for independent
living (SAIL) program may be
transferred to SAIL grants as the
commissioner determines necessary to
facilitate the delivery of the program.
[STUDY OF OUTPATIENT RATES.] The
commissioner shall conduct a review of
payment rates and methodologies for
medical services that are provided on
an outpatient basis. The commissioner
may convene a review panel that is
comprised of agency staff and staff
from hospitals and physician clinics to
assist in the review. The commissioner
shall submit a report on the results of
the review, along with any
recommendations for changes to the
payment system for outpatient services,
to the governor and the legislature by
January 15, 1996.
[ADDITIONAL WAIVERED SERVICES.] (a) The
commissioner shall seek the necessary
amendments to home and community-based
waiver programs to provide services to
persons who, due to the inability to
direct their own care, are no longer
eligible for personal care assistant
services but are eligible for the
community alternatives for disabled
individuals (CADI), community
alternative care (CAC), mental
retardation or related conditions
(MR/RC), traumatic brain injury (TBI),
or elderly waivers. These recipients
who transfer from personal care
services to home and community-based
waiver programs shall not be denied
personal care services until waivered
services are available.
(b) Notwithstanding Minnesota Rules,
parts 9525.1800 to 9525.1930 and
Minnesota Statutes, section 256B.092,
subdivision 4, resources for home and
community-based services for persons
with mental retardation or related
conditions, made available for the
purpose of providing alternative
services for persons affected by the
PCA restructuring, shall be allocated
based on criteria that considers the
assessed needs and home care
authorization levels of persons
affected by the restructuring and
provides preference to these persons
during the allocation process.
[CHILDREN INELIGIBLE FOR TEFRA.] When a
child is determined ineligible for
TEFRA or a child or adult for PCA
services, the commissioner shall
provide the adult or the child's parent
or guardian with information on how to
apply for alternative services from the
county, the local mental health
collaborative, the public health
agency, the departments of health and
human services, and the Minnesota
comprehensive health association.
[ALLOCATION OF WAIVERED SLOTS.] 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. Any unexpended appropriations
from the regional treatment center
supplements for state enhanced waiver
slots shall be transferred into the
regional treatment center salary
account.
[CONSUMER SATISFACTION SURVEY.] Any
federal matching money received through
the medical assistance program for the
consumer satisfaction survey is
appropriated to the commissioner for
this purpose. The commissioner may
expend the federal money received for
the consumer satisfaction survey in
either year of the biennium.
[NURSING HOME GEOGRAPHIC GROUPS.] The
commissioner shall report to the chairs
of the senate health care and family
services finance division and the house
health and human services finance
division by January 15, 1996, with
recommendations for changes in the
current geographic grouping of nursing
homes. The recommendations shall take
into account changes in the federal
definition of standard metropolitan
statistical areas and inequities that
result from the current groupings.
[LONG-TERM CARE OPTIONS PROJECT.]
Federal funds received by the
commissioner of human services for the
long-term care options project may be
transferred among object of expenditure
classifications as the commissioner
determines necessary for the
implementation of the project.
[MORATORIUM EXCEPTIONS.] Of this
appropriation, $200,000 each year is
for the medical assistance costs of
moratorium exceptions approved by the
commissioner of health under Minnesota
Statutes, section 144A.073.
[SURCHARGE COMPLIANCE.] 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 shall appeal the
determination to the fullest extent
permitted by law and may ratably reduce
all medical assistance and general
assistance medical care payments to
providers other than the state of
Minnesota 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 ratable reductions taken.
[MANAGED CARE.] The nonfederal share of
the Prepaid Medical Assistance Program
funds, which have been appropriated to
fund county managed care advocacy and
enrollment operating costs, shall be
disbursed as grants using either a
reimbursement or block grant mechanism.
[PMAP CARRYOVER.] Unexpended money
appropriated for fiscal year 1996 for
the nonfederal share of the prepaid
medical assistance program to fund
county managed care advocacy and
enrollment operating costs does not
cancel but is available in fiscal year
1997.
[PREPAID RATE DISCOUNTS.]
Notwithstanding section 12 of this
article, rates for rate years through
December 31, 1998, for the prepaid
medical assistance and prepaid general
assistance medical care programs shall,
in the aggregate for each program in
expansion counties after July 1, 1995,
include an effective ten percent
discount for individuals under 65, and
an effective five percent discount for
persons age 65 and older, compared with
expected fee-for-service costs for the
same population.
[COMPULSIVE GAMBLING.] (a) Of the 1995
appropriation for the compulsive
gambling program under Laws 1994,
chapter 633, article 8, section 8,
subdivision 1, up to $175,000 does not
cancel but shall remain available for
the development and implementation of
outcome evaluation, treatment
effectiveness research in the biennium
ending June 30, 1997.
(b) Only contributions to the
compulsive gambling program may be
carried forward between fiscal years or
from biennium to biennium.
(c) Paragraphs (a) and (b) are
effective the day following final
enactment.
Subd. 7. Community Mental Health
and State-Operated Services
General
254,604,000 260,379,000
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) Mental Health Grants - Children
7,097,000 12,536,000
[MENTAL HEALTH COLLABORATIVE.] Mental
health grants available for children
formerly served under the TEFRA program
shall be distributed and administered
by a children's mental health
collaborative where a collaborative
exists.
(b) Mental Health Grants - Adults
38,222,000 40,918,000
(c) Residential Treatment
Center Facilities
194,921,000 192,265,000
(d) Developmental Disability
and Mentally Ill (DD and MI)
State-Operated Community Services (SOCS)
13,001,000 13,297,000
(e) Administration and Other Grants
1,363,000 1,363,000
[MENTAL HEALTH GRANTS.] (a) Mental
health grants appropriated for the
biennium as part of the TEFRA and PCA
restructuring proposal shall be
distributed to children's mental health
collaboratives, or where there is no
collaborative, to counties. Grants
shall be prorated by county based on
the estimated dollar value of services
for children and adults with a mental
health diagnosis that will be lost due
to the changes in Minnesota Statutes,
sections 256B.055, subdivision 12, and
256B.0627.
(b) The commissioner shall form a work
group to recommend a process for
awarding grants that will maximize
services purchased and minimize
administrative overhead. The task
force shall include representatives of
the state advisory council on mental
health and the children's subcommittee,
parents, consumers, advocacy groups,
providers, and local social service and
public health staff. The work group
shall consider whether the process for
awarding consumer support grants under
Minnesota Statutes, section 256.476,
can be utilized for awarding these
mental health grants. In addition, the
work group shall recommend ways to
minimize harm to children and families
and to reduce barriers to accessing
alternative services.
(c) For the first year of the biennium,
funds must be distributed by January 1,
1996, and for the second year, by July
1, 1996. None of this appropriation
shall be used for county
administration, but must be used to
fund direct services to persons found
ineligible for TEFRA or PCA services.
[MENTAL HEALTH CASE MANAGEMENT.]
Notwithstanding section 12 of this
article, this paragraph does not
expire. The reimbursement rate for
mental health case management services
provided by counties under Minnesota
Statutes, sections 245.4881 and
256B.0625, for children with severe
emotional disturbance is $45.
[CALCULATION OF FTE's.] When
calculating regional treatment center
full-time equivalent employees, the
commissioner of finance shall make a
separate calculation for physicians and
their salaries.
[RELOCATIONS FROM FARIBAULT.] Of this
appropriation, $162,000 in fiscal year
1996 and $37,000 in fiscal year 1997
are for grants to counties for
discharge planning related to persons
with mental retardation or related
conditions being relocated from the
Faribault regional center to community
services.
[TRANSFERS TO MOOSE LAKE.]
Notwithstanding Minnesota Statutes,
sections 253B.18, subdivisions 4 and 6,
and 253B.185, subdivision 2, with the
establishment of the Minnesota sexual
psychopathic personality treatment
center, the commissioner is authorized
to transfer any person committed as a
psychopathic personality, sexual
psychopathic personality, or sexually
dangerous person, between the Minnesota
security hospital and the facility at
Moose Lake.
[RTC CHEMICAL DEPENDENCY PROGRAMS.]
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 may 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 in the
fiscal year that 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.
[RTC RESTRUCTURING.] 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 1996 shall be carried
forward into fiscal year 1997.
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.
[RTC POPULATION.] 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 1996-97
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.
[INFRASTRUCTURE REINVESTMENT.] $750,000
is available from the public facilities
authority under Minnesota Statutes
446A.071 for grant funds to a local
unit of government for the development
of infrastructure and planning for
redevelopment in response to the
memorandum of understanding for the
regional treatment centers. Eligible
costs include sewer, water, and
easements and engineering costs
associated with the project proposal.
[CAMP.] Of this appropriation, $30,000
is 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.
[IMD DOWNSIZING FLEXIBILITY.] If a
county presents a budget-neutral plan
for a net reduction in the number of
institution for mental disease (IMD)
beds funded under group residential
housing, the commissioner may transfer
the net savings from group residential
housing and general assistance medical
care to medical assistance and mental
health grants to provide appropriate
services in non-IMD settings.
[REPAIRS AND BETTERMENTS.] The
commissioner may transfer unencumbered
appropriation balances between fiscal
years for the state residential
facilities repairs and betterments
account and special equipment.
[PROJECT LABOR.] 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.
[PLAN FOR ADOLESCENT TREATMENT
EXPANSION.] The commissioner shall
report to the legislature by January
15, 1996, with a cost-neutral plan to
add up to 20 beds to each of the two
existing adolescent treatment
facilities at the regional treatment
centers in order to reduce or eliminate
out-of-state placement of adolescents
who have serious emotional disturbance
and exhibit violent behavior, if they
cannot be treated in their own
communities. Cost neutrality shall be
determined by comparing the costs of
program expansion with the projected
costs of out-of-state placements.
Sec. 3. COMMISSIONER OF HEALTH
Subdivision 1. Total
Appropriation 55,639,000 55,886,000
Summary by Fund
General 37,978,000 37,950,000
Metropolitan Landfill
Contingency Action Fund 193,000 193,000
State Government
Special Revenue 15,947,000 16,222,000
Trunk Highway 1,513,000 1,513,000
Special Revenue 8,000 8,000
[LANDFILL CONTINGENCY.] The
appropriation from the metropolitan
landfill contingency action fund is for
monitoring well water supplies and
conducting health assessments in the
metropolitan area.
[TRUNK HIGHWAY FUND.] The appropriation
from the trunk highway fund is for
emergency medical services activities.
Subd. 2. Health
Systems Development 27,928,000 27,784,000
Summary by Fund
General 27,499,000 27,354,000
State Government
Special Revenue 429,000 430,000
[WIC TRANSFERS.] 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.
[NURSING HOME RESIDENTS EDUCATION.] Any
efforts undertaken by the Minnesota
departments of health or human services
to conduct periodic education 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.
[HOSPITAL CONVERSION.] Of the
appropriation from the general fund,
the commissioner of health shall
provide $25,000 to a 28-bed hospital
located in Chisago county, to enable
that facility to plan for closure and
conversion, in partnership with other
entities, in order to offer outpatient
and emergency services at the site.
[CARRYOVER.] General fund
appropriations for treatment services
in the services for children with
special health care needs program are
available for either year of the
biennium.
Subd. 3. Health Quality
Assurance 6,934,000 7,065,000
Summary by Fund
General 1,135,000 1,135,000
Trunk Highway 1,431,000 1,431,000
State Government
Special Revenue 4,368,000 4,499,000
[NONCERTIFIED NURSING HOME.] Of the
appropriation from the state government
special revenue fund, up to $250,000 is
available if the commissioner
determines the need to place a
noncertified nursing home into
receivership under Minnesota Statutes,
section 144A.14 or 144A.15. Any money
expended from this account for this
purpose shall only be used to cover the
necessary costs for the receivership
and for the operation of the facility
during the time period necessary to
relocate residents from the facility.
The commissioner shall suspend
admissions to the nursing home
effective as of the date of the
commencement of the receivership.
Notwithstanding the provisions of
Minnesota Statutes, section 144A.16,
and Minnesota Rules, parts 4655.6810 to
4655.6830, the commissioner shall
relocate residents within 45 days from
the commencement of the receivership if
the receivership costs are covered by
this section. Once relocation of the
residents is completed, the nursing
home license shall expire.
Notwithstanding the provisions of
Minnesota Statutes, section 144A.071,
subdivision 3, paragraph (c), the
commissioner may issue a new license to
operate the facility as a nursing home
within 120 days from the commencement
of the receivership provided that the
licensed and certified capacity does
not exceed the capacity of the former
facility and all money expended from
the state government special revenue
account is repaid to the commissioner
prior to the issuance of the license.
Any unrecovered costs to the fund shall
be included as costs to the activity
under Minnesota Statutes, section
16A.1285. The commissioner shall
report any use of this authority to the
commissioner of finance and the chair
of the senate health care and family
services finance division and the chair
of the house human services finance
division.
Subd. 4. Health Protection 16,765,000 16,861,000
Summary by Fund
General 6,899,000 6,895,000
State Government
Special Revenue 9,687,000 9,787,000
Metropolitan Landfill
Contingency Action
Fund 171,000 171,000
Special Revenue 8,000 8,000
[LEAD ABATEMENT.] $200,000 is
appropriated from the general fund to
the commissioner of health for the
biennium ending June 30, 1997, for the
purpose of administering lead abatement
activities. Of this amount, $25,000
shall be used for the purposes of
lead-safe housing, and $25,000 shall be
used for the purposes of lead cleanup
equipment.
Subd. 5. Management and
Support Services 4,012,000 4,176,000
Summary by Fund
General 2,445,000 2,566,000
Metropolitan Landfill
Contingency Action Fund 22,000 22,000
Trunk Highway 82,000 82,000
State Government
Special Revenue 1,463,000 1,506,000
Sec. 4. VETERANS NURSING
HOMES BOARD 17,937,000 18,614,000
[SPECIAL REVENUE ACCOUNT.] The general
fund appropriations made to the
veterans homes board shall be
transferred to a veterans homes special
revenue account in the special revenue
fund in the same manner as other
receipts are deposited in accordance
with Minnesota Statutes, section
198.34, and are appropriated to the
veterans homes board of directors for
the operation of board facilities and
programs.
[SETTING THE COST OF CARE.] The
veterans homes board may set the cost
of care at the Silver Bay and Luverne
facilities based on the cost of average
skilled nursing care provided to
residents of the Minneapolis veterans
home for fiscal year 1996.
[ROOMS WITH MORE THAN FOUR BEDS.] (a)
Until June 30, 1996, 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.
(b) The veterans homes board may not
admit residents into the domiciliary
beds at the Minnesota veterans home at
Hastings before October 1, 1995.
[LICENSED CAPACITY.] The department of
health shall not reduce the licensed
bed capacity for the Minneapolis
veterans home pending completion of the
project authorized by Laws 1990,
chapter 610, article 1, section 9,
subdivision 3, unless the federal grant
for the project is not awarded.
[ALLOWANCE FOR FOOD.] 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
1996 and fiscal year 1997 must be based
on the June 1994 and June 1995 producer
price index respectively, but the
adjustment must be prorated if it would
require money in excess of the
appropriation.
[FERGUS FALLS.] If a federal grant for
the construction of the Fergus Falls
veterans home is received before the
start of the 1996 legislative session,
the veterans homes board of directors
may use up to $150,000 of this
appropriation to fund positions and
support services to coordinate and
oversee the construction of the home
and to begin planning for the opening
of the facility.
Sec. 5. HEALTH-RELATED BOARDS
Subdivision 1. Total
Appropriation 8,906,000 8,608,000
[STATE GOVERNMENT SPECIAL REVENUE
FUND.] The appropriations in this
section are from the state government
special revenue fund.
[NO SPENDING IN EXCESS OF REVENUES.]
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 or
accumulated surplus 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 309,000 313,000
Subd. 3. Board of Dentistry 698,000 708,000
Subd. 4. Board of Dietetic
and Nutrition Practice 63,000 64,000
Subd. 5. Board of Marriage and
Family Therapy 95,000 96,000
Subd. 6. Board of Medical
Practice 3,204,000 3,188,000
Subd. 7. Board of Nursing 2,258,000 2,009,000
[DISCIPLINE AND LICENSING SYSTEMS
PROJECT.] Of this appropriation,
$548,000 the first year and $295,000
the second year is to implement the
discipline and licensing systems
project as recommended by the
information policy office. In
accordance with Minnesota Statutes,
section 214.06, subdivision 1, the
board may raise fees to fund this
activity.
Subd. 8. Board of Nursing
Home Administrators 182,000 186,000
Subd. 9. Board of Optometry 78,000 79,000
Subd. 10. Board of Pharmacy 900,000 894,000
Subd. 11. Board of Podiatry 31,000 32,000
Subd. 12. Board of Psychology 393,000 396,000
Subd. 13. Board of Social Work 553,000 492,000
Subd. 14. Board of Veterinary
Medicine 142,000 151,000
Sec. 6. COUNCIL ON DISABILITY 725,000 581,000
[COUNCIL ON DISABILITY.] Of this
appropriation $150,000 is from the
general fund to the council on
disability for fiscal year 1996, for
the purposes of a matching grant to the
Fergus Falls Center for the Arts, Inc.
to complete renovations of a local
theater necessary to bring it into
compliance with the federal Americans
with Disabilities Act. This
appropriation must be matched by
$50,000 of nonstate local funds.
Sec. 7. OMBUDSMAN FOR MENTAL
HEALTH AND MENTAL RETARDATION 1,132,000 1,097,000
Sec. 8. OMBUDSMAN
FOR FAMILIES 133,000 137,000
Sec. 9. TRANSFERS.
Subdivision 1. Entitlement programs
(a) Transfers in fiscal year 1995
Effective the day following final
enactment, the commissioner of human
services may transfer unencumbered
appropriation balances for fiscal year
1995 among the aid to families with
dependent children, aid to families
with dependent children child care,
Minnesota family investment plan,
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, with the approval of
the commissioner of finance after
notification of the chair of the senate
health care and family services finance
division and the chair of the house of
representatives health and human
services finance division.
(b) Transfers of unencumbered
entitled grant and aid appropriations
The commissioner of human services,
with the approval of the commissioner
of finance, and after notification of
the chair of the senate health care and
family services finance division and
the chair of the house of
representatives health and human
services finance division, may transfer
unencumbered appropriation balances for
the biennium ending June 30, 1997,
within fiscal years among the aid to
families with dependent children, aid
to families with dependent children
child care, Minnesota family investment
plan, 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.
Subd. 2. Approval required
Positions, salary money, and nonsalary
administrative money may be transferred
within the departments of human
services and health and within the
programs operated by the veterans
nursing homes board as the
commissioners and the board consider
necessary, with the advance approval of
the commissioner of finance. The
commissioners and the board shall
inform the chairs of the health and
human services finance division of the
house of representatives and the health
and family services finance division of
the senate quarterly about transfers
made under this provision.
Subd. 3. Transfer
Funding appropriated by the legislature
may not be transferred to a different
department than that specified by the
legislature without legislative
authority.
Sec. 10. PROVISIONS
(a) Money appropriated to the
commissioner of human services 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 drugs and medical
and hospital supplies and equipment
with written approval of the governor
after consultation with the legislative
advisory commission.
(b) For fiscal year 1996 the allowance
for food may be adjusted to the
equivalent of the 75th percentile of
the comparable raw food costs for
community nursing homes as reported to
the commissioner of human services.
For fiscal year 1997 an adjustment may
be made to reflect the annual change in
the United States Bureau of Labor
Statistics producer price index as of
June 1996 with the approval of the
commissioner of finance. The
adjustments for either year must be
prorated if they would require money in
excess of this appropriation.
Sec. 11. CARRYOVER LIMITATION
None of the appropriations in this act
which are allowed to be carried forward
from fiscal year 1996 to fiscal year
1997 shall become part of the base
level funding for the 1997-1999
biennial budget, unless specifically
directed by the legislature.
Sec. 12. SUNSET OF UNCODIFIED LANGUAGE
All uncodified language contained in
this article expires on June 30, 1997,
unless a different expiration is
explicit.
ARTICLE 2
HUMAN SERVICES ADMINISTRATION
Section 1. Minnesota Statutes 1994, section 14.03,
subdivision 3, is amended to read:
Subd. 3. [RULEMAKING PROCEDURES.] The definition of a rule
in section 14.02, subdivision 4, does not include:
(1) rules concerning only the internal management of the
agency or other agencies that do not directly affect the rights
of or procedures available to the public;
(2) rules of the commissioner of corrections relating to
the placement and supervision of inmates serving a supervised
release term, the internal management of institutions under the
commissioner's control, and rules adopted under section 609.105
governing the inmates of those institutions;
(3) rules relating to weight limitations on the use of
highways when the substance of the rules is indicated to the
public by means of signs;
(4) opinions of the attorney general;
(5) the systems architecture plan and long-range plan of
the state education management information system provided by
section 121.931;
(6) the data element dictionary and the annual data
acquisition calendar of the department of education to the
extent provided by section 121.932;
(7) the occupational safety and health standards provided
in section 182.655;
(8) revenue notices and tax information bulletins of the
commissioner of revenue; or
(9) uniform conveyancing forms adopted by the commissioner
of commerce under section 507.09; or
(10) the interpretive guidelines developed by the
commissioner of human services to the extent provided in chapter
245A.
Sec. 2. Minnesota Statutes 1994, section 16B.08,
subdivision 5, is amended to read:
Subd. 5. [FEDERAL GENERAL SERVICES ADMINISTRATION AGENCY
PRICE SCHEDULES.] Notwithstanding anything in this chapter to
the contrary, the commissioner may, instead of soliciting bids,
contract for purchases with suppliers who have published
schedules of prices effective for sales to the General Services
Administration any federal agency of the United States. These
contracts may be entered into, regardless of the amount of the
purchase price, if the commissioner considers them advantageous
and if the purchase price of all the commodities purchased under
the contract do not exceed the price specified by the schedule.
Sec. 3. Minnesota Statutes 1994, section 171.07, is
amended by adding a subdivision to read:
Subd. 10. [AGREEMENTS WITH OTHER AGENCIES.] The
commissioner of public safety is authorized to enter into
agreements with other agencies to issue cards to clients of
those agencies for use in their programs. The cards may be
issued to persons who do not qualify for a Minnesota driver's
license or do not provide evidence of name and identity as
required by rule for a Minnesota identification card. Persons
issued cards under this subdivision will meet the identification
verification requirements of the contracting agency.
The interagency agreement may include provisions for the
payment of the county fee provided in section 171.06,
subdivision 4, and the actual cost to manufacture the card.
Cards issued under this subdivision are not Minnesota
identification cards for the purposes defined in sections
48.512, 201.061, 201.161, 332.50, and 340A.503.
Sec. 4. Minnesota Statutes 1994, section 245A.02, is
amended by adding a subdivision to read:
Subd. 7b. [INTERPRETIVE GUIDELINES.] "Interpretive
guidelines" means a policy statement that has been published
pursuant to section 245A.09, subdivision 12, and which provides
interpretation, details, or supplementary information concerning
the application of laws or rules. Interpretive guidelines are
published for the information and guidance of consumers,
providers of service, county agencies, the department of human
services, and others concerned.
Sec. 5. Minnesota Statutes 1994, section 245A.03,
subdivision 2a, is amended to read:
Subd. 2a. [LICENSING OF FOSTER CARE BY AN INDIVIDUAL WHO
IS RELATED TO A CHILD; LICENSE REQUIRED.] Notwithstanding
subdivision 2, clause (1), the commissioner must license or
approve an individual who is related to a child in order to
provide foster care for that a child, an individual who is
related to the child, other than a parent, or legal guardian,
must be licensed by the commissioner except as provided by
section 245A.035. The commissioner may issue the license or
approval retroactive to the date the child was placed in the
applicant's home, so long as no more than 90 days have elapsed
since the placement. If more than 90 days have elapsed since
the placement, the commissioner may issue the license or
approval retroactive 90 days. The granting of a license or
approval to an individual who is related to a child shall be
according to standards set forth by foster care rule. The
commissioner shall consider the importance of maintaining the
child's relationship to family as an additional significant
factor in determining whether to set aside a licensing
disqualifier under section 245A.04, subdivision 3b, or to grant
a variance of licensing requirements under section 245A.04,
subdivision 9, in licensing or approving an individual related
to a child.
Sec. 6. [245A.035] [RELATIVE FOSTER CARE; EMERGENCY
LICENSE.]
Subdivision 1. [GRANT OF EMERGENCY LICENSE.]
Notwithstanding section 245A.03, subdivision 2a, a county agency
may place a child for foster care with a relative who is not
licensed to provide foster care, provided the requirements of
subdivision 2 are met. As used in this section, the term
"relative" has the meaning given it under section 260.181,
subdivision 3.
Subd. 2. [COOPERATION WITH EMERGENCY LICENSING PROCESS.]
(a) A county agency that places a child with a relative who is
not licensed to provide foster care must begin the process of
securing an emergency license for the relative as soon as
possible and must conduct the initial inspection required by
subdivision 3, clause (1), whenever possible, prior to placing
the child in the relative's home, but no later than three
working days after placing the child in the home. A child
placed in the home of a relative who is not licensed to provide
foster care must be removed from that home if the relative fails
to cooperate with the county agency in securing an emergency
foster care license. The commissioner may only issue an
emergency foster care license to a relative with whom the county
agency wishes to place or has placed a child for foster care.
(b) If a child is to be placed in the home of a relative
not licensed to provide foster care, either the placing agency
or the county agency in the county in which the relative lives
shall conduct the emergency licensing process as required in
this section.
Subd. 3. [REQUIREMENTS FOR EMERGENCY LICENSE.] Before an
emergency license may be issued, the following requirements must
be met:
(1) the county agency must conduct an initial inspection of
the premises where the foster care is to be provided to ensure
the health and safety of any child placed in the home. The
county agency shall conduct the inspection using a form
developed by the commissioner;
(2) at the time of the inspection or placement, whichever
is earlier, the relative being considered for an emergency
license shall receive an application form for a child foster
care license; and
(3) whenever possible, prior to placing the child in the
relative's home, the relative being considered for an emergency
license shall provide the information required by section
245A.04, subdivision 3, paragraph (b).
Subd. 4. [APPLICANT STUDY.] When the county agency has
received the information required by section 245A.04,
subdivision 3, paragraph (b), the county agency shall begin an
applicant study according to the procedures in section 245A.04,
subdivision 3. The commissioner may issue an emergency license
upon recommendation of the county agency once the initial
inspection has been successfully completed and the information
necessary to begin the applicant background study has been
provided. If the county agency does not recommend that the
emergency license be granted, the agency shall notify the
relative in writing that the agency is recommending denial to
the commissioner; shall remove any child who has been placed in
the home prior to licensure; and shall inform the relative in
writing of the procedure to request review pursuant to
subdivision 6. An emergency license shall be effective until a
child foster care license is granted or denied, but shall in no
case remain in effect more than 90 days from the date of
placement.
Subd. 5. [CHILD FOSTER CARE LICENSE APPLICATION.] The
emergency license holder shall complete the child foster care
license application and necessary paperwork within ten days of
the placement. The county agency shall assist the emergency
license holder to complete the application. The granting of a
child foster care license to a relative shall be under the
procedures in this chapter and according to the standards set
forth by foster care rule. In licensing a relative, the
commissioner shall consider the importance of maintaining the
child's relationship with relatives as an additional significant
factor in determining whether to set aside a licensing
disqualifier under section 245A.04, subdivision 3b, or to grant
a variance of licensing requirements under section 245A.04,
subdivision 9.
Subd. 6. [DENIAL OF EMERGENCY LICENSE.] If the
commissioner denies an application for an emergency foster care
license under this section, that denial must be in writing and
must include reasons for the denial. Denial of an emergency
license is not subject to appeal under chapter 14. The relative
may request a review of the denial by submitting to the
commissioner a written statement of the reasons an emergency
license should be granted. The commissioner shall evaluate the
request for review and determine whether to grant the emergency
license. The commissioner's review shall be based on a review
of the records submitted by the county agency and the relative.
Within 15 working days of the receipt of the request for review,
the commissioner shall notify the relative requesting review in
written form whether the emergency license will be granted. The
commissioner's review shall be based on a review of the records
submitted by the county agency and the relative. A child shall
not be placed or remain placed in the relative's home while the
request for review is pending. Denial of an emergency license
shall not preclude an individual from reapplying for an
emergency license or from applying for a child foster care
license. The decision of the commissioner is the final
administrative agency action.
Sec. 7. Minnesota Statutes 1994, section 245A.04,
subdivision 3, is amended to read:
Subd. 3. [STUDY OF THE APPLICANT.] (a) Before the
commissioner issues a license, the commissioner shall conduct a
study of the individuals specified in clauses (1) to (4)
according to rules of the commissioner. The applicant, license
holder, the bureau of criminal apprehension, and county
agencies, after written notice to the individual who is the
subject of the study, shall help with the study by giving the
commissioner criminal conviction data and reports about abuse or
neglect of adults in licensed programs substantiated under
section 626.557 and the maltreatment of minors in licensed
programs substantiated under section 626.556. The individuals
to be studied shall include:
(1) the applicant;
(2) persons over the age of 13 living in the household
where the licensed program will be provided;
(3) current employees or contractors of the applicant who
will have direct contact with persons served by the program; and
(4) volunteers who have direct contact with persons served
by the program to provide program services, if the contact is
not directly supervised by the individuals listed in clause (1)
or (3).
The juvenile courts shall also help with the study by
giving the commissioner existing juvenile court records on
individuals described in clause (2) relating to delinquency
proceedings held within either the five years immediately
preceding the application or the five years immediately
preceding the individual's 18th birthday, whichever time period
is longer. The commissioner shall destroy juvenile records
obtained pursuant to this subdivision when the subject of the
records reaches age 23.
For purposes of this section and Minnesota Rules, part
9543.3070, a finding that a delinquency petition is proven in
juvenile court shall be considered a conviction in state
district court.
For purposes of this subdivision, "direct contact" means
providing face-to-face care, training, supervision, counseling,
consultation, or medication assistance to persons served by a
program. For purposes of this subdivision, "directly supervised"
means an individual listed in clause (1) or (3) is within sight
or hearing of a volunteer to the extent that the individual
listed in clause (1) or (3) is capable at all times of
intervening to protect the health and safety of the persons
served by the program who have direct contact with the volunteer.
A study of an individual in clauses (1) to (4) shall be
conducted at least upon application for initial license and
reapplication for a license. No applicant, license holder, or
individual who is the subject of the study shall pay any fees
required to conduct the study.
(b) The individual who is the subject of the study must
provide the applicant or license holder with sufficient
information to ensure an accurate study including the
individual's first, middle, and last name; home address, city,
county, and state of residence; zip code; sex; date of birth;
and driver's license number. The applicant or license holder
shall provide this information about an individual in paragraph
(a), clauses (1) to (4), on forms prescribed by the
commissioner. The commissioner may request additional
information of the individual, which shall be optional for the
individual to provide, such as the individual's social security
number or race.
(c) Except for child foster care, adult foster care, and
family day care homes, a study must include information from the
county agency's record of substantiated abuse or neglect of
adults in licensed programs, and the maltreatment of minors in
licensed programs, information from juvenile courts as required
in paragraph (a) for persons listed in paragraph (a), clause
(2), and information from the bureau of criminal apprehension.
For child foster care, adult foster care, and family day care
homes, the study must include information from the county
agency's record of substantiated abuse or neglect of adults, and
the maltreatment of minors, information from juvenile courts as
required in paragraph (a) for persons listed in paragraph (a),
clause (2), and information from the bureau of criminal
apprehension. The commissioner may also review arrest and
investigative information from the bureau of criminal
apprehension, a county attorney, county sheriff, county agency,
local chief of police, other states, the courts, or a national
criminal record repository if the commissioner has reasonable
cause to believe the information is pertinent to the
disqualification of an individual listed in paragraph (a),
clauses (1) to (4). The commissioner is not required to conduct
more than one review of a subject's records from the national
criminal record repository if a review of the subject's criminal
history with the national criminal record repository has already
been completed by the commissioner and there has been no break
in the subject's affiliation with the license holder who
initiated the background studies.
(d) An applicant's or license holder's failure or refusal
to cooperate with the commissioner is reasonable cause to deny
an application or immediately suspend, suspend, or revoke a
license. Failure or refusal of an individual to cooperate with
the study is just cause for denying or terminating employment of
the individual if the individual's failure or refusal to
cooperate could cause the applicant's application to be denied
or the license holder's license to be immediately suspended,
suspended, or revoked.
(e) The commissioner shall not consider an application to
be complete until all of the information required to be provided
under this subdivision has been received.
(f) No person in paragraph (a), clause (1), (2), (3), or
(4) who is disqualified as a result of this section may be
retained by the agency in a position involving direct contact
with persons served by the program.
(g) Termination of persons in paragraph (a), clause (1),
(2), (3), or (4) made in good faith reliance on a notice of
disqualification provided by the commissioner shall not subject
the applicant or license holder to civil liability.
(h) The commissioner may establish records to fulfill the
requirements of this section.
(i) The commissioner may not disqualify an individual
subject to a study under this section because that person has,
or has had, a mental illness as defined in section 245.462,
subdivision 20.
(j) An individual who is subject to an applicant background
study under this section and whose disqualification in
connection with a license would be subject to the limitations on
reconsideration set forth in subdivision 3b, paragraph (c),
shall be disqualified for conviction of the crimes specified in
the manner specified in subdivision 3b, paragraph (c). The
commissioner of human services shall amend Minnesota Rules, part
9543.3070, to conform to this section.
Sec. 8. Minnesota Statutes 1994, section 245A.04,
subdivision 3b, is amended to read:
Subd. 3b. [RECONSIDERATION OF DISQUALIFICATION.] (a)
Within 30 days after receiving notice of disqualification under
subdivision 3a, the individual who is the subject of the study
may request reconsideration of the notice of disqualification.
The individual must submit the request for reconsideration to
the commissioner in writing. The individual must present
information to show that:
(1) the information the commissioner relied upon is
incorrect; or
(2) the subject of the study does not pose a risk of harm
to any person served by the applicant or license holder.
(b) The commissioner may set aside the disqualification if
the commissioner finds that the information the commissioner
relied upon is incorrect or the individual does not pose a risk
of harm to any person served by the applicant or license
holder. The commissioner shall review the consequences of the
event or events that could lead to disqualification, whether
there is more than one disqualifying event, the vulnerability of
the victim at the time of the event, the time elapsed without a
repeat of the same or similar event, and documentation of
successful completion by the individual studied of training or
rehabilitation pertinent to the event. In reviewing a
disqualification, the commissioner shall give preeminent weight
to the safety of each person to be served by the license holder
or applicant over the interests of the license holder or
applicant.
(c) Unless the information the commissioner relied on in
disqualifying an individual is incorrect, the commissioner may
not set aside the disqualification of an individual in
connection with a license to provide family day care for
children, foster care for children in the provider's own home,
or foster care or day care services for adults in the provider's
own home if:
(1) less than ten years have passed since the discharge of
the sentence imposed for the offense; and the individual has
been convicted of a violation of any offense listed in section
609.20 (manslaughter in the first degree), 609.205 (manslaughter
in the second degree), 609.21 (criminal vehicular homicide),
609.215 (aiding suicide or aiding attempted suicide), 609.221 to
609.2231 (felony violations of assault in the first, second,
third, or fourth degree), 609.713 (terroristic threats), 609.235
(use of drugs to injure or to facilitate crime), 609.24 (simple
robbery), 609.245 (aggravated robbery), 609.25 (kidnapping),
609.255 (false imprisonment), 609.561 or 609.562 (arson in the
first or second degree), 609.71 (riot), 609.582 (burglary in the
first or second degree), 609.66 (reckless use of a gun or
dangerous weapon or intentionally pointing a gun at or towards a
human being), 609.665 (setting a spring gun), 609.67 (unlawfully
owning, possessing, or operating a machine gun), 609.749
(stalking), 152.021 or 152.022 (controlled substance crime in
the first or second degree), 152.023, subdivision 1, clause (3)
or (4), or subdivision 2, clause (4) (controlled substance crime
in the third degree), 152.024, subdivision 1, clause (2), (3),
or (4) (controlled substance crime in the fourth degree),
609.228 (great bodily harm caused by distribution of drugs),
609.23 (mistreatment of persons confined), 609.231 (mistreatment
of residents or patients), 609.265 (abduction), 609.2664 to
609.2665 (manslaughter of an unborn child in the first or second
degree), 609.267 to 609.2672 (assault of an unborn child in the
first, second, or third degree), 609.268 (injury or death of an
unborn child in the commission of a crime), 617.293
(disseminating or displaying harmful material to minors),
609.378 (neglect or endangerment of a child), 609.377 (a gross
misdemeanor offense of malicious punishment of a child); or an
attempt or conspiracy to commit any of these offenses, as each
of these offenses is defined in Minnesota Statutes; or an
offense in any other state, the elements of which are
substantially similar to the elements of any of the foregoing
offenses;
(2) regardless of how much time has passed since the
discharge of the sentence imposed for the offense, the
individual was convicted of a violation of any offense listed in
sections 609.185 to 609.195 (murder in the first, second, or
third degree), 609.2661 to 609.2663 (murder of an unborn child
in the first, second, or third degree), 609.377 (a felony
offense of malicious punishment of a child), 609.322
(soliciting, inducement, or promotion of prostitution), 609.323
(receiving profit derived from prostitution), 609.342 to 609.345
(criminal sexual conduct in the first, second, third, or fourth
degree), 609.352 (solicitation of children to engage in sexual
conduct), 617.246 (use of minors in a sexual performance),
617.247 (possession of pictorial representations of a minor),
609.365 (incest), or an attempt or conspiracy to commit any of
these offenses as defined in Minnesota Statutes, or an offense
in any other state, the elements of which are substantially
similar to any of the foregoing offenses;
(3) within the seven years preceding the study, the
individual committed an act that constitutes maltreatment of a
child under section 626.556, subdivision 10e, and that resulted
in substantial bodily harm as defined in section 609.02,
subdivision 7a, or substantial mental or emotional harm as
supported by competent psychological or psychiatric evidence; or
(4) within the seven years preceding the study, the
individual was determined under section 626.557 to be the
perpetrator of a substantiated incident of abuse of a vulnerable
adult that resulted in substantial bodily harm as defined in
section 609.02, subdivision 7a, or substantial mental or
emotional harm as supported by competent psychological or
psychiatric evidence.
In the case of any ground for disqualification under
clauses (1) to (4), if the act was committed by an individual
other than the applicant or license holder residing in the
applicant's or license holder's home, the applicant or license
holder may seek reconsideration when the individual who
committed the act no longer resides in the home.
The disqualification periods provided under clauses (1),
(3), and (4) are the minimum applicable disqualification
periods. The commissioner may determine that an individual
should continue to be disqualified from licensure because the
license holder or applicant poses a risk of harm to a person
served by that individual after the minimum disqualification
period has passed.
(d) The commissioner shall respond in writing to all
reconsideration requests within 15 working days after receiving
the request for reconsideration. If the disqualification is set
aside, the commissioner shall notify the applicant or license
holder in writing of the decision.
(e) Except as provided in subdivision 3c, the
commissioner's decision to disqualify an individual, including
the decision to grant or deny a reconsideration of
disqualification under this subdivision, or to set aside or
uphold the results of the study under subdivision 3, is the
final administrative agency action and shall not be subject to
further review in a contested case under chapter 14 involving a
negative licensing action taken in response to the
disqualification.
Sec. 9. Minnesota Statutes 1994, section 245A.04,
subdivision 7, is amended to read:
Subd. 7. [ISSUANCE OF A LICENSE; PROVISIONAL LICENSE.] (a)
If the commissioner determines that the program complies with
all applicable rules and laws, the commissioner shall issue a
license. At minimum, the license shall state:
(1) the name of the license holder;
(2) the address of the program;
(3) the effective date and expiration date of the license;
(4) the type of license;
(5) the maximum number and ages of persons that may receive
services from the program; and
(6) any special conditions of licensure.
(b) The commissioner may issue a provisional license for a
period not to exceed one year if:
(1) the commissioner is unable to conduct the evaluation or
observation required by subdivision 4, paragraph (a), clauses (3)
and (4), because the program is not yet operational;
(2) certain records and documents are not available because
persons are not yet receiving services from the program; and
(3) the applicant complies with applicable laws and rules
in all other respects.
A provisional license must not be issued except at the time that
a license is first issued to an applicant.
(c) A decision by the commissioner to issue a license does
not guarantee that any person or persons will be placed or cared
for in the licensed program. A license shall not be
transferable to another individual, corporation, partnership,
voluntary association, other organization, or controlling
individual, or to another location. Unless otherwise specified
by statute, all licenses expire at 12:01 a.m. on the day after
the expiration date stated on the license. A license holder
must apply for and be granted a new license to operate the
program or the program must not be operated after the expiration
date.
Sec. 10. Minnesota Statutes 1994, section 245A.04,
subdivision 9, is amended to read:
Subd. 9. [VARIANCES.] The commissioner may grant variances
to rules that do not affect the health or safety of persons in a
licensed program if the following conditions are met:
(1) the variance must be requested by an applicant or
license holder on a form and in a manner prescribed by the
commissioner;
(2) the request for a variance must include the reasons
that the applicant or license holder cannot comply with a
requirement as stated in the rule and the alternative equivalent
measures that the applicant or license holder will follow to
comply with the intent of the rule; and
(3) the request must state the period of time for which the
variance is requested.
The commissioner may grant a permanent variance when
conditions under which the variance is requested do not affect
the health or safety of persons being served by the licensed
program, nor compromise the qualifications of staff to provide
services. The permanent variance shall expire as soon as the
conditions that warranted the variance are modified in any way.
Any applicant or license holder must inform the commissioner of
any changes or modifications that have occurred in the
conditions that warranted the permanent variance. Failure to
advise the commissioner shall result in revocation of the
permanent variance and may be cause for other sanctions under
sections 245A.06 and 245A.07.
The commissioner's decision to grant or deny a variance
request is final and not subject to appeal under the provisions
of chapter 14.
Sec. 11. Minnesota Statutes 1994, section 245A.06,
subdivision 2, is amended to read:
Subd. 2. [RECONSIDERATION OF CORRECTION ORDERS.] If the
applicant or license holder believes that the contents of the
commissioner's correction order are in error, the applicant or
license holder may ask the department of human services to
reconsider the parts of the correction order that are alleged to
be in error. The request for reconsideration must be in
writing, delivered by certified mail and received by the
commissioner within 20 calendar days after receipt of the
correction order by the applicant or license holder, and:
(1) specify the parts of the correction order that are
alleged to be in error;
(2) explain why they are in error; and
(3) include documentation to support the allegation of
error.
A request for reconsideration does not stay any provisions
or requirements of the correction order. The commissioner's
disposition of a request for reconsideration is final and not
subject to appeal under chapter 14.
Sec. 12. Minnesota Statutes 1994, section 245A.06,
subdivision 4, is amended to read:
Subd. 4. [NOTICE OF FINE; APPEAL.] A license holder who is
ordered to pay a fine must be notified of the order by certified
mail. The notice must be mailed to the address shown on the
application or the last known address of the license holder.
The notice must state the reasons the fine was ordered and must
inform the license holder of the responsibility for payment of
fines in subdivision 7 and the right to a contested case hearing
under chapter 14. The license holder may appeal the order to
forfeit a fine by notifying the commissioner by certified mail
within 15 calendar days after receiving the order. A timely
appeal shall stay forfeiture of the fine until the commissioner
issues a final order under section 245A.08, subdivision 5.
Sec. 13. Minnesota Statutes 1994, section 245A.06, is
amended by adding a subdivision to read:
Subd. 7. [RESPONSIBILITY FOR PAYMENT OF FINES.] When a
fine has been assessed, the license holder may not avoid payment
by closing, selling, or otherwise transferring the licensed
program to a third party. In such an event, the license holder
will be personally liable for payment. In the case of a
corporation, each controlling individual is personally and
jointly liable for payment.
Sec. 14. Minnesota Statutes 1994, section 245A.07,
subdivision 3, is amended to read:
Subd. 3. [SUSPENSION, REVOCATION, PROBATION.] The
commissioner may suspend, revoke, or make probationary a license
if a license holder fails to comply fully with applicable laws
or rules or knowingly gives false or misleading information to
the commissioner in connection with an application for a license
or during an investigation. A license holder who has had a
license suspended, revoked, or made probationary must be given
notice of the action by certified mail. The notice must be
mailed to the address shown on the application or the last known
address of the license holder. The notice must state the
reasons the license was suspended, revoked, or made probationary.
(a) If the license was suspended or revoked, the notice
must inform the license holder of the right to a contested case
hearing under chapter 14. The license holder may appeal an
order suspending or revoking a license. The appeal of an order
suspending or revoking a license must be made in writing by
certified mail and must be received by the commissioner within
ten calendar days after the license holder receives notice that
the license has been suspended or revoked.
(b) If the license was made probationary, the notice must
inform the license holder of the right to request a
reconsideration by the commissioner. The request for
reconsideration must be made in writing by certified mail and
must be received by the commissioner within ten calendar days
after the license holder receives notice that the license has
been made probationary. The license holder may submit with the
request for reconsideration written argument or evidence in
support of the request for reconsideration. The commissioner's
disposition of a request for reconsideration is final and is not
subject to appeal under chapter 14.
Sec. 15. Minnesota Statutes 1994, section 245A.09, is
amended by adding a subdivision to read:
Subd. 8. [INTERPRETIVE GUIDELINES; AUTHORITY.] The
commissioner of human services may develop and publish
interpretive guidelines.
Sec. 16. Minnesota Statutes 1994, section 245A.09, is
amended by adding a subdivision to read:
Subd. 9. [EFFECT OF INTERPRETIVE GUIDELINES.] Interpretive
guidelines do not have the force and effect of law and have no
precedential effect, but may be relied on by consumers,
providers of service, county agencies, the department of human
services, and others concerned until revoked or modified. A
guideline may be expressly revoked or modified by the
commissioner, by the issuance of another interpretive guideline,
but may not be revoked or modified retroactively to the
detriment of consumers, providers of service, county agencies,
the department of human services, or others concerned. A change
in the law or an interpretation of the law occurring after the
interpretive guidelines are issued, whether in the form of a
statute, court decision, administrative ruling, or subsequent
interpretive guideline, results in the revocation or
modification of the previously adopted guidelines to the extent
that the change affects the guidelines.
Sec. 17. Minnesota Statutes 1994, section 245A.09, is
amended by adding a subdivision to read:
Subd. 10. [RULEMAKING PROCESS; COMMISSIONER EXEMPTED.]
When developing, making, adopting, and issuing interpretive
guidelines under the authority granted under subdivision 8, the
commissioner is exempt from the rulemaking provisions of chapter
14.
Sec. 18. Minnesota Statutes 1994, section 245A.09, is
amended by adding a subdivision to read:
Subd. 11. [ISSUANCE; DISCRETION OF THE COMMISSIONER.] The
issuance of interpretive guidelines is at the discretion of the
commissioner of human services.
Sec. 19. Minnesota Statutes 1994, section 245A.09, is
amended by adding a subdivision to read:
Subd. 12. [PUBLICATION OF GUIDELINES.] The commissioner
shall publish notice of interpretive guidelines availability in
the State Register. The commissioner may publish or make
available the interpretive guidelines in any manner determined
by the commissioner, provided they are accessible to the general
public. The commissioner may charge a reasonable fee for copies
of the guidelines requested by interested parties when they are
provided by the commissioner.
Sec. 20. Minnesota Statutes 1994, section 245A.14,
subdivision 6, is amended to read:
Subd. 6. [DROP-IN CHILD CARE PROGRAMS.] (a) Except as
expressly set forth in this subdivision, drop-in child care
programs must be licensed as a drop-in program under the rules
governing child care programs operated in a center.
(b) Drop-in child care programs are exempt from the
following Minnesota Rules:
(1) part 9503.0040;
(2) part 9503.0045, subpart 1, items F and G;
(3) part 9503.0050, subpart 6, except for children less
than 2-1/2 years old;
(4) one-half the requirements of part 9503.0060, subpart 4,
item A, subitems (2), (5), and (8), subpart 5, item A, subitems
(2), (3), and (7), and subpart 6, item A, subitems (3) and (6);
(5) part 9503.0070; and
(6) part 9503.0090, subpart 2.
(c) A drop-in child care program must be operated under the
supervision of a person qualified as a director and a teacher.
(d) A drop-in child care program must have at least two
persons on staff whenever the program is operating, except that
the commissioner may permit variances from this requirement
under specified circumstances for parent cooperative programs,
as long as all other staff-to-child ratios are met.
(e) Whenever the total number of children present to be
cared for at a center is more than 20, children that are younger
than age 2-1/2 must be in a separate group. This group may
contain children up to 60 months old. This group must be cared
for in an area that is physically separated from older children.
(f) A drop-in child care program must maintain a minimum
staff ratio for children age 2-1/2 or greater of one staff
person for each ten children.
(g) If the program has additional staff who are on call as
a mandatory condition of their employment, the minimum
child-to-staff ratio may be exceeded only for children age 2-1/2
or greater, by a maximum of four children, for no more than 20
minutes while additional staff are in transit.
(h) The minimum staff-to-child ratio for infants up to 16
months of age is one staff person for every four infants. The
minimum staff-to-child ratio for children age 17 months to 30
months is one staff for every seven children.
(i) In drop-in care programs that serve both infants and
older children, children up to age 2-1/2 may be supervised by
assistant teachers, as long as other staff are present in
appropriate ratios.
(j) The minimum staff distribution pattern for a drop-in
child care program serving children age 2-1/2 or greater is:
the first staff member must be a teacher; the second, third, and
fourth staff members must have at least the qualifications of a
child care aide; the fifth staff member must have at least the
qualifications of an assistant teacher; the sixth, seventh, and
eighth staff members must have at least the qualifications of a
child care aide; and the ninth staff person must have at least
the qualifications of an assistant teacher.
(k) A drop-in child care program may care for siblings 16
months or older together in any group. For purposes of this
subdivision, sibling is defined as sister or brother,
half-sister or half-brother, or stepsister or stepbrother.
(l) The commissioner may grant a variance to any of the
requirements in paragraphs (a) to (k), as long as the health and
safety of the persons served by the program are not affected.
The request for a variance shall comply with the provisions in
section 245A.04, subdivision 9.
Sec. 21. Minnesota Statutes 1994, section 256.014,
subdivision 1, is amended to read:
Subdivision 1. [ESTABLISHMENT OF SYSTEMS.] The
commissioner of human services shall establish and enhance
computer systems necessary for the efficient operation of the
programs the commissioner supervises, including:
(1) management and administration of the food stamp and
income maintenance programs, including the electronic
distribution of benefits;
(2) management and administration of the child support
enforcement program; and
(3) administration of medical assistance and general
assistance medical care.
The commissioner shall distribute the nonfederal share of
the costs of operating and maintaining the systems to the
commissioner and to the counties participating in the system in
a manner that reflects actual system usage, except that the
nonfederal share of the costs of the MAXIS computer system and
child support enforcement systems shall be borne entirely by the
commissioner. Development costs must not be assessed against
county agencies.
Sec. 22. Minnesota Statutes 1994, 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, excluding county optional costs which are not
reimbursable with state funds. 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 2002 has increased
over the base amount.
Sec. 23. Minnesota Statutes 1994, 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,
for assistance costs incurred prior to July 1, 1995;
(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 for
employment and training services costs incurred prior to July 1,
1995;
(10) case management services under section 256.736,
subdivision 13, for case management service costs incurred prior
to July 1, 1995;
(11) general assistance claims processing, medical
transportation and related costs;
(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. 24. Minnesota Statutes 1994, 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. Reimbursement may take the form of offsets to
billings of a county, if the county agrees to the offset process.
(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 or quarterly pay to the state, as required
by the department of human services, the portion of program
costs not met by federal and state funds. The payment 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 or quarterly pay 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 payments shall be made by the state agency in
any succeeding month.
Sec. 25. Minnesota Statutes 1994, section 256.026, is
amended to read:
256.026 [ANNUAL APPROPRIATION.]
(a) There shall be appropriated from the general fund to
the commissioner of human services in fiscal year 1994 1996 the
amount of $136,154,768 and in fiscal year 1997 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 $133,781,768.
(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 $5,574,241.
(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 1996 and
thereafter.
Sec. 26. Minnesota Statutes 1994, section 256.034,
subdivision 1, is amended to read:
Subdivision 1. [CONSOLIDATION OF TYPES OF ASSISTANCE.]
Under the Minnesota family investment plan, assistance
previously provided to families through the AFDC, food stamp,
and general assistance programs must be combined into a single
cash assistance program. As authorized by Congress, families
receiving assistance through the Minnesota family investment
plan are automatically eligible for and entitled to medical
assistance under chapter 256B. Federal, state, and local funds
that would otherwise be allocated for assistance to families
under the AFDC, food stamp, and general assistance programs must
be transferred to the Minnesota family investment plan. The
provisions of the Minnesota family investment plan prevail over
any provisions of sections 245.771, 256.72 to 256.87, 256D.01 to
256D.21, or 393.07, subdivisions 10 and 10a, and any rules
implementing those sections with which they are irreconcilable.
The food stamp, general assistance, and work readiness programs
for single persons and couples who are not responsible for the
care of children are not replaced by the Minnesota family
investment plan. Unless stated otherwise in statutes or rules
governing the Minnesota family investment plan, participants in
the Minnesota family investment plan shall be considered to be
recipients of aid under aid to families with dependent children,
family general assistance, and food stamps for the purposes of
statutes and rules affecting such recipients or allocations of
funding based on the assistance status of the recipients, and to
specifically be subject to the provisions of section 256.98.
Sec. 27. Minnesota Statutes 1994, section 256.045,
subdivision 3, is amended to read:
Subd. 3. [STATE AGENCY HEARINGS.] (a) Any person applying
for, receiving or having received public assistance or a program
of social services granted by the state agency or a county
agency under sections 252.32, 256.031 to 256.036, and 256.72 to
256.879, chapters 256B, 256D, 256E, 261, or the federal Food
Stamp Act whose application for assistance is denied, not acted
upon with reasonable promptness, or whose assistance is
suspended, reduced, terminated, or claimed to have been
incorrectly paid, or any patient or relative aggrieved by an
order of the commissioner under section 252.27, or a party
aggrieved by a ruling of a prepaid health plan, may contest that
action or decision before the state agency by submitting a
written request for a hearing to the state agency within 30 days
after receiving written notice of the action or decision, or
within 90 days of such written notice if the applicant,
recipient, patient, or relative shows good cause why the request
was not submitted within the 30-day time limit.
(b) Except for a prepaid health plan, a vendor of medical
care as defined in section 256B.02, subdivision 7, or a vendor
under contract with a county agency to provide social services
under section 256E.08, subdivision 4, is not a party and may not
request a hearing under this section, except if assisting a
recipient as provided in subdivision 4.
(c) An applicant or recipient is not entitled to receive
social services beyond the services included in the amended
community social services plan developed under section 256E.081,
subdivision 3, if the county agency has met the requirements in
section 256E.081.
Sec. 28. Minnesota Statutes 1994, section 256.045,
subdivision 4, is amended to read:
Subd. 4. [CONDUCT OF HEARINGS.] All hearings held pursuant
to subdivision 3, 3a, or 4a shall be conducted according to the
provisions of the federal Social Security Act and the
regulations implemented in accordance with that act to enable
this state to qualify for federal grants-in-aid, and according
to the rules and written policies of the commissioner of human
services. County agencies shall install equipment necessary to
conduct telephone hearings. A state human services referee may
schedule a telephone conference hearing when the distance or
time required to travel to the county agency offices will cause
a delay in the issuance of an order, or to promote efficiency,
or at the mutual request of the parties. Hearings may be
conducted by telephone conferences unless the applicant,
recipient, or former recipient objects. The hearing shall not
be held earlier than five days after filing of the required
notice with the county or state agency. The state human
services referee shall notify all interested persons of the
time, date, and location of the hearing at least five days
before the date of the hearing. Interested persons may be
represented by legal counsel or other representative of their
choice, including a provider of therapy services, at the hearing
and may appear personally, testify and offer evidence, and
examine and cross-examine witnesses. The applicant, recipient,
or former recipient shall have the opportunity to examine the
contents of the case file and all documents and records to be
used by the county or state agency at the hearing at a
reasonable time before the date of the hearing and during the
hearing. Upon request, the county agency shall provide
reimbursement for transportation, child care, photocopying,
medical assessment, witness fee, and other necessary and
reasonable costs incurred by the applicant, recipient, or former
recipient in connection with the appeal. All evidence, except
that privileged by law, commonly accepted by reasonable people
in the conduct of their affairs as having probative value with
respect to the issues shall be submitted at the hearing and such
hearing shall not be "a contested case" within the meaning of
section 14.02, subdivision 3. The agency must present its
evidence prior to or at the hearing, and may not submit evidence
after the hearing except by agreement of the parties at the
hearing, provided the recipient has the opportunity to respond.
Sec. 29. Minnesota Statutes 1994, section 256.045,
subdivision 5, is amended to read:
Subd. 5. [ORDERS OF THE COMMISSIONER OF HUMAN SERVICES.] A
state human services referee shall conduct a hearing on the
appeal and shall recommend an order to the commissioner of human
services. The recommended order must be based on all relevant
evidence and must not be limited to a review of the propriety of
the state or county agency's action. A referee may take
official notice of adjudicative facts. The commissioner of
human services may accept the recommended order of a state human
services referee and issue the order to the county agency and
the applicant, recipient, former recipient, or prepaid health
plan. The commissioner on refusing to accept the recommended
order of the state human services referee, shall notify the
county agency and the applicant, recipient, former recipient, or
prepaid health plan of that fact and shall state reasons
therefor and shall allow each party ten days' time to submit
additional written argument on the matter. After the expiration
of the ten-day period, the commissioner shall issue an order on
the matter to the county agency and the applicant, recipient,
former recipient, or prepaid health plan.
A party aggrieved by an order of the commissioner may
appeal under subdivision 7, or request reconsideration by the
commissioner within 30 days after the date the commissioner
issues the order. The commissioner may reconsider an order upon
request of any party or on the commissioner's own motion. A
request for reconsideration does not stay implementation of the
commissioner's order. Upon reconsideration, the commissioner
may issue an amended order or an order affirming the original
order.
Any order of the commissioner issued under this subdivision
shall be conclusive upon the parties unless appeal is taken in
the manner provided by subdivision 7. Any order of the
commissioner is binding on the parties and must be implemented
by the state agency or a county agency until the order is
reversed by the district court, or unless the commissioner or a
district court orders monthly assistance or aid or services paid
or provided under subdivision 10.
Except for a prepaid health plan, a vendor of medical care
as defined in section 256B.02, subdivision 7, or a vendor under
contract with a county agency to provide social services under
section 256E.08, subdivision 4, is not a party and may not
request a hearing or seek judicial review of an order issued
under this section, unless assisting a recipient as provided in
subdivision 4.
Sec. 30. Minnesota Statutes 1994, section 256.98,
subdivision 1, is amended to read:
Subdivision 1. [WRONGFULLY OBTAINING ASSISTANCE.] A person
who obtains, or attempts to obtain, or aids or abets any person
to obtain by means of a willfully false statement or
representation, by intentional concealment of a material fact,
or by impersonation or other fraudulent device, assistance to
which the person is not entitled or assistance greater than that
to which the person is entitled, or who knowingly aids or abets
in buying or in any way disposing of the property of a recipient
or applicant of assistance without the consent of the county
agency with intent to defeat the purposes of sections
256.12, 256.031 to 256.0361, 256.72 to 256.871, and chapter
256B, or all of these sections is guilty of theft and shall be
sentenced pursuant to section 609.52, subdivision 3, clauses
(2), (3)(a) and (c), (4), and (5).
Sec. 31. Minnesota Statutes 1994, section 256.98,
subdivision 8, is amended to read:
Subd. 8. [DISQUALIFICATION FROM PROGRAM.] Any person found
to be guilty of wrongfully obtaining assistance by a federal or
state court or by an administrative hearing determination, or
waiver thereof, through a disqualification consent agreement, or
as part of any approved diversion plan under section 401.065 in
either the aid to families with dependent children program or,
the food stamp program, the Minnesota family investment plan,
the general assistance or family general assistance program, the
Minnesota supplemental aid program, or the work readiness
program shall be disqualified from that program. The needs of
that individual shall not be taken into consideration in
determining the grant level for that assistance unit:
(1) for six months after the first offense;
(2) for 12 months after the second offense; and
(3) permanently after the third or subsequent offense.
Any The period for which sanctions are imposed is
effective, of program disqualification shall begin on the date
stipulated on the advance notice of disqualification without
possibility of postponement for administrative stay, or
administrative hearing and shall continue through completion
unless and until the findings upon which the sanctions were
imposed are reversed by a court of competent jurisdiction. The
period for which sanctions are imposed is not subject to
review. The sanctions provided under this subdivision are in
addition to, and not in substitution for, any other sanctions
that may be provided for by law for the offense involved. A
disqualification established through hearing or waiver shall
result in the disqualification period beginning immediately
unless the person has become otherwise ineligible for
assistance. If the person is ineligible for assistance, the
disqualification period begins when the person again meets the
eligibility criteria of the program from which they were
disqualified.
Sec. 32. Minnesota Statutes 1994, section 256.983,
subdivision 4, is amended to read:
Subd. 4. [FUNDING.] (a) Every involved county agency shall
either have in place or obtain an approved contract which meets
all federal requirements necessary to obtain enhanced federal
funding for its welfare fraud control and fraud prevention
investigation programs. County agency reimbursement shall be
made through the settlement provisions applicable to the aid to
families with dependent children and food stamp programs.
(b) After allowing an opportunity to establish compliance,
the commissioner will deny administrative reimbursement if for
any three-month period during any grant year, a county agency
fails to comply with fraud investigation guidelines, or fails to
meet the cost-effectiveness standards developed by the
commissioner. This result is contingent on the commissioner
providing written notice, including an offer of technical
assistance, within 30 days of the end of the third or subsequent
month of noncompliance. The county agency shall be required to
submit a corrective action plan to the commissioner within 30
days of receipt of a notice of noncompliance. Failure to submit
a corrective action plan or, continued deviation from standards
of more than ten percent after submission of a corrective action
plan, will result in denial of funding for each subsequent month
during the grant year or billing the county agency for fraud
prevention investigation (FPI) service provided by the
commissioner. The denial of funding shall apply to the general
settlement received by the county agency on a quarterly basis
and shall not reduce the grant amount applicable to the FPI
project.
Sec. 33. [256.9861] [FRAUD CONTROL; PROGRAM INTEGRITY
REINVESTMENT PROJECT.]
Subdivision 1. [PROGRAM ESTABLISHED.] Within the limits of
available state and federal appropriations, and to the extent
required or authorized by applicable federal regulations, the
commissioner of human services shall make funding available to
county agencies for the establishment of program integrity
reinvestment initiatives. The project shall initially be
limited to those county agencies participating in federally
funded optional fraud control programs as of January 1, 1995.
Subd. 2. [COUNTY PROPOSALS.] Each included county shall
develop and submit annual funding, staffing, and operating grant
proposals to the commissioner no later than April 30 of each
year. For the first operating year only, the proposal shall be
submitted no later than October 30. Each proposal shall provide
information on: (a) the staffing and funding of the fraud
investigation and prosecution operations; (b) job descriptions
for agency fraud control staff; (c) contracts covering outside
investigative agencies; (d) operational methods to integrate the
use of fraud prevention investigation techniques; and (e)
administrative disqualification hearings and diversions into the
existing county fraud control and prosecution procedures.
Subd. 3. [DEPARTMENT RESPONSIBILITIES.] The commissioner
shall provide written instructions outlining the contents of the
proposals to be submitted under this section. Instructions
shall be made available 30 days prior to the date by which
proposals under subdivision 2 must be submitted. The
commissioner shall establish training programs which shall be
attended by fraud control staff of all involved counties. The
commissioner shall also develop the necessary operational
guidelines, forms, and reporting mechanisms which shall be used
by the involved counties.
Subd. 4. [STANDARDS.] The commissioner shall establish
standards governing the performance levels of involved county
investigative units based on grant agreements negotiated with
the involved county agencies. The standards shall take into
consideration and may include investigative caseloads, grant
savings levels, the comparison of fraud prevention and
prosecution directed investigations, utilization levels of
administrative disqualification hearings, the timely reporting
and implementation of disqualifications, and the timeliness of
reports received from prosecutors.
Subd. 5. [FUNDING.] (a) Grant funds are intended to help
offset the reduction in federal financial participation to 50
percent and may be apportioned to the participating counties
whenever feasible, and within the commissioner's discretion, to
achieve this goal. State funding shall be made available
contingent on counties submitting a plan that is approved by the
department of human services. Failure or delay in obtaining
that approval shall not, however, eliminate the obligation to
maintain fraud control efforts at the January 1, 1995, level.
Additional counties may be added to the project to the extent
that funds are subsequently made available. Every involved
county must meet all federal requirements necessary to obtain
federal funding for its welfare fraud control and prevention
programs. County agency reimbursement shall be made through the
settlement provisions applicable to the AFDC and food stamp
programs.
(b) Should a county agency fail to comply with the
standards set, or fail to meet cost-effectiveness standards
developed by the commissioner for three months during any grant
year, the commissioner shall deny reimbursement or
administrative costs, after allowing an opportunity to establish
compliance.
(c) Any denial of reimbursement under clause (b) is
contingent on the commissioner providing written notice,
including an offer of technical assistance, within 30 days of
the end of the third or subsequent months of noncompliance. The
county agency shall be required to submit a corrective action
plan to the commissioner within 30 days of receipt of a notice
of noncompliance. Failure to submit a corrective action plan or
continued deviation from standards of more than ten percent
after submission of corrective action plan, will result in
denial of funding for each such month during the grant year, or
billing the county agency for program integrity reinvestment
project services provided by the commissioner. The denial of
funding shall apply to the general settlement received by the
county agency on a quarterly basis and shall not reduce the
grant amount applicable to the program integrity reinvestment
project.
Sec. 34. [256.9862] [ASSISTANCE TRANSACTION CARD FEE.]
Subdivision 1. [REPLACEMENT CARD.] The commissioner of
human services may charge a cardholder, defined as a person in
whose name the transaction card was issued, a $2 fee to replace
an assistance transaction card. The fees shall be appropriated
to the commissioner and used for electronic benefit purposes.
Subd. 2. [TRANSACTION FEE.] The commissioner may charge
transaction fees in accordance with this subdivision up to a
maximum of $10 in transaction fees per cardholder per month. In
a given month, the first four cash withdrawals made by an
individual cardholder are free. For subsequent cash
withdrawals, $1 may be charged. No transaction fee can be
charged if the card is used to purchase goods or services on a
point of sale basis. A transaction fee subsequently set by the
federal government may supersede a fee established under this
subdivision. The fees shall be appropriated to the commissioner
and used for electronic benefit purposes.
Sec. 35. Minnesota Statutes 1994, section 524.6-207, is
amended to read:
524.6-207 [RIGHTS OF CREDITORS.]
No multiple-party account will be effective against an
estate of a deceased party to transfer to a survivor sums needed
to pay debts, taxes, and expenses of administration, including
statutory allowances to the surviving spouse, minor children and
dependent children or against a county agency with a claim
authorized by section 256B.15, if other assets of the estate are
insufficient, to the extent the deceased party is the source of
the funds or beneficial owner. A surviving party or P.O.D.
payee who receives payment from a multiple-party account after
the death of a deceased party shall be liable to account to the
deceased party's personal representative or a county agency with
a claim authorized by section 256B.15 for amounts the decedent
owned beneficially immediately before death to the extent
necessary to discharge any such claims and charges remaining
unpaid after the application of the assets of the decedent's
estate. No proceeding to assert this liability shall be
commenced unless by the personal representative unless the
personal representative has received a written demand by a
surviving spouse, a creditor or one acting for a minor dependent
child of the decedent, and no proceeding shall be commenced
later than two years following the death of the decedent. Sums
recovered by the personal representative shall be administered
as part of the decedent's estate. This section shall not affect
the right of a financial institution to make payment on
multiple-party accounts according to the terms thereof, or make
it liable to the estate of a deceased party unless, before
payment, the institution has been served with process in a
proceeding by the personal representative or a county agency
with a claim authorized by section 256B.15.
Sec. 36. Minnesota Statutes 1994, section 550.37,
subdivision 14, is amended to read:
Subd. 14. [PUBLIC ASSISTANCE.] All relief based on need,
and the earnings or salary of a person who is a recipient of
relief based on need, shall be exempt from all claims of
creditors including any contractual setoff or security interest
asserted by a financial institution. For the purposes of this
chapter, relief based on need includes AFDC, general assistance
medical care, supplemental security income, medical assistance,
Minnesota supplemental assistance, and general assistance. The
salary or earnings of any debtor who is or has been a an
eligible recipient of relief based on need, or an inmate of a
correctional institution shall, upon the debtor's return to
private employment or farming after having been a an eligible
recipient of relief based on need, or an inmate of a
correctional institution, be exempt from attachment,
garnishment, or levy of execution for a period of six months
after the debtor's return to employment or farming and after all
public assistance for which eligibility existed has been
terminated. The exemption provisions contained in this
subdivision also apply for 60 days after deposit in any
financial institution, whether in a single or joint account. In
tracing the funds, the first-in first-out method of accounting
shall be used. The burden of establishing that funds are exempt
rests upon the debtor. Agencies distributing relief and the
correctional institutions shall, at the request of creditors,
inform them whether or not any debtor has been a an eligible
recipient of relief based on need, or an inmate of a
correctional institution, within the preceding six months.
Sec. 37. [MCLEOD COUNTY; COUNTY OFFICES OUTSIDE COUNTY
SEAT.]
Notwithstanding Minnesota Statutes, section 382.04 to the
contrary, the McLeod county auditor, treasurer, social service
director, and recorder may temporarily office at a location in
Glencoe township. The authority provided in this section
expires six years after final enactment.
Sec. 38. [WAIVER REQUEST; GRANDPARENT EXCLUSION FROM
LICENSURE.]
The commissioner of human services shall seek a federal
waiver to allow the exclusion of grandparents from the foster
care licensing requirements. If the waiver is granted,
notwithstanding Minnesota Statutes, section 245A.03, the
commissioner may exclude grandparents from foster care
licensure. The commissioner shall recommend to the legislature
in the legislative session following the approval of the waiver,
related, necessary changes in the law.
Sec. 39. [REPEALER.]
Minnesota Statutes 1994, section 256E.06, subdivisions 12
and 13, are repealed.
Sec. 40. [EFFECTIVE DATES.]
Subdivision 1. Sections 5 (245A.03, subdivision 2a), 6
(245A.035, subdivisions 1 to 6), 7 to 10 (245A.04, subdivisions
3, 3b, 7, and 9), 11 to 13 (245A.06, subdivisions 2, 4, and 7),
14 (245A.07, subdivision 3), and 20 (245A.14, subdivision 6),
are effective the day following final enactment.
Subd. 2. Under Minnesota Statutes, section 645.023,
subdivision 1, clause (a), section 32, takes effect, without
local approval, the day following final enactment.
ARTICLE 3
LIFE SKILLS; SELF-SUFFICIENCY
Section 1. Minnesota Statutes 1994, section 246.23,
subdivision 2, is amended to read:
Subd. 2. [CHEMICAL DEPENDENCY TREATMENT.] The commissioner
shall maintain a regionally based, state-administered system of
chemical dependency programs. Counties may refer individuals
who are eligible for services under chapter 254B to the chemical
dependency units in the regional treatment centers. A 15
percent county share of the per diem cost of treatment is
required for individuals served within the treatment capacity
funded by direct legislative appropriation. By July 1, 1991,
the commissioner shall establish criteria for admission to the
chemical dependency units that will maximize federal and private
funding sources, fully utilize the regional treatment center
capacity, and make state-funded treatment capacity available to
counties on an equitable basis. The admission criteria may be
adopted without rulemaking. Existing rules governing placements
under chapters 254A and 254B do not apply to admissions to the
capacity funded by direct appropriation. Private and
third-party collections and payments are appropriated to the
commissioner for the operation of the chemical dependency
units. In addition to the chemical dependency treatment
capacity funded by direct legislative appropriation, the
regional treatment centers may provide treatment to additional
individuals whose treatment is paid for out of the chemical
dependency consolidated treatment fund under chapter 254B, in
which case placement rules adopted under chapter 254B apply,; to
those individuals who are ineligible but committed for treatment
under chapter 253B as provided in section 254B.05, subdivision
4; or to individuals covered through other nonstate payment
sources.
Sec. 2. Minnesota Statutes 1994, section 252.275,
subdivision 3, is amended to read:
Subd. 3. [REIMBURSEMENT.] Counties shall be reimbursed for
all expenditures made pursuant to subdivision 1 at a rate of 70
percent, up to the allocation determined pursuant to
subdivisions 4, 4a, and 4b. However, the commissioner shall not
reimburse costs of services for any person if the costs exceed
the state share of the average medical assistance costs for
services provided by intermediate care facilities for a person
with mental retardation or a related condition for the same
fiscal year, and shall not reimburse costs of a one-time living
allowance for any person if the costs exceed $1,500 in a state
fiscal year. For the biennium ending June 30, 1993, the
commissioner shall not reimburse costs in excess of the 85th
percentile of hourly service costs based upon the cost
information supplied to the legislature in the proposed budget
for the biennium. The commissioner may make payments to each
county in quarterly installments. The commissioner may certify
an advance of up to 25 percent of the allocation. Subsequent
payments shall be made on a reimbursement basis for reported
expenditures and may be adjusted for anticipated spending
patterns.
Sec. 3. Minnesota Statutes 1994, section 252.275,
subdivision 4, is amended to read:
Subd. 4. [FORMULA.] Effective January 1, 1992, The
commissioner shall allocate funds on a calendar year basis. For
calendar year 1992, funds shall be allocated based on each
county's portion of the statewide reimbursement received under
this section for state fiscal year 1991. For subsequent
calendar years, funds shall be Beginning with the calendar year
in the 1996 grant period, funds shall be allocated first in
amounts equal to each county's guaranteed floor according to
subdivision 4b, with any remaining available funds allocated
based on each county's portion of the statewide expenditures
eligible for reimbursement under this section during the 12
months ending on June 30 of the preceding calendar year.
If the legislature appropriates funds for special purposes,
the commissioner may allocate the funds based on proposals
submitted by the counties to the commissioner in a format
prescribed by the commissioner. Nothing in this section
prevents a county from using other funds to pay for additional
costs of semi-independent living services.
Sec. 4. Minnesota Statutes 1994, 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
December 31, 1995.
Sec. 5. Minnesota Statutes 1994, section 252.292,
subdivision 4, is amended to read:
Subd. 4. [FACILITY RATES.] For purposes of this section,
the commissioner shall establish payment rates under section
256B.501 and Minnesota Rules, parts 9553.0010 to 9553.0080,
except that, in order to facilitate an orderly transition of
residents from community intermediate care facilities for
persons with mental retardation or related conditions to
services provided under the home and community-based services
program, the commissioner may, in a contract with the provider,
modify the effect of provisions in Minnesota Rules, parts
9553.0010 to 9553.0080, as stated in clauses (a) to (i):
(a) extend the interim and settle-up rate provisions to
include facilities covered by this section;
(b) extend the length of the interim period but not to
exceed 24 12 months. The commissioner may grant a variance to
exceed the 24-month 12-month interim period, as necessary, for
facilities which are licensed and certified to serve more than
99 persons. In no case shall the commissioner approve an
interim period which exceeds 36 24 months;
(c) waive the investment per bed limitations for the
interim period and the settle-up rate;
(d) limit the amount of reimbursable expenses related to
the acquisition of new capital assets;
(e) prohibit the acquisition of additional capital debt or
refinancing of existing capital debt unless prior approval is
obtained from the commissioner;
(f) establish an administrative operating cost limitation
for the interim period and the settle-up rate;
(g) require the retention of financial and statistical
records until the commissioner has audited the interim period
and the settle-up rate;
(h) require that the interim period be audited by a
certified or licensed public accounting firm; or
(i) change any other provision to which all parties to the
contract agree.
Sec. 6. Minnesota Statutes 1994, section 252.46,
subdivision 1, is amended to read:
Subdivision 1. [RATES.] (a) 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 19. 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.
(b) The commissioner may also approve an hourly job-coach,
follow-along rate for services provided by one employee at or en
route to or from community locations to supervise, support, and
assist one person receiving the vendor's services to learn
job-related skills necessary to obtain or retain employment when
and where no other persons receiving services are present and
when all the following criteria are met:
(1) the vendor requests and the county recommends the
optional rate;
(2) the service is prior authorized by the county on the
medicaid management information system for no more than 414
hours in a 12-month period and the daily per person charge to
medical assistance does not exceed the vendor's approved full
day plus transportation rates;
(3) separate full day, partial day, and transportation
rates are not billed for the same person on the same day;
(4) the approved hourly rate does not exceed the sum of the
vendor's current average hourly direct service wage, including
fringe benefits and taxes, plus a component equal to the
vendor's average hourly nondirect service wage expenses; and
(5) the actual revenue received for provision of hourly
job-coach, follow-along services is subtracted from the vendor's
total expenses for the same time period and those adjusted
expenses are used for determining recommended full day and
transportation payment rates under subdivision 5 in accordance
with the limitations in subdivision 3.
(c) 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.
Sec. 7. Minnesota Statutes 1994, section 252.46,
subdivision 3, is amended to read:
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.
Sec. 8. Minnesota Statutes 1994, section 252.46,
subdivision 6, is amended to read:
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.
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, transportation, and other program related
costs when any of the criteria in clauses (1) to (3) (4) is also
met:
(1) change is necessary to comply with licensing citations;
(2) a licensed vendor currently serving fewer than 70
persons with payment rates of 80 percent or less of the
statewide average rates and with clients meeting the behavioral
or medical criteria under clause (3) approved by the
commissioner as a significant program change under section
252.28;
(3) a significant change is approved by the commissioner
under section 252.28 that is necessary to provide authorized
services to a new client or 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 a new client or clients directly
discharged to the vendor's program from a regional treatment
center; or
(3) a significant increase in the average level of (4)
there is a need to maintain required staffing is needed levels
in order to provide authorized services approved by the
commissioner under section 252.28, that is necessitated by
a significant and permanent decrease in licensed capacity
or loss of clientele when counties choose alternative services
under Laws 1992, chapter 513, article 9, section 41.
The county shall review the adequacy of services provided
by vendors whose payment rates are 80 percent or more of the
statewide average rates and 50 percent or more of the vendor's
clients meet the behavioral or medical criteria in clause (3).
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
and 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 vendor documents efforts to reallocate current
staff and any additional 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.
(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.
(6) The county board's recommended payment rates do not
exceed 95 percent of the greater of 125 percent of the current
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.
Sec. 9. Minnesota Statutes 1994, section 252.46,
subdivision 17, is amended to read:
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. 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 this subdivision. If the rates meeting the
criteria in subdivisions 1 to 16 are lower than the county's or
vendor's current rate, the county or vendor must continue to
receive the current rate.
Sec. 10. Minnesota Statutes 1994, section 252.46, is
amended by adding a subdivision to read:
Subd. 19. [VENDOR APPEALS.] With the concurrence of the
county board, a vendor may appeal the commissioner's rejection
of a variance request which has been submitted by the county
under subdivision 6 and may appeal the commissioner's denial
under subdivision 9 of a rate which has been recommended by the
county. To appeal, the vendor and county board must file a
written notice of appeal with the commissioner. The notice of
appeal must be filed or received by the commissioner within 45
days of the postmark date on the commissioner's notification to
the vendor and county agency that a variance request or county
recommended rate has been denied. The notice of appeal must
specify the reasons for the appeal, the dollar amount in
dispute, and the basis in statute or rule for challenging the
commissioner's decision.
Within 45 days of receipt of the notice of appeal, the
commissioner must convene a reconciliation conference to attempt
to resolve the rate dispute. If the dispute is not resolved to
the satisfaction of the parties, the parties may initiate a
contested case proceeding under sections 14.57 to 14.69. In a
contested case hearing held under this section, the appealing
party must demonstrate by a preponderance of the evidence that
the commissioner incorrectly applied the governing law or
regulations, or that the commissioner improperly exercised the
commissioner's discretion, in refusing to grant a variance or in
refusing to adopt a county recommended rate.
Until the appeal is fully resolved, payments must continue
at the existing rate pending the appeal. Retroactive payments
consistent with the final decision shall be made after the
appeal is fully resolved.
Sec. 11. Minnesota Statutes 1994, section 252.46, is
amended by adding a subdivision to read:
Subd. 20. [STUDY OF DAY TRAINING AND HABILITATION
VENDORS.] The commissioner shall study the feasibility of
grouping vendors of similar size, location, direct service
staffing needs or performance outcomes to establish payment rate
limits that define cost-effective service. Based on the
conclusions of the feasibility study the department shall
consider developing a method to redistribute dollars from less
cost effective to more cost-effective services based on vendor
achievement of performance outcomes. The department shall
report to the legislature by January 15, 1996, with results of
the study and recommendations for further action. The
department shall consult with an advisory committee representing
counties, service consumers, vendors, and the legislature.
Sec. 12. Minnesota Statutes 1994, 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, and 1996, 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. A county must make a good
faith effort to provide the transportation service through the
most cost-effective community-based agencies or organizations
eligible to provide the service. 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. 13. Minnesota Statutes 1994, section 254B.02,
subdivision 1, is amended to read:
Subdivision 1. [CHEMICAL DEPENDENCY TREATMENT ALLOCATION.]
The chemical dependency funds appropriated for allocation shall
be placed in a special revenue account. For the fiscal year
beginning July 1, 1987, funds shall be transferred to operate
the vendor payment, invoice processing, and collections system
for one year. The commissioner shall annually transfer funds
from the chemical dependency fund to pay for operation of the
drug and alcohol abuse normative evaluation system and to pay
for all costs incurred by adding two positions for licensing of
chemical dependency treatment and rehabilitation programs
located in hospitals for which funds are not otherwise
appropriated. The commissioner shall annually divide the money
available in the chemical dependency fund that is not held in
reserve by counties from a previous allocation. Twelve percent
of the remaining money must be reserved for treatment of
American Indians by eligible vendors under section 254B.05. The
remainder of the money must be allocated among the counties
according to the following formula, using state demographer data
and other data sources determined by the commissioner:
(a) The county non-Indian and over age 14 per capita-months
of eligibility for aid to families with dependent children,
general assistance, and medical assistance is divided by the
total state non-Indian and over age 14 per capita-months of
eligibility to determine the caseload factor for each county.
(b) The average median married couple income for the
previous three years for the state is divided by the average
median married couple income for the previous three years for
each county to determine the income factor.
(c) The non-Indian and over age 14 population of the county
is multiplied by the sum of the income factor and the caseload
factor to determine the adjusted population.
(a) For purposes of this formula, American Indians and
children under age 14 are subtracted from the population of each
county to determine the restricted population.
(b) The amount of chemical dependency fund expenditures for
entitled persons for services not covered by prepaid plans
governed by section 256B.69 in the previous year is divided by
the amount of chemical dependency fund expenditures for entitled
persons for all services to determine the proportion of exempt
service expenditures for each county.
(c) The prepaid plan months of eligibility is multiplied by
the proportion of exempt service expenditures to determine the
adjusted prepaid plan months of eligibility for each county.
(d) The adjusted prepaid plan months of eligibility is
added to the number of restricted population fee for service
months of eligibility for aid to families with dependent
children, general assistance, and medical assistance and divided
by the county restricted population to determine county per
capita months of covered service eligibility.
(e) The number of adjusted prepaid plan months of
eligibility for the state is added to the number of fee for
service months of eligibility for aid to families with dependent
children, general assistance, and medical assistance for the
state restricted population and divided by the state restricted
population to determine state per capita months of covered
service eligibility.
(f) The county per capita months of covered service
eligibility is divided by the state per capita months of covered
service eligibility to determine the county welfare caseload
factor.
(g) The median married couple income for the most recent
three-year period available for the state is divided by the
median married couple income for the same period for each county
to determine the income factor for each county.
(h) The county restricted population is multiplied by the
sum of the county welfare caseload factor and the county income
factor to determine the adjusted population.
(d) (i) $15,000 shall be allocated to each county.
(e) (j) The remaining funds shall be allocated proportional
to the county adjusted population.
Sec. 14. Minnesota Statutes 1994, section 254B.05,
subdivision 1, is amended to read:
Subdivision 1. [LICENSURE REQUIRED.] Programs licensed by
the commissioner are eligible vendors. Hospitals may apply for
and receive licenses to be eligible vendors, notwithstanding the
provisions of section 245A.03. American Indian programs located
on federally recognized tribal lands that provide chemical
dependency primary treatment, extended care, transitional
residence, or outpatient treatment services, and are licensed by
tribal government are eligible vendors. Detoxification programs
are not eligible vendors. Programs that are not licensed as a
chemical dependency residential or nonresidential treatment
program by the commissioner or by tribal government are not
eligible vendors. To be eligible for payment under the
Consolidated Chemical Dependency Treatment Fund, a vendor must
participate in the Drug and Alcohol Abuse Normative Evaluation
System and the treatment accountability plan.
Sec. 15. [256.476] [CONSUMER SUPPORT PROGRAM.]
Subdivision 1. [PURPOSE AND GOALS.] The commissioner of
human services shall establish a consumer support grant program
to assist individuals with functional limitations and their
families in purchasing and securing supports which the
individuals need to live as independently and productively in
the community as possible. The commissioner and local agencies
shall jointly develop an implementation plan which must include
a way to resolve the issues related to county liability. The
program shall:
(1) make support grants available to individuals or
families as an effective alternative to existing programs and
services, such as the developmental disability family support
program, the alternative care program, personal care attendant
services, home health aide services, and nursing facility
services;
(2) provide consumers more control, flexibility, and
responsibility over the needed supports;
(3) promote local program management and decision-making;
and
(4) encourage the use of informal and typical community
supports.
Subd. 2. [DEFINITIONS.] For purposes of this section, the
following terms have the meanings given them:
(a) "County board" means the county board of commissioners
for the county of financial responsibility as defined in section
256G.02, subdivision 4, or its designated representative. When
a human services board has been established under sections
402.01 to 402.10, it shall be considered the county board for
the purposes of this section.
(b) "Family" means the person's birth parents, adoptive
parents or stepparents, siblings or stepsiblings, children or
stepchildren, grandparents, grandchildren, niece, nephew, aunt,
uncle, or spouse. For the purposes of this section, a family
member is at least 18 years of age.
(c) "Functional limitations" means the long-term inability
to perform an activity or task in one or more areas of major
life activity, including self-care, understanding and use of
language, learning, mobility, self-direction, and capacity for
independent living. For the purpose of this section, the
inability to perform an activity or task results from a mental,
emotional, psychological, sensory, or physical disability,
condition, or illness.
(d) "Informed choice" means a voluntary decision made by
the person or the person's legal representative, after becoming
familiarized with the alternatives to:
(1) select a preferred alternative from a number of
feasible alternatives;
(2) select an alternative which may be developed in the
future; and
(3) refuse any or all alternatives.
(e) "Local agency" means the local agency authorized by the
county board to carry out the provisions of this section.
(f) "Person" or "persons" means a person or persons meeting
the eligibility criteria in subdivision 3.
(g) "Responsible individual" means an individual designated
by the person or their legal representative to act on their
behalf. This individual may be a family member, guardian,
representative payee, or other individual designated by the
person or their legal representative, if any, to assist in
purchasing and arranging for supports. For the purposes of this
section, a responsible individual is at least 18 years of age.
(h) "Screening" means the screening of a person's service
needs under sections 256B.0911 and 256B.092.
(i) "Supports" means services, care, aids, home
modifications, or assistance purchased by the person or the
person's family. Examples of supports include respite care,
assistance with daily living, and adaptive aids. For the
purpose of this section, notwithstanding the provisions of
section 144A.43, supports purchased under the consumer support
program are not considered home care services.
Subd. 3. [ELIGIBILITY TO APPLY FOR GRANTS.] (a) A person
is eligible to apply for a consumer support grant if the person
meets all of the following criteria:
(1) the person is eligible for medical assistance as
determined under sections 256B.055 and 256B.056 or the person is
eligible for alternative care services as determined under
section 256B.0913;
(2) the person is able to direct and purchase their own
care and supports, or the person has a family member, legal
representative, or other responsible individual who can purchase
and arrange supports on the person's behalf;
(3) the person has functional limitations, requires ongoing
supports to live in the community, and is at risk of or would
continue institutionalization without such supports; and
(4) the person will live in a home. For the purpose of
this section, "home" means the person's own home or home of a
person's family member. These homes are natural home settings
and are not licensed by the department of health or human
services.
(b) Persons may not concurrently receive a consumer support
grant if they are:
(1) receiving home and community-based services under
United States Code, title 42, section 1396h(c); personal care
attendant and home health aide services under section 256B.0625;
a developmental disability family support grant; or alternative
care services under section 256B.0913; or
(2) residing in an institutional or congregate care setting.
(c) A person or person's family receiving a consumer
support grant shall not be charged a fee or premium by a local
agency for participating in the program. A person or person's
family is not eligible for a consumer support grant if their
income is at a level where they are required to pay a parental
fee under sections 252.27, 256B.055, subdivision 12, and 256B.14
and rules adopted under those sections for medical assistance
services to a disabled child living with at least one parent.
Subd. 4. [SUPPORT GRANTS; CRITERIA AND LIMITATIONS.] (a) A
county board may choose to participate in the consumer support
grant program. If a county board chooses to participate in the
program, the local agency shall establish written procedures and
criteria to determine the amount and use of support grants.
These procedures must include, at least, the availability of
respite care, assistance with daily living, and adaptive aids.
The local agency may establish monthly or annual maximum amounts
for grants and procedures where exceptional resources may be
required to meet the health and safety needs of the person on a
time-limited basis.
(b) Support grants to a person or a person's family may be
provided through a monthly subsidy or lump sum payment basis and
be in the form of cash, voucher, or direct county payment to
vendor. Support grant amounts must be determined by the local
agency. Each service and item purchased with a support grant
must meet all of the following criteria:
(1) it must be over and above the normal cost of caring for
the person if the person did not have functional limitations;
(2) it must be directly attributable to the person's
functional limitations;
(3) it must enable a person or the person's family to delay
or prevent out-of-home placement of the person; and
(4) it must be consistent with the needs identified in the
service plan, when applicable.
(c) Items and services purchased with support grants must
be those for which there are no other public or private funds
available to the person or the person's family. Fees assessed
to the person or the person's family for health and human
services are not reimbursable through the grant.
(d) In approving or denying applications, the local agency
shall consider the following factors:
(1) the extent and areas of the person's functional
limitations;
(2) the degree of need in the home environment for
additional support; and
(3) the potential effectiveness of the grant to maintain
and support the person in the family environment or the person's
own home.
(e) At the time of application to the program or screening
for other services, the person or the person's family shall be
provided sufficient information to ensure an informed choice of
alternatives by the person, the person's legal representative,
if any, or the person's family. The application shall be made
to the local agency and shall specify the needs of the person
and family, the form and amount of grant requested, the items
and services to be reimbursed, and evidence of eligibility for
medical assistance or alternative care program.
(f) Upon approval of an application by the local agency and
agreement on a support plan for the person or person's family,
the local agency shall make grants to the person or the person's
family. The grant shall be in an amount for the direct costs of
the services or supports outlined in the service agreement.
(g) Reimbursable costs shall not include costs for
resources already available, such as special education classes,
day training and habilitation, case management, other services
to which the person is entitled, medical costs covered by
insurance or other health programs, or other resources usually
available at no cost to the person or the person's family.
Subd. 5. [REIMBURSEMENT, ALLOCATIONS, AND REPORTING.] (a)
For the purpose of transferring persons to the consumer support
grant program from specific programs or services, such as the
developmental disability family support program and alternative
care program, personal care attendant, home health aide, or
nursing facility services, the amount of funds transferred by
the commissioner between the developmental disability family
support program account, the alternative care account, the
medical assistance account, or the consumer support grant
account shall be based on each county's participation in
transferring persons to the consumer support grant program from
those programs and services.
(b) At the beginning of each fiscal year, county
allocations for consumer support grants shall be based on:
(1) the number of persons to whom the county board expects
to provide consumer supports grants;
(2) their eligibility for current program and services;
(3) the amount of nonfederal dollars expended on those
individuals for those programs and services; and
(4) projected dates when persons will start receiving
grants. County allocations shall be adjusted periodically by
the commissioner based on the actual transfer of persons or
service openings, and the nonfederal dollars associated with
those persons or service openings, to the consumer support grant
program.
(c) The commissioner shall use up to five percent of each
county's allocation, as adjusted, for payments to that county
for administrative expenses, to be paid as a proportionate
addition to reported direct service expenditures.
(d) The commissioner may recover, suspend, or withhold
payments if the county board, local agency, or grantee does not
comply with the requirements of this section.
Subd. 6. [RIGHT TO APPEAL.] Notice, appeal, and hearing
procedures shall be conducted in accordance with section
256.045. The denial, suspension, or termination of services
under this program may be appealed by a recipient or applicant
under section 256.045, subdivision 3. It is an absolute defense
to an appeal under this section, if the county board proves that
it followed the established written procedures and criteria and
determined that the grant could not be provided within the
county board's allocation of money for consumer support grants.
Subd. 7. [FEDERAL FUNDS.] The commissioner and the
counties shall make reasonable efforts to maximize the use of
federal funds including funds available through grants and
federal waivers. If federal funds are made available to the
consumer support grant program, the money shall be allocated to
the responsible county agency's consumer support grant fund.
Subd. 8. [COMMISSIONER RESPONSIBILITIES.] The commissioner
shall:
(1) transfer and allocate funds pursuant to this section;
(2) determine allocations based on projected and actual
local agency use;
(3) monitor and oversee overall program spending;
(4) evaluate the effectiveness of the program;
(5) provide training and technical assistance for local
agencies and consumers to help identify potential applicants to
the program; and
(6) develop guidelines for local agency program
administration and consumer information.
Subd. 9. [COUNTY BOARD RESPONSIBILITIES.] County boards
receiving funds under this section shall:
(1) determine the needs of persons and families for
services and supports;
(2) determine the eligibility for persons proposed for
program participation;
(3) approve items and services to be reimbursed and inform
families of their determination;
(4) issue support grants directly to or on behalf of
persons;
(5) submit quarterly financial reports and an annual
program report to the commissioner;
(6) coordinate services and supports with other programs
offered or made available to persons or their families; and
(7) provide assistance to persons or their families in
securing or maintaining supports, as needed.
Subd. 10. [CONSUMER RESPONSIBILITIES.] Persons receiving
grants under this section shall:
(1) spend the grant money in a manner consistent with their
agreement with the local agency;
(2) notify the local agency of any necessary changes in the
grant or the items on which it is spent;
(3) notify the local agency of any decision made by the
person, the person's legal representative, or the person's
family that would change their eligibility for consumer support
grants;
(4) arrange and pay for supports; and
(5) inform the local agency of areas where they have
experienced difficulty securing or maintaining supports.
Sec. 16. [256.973] [HOUSING FOR PERSONS WHO ARE ELDERLY,
PERSONS WITH PHYSICAL OR DEVELOPMENTAL DISABILITIES, AND
SINGLE-PARENT FAMILIES.]
Subdivision 1. [HOME SHARING.] The home-sharing grant
program authorized by section 462A.05, subdivision 24, is
transferred from the Minnesota housing finance agency to the
department of human services. The housing finance agency shall
administer the current grants that terminate on August 30,
1995. The department of human services shall administer grants
funded after August 30, 1995. The department of human services
may engage in housing programs, as defined by the agency, to
provide grants to housing sponsors who will provide a
home-sharing program for low- and moderate-income elderly,
persons with physical or developmental disabilities, or
single-parent families in urban and rural areas.
Subd. 2. [MATCHING OWNERS AND TENANTS.] Housing sponsors
of home sharing programs, as defined by the agency, shall match
existing homeowners with prospective tenants who will contribute
either rent or services to the homeowner, where either the
homeowner or the prospective tenant is elderly, a person with
physical or developmental disabilities, or the head of a
single-parent family. Home-sharing projects will coordinate
efforts with appropriate public and private agencies and
organizations in their area.
Subd. 3. [INFORMATION FOR PARTICIPANTS.] Housing sponsors
who receive funding through these programs shall provide
homeowners and tenants participating in a home-sharing program
with information regarding their rights and obligations as they
relate to federal and state tax law including, but not limited
to, taxable rental income, homestead credit under chapter 273,
and the property tax refund act under chapter 290A.
Subd. 4. [TECHNICAL ASSISTANCE.] The department of human
services may provide technical assistance to sponsors of
home-sharing programs or may contract or delegate the provision
of technical assistance.
Subd. 5. [USING OUTSIDE AGENCIES.] The department of human
services may delegate, use, or employ any federal, state,
regional, or local public or private agency or organization,
including organizations of physically handicapped persons, upon
terms it deems necessary or desirable, to assist in the exercise
of any of the powers granted in this section.
Sec. 17. Minnesota Statutes 1994, section 256.975, is
amended by adding a subdivision to read:
Subd. 6. [INDIAN ELDERS POSITION.] The Minnesota board on
aging shall create an Indian elders coordinator position, and
shall hire staff as appropriations permit for the purposes of
coordinating efforts with the National Indian Council on Aging
and developing a comprehensive statewide service system for
Indian elders. An Indian elder is defined for purposes of this
subdivision as an Indian enrolled in a band or tribe who is 55
years or older. The statewide service system must include the
following components:
(1) an assessment of the program eligibility, examining the
need to change the age-based eligibility criteria to need-based
eligibility criteria;
(2) a planning system that would grant or make
recommendations for granting federal and state funding for
services;
(3) a plan for service focal points, senior centers, or
community centers for socialization and service accessibility
for Indian elders;
(4) a plan to develop and implement education and public
awareness campaigns including awareness programs, sensitivity
cultural training, and public education on Indian elder needs;
(5) a plan for information and referral services including
trained advocates and an Indian elder newsletter;
(6) a plan for a coordinated health care system including
health promotion/prevention, in-home service, long-term care
service, and health care services;
(7) a plan for ongoing research involving Indian elders
including needs assessment and needs analysis;
(8) information and referral services for legal advice or
legal counsel; and
(9) a plan to coordinate services with existing
organizations including the council of Indian affairs, the
Minnesota Indian council of elders, the Minnesota board on
aging, and tribal governments.
Sec. 18. Minnesota Statutes 1994, section 256B.0628, is
amended by adding a subdivision to read:
Subd. 3. [ASSESSMENT AND PRIOR AUTHORIZATION PROCESS FOR
RECIPIENTS OF BOTH HOME CARE AND HOME AND COMMUNITY-BASED
WAIVERED SERVICES FOR PERSONS WITH MENTAL RETARDATION OR RELATED
CONDITIONS.] Effective January 1, 1996, for purposes of
providing informed choice, coordinating of local planning
decisions, and streamlining administrative requirements, the
assessment and prior authorization process for persons receiving
both home care and home and community-based waivered services
for persons with mental retardation or related conditions shall
meet the requirements of this section and section 256B.0627 with
the following exceptions:
(a) Upon request for home care services and subsequent
assessment by the public health nurse under section 256B.0627,
the public health nurse shall participate in the screening
process, as appropriate, and, if home care services are
determined to be necessary, participate in the development of a
service plan coordinating the need for home care and home and
community-based waivered services with the assigned county case
manager, the recipient of services, and the recipient's legal
representative, if any.
(b) The public health nurse shall give prior authorization
for home care services to the extent that home care services are:
(1) medically necessary;
(2) chosen by the recipient and their legal representative,
if any, from the array of home care and home and community-based
waivered services available;
(3) coordinated with other services to be received by the
recipient as described in the service plan; and
(4) provided within the county's reimbursement limits for
home care and home and community-based waivered services for
persons with mental retardation or related conditions.
(c) If the public health agency is or may be the provider
of home care services to the recipient, the public health agency
shall provide the commissioner of human services with a written
plan that specifies how the assessment and prior authorization
process will be held separate and distinct from the provision of
services.
Sec. 19. Minnesota Statutes 1994, section 256B.092, is
amended by adding a subdivision to read:
Subd. 4c. [LIVING ARRANGEMENTS BASED ON A 24-HOUR PLAN OF
CARE.] (a) Notwithstanding the requirements for licensure under
Minnesota Rules, part 9525.1860, subpart 6, item D, and upon
federal approval of an amendment to the home and community-based
services waiver for persons with mental retardation or related
conditions, a person receiving home and community-based services
may choose to live in their own home without requiring that the
living arrangement be licensed under Minnesota Rules, parts
9555.5050 to 9555.6265, provided the following conditions are
met:
(1) the person receiving home and community-based services
has chosen to live in their own home;
(2) home and community-based services are provided by a
qualified vendor who meets the provider standards as approved in
the Minnesota home and community-based services waiver plan for
persons with mental retardation or related conditions;
(3) the person, or their legal representative, individually
or with others has purchased or rents the home and the person's
service provider has no financial interest in the home; and
(4) the service planning team, as defined in Minnesota
Rules, part 9525.0004, subpart 24, has determined that the
planned services, the 24-hour plan of care, and the housing
arrangement are appropriate to address the health, safety, and
welfare of the person.
(b) The county agency may require safety inspections of the
selected housing as part of their determination of the adequacy
of the living arrangement.
Sec. 20. [AUTHORIZATION FOR DOWNSIZING.]
Subdivision 1. [DUTIES OF THE COMMISSIONER.] (a) The
commissioner of human services in consultation with Brown county
and advocates of persons with mental retardation, shall carry
out a voluntary downsizing of MBW on Center, an intermediate
care facility for persons with mental retardation, to assure
that appropriate services are provided in the least restrictive
setting as provided under Minnesota Statutes, section 252.291,
subdivision 3.
(b) The commissioner shall present a proposal to address
issues relating to:
(1) redistribution of costs;
(2) specific plans for the development and provision of
alternative services for residents moved from the intermediate
care facility for persons with mental retardation or related
conditions;
(3) timelines and expected beginning dates for resident
relocation and facility downsizing; and
(4) projected expenditures for services provided to persons
with mental retardation or related conditions.
(c) The commissioner shall ensure that residents discharged
from the facility are appropriately placed according to need in
compliance with Minnesota Rules, parts 9525.0025 to 9525.0165.
(d) The commissioner shall ensure that the proposal
complies with need determination procedures in Minnesota
Statutes, sections 252.28 and 252.291; case management
responsibilities in Minnesota Statutes, section 256B.092; rate
requirements in Minnesota Statutes, section 256B.501; the
requirements under United States Code, title 42, section 1396,
and the rules and regulations adopted under these laws.
(e) The resulting downsizing must result in living units of
no larger than four persons, having single bedrooms and a common
living room, dining room/kitchen, and bathroom.
(f) The commissioner shall contract with Brown county where
the facility is located and the facility. The contract will
address and be consistent with the requirements of the proposal.
(g) Operating costs of the facility after downsizing may
not exceed the total allowable operating costs of the original
facility. For purposes of rate setting for the facility after
downsizing, fixed costs may be redistributed but must be based
on the actual costs reflected in existing rates.
Subd. 2. [IMPLEMENTATION OF THE PROPOSAL.] For the
purposes of the proposal, the commissioner shall:
(1) fund the downsizing of the ICF/MR; and
(2) notify Brown county and the facility of the selections
made and approved by the commissioner. The decision of the
commissioner is final and may not be appealed.
Sec. 21. [FACILITY CERTIFICATION.]
Notwithstanding Minnesota Statutes, section 252.291,
subdivisions 1 and 2, the commissioner of health shall inspect
to certify a large community-based facility currently licensed
under Minnesota Rules, parts 9525.0215 to 9525.0355, for more
than 16 beds and located in Northfield. The facility may be
certified for up to 44 beds. The commissioner of health must
inspect to certify the facility as soon as possible after the
effective date of this section. The commissioner of human
services shall work with the facility and affected counties to
relocate any current residents of the facility who do not meet
the admission criteria for an ICF/MR. To fund the ICF/MR
services and relocations of current residents authorized, the
commissioner of human services may transfer on a quarterly basis
to the medical assistance account from each affected county's
community social service allocation, an amount equal to the
state share of medical assistance reimbursement for the
residential and day habilitation services funded by medical
assistance and provided to clients for whom the county is
financially responsible. For nonresidents of Minnesota seeking
admission to the facility, Rice county shall be notified in
order to assure that appropriate funding is guaranteed from
their state or country of residence.
Sec. 22. [CRISIS INTERVENTION PROJECTS.]
(a) The commissioner of human services may authorize up to
five projects to provide crisis intervention through
community-based services in the private or public sector to
persons with developmental disabilities. The projects must be
geographically distributed in rural and urban areas. The
parameters of these projects may be consistent with the special
needs crisis services outlined under Minnesota Statutes, section
256B.501, subdivision 8a.
(b) The commissioner shall request proposals from
individual counties or groups of counties and establish criteria
for approval of proposals. Criteria shall include:
(1) avoidance of duplication of service by agreements with
hospitals and other public or private vendors as appropriate;
(2) reduction of inpatient psychiatric hospital expenses
using a cost-effective alternative service;
(3) maintenance of clients in their current homes;
(4) promotion of service to clients under a capitation
agreement with providers;
(5) coordination with other target populations and other
counties;
(6) provision of a full complement of on-site and off-site
behavioral support and crisis response services including:
training and technical assistance to prevent out of home
placements; crisis response, including in-home and short-term
placements; and assessment of service outcomes;
(7) evaluation of service program efficacy and cost
effectiveness.
(c) The commissioner shall review proposals in accordance
with Minnesota Statutes, section 252.28, and shall report to the
legislature on the cost effectiveness of the projects by January
15, 1997.
Sec. 23. [REPEALER.]
Minnesota Statutes 1994, section 252.275, subdivisions 4a
and 10, are repealed.
Sec. 24. [EFFECTIVE DATES.]
Section 15 (256.476) is effective July 1, 1996.
ARTICLE 4
CHILDREN'S PROGRAMS
Section 1. Minnesota Statutes 1994, section 245A.14,
subdivision 7, is amended to read:
Subd. 7. [CULTURAL DYNAMICS AND DISABILITIES TRAINING FOR
CHILD CARE PROVIDERS.] (a) The ongoing training required of
licensed child care centers center staff and group family and
group family child care providers and staff shall include
training in the cultural dynamics of early childhood development
and child care as an option.
(b) The cultural dynamics and disabilities training must
include, but not be limited to, the following: awareness of the
value and dignity of different cultures and how different
cultures complement each other; awareness of the emotional,
physical, and mental needs of children and families of different
cultures; knowledge of current and traditional roles of women
and men in different cultures, communities, and family
environments; and awareness of the diversity of child rearing
practices and parenting traditions. and skills development of
child care providers shall be designed to achieve outcomes for
providers of child care that include, but are not limited to:
(1) an understanding and support of the importance of
culture and differences in ability in children's identity
development;
(2) understanding the importance of awareness of cultural
differences and similarities in working with children and their
families;
(3) understanding and support of the needs of families and
children with differences in ability;
(4) developing skills to help children develop unbiased
attitudes about cultural differences and differences in ability;
(5) developing skills in culturally appropriate caregiving;
and
(6) developing skills in appropriate caregiving for
children of different abilities.
Curriculum for cultural dynamics and disability training
shall be approved by the commissioner.
(c) The commissioner shall amend current rules relating to
the initial training of the licensed child care center staff and
licensed providers included in paragraph (a) of family and group
family child care and staff to require cultural dynamics
training upon determining that sufficient curriculum is
developed statewide. Timelines established in the rule
amendments for complying with the cultural dynamics training
requirements shall be based on the commissioner's determination
that curriculum materials and trainers are available statewide.
Sec. 2. Minnesota Statutes 1994, section 256.8711, is
amended to read:
256.8711 [EMERGENCY ASSISTANCE; INTENSIVE FAMILY
PRESERVATION SERVICES.]
Subdivision 1. [SCOPE OF SERVICES.] (a) 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 include both intensive family preservation services and
emergency assistance placement services.
(b) For purposes of this section, intensive family
preservation services 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 or five
emergency assistance placement 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).
(c) For purposes of this section, emergency assistance
placement services include:
(1) emergency shelter services;
(2) foster care services;
(3) group home services;
(4) child residential treatment services; and
(5) correctional facility services.
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; or
when the dependent children have been removed from the home by a
peace officer, by order of the juvenile court, or pursuant to a
voluntary placement agreement, to a publicly funded out-of-home
placement.
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 12 months for eligible families under
this section and under section 256.871, subdivisions 1 and
3. Effective October 1, 1995, Once authorized, intensive family
services shall be used singly or in any combination or duration
up to 12 months appropriate to the needs of the child, as
determined by the county agency.
Subd. 3a. [LIMITATIONS ON FEDERAL FUNDING.] County
agencies shall determine eligibility under Title IV-E of the
Social Security Act for every child being considered for
emergency assistance placement services. The commissioner and
county agencies shall make every effort to use federal funding
under Title IV-E of the Social Security Act instead of federal
funding under this section, whenever possible. 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
if the federal revenue earned under this section is terminated.
If the federal revenue earned under this section is terminated
or inadequate, the state has no obligation to pay for these
services. In the event that federal limitations or ceilings are
imposed on federal emergency assistance funding, the
commissioner shall use the funds according to these priorities:
(1) emergency assistance benefits under section 256.871;
(2) emergency assistance benefits under the reserve
established in subdivision 5;
(3) intensive family preservation services under this
section; and
(4) emergency assistance placement services 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. Emergency assistance
placement services provided under this section shall not be
dependent on the client's available income or assets. However,
county agencies shall seek costs of care as required under
section 260.251 for emergency assistance placement services.
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); or 6b, paragraph (a), depending on
how the funds were earned.
Subd. 6. [DISTRIBUTION OF NEW FEDERAL REVENUE EARNED FOR
INTENSIVE FAMILY PRESERVATION SERVICES.] (a) All federal funds
not set aside under paragraph (b), and at least 50 percent of
all federal funds earned for intensive family preservation
services 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 core
services as defined in section 256F.03, subdivision 5 10, 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 for intensive
family preservation services under this section and earned
through assessment activity described under subdivision 3. The
set aside funds shall be used to develop and expand intensive
family preservation services statewide as provided in
subdivisions 6a and 7 and establish an emergency assistance
reserve as provided in subdivision 5.
Subd. 6a. [DEVELOPMENT GRANTS.] Except for the portion
needed for the emergency assistance reserve provided in
subdivision 5, the commissioner may shall distribute the funds
set aside under subdivision 6, paragraph (b),
through development grants to a county or counties to establish
and maintain approved intensive family preservation core
services as defined in section 256F.03, subdivision 10,
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 core services
statewide. Each county's development grant shall be paid and
used as provided in sections 256F.01 to 256F.06.
Subd. 6b. [DISTRIBUTION OF NEW FEDERAL REVENUE EARNED FOR
EMERGENCY ASSISTANCE PLACEMENT SERVICES.] (a) All federal funds
earned for emergency assistance placement services not set aside
under paragraph (b), shall be paid to each county based on its
earnings. These payments shall constitute the placement
earnings grant of the family preservation fund under sections
256F.01 to 256F.06.
(b) The commissioner may set aside a portion, not to exceed
15 percent, of the federal funds earned for emergency assistance
placement services under this section. The set aside funds
shall be used for the emergency assistance reserve as provided
in subdivision 5.
Subd. 7. [EXPANSION OF SERVICES AND BASE LEVEL OF
EXPENDITURES.] (a) Counties must continue the base level of
expenditures for family preservation core services as defined in
section 256F.03, subdivision 5 10, from any state, county, or
federal funding source, which, in the absence of federal funds
earned for intensive family preservation services 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 core services as defined in section 256F.03,
subdivision 5 10, 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 shall, at the request of a county,
reduce, suspend, or eliminate either or both of a county's
obligations to continue the base level of expenditures and to
expand family preservation core services as defined in section
256F.03, subdivision 5 10, if the commissioner determines that
one or more of the following conditions apply to that county:
(1) imposition of levy limits or other levy restrictions
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 or reduction of the federal revenue earned
under this section; or
(5) other changes in state law that significantly impact
the receipt or distribution of state and federal funding.
(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 core services as
defined in section 256F.03, subdivision 5 10, 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. 3. Minnesota Statutes 1994, 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.
For the period July 1, 1993 to June 30, 1995, 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. 4. Minnesota Statutes 1994, section 256E.115, is
amended to read:
256E.115 [SAFE HOUSES AND TRANSITIONAL HOUSING FOR HOMELESS
YOUTH.]
Subdivision 1. [COMMISSIONER DUTIES.] The commissioner
shall have authority to make grants for pilot programs when the
legislature authorizes money to encourage innovation in the
development of safe house programs to respond to the needs of
homeless youth issue a request for proposals from organizations
that are knowledgeable about the needs of homeless youth for the
purpose of providing safe houses and transitional housing for
homeless youth. The commissioner shall appoint a review
committee of up to eight members to evaluate the proposals. The
review panel must include representation from communities of
color, youth, and other community providers and agency
representatives who understand the needs and problems of
homeless youth. The commissioner shall also assist in
coordinating funding from federal and state grant programs and
funding available from a variety of sources for efforts to
promote a continuum of services for youth through a consolidated
grant application. The commissioner shall analyze the needs of
homeless youth and gaps in services throughout the state and
determine how to best serve those needs within the available
funding.
Subd. 2. [SAFE HOUSES AND TRANSITIONAL HOUSING.] A safe
house provides emergency housing for homeless youth ranging in
age from 13 to 22 with the goal of reuniting the family, if
appropriate, whenever possible. Transitional housing provides
housing for homeless youth ages 16 to 22 who are transitioning
into independent living.
In developing both types of housing, the commissioner and
the review committee shall try to create a family atmosphere in
a neighborhood or community and, if possible, provide separate
but cooperative homes for males and females. It may be
necessary, due to licensing restrictions, to provide separate
housing for different age groups. The following services, or
adequate access to referrals for the following services, must be
made available to the homeless youth:
(1) counseling services for the youth, and their families,
if appropriate, on site, to help with problems that resulted in
the homelessness;
(2) job services to help youth find employment in addition
to creating jobs on site, including food service, maintenance,
child care, and tutoring;
(3) health services that are confidential and provide
preventive care services, crisis referrals, and other necessary
health care services;
(4) living skills training to help youth learn how to care
for themselves; and
(5) education services that help youth enroll in academic
programs, if they are currently not in a program. Enrollment in
an academic program is required for residency in transitional
housing.
Sec. 5. Minnesota Statutes 1994, section 256F.01, is
amended to read:
256F.01 [PUBLIC POLICY.]
The public policy of this state is to assure that all
children, regardless of minority racial or ethnic heritage, live
in families that offer a safe, permanent relationship with
nurturing parents or caretakers. To help assure children the
opportunity to establish lifetime relationships, public social
services must strive to provide culturally competent services
and be directed toward:
(1) preventing the unnecessary separation of children from
their families by identifying family problems, assisting
families in resolving their problems, and preventing breakup of
the family if it is desirable and possible;
(2) restoring to their families children who have been
removed, by continuing to provide services to the reunited child
and the families;
(3) placing children in suitable adoptive homes, in cases
where restoration to the biological family is not possible or
appropriate; and
(4) assuring adequate care of children away from their
homes, in cases where the child cannot be returned home or
cannot be placed for adoption.
Sec. 6. Minnesota Statutes 1994, section 256F.02, is
amended to read:
256F.02 [CITATION.]
Sections 256F.01 to 256F.07 and 256F.10 may be cited as the
"Minnesota family preservation act."
Sec. 7. Minnesota Statutes 1994, section 256F.03,
subdivision 5, is amended to read:
Subd. 5. [FAMILY-BASED SERVICES.] "Family-based services"
means one or more of the services described in paragraphs (a) to
(f) provided to families primarily in their own home for a
limited time. Family-based services eligible for funding under
the family preservation act are the services described in
paragraphs (a) to (f).
(a) [CRISIS SERVICES.] "Crisis services" means professional
services provided within 24 hours of referral to alleviate a
family crisis and to offer an alternative to placing a child
outside the family home. The services are intensive and time
limited. The service may offer transition to other appropriate
community-based services.
(b) [COUNSELING SERVICES.] "Counseling services" means
professional family counseling provided to alleviate individual
and family dysfunction; provide an alternative to placing a
child outside the family home; or permit a child to return
home. The duration, frequency, and intensity of the service is
determined in the individual or family service plan.
(c) [LIFE MANAGEMENT SKILLS SERVICES.] "Life management
skills services" means paraprofessional services that teach
family members skills in such areas as parenting, budgeting,
home management, and communication. The goal is to strengthen
family skills as an alternative to placing a child outside the
family home or to permit a child to return home. A social
worker shall coordinate these services within the family case
plan.
(d) [CASE COORDINATION SERVICES.] "Case coordination
services" means professional services provided to an individual,
family, or caretaker as an alternative to placing a child
outside the family home, to permit a child to return home, or to
stabilize the long-term or permanent placement of a child.
Coordinated services are provided directly, are arranged, or are
monitored to meet the needs of a child and family. The
duration, frequency, and intensity of services is determined in
the individual or family service plan.
(e) [MENTAL HEALTH SERVICES.] "Mental health services"
means the professional services defined in section 245.4871,
subdivision 31.
(f) [EARLY INTERVENTION SERVICES.] "Early intervention
services" means family-based intervention services designed to
help at-risk families avoid crisis situations.
Sec. 8. Minnesota Statutes 1994, section 256F.03, is
amended by adding a subdivision to read:
Subd. 10. [FAMILY PRESERVATION CORE SERVICES.] "Family
preservation core services" means adequate capacity of crisis
services as defined in subdivision 5, paragraph (a), plus either
or both counseling services as defined in subdivision 5,
paragraph (b), and mental health services as defined in
subdivision 5, paragraph (e), plus life management skills
services as defined in subdivision 5, paragraph (c).
Sec. 9. Minnesota Statutes 1994, section 256F.04,
subdivision 1, is amended to read:
Subdivision 1. [GRANT PROGRAM FAMILY PRESERVATION FUND.]
The commissioner shall establish a statewide family preservation
grant program fund to assist counties in providing placement
prevention and family reunification services. This fund shall
include a basic grant for family preservation services, a
placement earnings grant under section 256.8711, subdivision 6b,
paragraph (a), and a development grant under section 256.8711,
subdivision 6a, to assist counties in developing and expanding
their family preservation core services as defined in section
256F.03, subdivision 10. Beginning with calendar year 1998,
after each annual or quarterly calculation, these three
component grants shall be added together and treated as a single
family preservation grant.
Sec. 10. Minnesota Statutes 1994, section 256F.04,
subdivision 2, is amended to read:
Subd. 2. [FORMS AND INSTRUCTIONS.] The commissioner shall
provide necessary forms and instructions to the counties for
their community social services plan, as required in section
256E.09, that incorporate the permanency plan format and
information necessary to apply for a family preservation fund
grant, and to exercise county options under section 256F.05,
subdivision 7, paragraph (a), or subdivision 8, paragraph (c).
Sec. 11. Minnesota Statutes 1994, section 256F.05, is
amended by adding a subdivision to read:
Subd. 1a. [DEVELOPMENT OF FAMILY PRESERVATION CORE
SERVICES.] The commissioner shall annually determine whether a
county's family preservation core services, as defined in
section 256F.03, subdivision 10, are developed for that calendar
year. In making this determination for any given calendar year,
the commissioner shall consider factors for each county such as
which family preservation core services are included in its
community services plan under section 256E.09, the ratio of
expenditures on family preservation core services to
expenditures on out-of-home placements, the availability of
crisis services as defined in section 256F.03, subdivision 5,
paragraph (a), and recent trends in out-of-home placements both
within that county and statewide.
Sec. 12. Minnesota Statutes 1994, section 256F.05,
subdivision 2, is amended to read:
Subd. 2. [MONEY AVAILABLE FOR THE BASIC GRANT.] Money
appropriated for family preservation grants to counties under
sections 256F.04 to 256F.07, together with an amount as
determined by the commissioner of title IV-B funds distributed
to Minnesota according to the Social Security Act, United States
Code, title 42, section 621, must be distributed to counties on
a calendar year basis according to the formula in subdivision 3.
Sec. 13. Minnesota Statutes 1994, section 256F.05,
subdivision 3, is amended to read:
Subd. 3. [BASIC GRANT FORMULA.] (a) The amount of money
allocated to counties under subdivision 2 must be based on the
following two factors shall first be allocated in amounts equal
to each county's guaranteed floor according to paragraph (b),
and second, any remaining available funds allocated as follows:
(1) 90 percent of the funds shall be allocated based on the
population of the county under age 19 years as compared to the
state as a whole as determined by the most recent data from the
state demographer's office; and
(2) ten percent of the funds shall be allocated based on
the county's percentage share of the number of minority children
in substitute care receiving children's case management services
as defined by the commissioner based on the most recent data as
determined by the most recent department of human services
annual report on children in foster care commissioner.
The amount of money allocated according to formula factor
(1) must not be less than 90 percent of the total allocated
under subdivision 2.
(b) Each county's basic grant guaranteed floor shall be
calculated as follows:
(1) 90 percent of the county's allocation received in the
preceding calendar year. For calendar year 1996 only, the
allocation received in the preceding calendar year shall be
determined by the commissioner based on the funding previously
distributed as separate grants under sections 256F.04 to
256F.07; and
(2) when the amounts of funds available for allocation is
less than the amount available in the previous year, each
county's previous year allocation shall be reduced in proportion
to the reduction in the statewide funding, for the purpose of
establishing the guaranteed floor.
(c) The commissioner shall regularly review the use of
family preservation fund allocations by county. The
commissioner may reallocate unexpended or unencumbered money at
any time among those counties that have expended or are
projected to expend their full allocation.
Sec. 14. Minnesota Statutes 1994, section 256F.05,
subdivision 4, is amended to read:
Subd. 4. [PAYMENTS.] The commissioner shall make grant
payments to each county whose biennial community social services
plan includes a permanency plan has been approved under section
256F.04, subdivision 2. The payment must be made basic grant
under subdivisions 2 and 3 and the development grant under
section 256.8711, subdivision 6a, shall be paid to counties in
four installments per year. The commissioner may certify the
payments for the first three months of a calendar year.
Subsequent payments must be made on May 15, August 15, and
November 15, of each calendar year. When an amount of title
IV-B funds as determined by the commissioner is made available,
it shall be reimbursed to counties on November 15. shall be
based on reported expenditures and may be adjusted for
anticipated spending patterns. The placement earnings grant
under section 256.8711, subdivision 6b, paragraph (a), shall be
based on earnings and coordinated with the other payments. In
calendar years 1996 and 1997, the placement earnings grant and
the development grant shall be distributed separately from the
basic grant, except as provided in subdivision 7, paragraph
(a). Beginning with calendar year 1998, after each annual or
quarterly calculation, these three component grants shall be
added together into a single family preservation fund grant and
treated as a single grant.
Sec. 15. Minnesota Statutes 1994, section 256F.05,
subdivision 5, is amended to read:
Subd. 5. [INAPPROPRIATE EXPENDITURES.] Family preservation
fund basic, placement earnings, and development grant money must
not be used for:
(1) child day care necessary solely because of the
employment or training to prepare for employment, of a parent or
other relative with whom the child is living;
(2) residential facility payments;
(3) adoption assistance payments;
(4) public assistance payments for aid to families with
dependent children, supplemental aid, medical assistance,
general assistance, general assistance medical care, or
community health services authorized by sections 145A.09 to
145A.13; or
(5) administrative costs for local social services agency
public assistance staff.
Sec. 16. Minnesota Statutes 1994, section 256F.05,
subdivision 7, is amended to read:
Subd. 7. [TRANSFER OF FUNDS USES OF PLACEMENT EARNINGS AND
DEVELOPMENT GRANTS.] Notwithstanding subdivision 1, the
commissioner may transfer money from the appropriation for
family preservation grants to counties into the subsidized
adoption account when a deficit in the subsidized adoption
program occurs. The amount of the transfer must not exceed five
percent of the appropriation for family preservation grants to
counties. (a) For calendar years 1996 and 1997, each county must
use its placement earnings and development grants to develop and
expand its family preservation core services as defined in
section 256F.03, subdivision 10. If a county demonstrates that
its family preservation core services are developed as provided
in subdivision 1a, then at the county's written request, the
commissioner shall add its placement earnings and development
grant to its basic grant, to be used as a single family
preservation fund grant.
(b) Beginning with calendar year 1998, each county which
has demonstrated that year that its family preservation core
services are developed as provided in subdivision 1a, shall have
its placement earnings and development grant added to its basic
grant, to be used as a single family preservation fund grant.
The development grant for any county which has not so
demonstrated shall be redistributed to all counties which have,
in proportion to their calculated development grants.
Sec. 17. Minnesota Statutes 1994, section 256F.05,
subdivision 8, is amended to read:
Subd. 8. [USES OF FAMILY PRESERVATION FUND GRANTS FOR
FAMILY-BASED CRISIS SERVICES.] Within the limits of
appropriations made for this purpose, the commissioner may award
grants for the families first program, including section
256F.08, to be distributed on a calendar year basis to counties
to provide programs for family-based crisis services defined in
section 256F.03, subdivision 5. The commissioner shall ask
counties to present proposals for the funding and shall award
grants for the funding on a competitive basis. Beginning
January 1, 1993, the state share of the costs of the programs
shall be 75 percent and the county share, 25 percent. For both
basic grants and single family preservation fund grants:
(a) A county which has not demonstrated that year that its
family preservation core services are developed as provided in
subdivision 1a, must use its family preservation fund grant
exclusively for family preservation services defined in section
256F.03, subdivision 5, paragraphs (a), (b), (c), and (e).
(b) A county which has demonstrated that year that its
family preservation core services are developed becomes eligible
either to continue using its family preservation fund grant as
provided in paragraph (a), or to exercise the expanded service
option under paragraph (c).
(c) The expanded service option permits an eligible county
to use its family preservation fund grant for child welfare
preventative services as defined in section 256F.10, subdivision
7, paragraph (d). To exercise this option, an eligible county
must notify the commissioner in writing of its intention to do
so no later than 30 days into the quarter during which it
intends to begin or in its county plan, as provided in section
256F.04, subdivision 2. Effective with the first day of that
quarter, the county must maintain its base level of expenditures
for child welfare preventative services and use the family
preservation fund to expand them. The base level of
expenditures for a county shall be that established under
section 256F.10, subdivision 7. For counties which have no such
base established, a comparable base shall be established with
the base year being the calendar year ending at least two
calendar quarters before the first calendar quarter in which the
county exercises its expanded service option. The commissioner
shall, at the request of the counties, reduce, suspend, or
eliminate either or both of a county's obligations to continue
the base level of expenditures and to expand child welfare
preventative services based on conditions described in section
256F.10, subdivision 7, paragraph (b) or (c).
(d) Each county's placement earnings and development grant
shall be determined under section 256.8711, but after each
annual or quarterly calculation, if added to that county's basic
grant, the three component grants shall be treated as a single
family preservation fund grant.
Sec. 18. Minnesota Statutes 1994, section 256F.06,
subdivision 1, is amended to read:
Subdivision 1. [RESPONSIBILITIES.] A county board may,
alone or in combination with other county boards, apply for a
family preservation fund grant as provided in section 256F.04,
subdivision 2. Upon approval of the family preservation grant,
the county board may contract for or directly provide
family-based and other eligible services.
Sec. 19. Minnesota Statutes 1994, section 256F.06,
subdivision 2, is amended to read:
Subd. 2. [USES OF GRANTS DEVELOPING FAMILY PRESERVATION
CORE SERVICES.] The grant must be used exclusively for
family-based services. A county board shall endeavor to develop
and expand its family preservation core services. When a county
can demonstrate that its family preservation core services are
developed as provided in section 256F.05, subdivision 1a, a
county board becomes eligible to exercise the expanded service
option under section 256F.05, subdivision 8, paragraph (c). For
calendar years 1996 and 1997, the county board also becomes
eligible to request that its basic, placement earnings, and
development grants be added into a single grant under section
256F.05, subdivision 7, paragraph (a).
Sec. 20. Minnesota Statutes 1994, section 256F.06,
subdivision 4, is amended to read:
Subd. 4. [REPORTING.] The commissioner shall specify
requirements for reports, including quarterly fiscal reports,
according to section 256.01, subdivision 2, paragraph (17). The
reports must include:
(1) a detailed statement of expenses attributable to the
grant during the preceding quarter; and
(2) a statement of the expenditure of money for
family-based services by the county during the preceding
quarter, including the number of clients served and the
expenditures, by client, for each service provided.
Sec. 21. Minnesota Statutes 1994, section 256F.09, is
amended to read:
256F.09 [GRANTS FOR CHILDREN'S SAFETY FAMILY VISITATION
CENTERS.]
Subdivision 1. [PURPOSE.] The commissioner shall issue a
request for proposals from existing local nonprofit,
nongovernmental, or governmental organizations, to use existing
local facilities as pilot children's safety family visitation
centers which may also be used for visitation exchanges. The
commissioner shall award grants in amounts up to $50,000 for the
purpose of creating children's safety or maintaining family
visitation centers in an effort to reduce children's
vulnerability to violence and trauma related to family
visitation, where there has been a history of domestic violence
or abuse within the family. At least one of the pilot projects
shall be located in the seven-county metropolitan area and at
least one of the projects shall be located outside the
seven-county metropolitan area, and The commissioner shall award
the grants to provide the greatest possible number of safety
family visitation centers and to locate them to provide for the
broadest possible geographic distribution of the centers
throughout the state.
Each children's safety family visitation center must use
existing local facilities to provide a healthy interactive
environment for parents who are separated or divorced and for
parents with children in foster homes to visit with their
children. The centers must be available for use by district
courts who may order visitation to occur at a safety family
visitation center. The centers may also be used as drop-off
sites, so that parents who are under court order to have no
contact with each other can exchange children for visitation at
a neutral site. Each center must provide sufficient security to
ensure a safe visitation environment for children and their
parents. A grantee must demonstrate the ability to provide a 25
percent local match, which may include in-kind contributions.
Subd. 1a. [COUNTY INVOLVEMENT.] Each county or group of
counties is encouraged to provide supervised visitation services
in an effort to fill the gap in the court system that orders
supervised visitation, but does not provide a center to
accomplish the supervised visitation as ordered. Each county or
group of counties is encouraged to either financially contribute
to an existing family visitation center in the area, or
establish a new center if there is not one in the area, possibly
through county social services. In creating a new center, the
county may collaborate with other counties, other family
visitation centers, family services collaboratives, court
services, and any other entity or organization. The goal is to
provide family visitation centers statewide. The county shall
apply for funding that may be available through the federal
government, specifically for family preservation or family
reunification purposes, or any other source of funding that will
aid in developing and maintaining this vital service.
Subd. 2. [PRIORITIES FUNDING.] The commissioner may award
grants to create or maintain family visitation centers.
In awarding grants to maintain a family visitation center,
the commissioner may award a grant to a center that can
demonstrate a 35 percent local match, provided the center is
diligently exploring and pursuing all available funding options
in an effort to become self-sustaining, and those efforts are
reported to the commissioner.
In awarding grants under the program to create a family
visitation center, the commissioner shall give priority to:
(1) areas of the state where no children's safety other
family visitation center or similar facility exists;
(2) applicants who demonstrate that private funding for the
center is available and will continue; and
(3) facilities that are adapted for use to care for
children, such as day care centers, religious institutions,
community centers, schools, technical colleges, parenting
resource centers, and child care referral services.
Subd. 3. [ADDITIONAL SERVICES.] Each family visitation
center may provide parenting and child development classes, and
offer support groups to participating custodial parents and hold
regular classes designed to assist children who have experienced
domestic violence and abuse.
Subd. 4. [REPORT.] The commissioner shall evaluate the
operation of the pilot children's safety family visitation
centers and report to the legislature by February 1, 1994, with
recommendations.
Subd. 5. [ADMINISTRATION.] In administering the grants
authorized by this section, the commissioner shall ensure that
the term "family visitation center" is used in all future
applications, publicity releases, requests for proposals, and
other materials of like nature. Materials published prior to
the enactment of this legislation which use different terms may
be distributed by the commissioner until supplies are gone.
Sec. 22. Minnesota Statutes 1994, section 256H.01,
subdivision 9, is amended to read:
Subd. 9. [FAMILY.] "Family" means parents, stepparents,
guardians and their spouses, or other eligible relative
caretakers and their spouses, and their blood related dependent
children and adoptive siblings under the age of 18 years living
in the same home including children temporarily absent from the
household in settings such as schools, foster care, and
residential treatment facilities. When a minor parent or
parents and his, her, or their child or children are living with
other relatives, and the minor parent or parents apply for a
child care subsidy, "family" means only the minor parent or
parents and the child or children. An adult may be considered a
dependent member of the family unit if 50 percent of the adult's
support is being provided by the parents, stepparents, guardians
and their spouses, or eligible relative caretakers and their
spouses, residing in the same household. An adult age 18 who is
a full-time high school student and can reasonably be expected
to graduate before age 19 may be considered a dependent member
of the family unit.
Sec. 23. Minnesota Statutes 1994, section 256H.01,
subdivision 12, is amended to read:
Subd. 12. [PROVIDER.] "Provider" means a child care
license holder who operates a family day care home, a group
family day care home, a day care center, a nursery school, a day
nursery, an extended day school age child care program; a person
exempt from licensure who meets child care standards established
legal nonlicensed extended day school age child care program
which operates under the auspices of a local school board that
has adopted school age child care standards which meet or exceed
standards recommended by the state board department of
education; or a legal nonlicensed caregiver who is at least 18
years of age, and who is not a member of the AFDC assistance
unit.
Sec. 24. Minnesota Statutes 1994, section 256H.02, is
amended to read:
256H.02 [DUTIES OF COMMISSIONER.]
The commissioner shall develop standards for county and
human services boards to provide child care services to enable
eligible families to participate in employment, training, or
education programs. Within the limits of available
appropriations, the commissioner shall distribute money to
counties to reduce the costs of child care for eligible
families. The commissioner shall adopt rules to govern the
program in accordance with this section. The rules must
establish a sliding schedule of fees for parents receiving child
care services. In the rules adopted under this section, county
and human services boards shall be authorized to establish
policies for payment of child care spaces for absent children,
when the payment is required by the child's regular provider.
The rules shall not set a maximum number of days for which
absence payments can be made, but instead shall direct the
county agency to set limits and pay for absences according to
the prevailing market practice in the county. County policies
for payment of absences shall be subject to the approval of the
commissioner. The commissioner shall maximize the use of
federal money under the AFDC employment special needs program in
section 256.736, subdivision 8, and other programs that provide
federal reimbursement for child care services for recipients of
aid to families with dependent children who are in education,
training, job search, or other activities allowed under those
programs. Money appropriated under this section must be
coordinated with the AFDC employment special needs program and
other programs that provide federal reimbursement for child care
services to accomplish this purpose. Federal reimbursement
obtained must be allocated to the county that spent money for
child care that is federally reimbursable under programs that
provide federal reimbursement for child care services. The
counties shall use the federal money to expand child care
services. The commissioner may adopt rules under chapter 14 to
implement and coordinate federal program requirements.
Sec. 25. Minnesota Statutes 1994, section 256H.03,
subdivision 1, is amended to read:
Subdivision 1. [ALLOCATION PERIOD; NOTICE OF ALLOCATION.]
When the commissioner notifies county and human service boards
of the forms and instructions they are to follow in the
development of their biennial community social services plans
required under section 256E.08, the commissioner shall also
notify county and human services boards of their estimated child
care fund program allocation for the two years covered by the
plan. By June October 1 of each year, the commissioner shall
notify all counties of their final child care fund program
allocation.
Sec. 26. Minnesota Statutes 1994, section 256H.03,
subdivision 2a, is amended to read:
Subd. 2a. [ELIGIBLE RECIPIENTS.] Families that meet the
eligibility requirements under sections 256H.10, except AFDC
recipients, MFIP recipients, and transition year families, and
256H.11 are eligible for child care assistance under the basic
sliding fee program. From July 1, 1990, to June 30, 1991, a
county may not accept new applications for the basic sliding fee
program unless the county can demonstrate that its state money
expenditures for the basic sliding fee program for this period
will not exceed 95 percent of the county's allocation of state
money for the fiscal year ending June 30, 1990. As basic
sliding fee program money becomes available to serve new
families, eligible families whose benefits were terminated
during the fiscal year ending June 30, 1990, for reasons other
than loss of eligibility shall be reinstated. Families enrolled
in the basic sliding fee program as of July 1, 1990, shall be
continued until they are no longer eligible. Counties shall
make vendor payments to the child care provider or pay the
parent directly for eligible child care expenses on a
reimbursement basis. Child care assistance provided through the
child care fund is considered assistance to the parent.
Sec. 27. Minnesota Statutes 1994, section 256H.03,
subdivision 4, is amended to read:
Subd. 4. [ALLOCATION FORMULA.] Beginning July 1, 1992
January 1, 1996, the basic sliding fee state and federal funds
shall be allocated on a calendar year basis. Funds shall be
allocated first in amounts equal to each county's guaranteed
floor according to subdivision 6, with any remaining available
funds allocated according to the following formula:
(a) One-half One-third of the funds shall be allocated in
proportion to each county's total expenditures for the basic
sliding fee child care program reported during the 12-month
period ending on December 31 of the preceding state fiscal
year most recent calendar year completed at the time of the
notice of allocation.
(b) One-fourth One-third of the funds shall be allocated
based on the number of children under age 13 in each county who
are enrolled in general assistance medical care, medical
assistance, and the children's health plan on July 1, of each
year MinnesotaCare on December 31 of the most recent calendar
year completed at the time of the notice of allocation.
(c) One-fourth One-third of the funds shall be allocated
based on the number of children under age 13 who reside in each
county, from the most recent estimates of the state demographer.
Sec. 28. Minnesota Statutes 1994, section 256H.03, is
amended by adding a subdivision to read:
Subd. 4a. [SIX-MONTH ALLOCATION.] For the period from July
1, 1995, to December 31, 1995, every county shall receive an
allocation at least equal and proportionate to one-half of its
original allocation in state fiscal year 1995. This six-month
allocation shall be combined with the calendar year 1996
allocation and be administered as one 18-month allocation.
Sec. 29. Minnesota Statutes 1994, section 256H.03,
subdivision 6, is amended to read:
Subd. 6. [GUARANTEED FLOOR.] (a) Each county's guaranteed
floor shall equal the lesser of:
(1) the county's original allocation in the preceding state
fiscal year; or
(2) 110 percent of the county's basic sliding fee child
care program state and federal earnings for the 12-month period
ending on December 31 of the preceding state fiscal year. For
purposes of this clause, "state and federal earnings" means the
reported direct child care expenditures adjusted for the
administrative allowance and 15 percent required county
match. Beginning January 1, 1996, each county's guaranteed floor
shall equal 90 percent of the allocation received in the
preceding calendar year. For the calendar year 1996 allocation,
the preceding calendar year shall be considered to be double the
six-month allocation as provided for in subdivision 4a.
(b) When the amount of funds available for allocation is
less than the amount available in the previous year, each
county's previous year allocation shall be reduced in proportion
to the reduction in the statewide funding, for the purpose of
establishing the guaranteed floor.
Sec. 30. Minnesota Statutes 1994, section 256H.05,
subdivision 6, is amended to read:
Subd. 6. [NON-STRIDE AFDC CHILD CARE PROGRAM ACCESS CHILD
CARE PROGRAM.] (a) Starting one month after April 30, 1992, the
department of human services commissioner shall reimburse
eligible expenditures for 2,000 family slots for AFDC caretakers
not eligible for services under section 256.736, who are engaged
in an authorized educational or job search program. Each county
will receive a number of family slots based on the county's
proportion of the AFDC caseload. A county must receive at least
two family slots. Eligibility and reimbursement are limited to
the number of family slots allocated to each county. County
agencies shall authorize an educational plan for each student
and may prioritize families eligible for this program in their
child care fund plan upon approval of the commissioner of human
services. (b) Persons eligible for but unable to participate in
the JOBS (STRIDE) program because of a waiting list may be
accepted as a new participant, or continue to participate in the
ACCESS child care program if a slot is available as long as all
other eligibility factors are met. Child care assistance must
continue under the ACCESS child care program until the
participant loses eligibility or is enrolled in project STRIDE.
(c)(1) Effective July 1, 1995, the commissioner shall
reclaim 90 percent of the vacant slots in each county and
distribute those slots to counties with waiting lists of persons
eligible for the ACCESS child care program. The slots must be
distributed to eligible families based on the July 1, 1995,
waiting list placement date, first come, first served basis.
(2) ACCESS child care slots remaining after the waiting
list under clause (1) has been eliminated must be distributed to
eligible families on a first come, first served basis, based on
the client's date of request.
(3) The county must notify the commissioner when an ACCESS
slot in the county becomes available. Notification by the
county must be within five calendar days of the effective date
of the termination of the ACCESS child care services. The
resulting vacant slot must be returned to the department of
human services. The slot must then be redistributed under
clause (2).
(4) The commissioner shall consult with the task force on
child care and make recommendations to the 1996 legislature for
future distribution of the ACCESS slots under this paragraph.
Sec. 31. Minnesota Statutes 1994, section 256H.08, is
amended to read:
256H.08 [USE OF MONEY.]
Money for persons listed in sections 256H.03, subdivision
2a, and 256H.05, subdivision 1b, shall be used to reduce the
costs of child care for students, including the costs of child
care for students while employed if enrolled in an eligible
education program at the same time and making satisfactory
progress towards completion of the program. Counties may not
limit the duration of child care subsidies for a person in an
employment or educational program, except when the person is
found to be ineligible under the child care fund eligibility
standards. Any limitation must be based on a person's
employability plan in the case of an AFDC recipient, and county
policies included in the child care allocation plan. Time
limitations for child care assistance, as specified in Minnesota
Rules, parts 9565.5000 to 9565.5200, do not apply to basic or
remedial educational programs needed to prepare for
post-secondary education or employment. These programs
include: high school, general equivalency diploma, and English
as a second language. Programs exempt from this time limit must
not run concurrently with a post-secondary program. High school
students who are participating in a post-secondary options
program and who receive a high school diploma issued by the
school district are exempt from the time limitations while
pursuing a high school diploma. Financially eligible students
who have received child care assistance for one academic year
shall be provided child care assistance in the following
academic year if funds allocated under sections 256H.03 and
256H.05 are available. If an AFDC recipient who is receiving
AFDC child care assistance under this chapter moves to another
county, continues to participate in educational or training
programs authorized in their employability development plans,
and continues to be eligible for AFDC child care assistance
under this chapter, the AFDC caretaker must receive continued
child care assistance from the county responsible for their
current employability development plan, without interruption.
Sec. 32. Minnesota Statutes 1994, section 256H.11,
subdivision 1, is amended to read:
Subdivision 1. [ASSISTANCE FOR PERSONS SEEKING AND
RETAINING EMPLOYMENT.] Persons who are seeking employment and
who are eligible for assistance under this section are eligible
to receive the equivalent of up to one month of child care up to
240 hours of child care assistance per calendar year. Employed
persons who work at least an average of ten hours a week and
receive at least a minimum wage for all hours worked are
eligible for continued child care assistance.
Sec. 33. Minnesota Statutes 1994, section 256H.12,
subdivision 1, is amended to read:
Subdivision 1. [COUNTY CONTRIBUTIONS REQUIRED.] Beginning
July 1, 1995, in addition to payments from parents basic sliding
fee child care program participants, counties shall contribute
from county tax or other sources a minimum of 15 percent of the
cost of the basic sliding fee program at the local match
percentage calculated according to subdivision 1a. The
commissioner shall recover funds from the county as necessary to
bring county expenditures into compliance with this subdivision.
Sec. 34. Minnesota Statutes 1994, section 256H.12, is
amended by adding a subdivision to read:
Subd. 1a. [LOCAL MATCH PERCENTAGE.] The local match
percentage shall equal the lesser of either (i) 15 percent of
the cost of the basic sliding fee program or (ii) the statewide
required local match in state fiscal year 1995, divided by the
sum of the current year's basic sliding fee allocation plus the
statewide required local match in state fiscal year 1995. The
resulting local match percentage shall be adjusted to reflect a
statewide local match of five percent on any state and federal
funding for the basic sliding fee program above the initial
state fiscal year 1995 statewide allocation. For purposes of
this computation, the statewide required local match in state
fiscal year 1995 shall be equal to the initial state fiscal year
1995 basic sliding fee allocation, divided by 85 percent, and
then multiplied by 15 percent. The calendar year 1996 local
match percentage shall be in effect for the six-month allocation
period defined in section 256H.03.
Sec. 35. Minnesota Statutes 1994, section 256H.12,
subdivision 3, as amended by Laws 1995, chapter 139, section 1,
is amended to read:
Subd. 3. [MAINTENANCE OF FUNDING EFFORT.] To receive money
through this program, each county shall certify, in its annual
plan to the commissioner, that the county has not reduced
allocations from other federal and state sources, which, in the
absence of the child care fund, would have been available for
child care assistance. However, the county must continue
contributions, as necessary, to maintain on the basic sliding
fee program for, families who are receiving assistance on July
1, 1995, until the family loses eligibility for the program or
until a family voluntarily withdraws from the program. This
subdivision does not affect the local match required for this
program under other sections of the law.
Sec. 36. Minnesota Statutes 1994, section 256H.15,
subdivision 1, is amended to read:
Subdivision 1. [SUBSIDY RESTRICTIONS.] (a) Until June 30,
1991, the maximum child care rate is determined under this
paragraph. The county board may limit the subsidy allowed by
setting a maximum on the provider child care rate that the
county shall subsidize. The maximum rate set by any county
shall not be lower than 110 percent or higher than 125 percent
of the median rate in that county for like care arrangements for
all types of care, including special needs and handicapped care,
as determined by the commissioner. If the county sets a maximum
rate, it must pay the provider's rate for each child receiving a
subsidy, up to the maximum rate set by the county. If a county
does not set a maximum provider rate, it shall pay the
provider's rate for every child in care. The maximum state
payment is 125 percent of the median provider rate. If the
county has not set a maximum provider rate and the provider rate
is greater than 125 percent of the median provider rate in the
county, the county shall pay the amount in excess of 125 percent
of the median provider rate from county funding sources. The
county shall pay the provider's full charges for every child in
care up to the maximum established. The commissioner shall
determine the maximum rate for each type of care, including
special needs and handicapped care.
(b) Effective July 1, 1991, the maximum rate paid for child
care assistance under the child care fund is the maximum rate
eligible for federal reimbursement except that a provider
receiving reimbursement under paragraph (a) as of January 1,
1991, shall be paid at a rate no less than the rate of
reimbursement received under that paragraph. A rate which
includes a provider bonus paid under subdivision 2 or a special
needs rate paid under subdivision 3 may be in excess of the
maximum rate allowed under this subdivision. The department of
human services shall monitor the effect of this paragraph on
provider rates. The county shall pay the provider's full
charges for every child in care up to the maximum established.
The commissioner shall determine the maximum rate for each type
of care, including special needs and handicapped care.
(c) When the provider charge is greater than the maximum
provider rate allowed, the parent is responsible for payment of
the difference in the rates in addition to any family copayment
fee.
Sec. 37. Minnesota Statutes 1994, section 256H.18, is
amended to read:
256H.18 [ADMINISTRATIVE EXPENSES.]
The commissioner shall use up to seven percent one-eleventh
of the state and federal funds appropriated available for the
basic sliding fee program for payments to counties for
administrative expenses. The commissioner shall use up to ten
percent of federal funds for payments to counties for
administrative expenses.
Sec. 38. Minnesota Statutes 1994, section 256H.20,
subdivision 3a, is amended to read:
Subd. 3a. [GRANT REQUIREMENTS AND PRIORITY.] Priority for
awarding resource and referral grants shall be given in the
following order:
(1) start up resource and referral programs in areas of the
state where they do not exist; and
(2) improve resource and referral programs.
Resource and referral programs shall meet the following
requirements:
(a) Each program shall identify all existing child care
services through information provided by all relevant public and
private agencies in the areas of service, and shall develop a
resource file of the services which shall be maintained and
updated at least quarterly. These services must include family
day care homes; public and private day care programs; full-time
and part-time programs; infant, preschool, and extended care
programs; and programs for school age children.
The resource file must include: the type of program, hours
of program service, ages of children served, fees, location of
the program, eligibility requirements for enrollment, special
needs services, and transportation available to the program.
The file may also include program information and special
program features.
(b) Each resource and referral program shall establish a
referral process which responds to parental need for information
and which fully recognizes confidentiality rights of parents.
The referral process must afford parents maximum access to all
referral information. This access must include telephone
referral available for no less than 20 hours per week.
Each child care resource and referral agency shall
publicize its services through popular media sources, agencies,
employers, and other appropriate methods.
(c) Each resource and referral program shall maintain
ongoing documentation of requests for service. All child care
resource and referral agencies must maintain documentation of
the number of calls and contacts to the child care information
and referral agency or component. A resource and referral
program shall collect and maintain the following information:
(1) ages of children served;
(2) time category of child care request for each child;
(3) special time category, such as nights, weekends, and
swing shift; and
(4) reason that the child care is needed.
(d) Each resource and referral program shall make available
the following information as an educational aid to parents:
(1) information on aspects of evaluating the quality and
suitability of child care services, including licensing
regulation, financial assistance available, child abuse
reporting procedures, appropriate child development information;
(2) information on available parent, early childhood, and
family education programs in the community.
(e) On or after one year of operation a resource and
referral program shall provide technical assistance to employers
and existing and potential providers of all types of child care
services. This assistance shall include:
(1) information on all aspects of initiating new child care
services including licensing, zoning, program and budget
development, and assistance in finding information from other
sources;
(2) information and resources which help existing child
care providers to maximize their ability to serve the children
and parents of their community;
(3) dissemination of information on current public issues
affecting the local and state delivery of child care services;
(4) facilitation of communication between existing child
care providers and child-related services in the community
served;
(5) recruitment of licensed providers; and
(6) options, and the benefits available to employers
utilizing the various options, to expand child care services to
employees.
Services prescribed by this section must be designed to
maximize parental choice in the selection of child care and to
facilitate the maintenance and development of child care
services and resources.
(f) Child care resource and referral information must be
provided to all persons requesting services and to all types of
child care providers and employers.
(g) Each resource and referral program shall coordinate
early childhood training for child care providers in that
program's service delivery area. The resource and referral
program shall convene an early childhood care and education
training advisory committee to assist in the following
activities:
(1) assess the early childhood care and education training
needs of child care center staff and family and group family
child care providers;
(2) coordinate existing early childhood care and education
training;
(3) develop new early childhood care and education training
opportunities; and
(4) publicize all early childhood training classes and
workshops to child care center staff and family and group family
child care providers in the service delivery area.
(h) Public or private entities may apply to the
commissioner for funding. A local match of up to 25 percent is
required.
Sec. 39. Minnesota Statutes 1994, section 257.3571,
subdivision 1, is amended to read:
Subdivision 1. [PRIMARY SUPPORT GRANTS.] The commissioner
shall establish direct grants to Indian tribes and, Indian
organizations, and tribal social service agency programs located
off-reservation that serve Indian children and their families to
provide primary support for Indian child welfare programs to
implement the Indian family preservation act.
Sec. 40. Minnesota Statutes 1994, section 257.3572, is
amended to read:
257.3572 [GRANT APPLICATIONS.]
A tribe or, Indian organization, or tribal social service
agency program located off-reservation may apply for primary
support grants under section 257.3571, subdivision 1. A local
social service agency, tribe, Indian organization, or other
social service organization may apply for special focus grants
under section 257.3571, subdivision 2. Civil legal service
organizations eligible for grants under section 257.3571,
subdivision 2a, may apply for grants under that section.
Application may be made alone or in combination with other
tribes or Indian organizations.
Sec. 41. Minnesota Statutes 1994, section 257.3577,
subdivision 1, is amended to read:
Subdivision 1. [PRIMARY SUPPORT GRANTS.] (a) The amount
available for grants established under section 257.3571,
subdivision 1, to tribes and, Indian organization grants
organizations, and tribal social service agency programs located
off-reservation is four-fifths of the total annual appropriation
for Indian child welfare grants.
(b) The commissioner shall award tribes at least 70 percent
of the amount set in paragraph (a) for primary support grants.
Each tribe shall be awarded a base amount of five percent of the
total amount set in this paragraph. In addition, each tribe
shall be allocated a proportion of the balance of the amount set
in this paragraph, less the total base amounts for all
reservations. This proportion must equal the ratio of the
tribe's on-reservation population to the state's total
on-reservation population. Population data must be based on the
most recent federal census data according to the state
demographer's office.
(c) The commissioner shall award Indian organizations and
tribal social service agency programs located off-reservation
that serve Indian children and families up to 30 percent of the
amount set in paragraph (a) for primary support grants. A
maximum of four multiservice Indian organizations and tribal
social service agency programs located off-reservation may be
awarded grants under this paragraph. "Multiservice Indian
organizations" means Indian organizations recognized by the
Indian community as providing a broad continuum of social,
educational, or cultural services, including Indian child
welfare services designed to meet the unique needs of the Indian
communities in Minneapolis, St. Paul, and Duluth. Grants may be
awarded to programs that submit acceptable proposals, comply
with the goals and the application process of the program, and
have budgets that reflect appropriate and efficient use of funds.
To maintain continuity of service in Indian communities, primary
support grants awarded under this paragraph which meet the grant
criteria and have demonstrated satisfactory performance as
established by the commissioner may be awarded on a
noncompetitive basis. The commissioner may revoke or deny
funding for Indian organizations or tribal social service
agencies failing to meet the grant criteria established by the
commissioner, and the commissioner may request new proposals
from Indian organizations or tribal social service agencies to
the extent that funding is available.
Sec. 42. [KINSHIP CAREGIVER INFORMATION.]
The commissioner of human services shall develop an
informational brochure which describes the laws and services
that may be applicable to and available to grandparents and
other kinship caregivers to assist them in caring for the minor
kinship children who are in their care. The brochure must also
indicate how a kinship caregiver can receive further
information. The brochure must be distributed to county social
service agencies, area agencies on aging, the ombudsperson for
families, and other known community organizations that may have
contact with kinship caregivers. For purposes of this section,
"kinship caregiver" means any of the following persons related
to the child by marriage, blood, or adoption: grandparent,
great grandparent, brother, sister, stepparent, stepsister,
stepbrother, niece, nephew, uncle, great uncle, aunt, or great
aunt.
Sec. 43. [DIFFICULTY OF CARE STUDY.]
The commissioner of human services shall study and report
to the house health and human services finance division, and to
the senate health care and family services finance division, on
the advisability of continuing to reimburse for foster care
services on the basis of difficulty of care factors. The report
shall be submitted no later than January 1, 1996, and shall
include specific recommendations as to whether the difficulty of
care reimbursement system should be retained, modified, or
abandoned. In preparing this report, the commissioner shall
consult with public and private foster care agencies and with
foster care providers, and shall consider the differential
impact, if any, on the child from receiving foster care
reimbursement through the difficulty of care reimbursement
system versus through an alternative reimbursement mechanism.
The report must also identify the legal and institutional
barriers, if any, to changing from a difficulty of care
reimbursement system to another type of reimbursement system.
Sec. 44. [REPEALER.]
Minnesota Statutes 1994, sections 256F.05, subdivisions 2a
and 4a; 256F.06, subdivision 3; 256F.09, subdivision 4; and
256H.03, subdivisions 2 and 5, are repealed.
Sec. 45. [EFFECTIVE DATE.]
Section 2 (256.8711, subdivisions 1 to 10) is effective
October 1, 1995.
Sections 5 (256F.01), 6 (256F.02), 7 and 8 (256F.03,
subdivisions 5 and 10), 9 and 10 (256F.04, subdivisions 1 and
2), 11 to 17 (256F.05, subdivisions 1a, 2, 3, 4, 5, 7, and 8),
and 18 and 19 (256F.06, subdivisions 1 and 2) are effective
January 1, 1996.
ARTICLE 5
ECONOMIC SELF-SUFFICIENCY
Section 1. Minnesota Statutes 1994, section 256.12,
subdivision 14, is amended to read:
Subd. 14. [DEPENDENT CHILD.] (a) "Dependent child," as
used in sections 256.72 to 256.87, means a child under the age
of 18 years, or a child under the age of 19 years who is
regularly attending as a full-time student, and is expected to
complete before reaching age 19, a high school or a secondary
level course of vocational or technical training designed to fit
students for gainful employment, who is found to be deprived of
parental support or care by reason of the death, continued
absence from the home, physical or mental incapacity of a
parent, or who is a child of an unemployed parent as that term
is defined by the commissioner of human services, such
definition to be consistent with and not to exceed minimum
standards established by the Congress of the United States and
the Secretary of Health and Human Services. When defining
"unemployed parent," the commissioner shall count up to four
calendar quarters of full-time attendance in any of the
following toward the requirement that a principal earner have
six or more quarters of work in any 13 calendar quarter period
ending within one year before application for aid to families
with dependent children:
(1) an elementary or secondary school;
(2) a federally approved vocational or technical training
course designed to prepare the parent for gainful employment; or
(3) full-time participation in an education or training
program established under the job training partnership act.
(b) Dependent child also means a child:
(1) whose relatives are liable under the law for the
child's support and are not able to provide adequate care and
support of the child; and
(2) who is living with father, mother, grandfather,
grandmother, brother, sister, stepfather, stepmother,
stepbrother, stepsister, uncle, aunt, first cousin, nephew, or
niece a parent or a person in one of the groups listed under
Code of Federal Regulations, title 45, section
233.90(c)(1)(v)(A) in a place of residence maintained by one or
more of these relatives as a home.
(c) Dependent child also means a child who has been removed
from the home of a relative after a judicial determination that
continuance in the home would be contrary to the welfare and
best interests of the child and whose care and placement in a
foster home, a different relative's home, or a private licensed
child care institution is, in accordance with the rules of the
commissioner, the responsibility of the state or county agency
under sections 256.72 to 256.87. This child is eligible for
benefits only through the foster care and adoption assistance
program contained in Title IV-E of the Social Security Act,
United States Code, title 42, sections 670 to 676, and is not
entitled to benefits under sections 256.72 to 256.87.
Sec. 2. Minnesota Statutes 1994, 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. The
assistance unit must sign an agreement to dispose of the
property and to repay assistance received during the nine months
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 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
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. give the local agency a lien
to secure repayment of benefits received by the assistance unit
during the nine-month period covered by the agreement. The
provisions of section 514.981, subdivision 2, clauses (a)(1),
(a)(3), (a)(4), (a)(5), and (e); subdivisions 4 and 5, clauses
(a)(2), (b)(3) (b)(4), and (d); and subdivision 6; section
514.982, subdivision 1, clauses (1), (2), and (4); and
subdivision 2; and sections 514.983 and 514.984, regarding
medical assistance liens, shall apply to AFDC liens under this
section, except that the filing fees paid by the county agency
under this section shall be deducted from recoveries made under
this lien provision. For purposes of this paragraph, all
references in sections 514.981 to 514.984, to medical assistance
liens and to medical assistance benefits shall be construed to
be references to AFDC liens and to AFDC benefits, respectively.
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. 3. Minnesota Statutes 1994, 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
months per calendar year and the earnings of a dependent child
that are derived from the jobs training and partnership act
(JTPA) may be disregarded for six 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;. If a stepparent's
needs are included in the assistance unit as specified in
section 256.74, subdivision 1, the disregards specified in
section 256.74, subdivision 1, shall be applied.
(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. 4. Minnesota Statutes 1994, section 256.736,
subdivision 3, is amended to read:
Subd. 3. [REGISTRATION.] (a) To the extent permissible
under federal law, every caretaker or child is required to
register for employment and training services, as a condition of
receiving AFDC, unless the caretaker or child is:
(1) a child who is under age 16, a child age 16 or 17 who
is attending elementary or secondary school or a secondary level
vocational or technical school full time;
(2) ill, incapacitated, or age 60 or older;
(3) a person for whom participation in an employment and
training service would require a round trip commuting time by
available transportation of more than two hours;
(4) a person whose presence in the home is required because
of illness or incapacity of another member of the household;
(5) a caretaker or other caretaker relative of a child
under the age of three who personally provides full-time care
for the child. In AFDC-UP cases, only one parent or other
relative may qualify for this exemption;
(6) a caretaker or other caretaker relative personally
providing care for a child under six years of age, except that
when child care is arranged for or provided, the caretaker or
caretaker relative may be required to register and participate
in employment and training services up to a maximum of 20 hours
per week. In AFDC-UP cases, only one parent or other relative
may qualify for this exemption;
(7) a pregnant woman, if it has been medically verified
that the child is expected to be born within the next six
months; or
(8) employed at least 30 hours per week; or
(9) an individual added to an assistance unit as an
essential person under section 256.74, subdivision 1, who does
not meet the definition of a "caretaker" as defined in
subdivision 1a, paragraph (c).
(b) To the extent permissible by federal law, applicants
for benefits under the AFDC program are registered for
employment and training services by signing the application
form. Applicants must be informed that they are registering for
employment and training services by signing the form. Persons
receiving benefits on or after July 1, 1987, shall register for
employment and training services to the extent permissible by
federal law. The caretaker has a right to a fair hearing under
section 256.045 with respect to the appropriateness of the
registration.
Sec. 5. Minnesota Statutes 1994, section 256.736,
subdivision 13, is amended to read:
Subd. 13. [STATE SHARE.] The state must pay 75 percent of
the nonfederal share of costs incurred by counties under
subdivision 11.
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
county agency expenditures made under subdivision 11 from
January 1, 1991, on to June 30, 1995. Payment to counties under
this subdivision is subject to the provisions of section 256.017.
Beginning July 1, 1995, the state must pay 100 percent of
the nonfederal share incurred by counties under subdivision 11,
up to the limit of state appropriations. If the state
appropriation is not sufficient to fund the cost of case
management services for all caretakers identified in subdivision
2a, the commissioner must define a statewide subgroup of
caretakers which includes all caretakers in subdivision 2a,
clause (1), and as many caretakers as possible from subdivision
2a, clauses (2) and (3).
Sec. 6. Minnesota Statutes 1994, 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 parent 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. To the extent
permissible under federal law, an eligible relative caretaker or
parent shall have the option to include in the assistance unit
the needs, income, and resources of the following essential
persons who are not otherwise eligible for AFDC because they do
not qualify as a caretaker or as a dependent child:
(1) a parent or relative caretaker's spouse and
stepchildren; or
(2) blood or legally adopted relatives who are under the
age of 18 or under the age of 19 years who are regularly
attending as a full-time student, and are expected to complete
before or during the month of their 19th birthday, a high school
or secondary level course of vocational or technical training
designed to prepare students for gainful employment. 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 AFDC family must be budgeted in the
normal retrospective cycle. When the family's income, after
application of the applicable disregards, exceeds the need
standard for the 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. Any income remaining from this calculation
is income in the first month following the period of
ineligibility. 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 AFDC who is a
full-time student or is a part-time student 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 and
includes a participant in the Job Corps program under the Job
Training Partnership Act (JTPA). The county agency shall also
disregard all income of each dependent child 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 months per calendar year;
(2) all educational grants and loans assistance, except the
county agency shall count graduate student teaching
assistantships, fellowships, and other similar paid work as
earned income and, after allowing deductions for any unmet and
necessary educational expenses, shall count scholarships or
grants awarded to graduate students that do not require teaching
or research as unearned income;
(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. 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. 7. Minnesota Statutes 1994, section 256D.05,
subdivision 7, is amended to read:
Subd. 7. [INELIGIBILITY FOR GENERAL ASSISTANCE.] No person
disqualified from any federally aided assistance program shall
be eligible for general assistance during the a period covered
by the disqualification sanction of disqualification because of
sanctions, from any federally aided assistance program; or if
the person could be considered an essential person under section
256.74, subdivision 1.
Sec. 8. Minnesota Statutes 1994, section 256D.36,
subdivision 1, is amended to read:
Subdivision 1. [STATE PARTICIPATION.] (a) [ELIGIBILITY.]
Commencing January 1, 1974, the commissioner shall certify to
each county agency the names of all county residents who were
eligible for and did receive aid during December, 1973, pursuant
to a categorical aid program of old age assistance, aid to the
blind, or aid to the disabled. The amount of supplemental aid
for each individual eligible under this section shall be
calculated according to the formula in title II, section 212(a)
(3) of Public Law Number 93-66, as amended.
(b) [DIVISION COSTS.] From and after January 1, 1980,
until January 1, 1981, the state shall pay 70 percent and the
county shall pay 30 percent of the supplemental aid calculated
for each county resident certified under this section who is an
applicant for or recipient of supplemental security income.
After December 31, 1980, The state share of aid paid shall be 85
percent and the county share shall be 15 percent. Benefits
shall be issued to recipients by the state or county and funded
according to section 256.025, subdivision 3, subject to
provisions of section 256.017.
Beginning July 1, 1991, the state will reimburse counties
according to the payment schedule in section 256.025 for the
county share of county agency expenditures for financial
benefits to individuals under this subdivision from January 1,
1991, on. Payment to counties under this subdivision is subject
to the provisions of section 256.017.
Sec. 9. Minnesota Statutes 1994, section 256D.385, is
amended to read:
256D.385 [RESIDENCE.]
To be eligible for Minnesota supplemental aid, a person
must be a resident of Minnesota and (1) a citizen of the United
States, or (2) an alien lawfully admitted to the United States
for permanent residence, or (3) otherwise permanently residing
in the United States under color of law as defined by an alien
eligible to receive benefits from the supplemental security
income program.
Sec. 10. Minnesota Statutes 1994, section 256D.405,
subdivision 3, is amended to read:
Subd. 3. [REPORTS.] Recipients must report changes in
circumstances that affect eligibility or assistance payment
amounts within ten days of the change. Recipients with earned
income, and recipients who do not receive SSI because of excess
income must complete a monthly report form if they have earned
income, if they have income allocated deemed to them from a
financially responsible relative with whom the recipient
resides, must complete a monthly household report form or if
they have income deemed to them by a sponsor. If the report
form is not received before the end of the month in which it is
due, the county agency must terminate assistance. 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 the assistance was
terminated, the assistance unit is considered to have continued
its application for assistance, effective the first day of the
month the assistance was terminated.
Sec. 11. Minnesota Statutes 1994, section 256D.425,
subdivision 1, is amended to read:
Subdivision 1. [PERSONS ENTITLED TO RECEIVE AID.] A person
who is aged, blind, or 18 years of age or older and disabled,
whose income is less than the standards of assistance in section
256D.44 and whose resources are less than the limits in
subdivision 2 is eligible for and entitled to Minnesota
supplemental aid. A person found eligible by the Social
Security Administration for supplemental security income under
Title XVI on the basis of age, blindness, or disability meets
these requirements. A person who would be eligible for the
supplemental security income program except for income that
exceeds the limit of that program but that A person receiving
supplemental security benefits under Title XVI on the basis of
age, blindness, or disability (or would be eligible for such
benefits except for excess income) is eligible for a payment
under the Minnesota supplemental aid program, if the person's
net income is less than the standards in section 256D.44.
Persons who are not receiving supplemental security income
benefits under Title XVI of the Social Security Act or
disability insurance benefits under Title II of the Social
Security Act due to exhausting time limited benefits are not
eligible to receive benefits under the MSA program. Persons who
are not receiving social security or other maintenance benefits
for failure to meet or comply with the social security or other
maintenance program requirements are not eligible to receive
benefits under the MSA program. Persons who are found
ineligible for supplemental security income because of excess
income, but whose income is within the limits of the Minnesota
supplemental aid program, must have blindness or disability
determined by the state medical review team.
Sec. 12. Minnesota Statutes 1994, section 256D.435,
subdivision 1, is amended to read:
Subdivision 1. [EXCLUSIONS INCOME.] The following is
excluded from income in determining eligibility for Minnesota
supplemental aid:
(1) the value of food stamps;
(2) home-produced food used by the household;
(3) Indian claim payments made by the United States
Congress to compensate members of Indian tribes for the taking
of tribal lands by the federal government;
(4) cash payments to displaced persons who face relocation
as a result of the Housing Act of 1965, the Housing and Urban
Development Act of 1965, or the Uniform Relocation Assistance
and Real Property Acquisition Policies Act of 1970;
(5) one-third of child support payments received by an
eligible child from an absent parent;
(6) displaced homemaker payments;
(7) reimbursement received for maintenance costs of
providing foster care to adults or children;
(8) benefits received under Title IV and Title VII of the
Older Americans Act of 1965;
(9) Minnesota renter or homeowner property tax refunds;
(10) infrequent, irregular income that does not total more
than $20 per person in a month;
(11) reimbursement payments received from the VISTA
program;
(12) in-kind income;
(13) payments received for providing volunteer services
under Title I, Title II, and Title III of the Domestic Volunteer
Service Act of 1973;
(14) loans that have to be repaid;
(15) federal low-income heating assistance program
payments;
(16) any other type of funds excluded as income by state
law;
(17) student financial aid, as allowed for the supplemental
security income program; and
(18) other income excluded by the supplemental security
income program. For persons receiving supplemental security
income benefits, the countable income used to determine
eligibility and benefits for Minnesota supplemental aid is the
gross amount of the Federal Benefit Rate (FBR) after allowing
for the general income disregard in subdivision 5. For persons
who have been denied a supplemental security income benefit due
to excess income, and have had their blindness or disability
determined through the state medical review team, the countable
income is the gross amount of earned and unearned income, minus
the exclusions and disregards listed in subdivisions 4a, 5, and
6.
Sec. 13. Minnesota Statutes 1994, section 256D.435,
subdivision 3, is amended to read:
Subd. 3. [APPLICATION FOR FEDERALLY FUNDED BENEFITS.]
Persons for whom the applicant or recipient has financial
responsibility and who have unmet needs Persons who live with
the applicant or recipient, who have unmet needs and for whom
the applicant or recipient has financial responsibility, must
apply for and, if eligible, accept AFDC and other federally
funded benefits. If the persons are determined potentially
eligible for AFDC by the county agency, the applicant or
recipient may not allocate earned or unearned income to those
persons while an AFDC application is pending, or after the
persons are determined eligible for AFDC. If the persons are
determined potentially eligible for other federal benefits, the
applicant or recipient may only allocate income to those persons
until they are determined eligible for those other benefits
unless the amount of those benefits is less than the amount in
subdivision 4.
Sec. 14. Minnesota Statutes 1994, section 256D.435,
subdivision 4, is amended to read:
Subd. 4. [ALLOCATION AND DEEMING OF INCOME.] The rate of
allocation to relatives for whom the applicant or recipient is
financially responsible is one-half the individual supplemental
security income standard of assistance, except as restricted in
subdivision 3.
If the applicant or recipient shares a residence with
another person who has financial responsibility for the
applicant or recipient, the income of that person is considered
available to the applicant or recipient after allowing: (1) the
deductions in subdivisions 7 and 8; and (2) a deduction for the
needs of the financially responsible relative and others in the
household for whom that relative is financially responsible.
The rate allowed to meet the needs of each of these people is
one-half the individual supplemental security income
standard. The county agency shall apply the supplemental
security income rules regarding financial responsibility when
determining the amount of income to allocate or deem.
Sec. 15. Minnesota Statutes 1994, section 256D.435, is
amended by adding a subdivision to read:
Subd. 4a. [EXCLUSIONS.] The income exclusions used to
determine eligibility for Minnesota supplemental aid are those
used to determine benefits for supplemental security income.
Sec. 16. Minnesota Statutes 1994, section 256D.435,
subdivision 5, is amended to read:
Subd. 5. [GENERAL INCOME DISREGARD.] The county agency
shall disregard the first $20 of the assistance unit's unearned
or earned income from the assistance unit's gross earned income.
Sec. 17. Minnesota Statutes 1994, section 256D.435,
subdivision 6, is amended to read:
Subd. 6. [EARNED INCOME DISREGARDS.] From the assistance
unit's gross earned income, the county agency shall disregard
$65 plus one-half of the remaining income. The earned income
disregards used to determine eligibility for Minnesota
supplemental aid are those used to determine benefits for
supplemental security income.
Sec. 18. Minnesota Statutes 1994, section 256D.44,
subdivision 1, is amended to read:
Subdivision 1. [USE OF STANDARDS; INCREASES.] The state
standards of assistance for shelter, basic needs, and plus
special need items that establish the total amount of
maintenance need for an applicant for or recipient of Minnesota
supplemental aid, are used to determine the assistance unit's
eligibility for Minnesota supplemental aid. The state standards
of assistance for basic needs must increase by an amount equal
to the dollar value, rounded up to the nearest dollar, of any
cost of living increases in the supplemental security income
program.
Sec. 19. Minnesota Statutes 1994, section 256D.44,
subdivision 2, is amended to read:
Subd. 2. [STANDARD OF ASSISTANCE FOR SHELTER PERSONS
ELIGIBLE FOR MEDICAL ASSISTANCE WAIVERS OR AT RISK OF PLACEMENT
IN A GROUP RESIDENTIAL HOUSING FACILITY.] 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 (f).
(a) If 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 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) 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). The state standard of assistance for a
person who is eligible for a medical assistance home and
community-based services waiver or a person who has been
determined by the local agency to meet the plan requirements for
placement in a group residential housing facility under section
256I.04, subdivision 1a, is the standard established in
subdivision 3, paragraph (a) or (b).
Sec. 20. Minnesota Statutes 1994, 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) If an applicant or recipient does not reside with
another person or persons, the state standard of assistance is
$371 $519.
(b) If an applicant married couple or recipient married
couple who live together, does not reside with others, the state
standard of assistance is $557 $778.
(c) If an applicant or recipient resides with another
person or persons, the state standard of assistance is $286 $395.
(d) If an applicant married couple or recipient married
couple who live together, resides with others, the state
standard of assistance is $371 $519.
(e) Married couples, living together who do not reside with
others and were receiving MSA on prior to January 1, 1994, and
whose eligibility has not been terminated a full calendar month,
are exempt from the standards in paragraphs (b) and (d) the
state standard of assistance is $793.
(f) Married couples living together who reside with others
and were receiving MSA prior to January 1, 1994, and whose
eligibility has not been terminated a full calendar month, the
state standard of assistance is $682.
(g) For an individual who is a resident of a nursing home,
a regional treatment center or a group residential housing
facility, the state standard of assistance is the personal needs
allowance for medical assistance recipients under section
256B.35.
Sec. 21. Minnesota Statutes 1994, section 256D.44,
subdivision 4, is amended to read:
Subd. 4. [TEMPORARY ABSENCE DUE TO ILLNESS.] For the
purposes of this subdivision, "home" means a residence owned or
rented by a recipient or the recipient's spouse. Home does not
include a negotiated rate group residential housing facility.
Assistance payments for recipients who are temporarily absent
from their home due to hospitalization for illness must continue
at the same level of payment during their absence if the
following criteria are met:
(1) a physician certifies that the absence is not expected
to continue for more than three months;
(2) a physician certifies that the recipient will be able
to return to independent living; and
(3) the recipient has expenses associated with maintaining
a residence in the community.
Sec. 22. Minnesota Statutes 1994, section 256D.44,
subdivision 5, is amended to read:
Subd. 5. [SPECIAL NEEDS.] Notwithstanding In addition to
the state standards of assistance established in subdivisions 1
to 4, payments are allowed for the following special needs of
recipients of Minnesota supplemental aid who are not residents
of a nursing home, a regional treatment center, or a group
residential housing facility:
(a) The county agency shall pay a monthly allowance for
medically prescribed diets payable under the AFDC program if the
cost of those additional dietary needs cannot be met through
some other maintenance benefit.
(b) Payment for nonrecurring special needs must be allowed
for necessary home repairs or necessary repairs or replacement
of household furniture and appliances using the payment standard
of the AFDC program for these expenses, as long as other funding
sources are not available.
(c) A fee for guardian or conservator service is allowed at
a reasonable rate negotiated by the county or approved by the
court. This rate shall not exceed five percent of the
assistance unit's gross monthly income up to a maximum of $100
per month. If the guardian or conservator is a member of the
county agency staff, no fee is allowed.
(d) The county agency shall continue to pay a monthly
allowance of $68 for restaurant meals for a person who was
receiving a restaurant meal allowance on June 1, 1990, and who
eats two or more meals in a restaurant daily. The allowance
must continue until the person has not received Minnesota
supplemental aid for one full calendar month or until the
person's living arrangement changes and the person no longer
meets the criteria for the restaurant meal allowance, whichever
occurs first.
(e) A fee of ten percent of the recipients gross income or
$25, whichever is less, is allowed for representative payee
services provided by an agency that meets the requirements under
SSI regulations to charge a fee for representative payee
services. This special need is available to all recipients of
Minnesota supplemental aid regardless of their living
arrangement.
Sec. 23. Minnesota Statutes 1994, section 256D.44,
subdivision 6, is amended to read:
Subd. 6. [COUNTY AGENCY STANDARDS OF ASSISTANCE.] The
county agency may establish standards of assistance for shelter,
basic needs, special needs, and clothing and personal needs, and
negotiated rates that exceed the corresponding state standards
of assistance. State aid is not available for costs above state
standards.
Sec. 24. Minnesota Statutes 1994, section 256D.45,
subdivision 1, is amended to read:
Subdivision 1. [PROSPECTIVE BUDGETING.] A calendar month
is The payment period and budgeting cycle for Minnesota
supplemental aid. The monthly payment to a recipient must be
determined prospectively are those of the supplemental security
income program.
Sec. 25. Minnesota Statutes 1994, section 256D.46,
subdivision 1, is amended to read:
Subdivision 1. [ELIGIBILITY.] Emergency Minnesota
supplemental aid must be granted if the recipient is without
adequate resources to resolve an emergency that, if unresolved,
will threaten the health or safety of the recipient. For the
purposes of this section, the term "recipient" includes persons
for whom a group residential housing benefit is being paid under
sections 256I.01 to 256I.06.
Sec. 26. Minnesota Statutes 1994, section 256D.46,
subdivision 2, is amended to read:
Subd. 2. [INCOME AND RESOURCE TEST.] All income and
resources available to the recipient during the month in which
the need for emergency Minnesota supplemental aid arises must be
considered in determining the recipient's ability to meet the
emergency need. Property that can be liquidated in time to
resolve the emergency and income (excluding Minnesota
supplemental aid issued for current month's need) that is
normally disregarded or excluded under the Minnesota
supplemental aid program must be considered available to meet
the emergency need.
Sec. 27. Minnesota Statutes 1994, section 256D.48,
subdivision 1, is amended to read:
Subdivision 1. [NEED FOR PROTECTIVE PAYEE.] The county
agency shall determine whether a recipient needs a protective
payee when a physical or mental condition renders the recipient
unable to manage funds and when payments to the recipient would
be contrary to the recipient's welfare. Protective payments
must be issued when there is evidence of: (1) repeated
inability to plan the use of income to meet necessary
expenditures; (2) repeated observation that the recipient is not
properly fed or clothed; (3) repeated failure to meet
obligations for rent, utilities, food, and other essentials; (4)
evictions or a repeated incurrence of debts; or (5) lost or
stolen checks; or (6) use of emergency Minnesota supplemental
aid more than twice in a calendar year. The determination of
representative payment by the Social Security Administration for
the recipient is sufficient reason for protective payment of
Minnesota supplemental aid payments.
Sec. 28. Minnesota Statutes 1994, section 256I.03,
subdivision 5, is amended 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. 29. Minnesota Statutes 1994, section 256I.03, is
amended by adding a subdivision to read:
Subd. 7. [COUNTABLE INCOME.] "Countable income" means all
income received by an applicant or recipient less any applicable
exclusions or disregards. For a recipient of any cash benefit
from the SSI program, countable income means the SSI benefit
limit in effect at the time the person is in a GRH setting less
$20, less the medical assistance personal needs allowance. If
the SSI limit has been reduced for a person due to events
occurring prior to the persons entering the GRH setting,
countable income means actual income less any applicable
exclusions and disregards.
Sec. 30. Minnesota Statutes 1994, section 256I.04,
subdivision 2b, is amended 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 specific license or
registration from the department of health or the department of
human services held by the provider and the number of beds
subject to that license; 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;
whether the license holder is a not-for-profit corporation under
section 501(c)(3) of the Internal Revenue Code; 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. 31. Minnesota Statutes 1994, 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 group residential housing beds with
total rates in excess of the MSA equivalent rate except: (1)
for group residential housing establishments meeting the
requirements of subdivision 2a, clause (2) with department
approval; (2) for group residential housing establishments
licensed under Minnesota Rules, parts 9525.0215 to 9525.0355,
provided the facility is needed to meet the census reduction
targets for persons with 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).; or (5) notwithstanding the provisions of subdivision 2a,
for up to 180 supportive housing units in Anoka, Dakota,
Hennepin, or Ramsey county for homeless adults with a mental
illness, a history of substance abuse, or human immunodeficiency
virus or acquired immunodeficiency syndrome. For purposes of
this section, "homeless adult" means a person who is living on
the street or in a shelter or is evicted from a dwelling unit or
discharged from a regional treatment center, community hospital,
or residential treatment program and has no appropriate housing
available and lacks the resources and support necessary to
access appropriate housing. At least 70 percent of the
supportive housing units must serve homeless adults with mental
illness, substance abuse problems, or human immunodeficiency
virus or acquired immunodeficiency syndrome who are about to be
discharged from a regional treatment center, or a
state-contracted psychiatric bed in a community hospital, or a
residential mental health or chemical dependency treatment
program. If a person meets the requirements of subdivision 1,
paragraph (a), the group residential housing rate for that
person is limited to the supplementary rate under section
256I.05, subdivision 1a, and is determined by subtracting the
amount of the person's countable income that exceeds the MSA
equivalent rate from the group residential housing supplementary
rate. Service funding under section 256I.05, subdivision 1a,
must end June 30, 1997. Effective July 1, 1997, services to
persons in these settings must be provided through a managed
care entity. This provision is subject to the availability of
matching federal funds.
(b) A county agency may enter into a group residential
housing agreement for beds with rates in excess of the MSA
equivalent rate in addition to those currently covered under a
group residential housing agreement if the additional beds are
only a replacement of beds with rates in excess of the MSA
equivalent rate which have been made available due to closure of
a setting, a change of licensure or certification which removes
the beds from group residential housing payment, or as a result
of the downsizing of a group residential housing setting. The
transfer of available beds from one county to another can only
occur by the agreement of both counties.
(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. 32. Minnesota Statutes 1994, section 256I.05,
subdivision 1, is amended to read:
Subdivision 1. [MAXIMUM RATES.] (a) Monthly room and board
rates negotiated by a county agency for a recipient living in
group residential housing must not exceed 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
(3) 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 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 this subdivision.
This is effective until June 30, 1994.
Sec. 33. Minnesota Statutes 1994, section 256I.05,
subdivision 1a, is amended to read:
Subd. 1a. [SUPPLEMENTARY RATES.] 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 provider of services is not also concurrently
receiving funding for services for a recipient 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. If funding is
available for other necessary services through a home and
community-based waiver, then the GRH rate is limited to the rate
set in subdivision 1. 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. 34. Minnesota Statutes 1994, section 256I.05,
subdivision 5, is amended to read:
Subd. 5. [ADULT FOSTER CARE RATES.] The commissioner shall
annually establish statewide maintenance and difficulty of
care rates limits for adults in foster care. The commissioner
shall adopt rules to implement statewide rates. In adopting
rules, the commissioner shall consider existing maintenance and
difficulty of care rates so that, to the extent possible, an
adult for whom a maintenance or difficulty of care rate is
established will not be adversely affected.
Sec. 35. Minnesota Statutes 1994, section 256I.06,
subdivision 2, is amended to read:
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 countable earned income must be made
subsequent to receipt of a monthly household report form.
Sec. 36. Minnesota Statutes 1994, section 256I.06,
subdivision 6, is amended to read:
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 countable 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.
Sec. 37. Minnesota Statutes 1994, section 393.07,
subdivision 10, is amended to read:
Subd. 10. [FEDERAL FOOD STAMP PROGRAM.] (a) The local
social services agency 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 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;
(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.
(e) Food stamp overpayment claims which are due in whole or
in part to client error shall be established by the county
agency for a period of six years from the date of any resultant
overpayment.
(f) With regard to the federal tax revenue offset program
only, recovery incentives authorized by the federal food and
consumer service shall be retained at the rate of 50 percent by
the state agency and 50 percent by the certifying county agency.
Sec. 38. [RAMSEY COUNTY ELECTRONIC BENEFIT SERVICE.]
Notwithstanding the requirements for state contracts
contained in Minnesota Statutes, chapter 16B, or Laws 1993,
First Special Session chapter 1, article 1, section 2,
subdivision 5, or any other law to the contrary, the
commissioner, under terms and conditions approved by the
attorney general, may accept assignment from Ramsey county of
any existing contract, license agreement, or similar
transactional document related to the Ramsey county electronic
benefit system. The term of any contract, agreement, or other
document assigned to the state, including the agreement arising
from the Ramsey county electronic benefit services pilot
project, may not extend beyond June 30, 1997, and the
commissioner must publish a request for proposals for succeeding
electronic benefits services, including services required for
statewide expansion in the State Register before January 1, 1996.
Sec. 39. Laws 1993, First Special Session chapter 1,
article 8, section 30, subdivision 2, is amended to read:
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. The amendments and repeals
by Laws 1993, First Special Session chapter 1, article 8,
sections 1 to 3, 8, 9, 13 to 17, 22, 23, 26, and 29, are
effective July 1, 1994.
Sec. 40. [REPEALER.]
Minnesota Statutes 1994, sections 256.851; 256D.35,
subdivisions 14 and 19; 256D.36, subdivision 1a; 256D.37;
256D.425, subdivision 3; 256D.435, subdivisions 2, 7, 8, 9, and
10; and 256D.44, subdivision 7, are repealed.
Sec. 41. [EFFECTIVE DATES.]
Section 31 (256I.04, subdivision 3) is effective July 1,
1996.
ARTICLE 6
MA AND GAMC
Section 1. Minnesota Statutes 1994, section 144.0721, is
amended by adding a subdivision to read:
Subd. 3. [LEVEL OF CARE CRITERIA; MODIFICATIONS.] The
commissioner shall seek appropriate federal waivers to implement
this subdivision. Notwithstanding any laws or rules to the
contrary, effective July 1, 1996, Minnesota's level of care
criteria for admission of any person to a nursing facility
licensed under chapter 144A, or a boarding care home licensed
under sections 144.50 to 144.56, are modified as follows:
(1) the resident reimbursement classifications and
terminology established by rule under sections 256B.41 to
256B.48 are the basis for applying the level of care criteria
changes;
(2) an applicant to a certified nursing facility or
certified boarding care home who is dependent in one or two case
mix activities of daily living, is classified as a case mix A,
and is independent in orientation and self-preservation, is
reclassified as a high function class A person and is not
eligible for admission to Minnesota certified nursing facilities
or certified boarding care homes;
(3) applicants in clause (2) who are eligible for
assistance as determined under sections 256B.055 and 256B.056 or
meet eligibility criteria for section 256B.0913 are eligible for
a service allowance under section 256B.0913, subdivision 15, and
are not eligible for services under sections 256B.0913,
subdivisions 1 to 14, and 256B.0915. Applicants in clause (2)
shall have the option of receiving personal care assistant and
home health aide services under section 256B.0625, if otherwise
eligible, or of receiving the service allowance option, but not
both. Applicants in clause (2) shall have the option of
residing in community settings under sections 256I.01 to
256I.06, if otherwise eligible, or receiving the services
allowance option under section 256B.0913, subdivision 15, but
not both;
(4) residents of a certified nursing facility or certified
boarding care home who were admitted before July 1, 1996, or
individuals receiving services under section 256B.0913,
subdivisions 1 to 14, or 256B.0915, before July 1, 1996, are not
subject to the new level of care criteria unless the resident is
discharged home or to another service setting other than a
certified nursing facility or certified boarding care home and
applies for admission to a certified nursing facility or
certified boarding care home after June 30, 1996;
(5) the local screening teams under section 256B.0911 shall
make preliminary determinations concerning the existence of
extraordinary circumstances and may authorize an admission for a
short-term stay at a certified nursing facility or certified
boarding care home in accordance with a treatment and discharge
plan for up to 30 days per year; and
(6) an individual deemed ineligible for admission to
Minnesota certified nursing facilities is entitled to an appeal
under section 256.045.
If the commissioner determines upon appeal that an
applicant in clause (2) presents extraordinary circumstances
including but not limited to the absence or inaccessibility of
suitable alternatives, contravening family circumstances, and
protective service issues, the applicant may be eligible for
admission to Minnesota certified nursing facilities or certified
boarding care homes.
Sec. 2. Minnesota Statutes 1994, section 144.0721, is
amended by adding a subdivision to read:
Subd. 3a. [EXCEPTION.] Subdivision 3 does not apply to a
facility whose rates are subject to section 256I.05, subdivision
2.
Sec. 3. Minnesota Statutes 1994, section 144.702,
subdivision 2, is amended to read:
Subd. 2. [APPROVAL OF ORGANIZATION'S REPORTING
PROCEDURES.] The commissioner of health may approve voluntary
reporting procedures consistent with written operating
requirements for the voluntary, nonprofit reporting organization
which shall be established annually by the commissioner. These
written operating requirements shall specify reports, analyses,
and other deliverables to be produced by the voluntary,
nonprofit reporting organization, and the dates on which those
deliverables must be submitted to the commissioner. These
written operating requirements shall specify deliverable dates
sufficient to enable the commissioner of health to process and
report health care cost information system data to the
commissioner of human services by August 15 of each year. The
commissioner of health shall, by rule, prescribe standards for
submission of data by hospitals and outpatient surgical centers
to the voluntary, nonprofit reporting organization or to the
commissioner. These standards shall provide for:
(a) The filing of appropriate financial information with
the reporting organization;
(b) Adequate analysis and verification of that financial
information; and
(c) Timely publication of the costs, revenues, and rates of
individual hospitals and outpatient surgical centers prior to
the effective date of any proposed rate increase. The
commissioner of health shall annually review the procedures
approved pursuant to this subdivision.
Sec. 4. Minnesota Statutes 1994, section 252.27,
subdivision 1, is amended to read:
Subdivision 1. [COUNTY OF FINANCIAL RESPONSIBILITY.]
Whenever any child who has mental retardation or a related
condition, or a physical disability or emotional disturbance is
in 24-hour care outside the home including respite care, in a
facility licensed by the commissioner of human services, the
cost of services shall be paid by the county of financial
responsibility determined pursuant to chapter 256G. If the
child's parents or guardians do not reside in this state, the
cost shall be paid by the responsible governmental agency in the
state from which the child came, by the parents or guardians of
the child if they are financially able, or, if no other payment
source is available, by the commissioner of human services.
Sec. 5. Minnesota Statutes 1994, section 252.27,
subdivision 1a, is amended to read:
Subd. 1a. [DEFINITIONS.] A person has a "related
condition" if that person has is a condition that is found to be
closely related to mental retardation, including, but not
limited to, cerebral palsy, epilepsy, autism, and Prader-Willi
syndrome and that meets all of the following criteria: (a) is
severe, and chronic disability that meets all of the following
conditions: (a) is attributable to cerebral palsy, epilepsy,
autism, Prader-Willi syndrome, or any other condition, other
than mental illness as defined under section 245.462,
subdivision 20, or an emotional disturbance, as defined under
section 245.4871, subdivision 15, found to be closely related to
mental retardation because the condition; (b) results in
impairment of general intellectual functioning or adaptive
behavior similar to that of persons with mental retardation and;
(c) requires treatment or services similar to those required for
persons with mental retardation; (b) (d) is manifested before
the person reaches 22 years of age; (c) (e) is likely to
continue indefinitely; and (d) (f) results in substantial
functional limitations in three or more of the following areas
of major life activity: (1) self-care, (2) understanding and
use of language, (3) learning, (4) mobility, (5) self-direction,
(6) capacity for independent living; and (g) is not attributable
to mental illness as defined in section 245.462, subdivision 20,
or an emotional disturbance as defined in section 245.4871,
subdivision 15. For purposes of clause (g), notwithstanding
section 245.462, subdivision 20, or 245.4871, subdivision 15,
"mental illness" does not include autism or other pervasive
developmental disorders.
Sec. 6. Minnesota Statutes 1994, section 252.27,
subdivision 2a, is amended to read:
Subd. 2a. [CONTRIBUTION AMOUNT.] (a) The natural or
adoptive parents of a minor child, including a child determined
eligible for medical assistance without consideration of
parental income, must contribute monthly to the cost of
services, unless the child is married or has been married,
parental rights have been terminated, or the child's adoption is
subsidized according to section 259.67 or through title IV-E of
the Social Security Act.
(b) The parental contribution shall be the greater of a
minimum monthly fee of $25 for households with adjusted gross
income of $30,000 and over, or an amount to be computed by
applying to the adjusted gross income of the natural or adoptive
parents that exceeds 200 150 percent of the federal poverty
guidelines for the applicable household size, the following
schedule of rates:
(1) on the amount of adjusted gross income over 200 150
percent of poverty, but not over $50,000, ten percent;
(2) on the amount of adjusted gross income over 200 150
percent of poverty and over $50,000 but not over $60,000, 12
percent;
(3) on the amount of adjusted gross income over 200 150
percent of poverty, and over $60,000 but not over $75,000, 14
percent; and
(4) on all adjusted gross income amounts over 200 150
percent of poverty, and over $75,000, 15 percent.
If the child lives with the parent, the parental
contribution is reduced by $200, except that the parent must pay
the minimum monthly $25 fee under this paragraph. If the child
resides in an institution specified in section 256B.35, the
parent is responsible for the personal needs allowance specified
under that section in addition to the parental contribution
determined under this section. The parental contribution is
reduced by any amount required to be paid directly to the child
pursuant to a court order, but only if actually paid.
(c) The household size to be used in determining the amount
of contribution under paragraph (b) includes natural and
adoptive parents and their dependents under age 21, including
the child receiving services. Adjustments in the contribution
amount due to annual changes in the federal poverty guidelines
shall be implemented on the first day of July following
publication of the changes.
(d) For purposes of paragraph (b), "income" means the
adjusted gross income of the natural or adoptive parents
determined according to the previous year's federal tax form.
(e) The contribution shall be explained in writing to the
parents at the time eligibility for services is being
determined. The contribution shall be made on a monthly basis
effective with the first month in which the child receives
services. Annually upon redetermination or at termination of
eligibility, if the contribution exceeded the cost of services
provided, the local agency or the state shall reimburse that
excess amount to the parents, either by direct reimbursement if
the parent is no longer required to pay a contribution, or by a
reduction in or waiver of parental fees until the excess amount
is exhausted.
(f) The monthly contribution amount must be reviewed at
least every 12 months; when there is a change in household size;
and when there is a loss of or gain in income from one month to
another in excess of ten percent. The local agency shall mail a
written notice 30 days in advance of the effective date of a
change in the contribution amount. A decrease in the
contribution amount is effective in the month that the parent
verifies a reduction in income or change in household size.
(g) Parents of a minor child who do not live with each
other shall each pay the contribution required under paragraph
(a), except that a court-ordered child support payment actually
paid on behalf of the child receiving services shall be deducted
from the contribution of the parent making the payment.
(h) The contribution under paragraph (b) shall be increased
by an additional five percent if the local agency determines
that insurance coverage is available but not obtained for the
child. For purposes of this section, "available" means the
insurance is a benefit of employment for a family member at an
annual cost of no more than five percent of the family's annual
income. For purposes of this section, insurance means health
and accident insurance coverage, enrollment in a nonprofit
health service plan, health maintenance organization,
self-insured plan, or preferred provider organization.
Parents who have more than one child receiving services
shall not be required to pay more than the amount for the child
with the highest expenditures. There shall be no resource
contribution from the parents. The parent shall not be required
to pay a contribution in excess of the cost of the services
provided to the child, not counting payments made to school
districts for education-related services. Notice of an increase
in fee payment must be given at least 30 days before the
increased fee is due.
Sec. 7. Minnesota Statutes 1994, section 252.27, is
amended by adding a subdivision to read:
Subd. 5. [DETERMINATION; REDETERMINATION; NOTICE.] A
determination order and notice of parental fee shall be mailed
to the parent at least annually, or more frequently as provided
in Minnesota Rules, parts 9550.6220 to 9550.6229. The
determination order and notice shall contain the following
information: (1) the amount the parent is required to
contribute; (2) notice of the right to a redetermination and
appeal; and (3) the telephone number of the division at the
department of human services that is responsible for
redeterminations.
Sec. 8. Minnesota Statutes 1994, section 252.27, is
amended by adding a subdivision to read:
Subd. 6. [APPEALS.] A parent may appeal the determination
or redetermination of an obligation to make a contribution under
this section, according to section 256.045. The parent must
make a request for a hearing in writing within 30 days of the
date the determination or redetermination order is mailed, or
within 90 days of such written notice if the parent shows good
cause why the request was not submitted within the 30-day time
limit. The commissioner must provide the parent with a written
notice that acknowledges receipt of the request and notifies the
parent of the date of the hearing. While the appeal is pending,
the parent has the rights regarding making payment that are
provided in Minnesota Rules, part 9550.6235. If the
commissioner's determination or redetermination is affirmed, the
parent shall, within 90 calendar days after the date an order is
issued under section 256.045, subdivision 5, pay the total
amount due from the effective date of the notice of
determination or redetermination that was appealed by the
parent. If the commissioner's order under this subdivision
results in a decrease in the parental fee amount, any payments
made by the parent that result in an overpayment shall be
credited to the parent as provided in Minnesota Rules, part
9550.6235, subpart 3.
Sec. 9. Minnesota Statutes 1994, section 256.015,
subdivision 1, is amended to read:
Subdivision 1. [STATE AGENCY HAS LIEN.] When the state
agency provides, pays for, or becomes liable for medical care or
furnishes subsistence or other payments to a person, the agency
has a lien for the cost of the care and payments on all causes
of action that accrue to the person to whom the care or payments
were furnished, or to the person's legal representatives, as a
result of the occurrence that necessitated the medical care,
subsistence, or other payments. For purposes of this section,
"state agency" includes authorized agents of the state agency.
Sec. 10. Minnesota Statutes 1994, section 256.015,
subdivision 2, is amended to read:
Subd. 2. [PERFECTION; ENFORCEMENT.] The state agency may
perfect and enforce its lien under sections 514.69, 514.70, and
514.71, and must file the verified lien statement with the
appropriate court administrator in the county of financial
responsibility. The verified lien statement must contain the
following: the name and address of the person to whom medical
care, subsistence, or other payment was furnished; the date of
injury; the name and address of vendors furnishing medical care;
the dates of the service or payment; the amount claimed to be
due for the care or payment; and to the best of the state
agency's knowledge, the names and addresses of all persons,
firms, or corporations claimed to be liable for damages arising
from the injuries.
This section does not affect the priority of any attorney's
lien. The state agency is not subject to any limitations period
referred to in section 514.69 or 514.71 and has one year from
the date notice is first received by it under subdivision 4,
paragraph (c), even if the notice is untimely, or one year from
the date medical bills are first paid by the state agency,
whichever is later, to file its verified lien statement. The
state agency may commence an action to enforce the lien within
one year of (1) the date the notice required by subdivision 4,
paragraph (c), is received, or (2) the date the person's cause
of action is concluded by judgment, award, settlement, or
otherwise, whichever is later.
Sec. 11. Minnesota Statutes 1994, section 256.015,
subdivision 7, is amended to read:
Subd. 7. [COOPERATION REQUIRED.] Upon the request of the
department of human services, any state agency or third party
payer shall cooperate with the department in furnishing
information to help establish a third party liability. Upon the
request of the department of human services or county child
support or human service agencies, any employer or third party
payer shall cooperate in furnishing information about group
health insurance plans or medical benefit plans available to its
employees. The department of human services and county agencies
shall limit its use of information gained from agencies and,
third party payers, and employers to purposes directly connected
with the administration of its public assistance and child
support programs. The provision of information by agencies and,
third party payers, and employers to the department under this
subdivision is not a violation of any right of confidentiality
or data privacy.
Sec. 12. Minnesota Statutes 1994, section 256.9353,
subdivision 8, is amended to read:
Subd. 8. [LIEN.] When the state agency provides, pays for,
or becomes liable for covered health services, the agency shall
have a lien for the cost of the covered health services upon any
and all causes of action accruing to the enrollee, or to the
enrollee's legal representatives, as a result of the occurrence
that necessitated the payment for the covered health services.
All liens under this section shall be subject to the provisions
of section 256.015. For purposes of this subdivision, "state
agency" includes authorized agents of the state agency.
Sec. 13. Minnesota Statutes 1994, section 256.9365, is
amended to read:
256.9365 [PURCHASE OF CONTINUATION COVERAGE FOR AIDS
PATIENTS.]
Subdivision 1. [PROGRAM ESTABLISHED.] The commissioner of
human services shall establish a program to pay private health
plan premiums for persons who have contracted human
immunodeficiency virus (HIV) to enable them to continue coverage
under a group or individual health plan. If a person is
determined to be eligible under subdivision 2, the commissioner
shall: (1) pay the eligible person's group plan premium for the
period of continuation coverage provided in the Consolidated
Omnibus Budget Reconciliation Act of 1985; or (2) pay the
eligible person's individual plan premium for 24 months pay the
portion of the group plan premium for which the individual is
responsible, if the individual is responsible for at least 50
percent of the cost of the premium, or pay the individual plan
premium. The commissioner shall not pay for that portion of a
premium that is attributable to other family members or
dependents.
Subd. 2. [ELIGIBILITY REQUIREMENTS.] To be eligible for
the program, an applicant must satisfy the following
requirements:
(1) the applicant must provide a physician's statement
verifying that the applicant is infected with HIV and is, or
within three months is likely to become, too ill to work in the
applicant's current employment because of HIV-related disease;
(2) the applicant's monthly gross family income must not
exceed 300 percent of the federal poverty guidelines, after
deducting medical expenses and insurance premiums;
(3) the applicant must not own assets with a combined value
of more than $25,000; and
(4) if applying for payment of group plan premiums, the
applicant must be covered by an employer's or former employer's
group insurance plan and be eligible to purchase continuation
coverage; and
(5) if applying for payment of individual plan premiums,
the applicant must be covered by an individual health plan whose
coverage and premium costs satisfy additional requirements
established by the commissioner in rule.
Subd. 3. [RULES COST-EFFECTIVE COVERAGE.] The commissioner
shall establish rules as necessary to implement the program.
Special Requirements for the payment of individual plan premiums
under subdivision 2, clause (5), must be designed to ensure that
the state cost of paying an individual plan premium over a
two-year period does not exceed the estimated state cost that
would otherwise be incurred in the medical assistance or general
assistance medical care program. The commissioner shall
purchase the most cost-effective coverage available for eligible
individuals.
Sec. 14. Minnesota Statutes 1994, section 256.9657,
subdivision 3, is amended to read:
Subd. 3. [HEALTH MAINTENANCE ORGANIZATION; INTEGRATED
SERVICE NETWORK SURCHARGE.] (a) Effective October 1, 1992, each
health maintenance organization with a certificate of authority
issued by the commissioner of health under chapter 62D and each
integrated service network and community integrated service
network licensed by the commissioner under chapter 62N 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, integrated service network, or
community integrated service network 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, integrated service network, or community
integrated service network 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, an integrated service
network, or a community integrated service network 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,
integrated service network, or community integrated service
network 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, integrated service network, or
community integrated service network for more than one reporting
period, the portion of the payment that has not yet been earned
must be treated as a liability.
(c) When a health maintenance organization or an integrated
service network or community integrated service network merges
or consolidates with or is acquired by another health
maintenance organization, integrated service network, or
community integrated service network, the surviving corporation
or the new corporation shall be responsible for the annual
surcharge originally imposed on each of the entities or
corporations subject to the merger, consolidation, or
acquisition, regardless of whether one of the entities or
corporations does not retain a certificate of authority under
chapter 62D or a license under chapter 62N.
(d) Effective July 1 of each year, the surviving
corporation's or the new corporation's surcharge shall be based
on the revenues earned in the second previous calendar year by
all of the entities or corporations subject to the merger,
consolidation, or acquisition regardless of whether one of the
entities or corporations does not retain a certificate of
authority under chapter 62D or a license under chapter 62N until
the total premium revenues of the surviving corporation include
the total premium revenues of all the merged entities as
reported to the commissioner of health.
(e) When a health maintenance organization, integrated
service network, or community integrated service network, which
is subject to liability for the surcharge under this chapter,
transfers, assigns, sells, leases, or disposes of all or
substantially all of its property or assets, liability for the
surcharge imposed by this chapter is imposed on the transferee,
assignee, or buyer of the health maintenance organization,
integrated service network, or community integrated service
network.
(f) In the event a health maintenance organization,
integrated service network, or community integrated service
network converts its licensure to a different type of entity
subject to liability for the surcharge under this chapter, but
survives in the same or substantially similar form, the
surviving entity remains liable for the surcharge regardless of
whether one of the entities or corporations does not retain a
certificate of authority under chapter 62D or a license under
chapter 62N.
(g) The surcharge assessed to a health maintenance
organization, integrated service network, or community
integrated service network ends when the entity ceases providing
services for premiums and the cessation is not connected with a
merger, consolidation, acquisition, or conversion.
Sec. 15. Minnesota Statutes 1994, section 256.9657,
subdivision 4, is amended to read:
Subd. 4. [PAYMENTS INTO THE ACCOUNT.] (a) Payments to the
commissioner under subdivisions 1 to 3 must be paid in monthly
installments due on the 15th of the month beginning October 15,
1992. The monthly payment must be equal to the annual surcharge
divided by 12. Payments to the commissioner under subdivisions
2 and 3 for fiscal year 1993 must be based on calendar year 1990
revenues. Effective July 1 of each year, beginning in 1993,
payments under subdivisions 2 and 3 must be based on revenues
earned in the second previous calendar year.
(b) Effective October 1, 1995, and each October 1
thereafter, the payments in subdivisions 2 and 3 must be based
on revenues earned in the previous calendar year.
(c) If the commissioner of health does not provide by
August 15 of any year data needed to update the base year for
the hospital and health maintenance organization surcharges, the
commissioner of human services may estimate base year revenue
and use that estimate for the purposes of this section until
actual data is provided by the commissioner of health.
Sec. 16. Minnesota Statutes 1994, section 256.9685,
subdivision 1b, is amended to read:
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 after the reconsideration 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. 17. Minnesota Statutes 1994, section 256.9685, is
amended by adding a subdivision to read:
Subd. 1c. [JUDICIAL REVIEW.] A hospital or physician
aggrieved by an order of the commissioner under subdivision 1b
may appeal the order to the district court of the county in
which the physician or hospital is located by:
(1) serving a written copy of a notice of appeal upon the
commissioner within 30 days after the date the commissioner
issued the order; and
(2) filing the original notice of appeal and proof of
service with the court administrator of the district court. The
appeal shall be treated as a dispositive motion under the
Minnesota General Rules of Practice, rule 115. The district
court scope of review shall be as set forth in section 14.69.
Sec. 18. Minnesota Statutes 1994, section 256.9685, is
amended by adding a subdivision to read:
Subd. 1d. [TRANSMITTAL OF RECORD.] Within 30 days after
being served with the notice of appeal, the commissioner shall
transmit to the district court the original or certified copy of
the entire record considered by the commissioner in making the
final agency decision. The district court shall not consider
evidence that was not included in the record before the
commissioner.
Sec. 19. Minnesota Statutes 1994, 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 change in the Consumer Price Index-All Items
(United States city average) (CPI-U) forecasted by Data
Resources, Inc. The commissioner shall use the indices as
forecasted in the third quarter of the calendar year prior to
the rate year. 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, 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, nor under general assistance medical care,
except that the inflation adjustments under paragraph (a) for
medical assistance, excluding general assistance medical care,
shall apply for the biennium ending June 30, 1997. 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. 20. Minnesota Statutes 1994, section 256.969,
subdivision 2b, is amended to read:
Subd. 2b. [OPERATING PAYMENT RATES.] In determining
operating payment rates for admissions occurring on or after the
rate year beginning January 1, 1991, and every two years after,
or more frequently as determined by the commissioner, the
commissioner shall obtain operating data from an updated base
year and establish operating payment rates per admission for
each hospital based on the cost-finding methods and allowable
costs of the Medicare program in effect during the base year.
Rates under the general assistance medical care program shall
not be rebased to more current data on January 1, 1997. The
base year operating payment rate per admission is standardized
by the case mix index and adjusted by the hospital cost index,
relative values, and disproportionate population adjustment.
The cost and charge data used to establish operating rates shall
only reflect inpatient services covered by medical assistance
and shall not include property cost information and costs
recognized in outlier payments.
Sec. 21. Minnesota Statutes 1994, section 256.969, is
amended by adding a subdivision to read:
Subd. 8a. [UNUSUAL SHORT LENGTH OF STAY.] Except as
provided in subdivision 13, for admissions occurring on or after
July 1, 1995, payment shall be determined as follows and shall
be included in the base year for rate setting purposes.
(1) For an admission that is categorized to a neonatal
diagnostic related group in which the length of stay is less
than 50 percent of the average length of stay for the category
in the base year and the patient at admission is equal to or
greater than the age of one, payments shall be established
according to the methods of subdivision 14.
(2) For an admission that is categorized to a diagnostic
category that includes neonatal respiratory distress syndrome,
the hospital must have a level II or level III nursery and the
patient must receive treatment in that unit or payment will be
made without regard to the syndrome condition.
Sec. 22. Minnesota Statutes 1994, section 256.969,
subdivision 9, 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 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), a medical assistance disproportionate
population adjustment shall be paid in addition to any other
disproportionate payment due under this subdivision as follows:
$1,515,000 due on the 15th of each month after noon, beginning
July 15, 1995. For a hospital that 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 $505,000 due on the 15th of each month after noon,
beginning July 15, 1993 1995.
(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. 23. Minnesota Statutes 1994, section 256.969,
subdivision 10, is amended to read:
Subd. 10. [SEPARATE BILLING BY CERTIFIED REGISTERED NURSE
ANESTHETISTS.] Hospitals may exclude certified registered nurse
anesthetist costs from the operating payment rate as allowed by
section 256B.0625, subdivision 11. To be eligible, a hospital
must notify the commissioner in writing by October 1 of the year
preceding the rate year of the request to exclude certified
registered nurse anesthetist costs. The hospital must agree
that all hospital claims for the cost and charges of certified
registered nurse anesthetist services will not be included as
part of the rates for inpatient services provided during the
rate year. In this case, the operating payment rate shall be
adjusted to exclude the cost of certified registered nurse
anesthetist services. Payments made through separate claims for
certified registered nurse anesthetist services shall not be
paid directly through the hospital provider number or indirectly
by the certified registered nurse anesthetist to the hospital or
related organizations.
For admissions occurring on or after July 1, 1991, and
until the expiration date of section 256.9695, subdivision 3,
services of certified registered nurse anesthetists provided on
an inpatient basis may be paid as allowed by section 256B.0625,
subdivision 11, when the hospital's base year did not include
the cost of these services. To be eligible, a hospital must
notify the commissioner in writing by July 1, 1991, of the
request and must comply with all other requirements of this
subdivision.
Sec. 24. Minnesota Statutes 1994, section 256.969,
subdivision 16, is amended to read:
Subd. 16. [INDIAN HEALTH SERVICE FACILITIES.] Indian
health service facilities are exempt from the rate establishment
methods required by this section and shall be reimbursed at
charges as limited to the amount allowed under federal law.
This exemption is not effective for payments under general
assistance medical care.
Sec. 25. Minnesota Statutes 1994, section 256.969, is
amended by adding a subdivision to read:
Subd. 25. [LONG-TERM HOSPITAL RATES.] For admissions
occurring on or after April 1, 1995, a long-term hospital as
designated by Medicare that does not have admissions in the base
year shall have inpatient rates established at the average of
other hospitals with the same designation. For subsequent
rate-setting periods in which base years are updated, the
hospital's base year shall be the first Medicare cost report
filed with the long-term hospital designation and shall remain
in effect until it falls within the same period as other
hospitals.
Sec. 26. Minnesota Statutes 1994, section 256B.042,
subdivision 2, is amended to read:
Subd. 2. [LIEN ENFORCEMENT.] The state agency may perfect
and enforce its lien by following the procedures set forth in
sections 514.69, 514.70 and 514.71, and its verified lien
statement shall be filed with the appropriate court
administrator in the county of financial responsibility. The
verified lien statement shall contain the following: the name
and address of the person to whom medical care was furnished,
the date of injury, the name and address of the vendor or
vendors furnishing medical care, the dates of the service, the
amount claimed to be due for the care, and, to the best of the
state agency's knowledge, the names and addresses of all
persons, firms, or corporations claimed to be liable for damages
arising from the injuries. This section shall not affect the
priority of any attorney's lien. The state agency is not
subject to any limitations period referred to in section 514.69
or 514.71 and has one year from the date notice is first
received by it under subdivision 4, paragraph (c), even if the
notice is untimely, or one year from the date medical bills are
first paid by the state agency, whichever is later, to file its
verified lien statement. The state agency may commence an
action to enforce the lien within one year of (1) the date the
notice required by subdivision 4, paragraph (c), is received or
(2) the date the recipient's cause of action is concluded by
judgment, award, settlement, or otherwise, whichever is
later. For purposes of this section, "state agency" includes
authorized agents of the state agency.
Sec. 27. Minnesota Statutes 1994, section 256B.055,
subdivision 12, is amended to read:
Subd. 12. [DISABLED CHILDREN.] (a) A person is eligible
for medical assistance if the person is under age 19 and
qualifies as a disabled individual under United States Code,
title 42, section 1382c(a), and would be eligible for medical
assistance under the state plan if residing in a medical
institution, and who the child requires a level of care provided
in a hospital, skilled nursing facility, intermediate care
facility, or intermediate care facility for persons with mental
retardation or related conditions, for whom home care is
appropriate, provided that the cost to medical assistance for
home care services under this section is not more than the
amount that medical assistance would pay for appropriate
institutional care if the child resides in an institution.
Eligibility under this section must be determined annually.
(b) For purposes of this subdivision, "hospital" means an
acute care institution as defined in section 144.696,
subdivision 3, 144.55, subdivision 3, or Minnesota Rules, part
4640.3600, and licensed pursuant to sections 144.50 to 144.58,
which is appropriate if a person is technology dependent or has
a chronic health condition which requires frequent intervention
by a health care professional to avoid death. For purposes of
this subdivision, a child requires a level of care provided in a
hospital if the child is determined by the commissioner to need
an extensive array of health services, including mental health
services, for an undetermined period of time, whose health
condition requires frequent monitoring and treatment by a health
care professional or by a person supervised by a health care
professional, who would reside in a hospital or require frequent
hospitalization if these services were not provided, and the
daily care needs are more complex than a nursing facility level
of care.
A child with serious emotional disturbance requires a level
of care provided in a hospital if the commissioner determines
that the individual requires 24-hour supervision because the
person exhibits recurrent or frequent suicidal or homicidal
ideation or behavior, recurrent or frequent psychosomatic
disorders or somatopsychic disorders that may become life
threatening, recurrent or frequent severe socially unacceptable
behavior associated with psychiatric disorder, ongoing and
chronic psychosis or severe, ongoing and chronic developmental
problems requiring continuous skilled observation, or severe
disabling symptoms for which office-centered outpatient
treatment is not adequate, and which overall severely impact the
individual's ability to function.
(c) For purposes of this subdivision, "skilled nursing
facility" and "intermediate care facility" means a facility
which provides nursing care as defined in section 144A.01,
subdivision 5, licensed pursuant to sections 144A.02 to 144A.10,
which is appropriate if a person is in active restorative
treatment; is in need of special treatments provided or
supervised by a licensed nurse; or has unpredictable episodes of
active disease processes requiring immediate judgment by a
licensed nurse. For purposes of this subdivision, a child
requires the level of care provided in a nursing facility if the
child is determined by the commissioner to meet the requirements
of the preadmission screening assessment document under section
256B.0911 and the home care independent rating document under
section 256B.0627, subdivision 5, paragraph (f), item (iii),
adjusted to address age-appropriate standards for children age
18 and under, pursuant to section 256B.0627, subdivision 5,
paragraph (d), clause (2).
(d) For purposes of this subdivision, "intermediate care
facility for the mentally retarded persons with mental
retardation or related conditions" or "ICF/MR" means a program
licensed to provide services to persons with mental retardation
under section 252.28, and chapter 245A, and a physical plant
licensed as a supervised living facility under chapter 144,
which together are certified by the Minnesota department of
health as meeting the standards in Code of Federal Regulations,
title 42, part 483, for an intermediate care facility which
provides services for persons with mental retardation or persons
with related conditions who require 24-hour supervision and
active treatment for medical, behavioral, or habilitation
needs. For purposes of this subdivision, a child requires a
level of care provided in an ICF/MR if the commissioner finds
that the child has mental retardation or a related condition in
accordance with section 256B.092, is in need of a 24-hour plan
of care and active treatment similar to persons with mental
retardation, and there is a reasonable indication that the child
will need ICF/MR services.
(e) For purposes of this subdivision, a person "requires a
level of care provided in a hospital, skilled nursing facility,
intermediate care facility, or intermediate care facility for
persons with mental retardation or related conditions" if the
person requires 24-hour supervision because the person exhibits
suicidal or homicidal ideation or behavior, psychosomatic
disorders or somatopsychic disorders that may become life
threatening, severe socially unacceptable behavior associated
with psychiatric disorder, psychosis or severe developmental
problems requiring continuous skilled observation, or disabling
symptoms that do not respond to office-centered outpatient
treatment. The determination of the level of care needed by the
child shall be made by the commissioner based on information
supplied to the commissioner by the case manager if the child
has one, the parent or guardian, the child's physician or
physicians or, if available, the screening information obtained
under section 256B.092, and other professionals as requested by
the commissioner. The commissioner shall establish a screening
team to conduct the level of care determinations according to
this subdivision.
(f) If a child meets the conditions in paragraph (b), (c),
or (d), the commissioner must assess the case to determine
whether:
(1) the child qualifies as a disabled individual under
United States Code, title 42, section 1382c(a) and would be
eligible for medical assistance if residing in a medical
institution; and
(2) the cost of medical assistance services for the child,
if eligible under this subdivision, would not be more than the
cost to medical assistance if the child resides in a medical
institution to be determined as follows:
(i) for a child who requires a level of care provided in an
ICF/MR, the cost of care for the child in an institution shall
be determined using the average payment rate established for the
regional treatment centers that are certified as ICFs/MR;
(ii) for a child who requires a level of care provided in
an inpatient hospital setting according to paragraph (b),
cost-effectiveness shall be determined according to Minnesota
Rules, part 9505.3520, items F and G; and
(iii) for a child who requires a level of care provided in
a nursing facility according to paragraph (c),
cost-effectiveness shall be determined according to Minnesota
Rules, part 9505.3040, except that the nursing facility average
rate shall be adjusted to reflect rates which would be paid for
children under age 16. The commissioner may authorize an amount
up to the amount medical assistance would pay for a child
referred to the commissioner by the preadmission screening team
under section 256B.0911.
(g) Children eligible for medical assistance services under
section 256B.055, subdivision 12, as of June 30, 1995, must be
screened according to the criteria in this subdivision prior to
January 1, 1996. Children found to be ineligible may not be
removed from the program until January 1, 1996.
Sec. 28. Minnesota Statutes 1994, section 256B.056, is
amended by adding a subdivision to read:
Subd. 3b. [TREATMENT OF TRUSTS.] (a) A "medical assistance
qualifying trust" is a revocable or irrevocable trust, or
similar legal device, established on or before August 10, 1993,
by a person or the person's spouse under the terms of which the
person receives or could receive payments from the trust
principal or income and the trustee has discretion in making
payments to the person from the trust principal or income.
Notwithstanding that definition, a medical assistance qualifying
trust does not include: (1) a trust set up by will; (2) a trust
set up before April 7, 1986, solely to benefit a person with
mental retardation living in an intermediate care facility for
persons with mental retardation; or (3) a trust set up by a
person with payments made by the Social Security Administration
pursuant to the United States Supreme Court decision in Sullivan
v. Zebley, 110 S. Ct. 885 (1990). The maximum amount of
payments that a trustee of a medical assistance qualifying trust
may make to a person under the terms of the trust is considered
to be available assets to the person, without regard to whether
the trustee actually makes the maximum payments to the person
and without regard to the purpose for which the medical
assistance qualifying trust was established.
(b) Trusts established after August 10, 1993, are treated
according to section 13611(b) of the Omnibus Budget
Reconciliation Act of 1993 (OBRA), Public Law Number 103-66.
Sec. 29. Minnesota Statutes 1994, section 256B.056,
subdivision 4, is amended to read:
Subd. 4. [INCOME.] To be eligible for medical assistance,
a person must not have, or anticipate receiving, semiannual
income in excess of 120 percent of the income standards by
family size used in the aid to families with dependent children
program, except that families and children may have an income up
to 133-1/3 percent of the AFDC income standard. In computing
income to determine eligibility of persons who are not residents
of long-term care facilities, the commissioner shall disregard
increases in income as required by Public Law Numbers 94-566,
section 503; 99-272; and 99-509. Veterans aid and attendance
benefits are considered income to the recipient.
Sec. 30. Minnesota Statutes 1994, 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 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 reparations payments made by the Netherlands for
victims of Nazi persecution between 1940 and 1945; 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. 31. Minnesota Statutes 1994, section 256B.059,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITIONS.] (a) For purposes of this
section, the terms defined in this subdivision have the meanings
given them.
(b) "Community spouse" means the spouse of an
institutionalized person spouse.
(c) "Spousal share" means one-half of the total value of
all assets, to the extent that either the institutionalized
spouse or the community spouse had an ownership interest at the
time of institutionalization.
(d) "Assets otherwise available to the community spouse"
means assets individually or jointly owned by the community
spouse, other than assets excluded by subdivision 5, paragraph
(c).
(e) "Community spouse asset allowance" is the value of
assets that can be transferred under subdivision 3.
(f) "Institutionalized spouse" means a person who is:
(1) in a hospital, nursing facility, or intermediate care
facility for persons with mental retardation, or receiving home
and community-based services under section 256B.0915 or 256B.49,
and is expected to remain in the facility or institution or
receive the home and community-based services for at least 30
consecutive days; and
(2) married to a person who is not in a hospital, nursing
facility, or intermediate care facility for persons with mental
retardation, and is not receiving home and community-based
services under section 256B.0915 or 256B.49.
Sec. 32. Minnesota Statutes 1994, section 256B.059,
subdivision 3, is amended to read:
Subd. 3. [COMMUNITY SPOUSE ASSET ALLOWANCE.] 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 as follows:
(1) prior to July 1, 1994, the greater of:
(i) $14,148;
(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; and
(2) for persons who begin whose date of initial
determination of eligibility for medical assistance following
their first continuous period of institutionalization occurs 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, 1994, and
every January 1 thereafter, the 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 limits in subdivision 5.
Sec. 33. Minnesota Statutes 1994, section 256B.059,
subdivision 5, is amended to read:
Subd. 5. [ASSET AVAILABILITY.] (a) At the time of
application initial determination of eligibility for medical
assistance benefits following the first continuous period of
institutionalization, 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
following:
(1) prior to July 1, 1994, the greater of:
(i) $14,148;
(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;
(2) for persons who begin whose date of initial
determination of eligibility for medical assistance following
their first continuous period of institutionalization occurs 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 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 paragraph (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 the supplemental
security income program.
Sec. 34. Minnesota Statutes 1994, section 256B.0595,
subdivision 1, is amended to read:
Subdivision 1. [PROHIBITED TRANSFERS.] (a) For transfers
of assets made on or before August 10, 1993, 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 the supplemental security program,
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 August 10, 1993, a
person, a person's spouse, or a person's authorized
representative any person, court, or administrative body with
legal authority to act in place of, on behalf of, at the
direction of, or upon the request of the person or person's
spouse, may not give away, sell, or dispose of, for less than
fair market value, any asset or interest therein, except assets
other than the homestead that are excluded under the
supplemental security income program, for the purpose of
establishing or maintaining medical assistance eligibility. For
purposes of determining eligibility for medical assistance
long-term care services, any transfer of an asset such assets
within 60 36 months preceding application before or any time
after an institutionalized person applies for medical assistance
or during the period of medical assistance eligibility,
including assets excluded under section 256B.056, subdivision 3,
or 36 months before or any time after a medical assistance
recipient becomes institutionalized, for less than fair market
value may be considered. Any such 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 long-term care
services 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 subdivision
3 or 4. Notwithstanding the provisions of this paragraph, in
the case of payments from a trust or portions of a trust that
are considered transfers of assets under federal law, any
transfers made within 60 months before or any time after an
institutionalized person applies for medical assistance and
within 60 months before or any time after a medical assistance
recipient becomes institutionalized, may be considered.
(c) This section applies to transfers, for less than fair
market value, of income or assets, including assets that are
considered income in the month received, such as inheritances,
court settlements, and retroactive benefit payments or income to
which the person or the person's spouse is entitled but does not
receive due to action by the person, the person's spouse, or any
person, court, or administrative body with legal authority to
act in place of, on behalf of, at the direction of, or upon the
request of the person or the person's spouse.
(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.
(e) This section applies to the portion of any asset or
interest that a person or, a person's spouse transfers, or any
person, court, or administrative body with legal authority to
act in place of, on behalf of, at the direction of, or upon the
request of the person or the person's spouse, to an
irrevocable any 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.
(f) For purposes of this section, long-term care services
include services in a nursing facility, services that are
eligible for payment according to section 256B.0625, subdivision
2, because they are provided in a swing bed, intermediate care
facility for persons with mental retardation, and home and
community-based services provided pursuant to section 256B.491
sections 256B.0915, 256B.092, and 256B.49. 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 in a swing bed, or intermediate care facility for
persons with mental retardation or who is receiving home and
community-based services under section 256B.491 sections
256B.0915, 256B.092, and 256B.49.
(g) Effective for transfers made on or after July 1, 1995,
or upon federal approval, whichever is later, a person, a
person's spouse, or any person, court, or administrative body
with legal authority to act in place of, on behalf of, at the
direction of, or upon the request of the person or person's
spouse, 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
long-term care services, any transfer of such assets within 60
months before, or any time after, an institutionalized person
applies for medical assistance, or 60 months before, or any time
after, a medical assistance recipient becomes institutionalized,
for less than fair market value may be considered. Any such
transfer is presumed to have been made for the purpose of
establishing or maintaining medical assistance eligibility and
the person is ineligible for long-term care services 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 subdivision 3 or 4.
Sec. 35. Minnesota Statutes 1994, section 256B.0595,
subdivision 2, is amended to read:
Subd. 2. [PERIOD OF INELIGIBILITY.] (a) For any
uncompensated transfer occurring on or before August 10, 1993,
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,
August 10, 1993, or upon federal approval, whichever is later,
the number of months of ineligibility, including partial months,
for medical assistance long-term care 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. If a calculation of a penalty
period results in a partial month, payments for long-term care
services shall be reduced in an amount equal to the fraction,
except that in calculating the value of uncompensated transfers,
if the total value of all uncompensated transfers made in a
month does not exceed $1,000, then such transfers shall be
disregarded for each month prior to the month of application for
or during receipt of medical assistance.
Sec. 36. Minnesota Statutes 1994, section 256B.0595,
subdivision 3, is amended to read:
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:
(1) 30 months of the a transfer made on or before August
10, 1993;
(2) 60 months if the homestead was transferred after August
10, 1993, to a trust or portion of a trust that is considered a
transfer of assets under federal law; or
(3) 36 months if transferred in any other manner after
August 10, 1993,
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.
Sec. 37. Minnesota Statutes 1994, section 256B.0595,
subdivision 4, is amended to read:
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
individual's spouse, as defined in section 256B.059 or to
another for the sole benefit of the spouse; 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:
(i) 30 months of the a transfer made on or before August
10, 1993;
(ii) 60 months of a transfer if the assets were transferred
after August 30, 1993, to a trust or portion of a trust that is
considered a transfer of assets under federal law; or
(iii) 36 months of a transfer if transferred in any other
manner after August 10, 1993,
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.; or
(6) for transfers occurring after August 10, 1993, the
assets were transferred by the person or person's spouse: (i)
into a trust established solely for the benefit of a son or
daughter of any age who is blind or disabled as defined by the
Supplemental Security Income program; or (ii) into a trust
established solely for the benefit of an individual who is under
65 years of age who is disabled as defined by the Supplemental
Security Income program.
(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.
Sec. 38. Minnesota Statutes 1994, section 256B.06,
subdivision 4, is amended to read:
Subd. 4. [CITIZENSHIP REQUIREMENTS.] Eligibility for
medical assistance is limited to citizens of the United States
and aliens lawfully admitted for permanent residence or
otherwise permanently residing in the United States under the
color of law. Aliens who are seeking legalization under the
Immigration Reform and Control Act of 1986, Public Law Number
99-603, who are under age 18, over age 65, blind, disabled, or
Cuban or Haitian, and who meet the eligibility requirements of
medical assistance under subdivision 1 and sections 256B.055 to
256B.062 are eligible to receive medical assistance. Pregnant
women who are aliens seeking legalization under the Immigration
Reform and Control Act of 1986, Public Law Number 99-603, and
who meet the eligibility requirements of medical assistance
under subdivision 1 are eligible for payment of care and
services through the period of pregnancy and six weeks
postpartum. Payment shall also be made for care and services
that are furnished to an alien, regardless of immigration
status, who otherwise meets the eligibility requirements of this
section if such care and services are necessary for the
treatment of an emergency medical condition, except for organ
transplants and related care and services. For purposes of this
subdivision, the term "emergency medical condition" means a
medical condition, including labor and delivery, that if not
immediately treated could cause a person physical or mental
disability, continuation of severe pain, or death.
Sec. 39. Minnesota Statutes 1994, section 256B.0625,
subdivision 5, is amended to read:
Subd. 5. [COMMUNITY MENTAL HEALTH CENTER SERVICES.]
Medical assistance covers community mental health center
services, as defined in rules adopted by the commissioner
pursuant to section 256B.04, subdivision 2, and provided by a
community mental health center as defined in section 245.62,
subdivision 2 that meets the requirements in paragraphs (a) to
(j).
(a) The provider is licensed under Minnesota Rules, parts
9520.0750 to 9520.0870.
(b) The provider provides mental health services under the
clinical supervision of a mental health professional who is
licensed for independent practice at the doctoral level or by a
board-certified psychiatrist or a psychiatrist who is eligible
for board certification. Clinical supervision has the meaning
given in Minnesota Rules, part 9505.0323, subpart 1, item F.
(c) The provider must be a private nonprofit corporation or
a governmental agency and have a community board of directors as
specified by section 245.66.
(d) The provider must have a sliding fee scale that meets
the requirements in Minnesota Rules, part 9550.0060, and agree
to serve within the limits of its capacity all individuals
residing in its service delivery area.
(e) At a minimum, the provider must provide the following
outpatient mental health services: diagnostic assessment;
explanation of findings; family, group, and individual
psychotherapy, including crisis intervention psychotherapy
services, multiple family group psychotherapy, psychological
testing, and medication management. In addition, the provider
must provide or be capable of providing upon request of the
local mental health authority day treatment services and
professional home-based mental health services. The provider
must have the capacity to provide such services to specialized
populations such as the elderly, families with children, persons
who are seriously and persistently mentally ill, and children
who are seriously emotionally disturbed.
(f) The provider must be capable of providing the services
specified in paragraph (e) to individuals who are diagnosed with
both mental illness or emotional disturbance, and chemical
dependency, and to individuals dually diagnosed with a mental
illness or emotional disturbance and mental retardation or a
related condition.
(g) The provider must provide 24-hour emergency care
services or demonstrate the capacity to assist recipients in
need of such services to access such services on a 24-hour basis.
(h) The provider must have a contract with the local mental
health authority to provide one or more of the services
specified in paragraph (e).
(i) The provider must agree, upon request of the local
mental health authority, to enter into a contract with the
county to provide mental health services not reimbursable under
the medical assistance program.
(j) The provider may not be enrolled with the medical
assistance program as both a hospital and a community mental
health center. The community mental health center's
administrative, organizational, and financial structure must be
separate and distinct from that of the hospital.
Sec. 40. Minnesota Statutes 1994, section 256B.0625,
subdivision 8, is amended to read:
Subd. 8. [PHYSICAL THERAPY.] Medical assistance covers
physical therapy and related services. 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.
Sec. 41. Minnesota Statutes 1994, section 256B.0625,
subdivision 8a, is amended to read:
Subd. 8a. [OCCUPATIONAL THERAPY.] Medical assistance
covers occupational therapy and related services. 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 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.
Sec. 42. Minnesota Statutes 1994, 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, or by a physician
or a nurse practitioner employed by or under contract with a
community health board as defined in section 145A.02,
subdivision 5, for the purposes of communicable disease
control. The commissioner, after receiving recommendations from
professional medical associations and 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
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 three-year terms and shall serve without
compensation. Members may be reappointed once.
(b) 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:
(i) drugs or products for which there is no federal
funding;
(ii) over-the-counter drugs, except for antacids,
acetaminophen, family planning products, aspirin, insulin,
products for the treatment of lice, vitamins for adults with
documented vitamin deficiencies, and vitamins for children under
the age of seven and pregnant or nursing women;
(iii) 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;
(iv) anorectics; and
(v) drugs for which medical value has not been established.
The commissioner shall publish conditions for prohibiting
payment for specific drugs after considering the formulary
committee's recommendations.
(c) 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. The pharmacy dispensing
fee shall be $3.85. Actual acquisition cost includes quantity
and other special discounts except time and cash discounts. The
actual acquisition cost of a drug shall be estimated by the
commissioner, at average wholesale price minus 7.6 nine percent
effective January 1, 1994. 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.
(d) Until the date the on-line, real-time Medicaid
Management Information System (MMIS) upgrade is successfully
implemented, as determined by the commissioner of
administration, a pharmacy provider may require individuals who
seek to become eligible for medical assistance under a one-month
spenddown, as provided in section 256B.056, subdivision 5, to
pay for services to the extent of the spenddown 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 spenddown of (1) their
right to appeal the denial of services on the grounds that they
have satisfied the spenddown requirement, and (2) their
potential eligibility for the MinnesotaCare program or the
children's health plan.
Sec. 43. Minnesota Statutes 1994, section 256B.0625,
subdivision 13a, is amended to read:
Subd. 13a. [DRUG UTILIZATION REVIEW BOARD.] A
12-member nine-member drug utilization review board is
established. The board is comprised of six at least three but
no more than four licensed physicians actively engaged in the
practice of medicine in Minnesota; five at least three licensed
pharmacists actively engaged in the practice of pharmacy in
Minnesota; and one consumer representative; the remainder to be
made up of health care professionals who are licensed in their
field and have recognized knowledge in the clinically
appropriate prescribing, dispensing, and monitoring of covered
outpatient drugs. 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 lists submitted by
professional medical associations. The pharmacist members shall
be selected from lists submitted by professional pharmacist
associations. The commissioner shall appoint the initial
members of the board for terms expiring as follows: four three
members for terms expiring June 30, 1995 1996; four three
members for terms expiring June 30, 1994 1997; and four three
members for terms expiring June 30, 1993 1998. 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 date the Drug Utilization Review Annual Report is
due to the Health Care Financing Administration. This report is
to cover the preceding federal fiscal year. 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. An honorarium of $50 per meeting shall be paid to each
board member in attendance.
Sec. 44. Minnesota Statutes 1994, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 13b. [PHARMACY COPAYMENT REQUIREMENTS.] A copayment
of $1 per prescription shall be required under the medical
assistance and general assistance medical care programs
according to paragraphs (a) to (d):
(a) A copayment shall not be required of children, pregnant
women through the postpartum period, recipients whose only
available income is a personal needs allowance in the amount
established under section 256B.35 or 256B.36, recipients
residing in a setting which receives funding under sections
256I.01 to 256I.06, or institutionalized recipients or, under
medical assistance only, from any other persons required to be
exempted under federal law;
(b) A copayment shall not be required for family planning
services or supplies, psychotropic drugs or emergency services;
(c) A provider may not deny a prescription to a recipient
because the recipient is unable to pay the copayment;
(d) A lower copayment shall be collected, under medical
assistance only, up to the maximum permitted by federal law, for
prescriptions on which federal law prohibits a $1 copayment;
(e) The amount of the copayment under this subdivision
shall be subtracted from the payment under subdivision 13; and
(f) This subdivision does not apply to services under the
MinnesotaCare program.
Sec. 45. Minnesota Statutes 1994, 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 certifying that the
recipient is so mentally or physically impaired as to be unable
to safely access and use a bus, taxi, other commercial
transportation, or private automobile. 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 $14 for
the base rate and $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. 46. Minnesota Statutes 1994, section 256B.0625,
subdivision 18, is amended to read:
Subd. 18. [BUS OR TAXICAB TRANSPORTATION.] To the extent
authorized by rule of the state agency, medical assistance
covers costs of bus or taxicab the most appropriate and
cost-effective form of transportation incurred by any ambulatory
eligible person for obtaining nonemergency medical care.
Sec. 47. Minnesota Statutes 1994, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 18a. [PAYMENT FOR MEALS AND LODGING.] (a) Medical
assistance reimbursement for meals for persons traveling to
receive medical care may not exceed $5.50 for breakfast, $6.50
for lunch, or $8 for dinner.
(b) Medical assistance reimbursement for lodging for
persons traveling to receive medical care may not exceed $50 per
day unless prior authorized by the local agency.
(c) Medical assistance direct mileage reimbursement to the
eligible person or the eligible person's driver may not exceed
20 cents per mile.
Sec. 48. Minnesota Statutes 1994, 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. To qualify
for personal care services recipients who can direct their own
care, or persons who cannot direct their own care when
authorized by the responsible party, may use must be able to
identify their needs, direct and evaluate task accomplishment,
and assure their health and safety. Approved hours may be used
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. Total hours for
services, whether actually performed inside or outside the
recipient's home, cannot exceed that which is otherwise allowed
for personal care services in an in-home setting according to
section 256B.0627. Medical assistance does not cover personal
care services for residents of a hospital, nursing facility,
intermediate care facility, 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 or legal guardian 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 not the recipient's legal guardian and are granted a
waiver under section 256B.0627.
Sec. 49. Minnesota Statutes 1994, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 38. [PAYMENTS FOR MENTAL HEALTH SERVICES.] Payments
for mental health services covered under the medical assistance
program that are provided by masters-prepared mental health
professionals shall be 80 percent of the rate paid to
doctoral-prepared professionals. Payments for mental health
services covered under the medical assistance program that are
provided by masters-prepared mental health professionals
employed by community mental health centers shall be 100 percent
of the rate paid to doctoral-prepared professionals.
Sec. 50. Minnesota Statutes 1994, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 39. [CHILDHOOD IMMUNIZATIONS.] Providers who
administer pediatric vaccines within the scope of their
licensure, and who are enrolled as a medical assistance
provider, must enroll in the pediatric vaccine administration
program established by section 13631 of the Omnibus Budget
Reconciliation Act of 1993. Medical assistance shall pay an
$8.50 fee per dose for administration of the vaccine to children
eligible for medical assistance. Medical assistance does not
pay for vaccines that are available at no cost from the
pediatric vaccine administration program.
Sec. 51. Minnesota Statutes 1994, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 40. [TUBERCULOSIS RELATED SERVICES.] (a) For persons
infected with tuberculosis, medical assistance covers case
management services and direct observation of the intake of
drugs prescribed to treat tuberculosis.
(b) "Case management services" means services furnished to
assist persons infected with tuberculosis in gaining access to
needed medical services. Case management services include at a
minimum:
(1) assessing a person's need for medical services to treat
tuberculosis;
(2) developing a care plan that addresses the needs
identified in clause (1);
(3) assisting the person in accessing medical services
identified in the care plan; and
(4) monitoring the person's compliance with the care plan
to ensure completion of tuberculosis therapy. Medical
assistance covers case management services under this
subdivision only if the services are provided by a certified
public health nurse who is employed by a community health board
as defined in section 145A.02, subdivision 5.
(c) To be covered by medical assistance, direct observation
of the intake of drugs prescribed to treat tuberculosis must be
provided by a community outreach worker, licensed practical
nurse, registered nurse who is trained and supervised by a
public health nurse employed by a community health board as
defined in section 145A.02, subdivision 5, or a public health
nurse employed by a community health board.
Sec. 52. Minnesota Statutes 1994, 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) "Assessment" means a review and evaluation of a
recipient's need for home care services conducted in person.
Assessments for private duty nursing shall be conducted by a
private duty nurse. Assessments for home health agency services
shall be conducted by a home health agency nurse. Assessments
for personal care services shall be conducted by the county
public health nurse or a certified public health nurse under
contract with the county. Assessments must be completed on
forms provided by the commissioner within 30 days of a request
for home care services by a recipient or responsible party.
(c) "Care plan" (d) "Service plan" means a written
description of the services needed which is based on the
assessment developed by the supervisory nurse who conducts the
assessment together with the recipient or responsible party and
includes a detailed. The service plan shall include a
description of the covered home care services, who is providing
the services, frequency and duration of services, and expected
outcomes and goals. The provider must give the recipient or
responsible party recipient and the provider chosen by the
recipient or responsible party must be given a copy of the
completed care service plan within 30 calendar days of beginning
home care services. of the request for home care services by the
recipient or responsible party.
(e) "Care plan" means a written description of personal
care assistant services developed by the agency nurse with the
recipient or responsible party to be used by the personal care
assistant with a copy provided to the recipient or responsible
party.
(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. (f) "Personal care
assistant" means a person who: (1) is at least 18 years old;
(2) is able to read, write, and speak English, or communicate
with sign language, as well as communicate with the recipient;
(3) effective July 1, 1996, has completed one of the training
requirements as specified in Minnesota Rules, part 9505.0335,
subpart 3, items A to D; (4) has the ability to, and provides
covered personal care services according to the recipient's care
plan; (5) is not a consumer of personal care services; and (6)
is subject to criminal background checks. An individual who has
ever been convicted of a crime specified in Minnesota Rules,
part 4668.0020, subpart 14, or a comparable crime in another
jurisdiction is disqualified from being a personal care
assistant.
(g) "Personal care provider organization" means an
organization enrolled to provide personal care services under
the medical assistance program that complies with the
following: (1) owners who have a five percent interest or more
are subject to a criminal history check as provided in section
245A.04 at the time of application. An organization will be
barred from enrollment if an owner or managerial official of the
organization has ever been convicted of a crime specified in
Minnesota Rules, part 4668.0020, subpart 14, or a comparable
crime in another jurisdiction; (2) the organization must
maintain a surety bond and liability insurance throughout the
duration of enrollment and provides proof thereof. The insurer
must notify the department of human services of the cancellation
or lapse of policy; and (3) the organization must maintain
documentation of services as specified in Minnesota Rules, part
9505.2175, subpart 7, as well as evidence of compliance with
personal care assistant training requirements.
Sec. 53. Minnesota Statutes 1994, section 256B.0627,
subdivision 2, is amended to read:
Subd. 2. [SERVICES COVERED.] Home care services covered
under this section include:
(1) nursing services under section 256B.0625, subdivision
6a;
(2) private duty nursing services under section 256B.0625,
subdivision 7;
(3) home health aide services under section 256B.0625,
subdivision 6a;
(4) personal care services under section 256B.0625,
subdivision 19a; and
(5) nursing supervision of personal care services under
section 256B.0625, subdivision 19a; and
(6) assessments by county public health nurses for services
under section 256B.0625, subdivision 19a.
Sec. 54. Minnesota Statutes 1994, 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 repetitive
maintenance range of motion and muscle strengthening
exercises specific to maintaining a recipient's optimal level of
function;
(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 eating and meal preparation and necessary grocery
shopping;
(13) accompanying a recipient to obtain medical diagnosis
or treatment; and
(14) assisting, monitoring, or prompting the recipient to
complete the services in clauses (1) to (13);
(15) redirection, monitoring, and observation that are
medically necessary 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 (17) (13).
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 ordered by
the physician;
(2) assessments by personal care provider organizations or
by independently enrolled registered nurses;
(3) services that are not supervised by the registered
nurse in the service plan;
(3) (4) services provided by the recipient's spouse, legal
guardian for an adult or child recipient, or parent of a minor
child recipient under age 18;
(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;
(7) sterile procedures;
(8) injections of fluids into veins, muscles, or skin;
(9) services provided by parents of adult recipients, adult
children, or adult siblings of the recipient, 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;
(10) homemaker services that are not an integral part of a
personal care services; and
(11) home maintenance, or chore services;
(12) services not specified under paragraph (a); and
(13) services not authorized by the commissioner or the
commissioner's designee.
Sec. 55. Minnesota Statutes 1994, 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) up to two assessments by a supervising registered nurse
assessments and reassessments done 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) (b) [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care
services above the limits in paragraph (b) (a) 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;
(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) (c) [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) (d) [ASSESSMENT AND CARE SERVICE PLAN.] The home care
provider Assessments under section 256B.0627, subdivision 1,
paragraph (c), shall conduct be conducted initially, and at
least annually thereafter, a face-to-face assessment of the
recipient and complete a care plan in person with the recipient
and result in a completed service 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, Within 30
days of recipient or responsible party request for home care
services, the assessment, the service 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 shall be submitted
to the commissioner. For personal care services:
(1) The amount and type of service authorized based upon
the assessment and service plan will follow the recipient if the
recipient chooses to change providers.
(2) If the recipient's medical need changes, the
recipient's provider may assess the need for a change in service
authorization and request the change from the county public
health nurse. Within 30 days of the request, the public health
nurse will determine whether to request the change in services
based upon the provider assessment, or conduct a home visit to
assess the need and determine whether the change is appropriate.
(3) To continue to receive home personal care services when
the recipient displays no significant change, the supervising
nurse county public health nurse has the option to review with
the commissioner, or the commissioner's designee, the care
service plan on record and receive authorization for up to an
additional 12 months.
(f) (e) [PRIOR AUTHORIZATION.] The commissioner, or the
commissioner's designee, shall review the assessment, the care
service plan, and any additional information that is submitted.
The commissioner shall, within 30 days after receiving a
complete request, assessment, and care service 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) (a) 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 and registered nurse supervision must be prior
authorized by the commissioner or the commissioner's designee
except for the limits on supervision assessments established in
paragraph (b) (a). The amount of personal care services
authorized must be based on the recipient's 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 1.75 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 2.625 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 but in no case shall the
dollar amount authorized exceed the statewide weighted average
nursing facility payment rate for fiscal year 1995; 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 Level I behavior; or
(D) up to the amount the commissioner would pay, as of July
1, 1991, plus any inflation adjustment provided for home care
services, 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) (D) 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) (E) 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 report submitted to the department
by nursing facilities. The average number of direct care hours,
as established by May 1, 1992 for the report year 1993, as
established by July 11, 1994, shall be calculated and
incorporated into the home care limits on July 1, 1992 1996.
These limits shall be calculated to the nearest quarter hour.
(iii) The 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
county public health nurse on forms specified by the
commissioner. The 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 recipients 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 and shall use an advisory group,
including representatives of recipients, providers, and
counties, for consultation in establishing and revising the
forms and protocols.
(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 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 Level I behavior if
there is reasonable supporting evidence that the recipient
exhibits, 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) injury to his or her own body;
(B) physical injury to other people; or
(C) destruction of property.
(vi) 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
medically necessary private duty nursing services or up to 24
hours per day of medically necessary 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) (f) [PRIOR AUTHORIZATION; TIME LIMITS.] The
commissioner or the commissioner's designee shall determine the
time period for which a prior authorization shall 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) (b), 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 continue previously authorized services, other than
temporary services under paragraph (i) (h), pending an appeal
under section 256.045. 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) (g) [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) (h) [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.]
Providers The agency nurse, the independently enrolled private
duty nurse, or county public health nurse 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 service or care plan
information provided by an appropriately licensed nurse.
Authorization for a temporary level of home care
services including nurse supervision is limited to the time
specified by the commissioner, but shall not exceed 45 days,
unless extended because the county public health nurse has not
completed the required assessment and service plan, or the
commissioner's determination has not been made. The level of
services authorized under this provision shall have no bearing
on a future prior authorization.
(j) (i) [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) (a).
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) (3) 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. 56. Minnesota Statutes 1994, section 256B.0628,
subdivision 2, is amended to read:
Subd. 2. [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
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 service 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 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 commissioner or the commissioner's
designee may:
(1) review care service 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 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. 57. Minnesota Statutes 1994, 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 located within the state of Minnesota;
(3) individuals who have a contractual right to have their
nursing facility care paid for indefinitely by the veteran's
administration; or
(4) individuals who are enrolled in the Ebenezer/Group
Health social health maintenance organization project, or
enrolled in a demonstration project under section 256B.69,
subdivision 18, at the time of application to a nursing home; or
(5) individuals previously screened and currently being
served under the alternative care program or under a home and
community-based services waiver authorized under section 1915(c)
of the Social Security Act.
Regardless of the exemptions in clauses (2) to (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.
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. 58. Minnesota Statutes 1994, section 256B.0911,
subdivision 2a, is amended 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. The screener
shall confer with the screening team to ensure that the health
and social needs of the individual are assessed. 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. 59. Minnesota Statutes 1994, 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 board of commissioners. Each local
screening team shall 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. The
screening team members must confer regarding the most
appropriate care for each individual screened. Two or more
counties may collaborate to establish a joint local screening
team or teams.
(b) In assessing a person's needs, 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 if the physician
chooses to participate. Other personnel may be included on the
team as deemed appropriate by the county agencies.
Sec. 60. Minnesota Statutes 1994, section 256B.0911,
subdivision 4, is amended to read:
Subd. 4. [RESPONSIBILITIES OF THE COUNTY AND THE SCREENING
TEAM.] (a) The county 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 specialized service needs 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.
(b) The 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.
(c) Screeners shall adhere to the level of care criteria
for admission to a certified nursing facility established under
section 144.0721.
(d) 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 a screener or the case manager in the
discharge planning process for those individuals who the team
has determined have discharge potential. The screener or the
case manager must ensure a smooth transition and follow-up for
the individual's return to the community.
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
screeners shall encourage the use of volunteers from families,
religious organizations, social clubs, and similar civic and
service organizations to provide services.
Sec. 61. Minnesota Statutes 1994, 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 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 county preadmission screening team may deny
certified nursing facility admission using the level of care
criteria established under section 144.0721 and deny medical
assistance reimbursement for certified nursing facility care.
Persons receiving care in a certified nursing facility or
certified boarding care home who are reassessed and no longer
meet the level of care criteria for a certified nursing facility
or certified boarding care home may no longer remain a resident
in the certified nursing facility or certified boarding care
home and must be relocated to the community if the persons were
admitted on or after July 1, 1996. Persons receiving services
under section 256B.0913, subdivisions 1 to 14, or 256B.0915 who
are reassessed and found to not meet the level of care criteria
for admission to a certified nursing facility or certified
boarding care home may no longer receive these services after
July 1, 1996. 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).
(b) The local county mental health authority or the 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 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. [256B.0912] [ALTERNATIVE CARE AND WAIVERED
SERVICE PROGRAMS.]
Subdivision 1. [RESTRUCTURING PLAN.] By January 1, 1996,
the commissioner shall present a plan to the legislature to
restructure administration of the alternative care, elderly
waiver, and disabled waiver programs. The plan must demonstrate
cost neutrality and provide counties with the flexibility,
authority, and accountability to administer home and
community-based service programs within predetermined fixed
budgets. To support this local program administration, the
commissioner shall explore options with the health care
financing administration to assure flexibility to expand core
services within the elderly and disabled waivers as long as cost
neutrality is maintained.
Subd. 2. [WAIVER PROGRAM MODIFICATIONS.] The commissioner
of human services shall make the following modifications in
medical assistance waiver programs, effective for services
rendered after June 30, 1995, or, if necessary, after federal
approval is granted:
(a) The community alternatives for disabled individuals
waiver shall:
(1) if medical supplies and equipment or adaptations are or
will be purchased for a waiver services recipient, allow the
prorating of costs on a monthly basis throughout the year in
which they are purchased. If the monthly cost of a recipient's
other waivered services exceeds the monthly limit established in
this paragraph, the annual cost of the waivered services shall
be determined. In this event, the annual cost of waivered
services shall not exceed 12 times the monthly limit calculated
in this paragraph;
(2) require client reassessments once every 12 months;
(3) permit the purchase of supplies and equipment costing
$150 or less without prior approval of the commissioner of human
services. A county is not required to contract with a provider
of supplies and equipment if the monthly cost of supplies and
equipment is less than $250; and
(4) allow the implementation of care plans without the
approval of the county of financial responsibility when the
client receives services from another county.
(b) The traumatic brain injury waiver shall:
(1) require client reassessments once every 12 months;
(2) permit the purchase of supplies and equipment costing
$250 or less without having a contract with the supplier; and
(3) allow the implementation of care plans without the
approval of the county of financial responsibility when the
client receives services from another county.
Sec. 63. Minnesota Statutes 1994, 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;
(6) the person needs services that are not available at
that time in the county through other county, state, or federal
funding sources; and
(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. If medical
supplies and equipment or adaptations are or will be purchased
for an alternative care services recipient, the costs may be
prorated on a monthly basis throughout the year in which they
are purchased. If the monthly cost of a recipient's other
alternative care services exceeds the monthly limit established
in this paragraph, the annual cost of the alternative care
services shall be determined. In this event, the annual cost of
alternative care services shall not exceed 12 times the monthly
limit calculated in this paragraph.
(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 spenddown
if the person applied, unless authorized by the commissioner. 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
from the date 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. 64. Minnesota Statutes 1994, 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;
(9) residential care services;
(10) care-related supplies and equipment;
(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.
(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.
(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 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.
(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.
(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.
(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. A county is
not required to contract with a provider of supplies and
equipment if the monthly cost of the supplies and equipment is
less than $250.
(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
clients who reside in the same apartment building of three or
more units. 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.
(i) For the purposes of this section, 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 and authorized by 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 Laws 1988, chapter 689, article 2,
section 256, whose monthly rates may not exceed 65 percent of
either the greater of either 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) (j) 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) (k) 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. 65. Minnesota Statutes 1994, section 256B.0913,
subdivision 8, is amended to read:
Subd. 8. [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The
case manager shall implement the plan of care for each 180-day
eligible client and ensure that a client's service needs and
eligibility are reassessed at least every six 12 months. The
plan shall include any services prescribed by the individual's
attending physician as necessary to allow the individual to
remain in a community setting. In developing the individual's
care plan, the case manager should include the use of volunteers
from families and neighbors, religious organizations, social
clubs, and civic and service organizations to support the formal
home care services. The county shall be held harmless for
damages or injuries sustained through the use of volunteers
under this subdivision including workers' compensation
liability. The lead agency shall provide documentation to the
commissioner verifying that the individual's alternative care is
not available at that time through any other public assistance
or service program. The lead agency shall provide documentation
in each individual's plan of care and to the commissioner that
the most cost-effective alternatives available have been offered
to the individual and that the individual was free to choose
among available qualified providers, both public and private.
The case manager must give the individual a ten-day written
notice of any decrease in or termination of alternative care
services.
(b) If the county administering alternative care services
is different than the county of financial responsibility, the
care plan may be implemented without the approval of the county
of financial responsibility.
Sec. 66. Minnesota Statutes 1994, 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 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 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 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 based on the cost of the first full month in which the of
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 until the next reassessment
is completed or at the end of 12 months, whichever comes first.
Premiums are due and payable each month alternative care
services are received unless the actual cost of the services is
less than the premium.
(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; or
(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 spenddown, 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. 67. Minnesota Statutes 1994, section 256B.0913,
subdivision 14, is amended to read:
Subd. 14. [REIMBURSEMENT AND RATE ADJUSTMENTS.] (a)
Reimbursement for expenditures for the alternative care services
as approved by the client's case manager 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 12 months
following the month date 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 1994, section 256B.0913, is
amended by adding a subdivision to read:
Subd. 15. [SERVICE ALLOWANCE FUND AVAILABILITY.] (a)
Effective July 1, 1996, the commissioner may use alternative
care funds for services to high function class A persons as
defined in section 144.0721, subdivision 3, clause (2). The
county alternative care grant allocation will be supplemented
with a special allocation amount based on the projected number
of eligible high function class A's and computed on the basis of
$240 per month per projected eligible person. Individual
monthly expenditures under the service allowance option are
permitted to be either greater or less than the amount of $240
per month based on individual need. County allocations shall be
adjusted periodically based on the actual provision of services
to high function class A persons.
(b) Counties shall have the option of providing services,
cash service allowances, vouchers, or a combination of these
options to high function class A persons defined in section
144.0721, subdivision 3, clause (2). High function class A
persons may choose services from among the categories of
services listed under section 256B.0913, subdivision 5, except
for case management services.
(c) If the allocation to a county is not sufficient to
serve all persons who qualify for alternative care services, the
county is not required to provide any alternative care services
to a high function class A person but shall establish a waiting
list to provide services as funding becomes available.
Sec. 69. Minnesota Statutes 1994, section 256B.0913, is
amended by adding a subdivision to read:
Subd. 15a. [REIMBURSEMENT RATE; ANOKA COUNTY.]
Notwithstanding subdivision 14, paragraph (e), or any other law
to the contrary, for services rendered on or after January 1,
1996, Anoka county may pay vendors, and the commissioner shall
reimburse the county, for actual costs up to the rate in effect
on December 31, 1995, plus half the difference between that rate
and the maximum allowed state rate for home health aide and
homemaker services.
Sec. 70. Minnesota Statutes 1994, section 256B.0915,
subdivision 2, is amended to read:
Subd. 2. [SPOUSAL IMPOVERISHMENT POLICIES.] The
commissioner shall seek to amend the federal waiver and the
medical assistance state plan to allow spousal impoverishment
criteria as authorized in Code of Federal Regulations, title 42,
section 435.726(1924) under United States Code, title 42,
section 1396r-5, and as implemented in sections 256B.0575,
256B.058, and 256B.059 to be applied to persons who are screened
and determined to need a nursing facility level of care, except
that the amendment shall seek to add to the personal needs
allowance permitted in section 256B.0575, an amount equivalent
to the group residential housing rate as set by section 256I.03,
subdivision 5.
Sec. 71. Minnesota Statutes 1994, 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 the medical assistance case mix
reimbursement system. If medical supplies and equipment or
adaptations are or will be purchased for an elderly waiver
services recipient, the costs may be prorated on a monthly basis
throughout the year in which they are purchased. If the monthly
cost of a recipient's other waivered services exceeds the
monthly limit established in this paragraph, the annual cost of
the waivered services shall be determined. In this event, the
annual cost of waivered services shall not exceed 12 times the
monthly limit calculated in this paragraph. 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 annual cost
divided by 12 of elderly or disabled waivered services for a
person who is a nursing facility resident at the time of
requesting a determination of eligibility for elderly or
disabled waivered services shall not exceed the monthly payment
for the resident class assigned under Minnesota Rules, parts
9549.0050 to 9549.0059, for that resident in the nursing
facility where the resident currently resides. 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. A county is not required to contract with a
provider of supplies and equipment if the monthly cost of the
supplies and equipment is less than $250.
(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; the rate 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 community alternatives for disabled
individuals (CADI) 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, except. For alternative care assisted living
projects established under Laws 1988, chapter 689, article 2,
section 256, whose monthly rates may not exceed 65 percent of
the greater of either the statewide or any of the geographic
groups' weighted average monthly medical assistance nursing
facility payment rate for 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.
(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.
(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. 72. Minnesota Statutes 1994, section 256B.0915, is
amended by adding a subdivision to read:
Subd. 3a. [REIMBURSEMENT RATE; ANOKA COUNTY.]
Notwithstanding subdivision 3, paragraph (h), or any other law
to the contrary, for services rendered on or after January 1,
1996, Anoka county may pay vendors, and the commissioner shall
reimburse the county, for actual costs up to the rate in effect
on December 31, 1995, plus half the difference between that rate
and the maximum allowed state rate for home health aide and
homemaker services.
Sec. 73. Minnesota Statutes 1994, section 256B.0915,
subdivision 5, is amended to read:
Subd. 5. [REASSESSMENTS FOR WAIVER CLIENTS.] A
reassessment of a client served under the elderly or disabled
waiver must be conducted at least every six 12 months and at
other times when the case manager determines that there has been
significant change in the client's functioning. This may
include instances where the client is discharged from the
hospital.
Sec. 74. Minnesota Statutes 1994, section 256B.0915, is
amended by adding a subdivision to read:
Subd. 6. [IMPLEMENTATION OF CARE PLAN.] If the county
administering waivered services is different than the county of
financial responsibility, the care plan may be implemented
without the approval of the county of financial responsibility.
Sec. 75. Minnesota Statutes 1994, section 256B.093,
subdivision 1, is amended to read:
Subdivision 1. [STATE TRAUMATIC BRAIN INJURY PROGRAM.] The
commissioner of human services shall:
(1) establish and maintain a statewide traumatic brain
injury 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
consultation;
(4) establish maintain an advisory committee to provide
recommendations in a report reports to the 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) the traumatic brain injury home and community-based
services waiver; and
(ii) traumatic brain injury services not covered by any
other statute or rule (6) investigate present and potential
models of service coordination which can be delivered at the
local level.
Sec. 76. Minnesota Statutes 1994, section 256B.093,
subdivision 2, is amended to read:
Subd. 2. [ELIGIBILITY.] Persons eligible for traumatic
brain injury administrative case management and consultation
must be eligible medical assistance recipients who have
traumatic or certain acquired brain injury and:
(1) are at risk of institutionalization; or
(2) exceed limits established by the commissioner in
section 256B.0627, subdivision 5, paragraph (b).
Sec. 77. Minnesota Statutes 1994, section 256B.093,
subdivision 3, is amended to read:
Subd. 3. [TRAUMATIC BRAIN INJURY PROGRAM DUTIES.] The
department shall fund administrative case management under this
subdivision using medical assistance administrative funds. 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;
(10) (1) 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) (2) coordinating the traumatic brain injury home and
community-based waiver; and
(12) (3) approving traumatic brain injury waiver
eligibility or care plans or both;
(4) providing ongoing technical assistance and consultation
to county and facility case managers to facilitate care plan
development for appropriate, accessible, and cost-effective
medical assistance services;
(5) providing technical assistance to promote statewide
development of appropriate, accessible, and cost-effective
medical assistance services and related policy;
(6) providing training and outreach to facilitate access to
appropriate home and community-based services to prevent
institutionalization;
(7) facilitating appropriate admissions, continued stay
review, discharges, and utilization review for neurobehavioral
hospitals and other specialized institutions;
(8) providing technical assistance on the use of prior
authorization of home care services and coordination of these
services with other medical assistance services;
(9) developing a system for identification of nursing
facility and hospital residents with traumatic brain injury to
assist in long-term planning for medical assistance services.
Factors will include, but are not limited to, number of
individuals served, length of stay, services received, and
barriers to community placement; and
(10) providing information, referral, and case consultation
to access medical assistance services for recipients without a
county or facility case manager. Direct access to this
assistance may be limited due to the structure of the program.
Sec. 78. Minnesota Statutes 1994, section 256B.093, is
amended by adding a subdivision to read:
Subd. 3a. [TRAUMATIC BRAIN INJURY CASE MANAGEMENT
SERVICES.] The annual appropriation established under section
171.29, subdivision 2, paragraph (b), clause (5), shall be used
for traumatic brain injury program services that include, but
are not limited to:
(1) collaborating with counties, providers, and other
public and private organizations to expand and strengthen local
capacity for delivering needed services and supports, including
efforts to increase access to supportive residential housing
options;
(2) participating in planning and accessing services not
otherwise covered in subdivision 3 to allow individuals to
attain and maintain community-based services;
(3) providing information, referral, and case consultation
to access health and human services for persons with traumatic
brain injury not eligible for medical assistance, though direct
access to this assistance may be limited due to the structure of
the program; and
(4) collaborating on injury prevention efforts.
Sec. 79. Minnesota Statutes 1994, section 256B.15,
subdivision 1a, is amended to read:
Subd. 1a. [ESTATES SUBJECT TO CLAIMS.] If a person
receives any medical assistance hereunder, on the person's
death, if single, or on the death of the survivor of a married
couple, either or both of whom received medical assistance, the
total amount paid for medical assistance rendered for the person
and spouse shall be filed as a claim against the estate of the
person or the estate of the surviving spouse in the court having
jurisdiction to probate the estate.
A claim shall be filed if medical assistance was rendered
for either or both persons under one of the following
circumstances:
(a) the person was over 65 55 years of age, and received
services under this chapter, excluding alternative care;
(b) the person resided in a medical institution for six
months or longer, received services under this chapter excluding
alternative care, and, at the time of institutionalization or
application for medical assistance, whichever is later, the
person could not have reasonably been expected to be discharged
and returned home, as certified in writing by the person's
treating physician. For purposes of this section only, a
"medical institution" means a skilled nursing facility,
intermediate care facility, intermediate care facility for
persons with mental retardation, nursing facility, or inpatient
hospital; or
(c) the person received general assistance medical care
services under chapter 256D.
The claim shall be considered an expense of the last
illness of the decedent for the purpose of section 524.3-805.
Any statute of limitations that purports to limit any county
agency or the state agency, or both, to recover for medical
assistance granted hereunder shall not apply to any claim made
hereunder for reimbursement for any medical assistance granted
hereunder. Notice of the claim shall be given to all heirs and
devisees of the decedent whose identity can be ascertained with
reasonable diligence. The notice must include procedures and
instructions for making an application for a hardship waiver
under subdivision 5; time frames for submitting an application
and determination; and information regarding appeal rights and
procedures. Counties are entitled to one-half of the nonfederal
share of medical assistance collections from estates that are
directly attributable to county effort.
Sec. 80. Minnesota Statutes 1994, 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 55 or during a period of institutionalization described
in subdivision 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. 81. Minnesota Statutes 1994, section 256B.15, is
amended by adding a subdivision to read:
Subd. 5. [UNDUE HARDSHIP.] Any person entitled to notice
in subdivision 1a has a right to apply for waiver of the claim
based upon undue hardship. Any claim pursuant to this section
may be fully or partially waived because of undue hardship.
Undue hardship does not include action taken by the decedent
which divested or diverted assets in order to avoid estate
recovery. Any waiver of a claim must benefit the person
claiming undue hardship.
Sec. 82. Minnesota Statutes 1994, 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 University of Minnesota. For purposes of this
subdivision, "public hospital" means the Hennepin County Medical
Center and the University of Minnesota hospital.
(b) From July 1, 1993 through June 30, 1994, Hennepin
county 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.
(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. The base year for determining this transfer amount
shall be established according to section 256.9657, subdivision
4.
(d) 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. 83. Minnesota Statutes 1994, section 256B.19,
subdivision 1c, is amended 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 $1,500,000, due before
noon on the 15th of each month and the University of Minnesota
shall be responsible for a monthly transfer payment of $500,000
due before noon on the 15th of each month, beginning July 15,
1993 1995. 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. 84. Minnesota Statutes 1994, section 256B.19,
subdivision 1d, is amended 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 and operated by the
county, with the county named as licensee, multiplied by $5,723.
If two or more counties own and operate 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. 85. Minnesota Statutes 1994, 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 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.
(i) For the cost report year ending September 30, 1996, and
for all subsequent reporting years, certified nursing facilities
must identify, differentiate, and record resident day statistics
for residents in case mix classification A who, on or after July
1, 1996, meet the modified level of care criteria in section
144.0721. The resident day statistics shall be separated into
case mix classification A-1 for any resident day meeting the
high-function class A level of care criteria and case mix
classification A-2 for other case mix class A resident days.
Sec. 86. Minnesota Statutes 1994, section 256B.431,
subdivision 23, is amended 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 operated, with the county named as
licensee by the commissioner of health, 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. 87. Minnesota Statutes 1994, section 256B.49,
subdivision 1, is amended to read:
Subdivision 1. [STUDY; WAIVER APPLICATION.] The
commissioner shall authorize a study to assess the need for home
and community-based waivers for chronically ill children who
have been and will continue to be hospitalized without a waiver,
and for disabled individuals under the age of 65 who are likely
to reside in an acute care or nursing home facility in the
absence of a waiver. If a need for these waivers can be
demonstrated, the commissioner shall apply for federal waivers
necessary to secure, to the extent allowed by law, federal
participation under United States Code, title 42, sections
1396-1396p, as amended through December 31, 1982, for the
provision of home and community-based services to chronically
ill children who, in the absence of such a waiver, would remain
in an acute care setting, and to disabled individuals under the
age of 65 who, in the absence of a waiver, would reside in an
acute care or nursing home setting. If the need is
demonstrated, the commissioner shall request a waiver under
United States Code, title 42, sections 1396-1396p, to allow
medicaid eligibility for blind or disabled children with
ineligible parents where income deemed from the parents would
cause the applicant to be ineligible for supplemental security
income if the family shared a household and to furnish necessary
services in the home or community to disabled individuals under
the age of 65 who would be eligible for medicaid if
institutionalized in an acute care or nursing home setting.
These waivers are requested to furnish necessary services in the
home and community setting to children or disabled adults under
age 65 who are medicaid eligible when institutionalized in an
acute care or nursing home setting. The commissioner shall
assure that the cost of home and community-based care will not
be more than the cost of care if the eligible child or disabled
adult under age 65 were to remain institutionalized. The
commissioner shall seek to amend the federal waivers obtained
under this section to apply criteria to protect against spousal
impoverishment as authorized under United States Code, title 42,
section 1396r-5, and as implemented in sections 256B.0575,
256B.058, and 256B.059, except that the amendment shall seek to
add to the personal needs allowance permitted in section
256B.0575, an amount equivalent to the group residential housing
rate as set by section 256I.03, subdivision 5.
Sec. 88. Minnesota Statutes 1994, section 256B.49, is
amended by adding a subdivision to read:
Subd. 6. [ADMISSION CERTIFICATION.] In determining an
individual's eligibility for the community alternative care
waiver program, and an individual's eligibility for medical
assistance under section 256B.055, subdivision 12, paragraph
(b), the commissioner may review or contract for review of the
individual's medical condition to determine level of care using
criteria in Minnesota Rules, parts 9505.0520 to 9505.0540.
For purposes of this subdivision, a person requires
long-term care in an inpatient hospital setting if the person
has an ongoing condition that is expected to last one year or
longer, and would require continuous or frequent
hospitalizations during that period, but for the provision of
home care services under this section.
Sec. 89. Minnesota Statutes 1994, section 256B.49, is
amended by adding a subdivision to read:
Subd. 7. [PERSONS WITH DEVELOPMENTAL DISABILITIES OR
RELATED CONDITIONS.] Individuals who apply for services under
the community alternatives for disabled individuals (CADI)
waiver program who have developmental disabilities or related
conditions must be screened for the appropriate institutional
level of care in accordance with section 256B.092.
Sec. 90. Minnesota Statutes 1994, section 256B.69, is
amended by adding a subdivision to read:
Subd. 3a. [COUNTY AUTHORITY.] The commissioner, when
implementing the general assistance medical care or medical
assistance prepayment program within a county, must include the
county board in the process of development, approval, and
issuance of the request for proposals to provide services to
eligible individuals within the proposed county. County boards
must be given reasonable opportunity to make recommendations
regarding the development, issuance, review of responses, and
changes needed in the request for proposals. The commissioner
must provide county boards the opportunity to review each
proposal based on the identification of community needs under
chapters 145A and 256E and county advocacy activities. If a
county board finds that a proposal does not address certain
community needs, the county board and commissioner shall
continue efforts for improving the proposal and network prior to
the approval of the contract. The county board shall make
recommendations regarding the approval of local networks and
their operations to ensure adequate availability and access to
covered services. The provider or health plan must respond
directly to county advocates and the state prepaid medical
assistance ombudsperson regarding service delivery and must be
accountable to the state regarding contracts with medical
assistance and general assistance medical care funds. The
county board may recommend a maximum number of participating
health plans after considering the size of the enrolling
population; ensuring adequate access and capacity; considering
the client and county administrative complexity; and considering
the need to promote the viability of locally developed health
plans. Prior to the development of the request for proposal,
there shall be established a mutually agreed upon timetable.
This process shall in no way delay the department's ability to
secure and finalize contracts for the medical assistance
prepayment program.
Sec. 91. Minnesota Statutes 1994, section 256B.69,
subdivision 4, is amended to read:
Subd. 4. [LIMITATION OF CHOICE.] The commissioner shall
develop criteria to determine when limitation of choice may be
implemented in the experimental counties. The criteria shall
ensure that all eligible individuals in the county have
continuing access to the full range of medical assistance
services as specified in subdivision 6. The commissioner shall
exempt the following persons from participation in the project,
in addition to those who do not meet the criteria for limitation
of choice: (1) persons eligible for medical assistance
according to section 256B.055, subdivision 1, and children under
age 21 who are in foster placement; (2) persons eligible for
medical assistance due to blindness or disability as determined
by the social security administration or the state medical
review team, unless: (i) they are 65 years of age or older, or
(ii) they are eligible for medical assistance according to
section 256B.055, subdivision 12; (3) recipients who currently
have private coverage through a health maintenance organization;
and (4) recipients who are eligible for medical assistance by
spending down excess income for medical expenses other than the
nursing facility per diem expense; and (5) recipients who
receive benefits under the Refugee Assistance Program,
established under United States Code, title 8, section 1522(e).
Children under age 21 who are in foster placement may enroll in
the project on an elective basis. The commissioner may allow
persons with a one-month spenddown who are otherwise eligible to
enroll to voluntarily enroll or remain enrolled, if they elect
to prepay their monthly spenddown to the state. Before
limitation of choice is implemented, eligible individuals shall
be notified and after notification, shall be allowed to choose
only among demonstration providers. After initially choosing a
provider, the recipient is allowed to change that choice only at
specified times as allowed by the commissioner. If a
demonstration provider ends participation in the project for any
reason, a recipient enrolled with that provider must select a
new provider but may change providers without cause once more
within the first 60 days after enrollment with the second
provider.
Sec. 92. Minnesota Statutes 1994, section 256B.69, is
amended by adding a subdivision to read:
Subd. 4a. [REQUIREMENTS OF REQUEST FOR PROPOSAL.] In
implementing the limitation of choice for persons eligible for
medical assistance according to section 256B.055, subdivision
12, hereinafter referred to as TEFRA recipients, the
commissioner shall comply with the request for proposal process
applicable to the prepaid medical assistance program.
Notwithstanding any provision to the contrary, the commissioner
shall include the following in the request for proposal issued
to health plans for purposes of covering TEFRA recipients:
(1) evidence that eligibility criteria for personal care
assistant services have been developed and implemented with
respect to TEFRA recipients;
(2) a complete and detailed description of the benefits the
health plan is responsible for providing to the TEFRA
recipients;
(3) identification of the circumstances under which and the
point at which the health plan covering the TEFRA recipient
pursuant to this section is responsible for the costs of and
delivery of benefits to the TEFRA recipient. The purpose of
this information is to facilitate coordination of benefits with
private health plans, including self-insured employers who are
covering the TEFRA recipients. The point at which and
circumstances under which the health plan is responsible must be
identified and developed so as to be applied consistently to all
TEFRA recipients;
(4) statistical information including the following:
(i) how many TEFRA recipients will be enrolled;
(ii) historical cost and utilization information, by type
of service and diagnosis or condition, and any other data or
statistics used in developing the proposed rate of payment to
the health plan;
(iii) average cost per TEFRA recipient to the state; and
(iv) outlier information, including diagnosis categories,
cost, and the number of TEFRA recipients; and
(5) actuarially valid rates of payment proposed to be paid
to the health plans.
Sec. 93. Minnesota Statutes 1994, section 256B.69,
subdivision 5, is amended to read:
Subd. 5. [PROSPECTIVE PER CAPITA PAYMENT.] The
commissioner shall establish the method and amount of payments
for services. The commissioner shall annually contract with
demonstration providers to provide services consistent with
these established methods and amounts for payment.
Notwithstanding section 62D.02, subdivision 1, payments for
services rendered as part of the project may be made to
providers that are not licensed health maintenance organizations
on a risk-based, prepaid capitation basis.
If allowed by the commissioner, a demonstration provider
may contract with an insurer, health care provider, nonprofit
health service plan corporation, or the commissioner, to provide
insurance or similar protection against the cost of care
provided by the demonstration provider or to provide coverage
against the risks incurred by demonstration providers under this
section. The recipients enrolled with a demonstration provider
are a permissible group under group insurance laws and chapter
62C, the Nonprofit Health Service Plan Corporations Act. Under
this type of contract, the insurer or corporation may make
benefit payments to a demonstration provider for services
rendered or to be rendered to a recipient. Any insurer or
nonprofit health service plan corporation licensed to do
business in this state is authorized to provide this insurance
or similar protection.
Payments to providers participating in the project are
exempt from the requirements of sections 256.966 and 256B.03,
subdivision 2. The commissioner shall complete development of
capitation rates for payments before delivery of services under
this section is begun. For payments made during calendar year
1990 and later years, the commissioner shall contract with an
independent actuary to establish prepayment rates.
By January 15, 1996, the commissioner shall report to the
legislature on the methodology used to allocate to participating
counties available administrative reimbursement for advocacy and
enrollment costs. The report shall reflect the commissioner's
judgment as to the adequacy of the funds made available and of
the methodology for equitable distribution of the funds. The
commissioner must involve participating counties in the
development of the report.
Sec. 94. Minnesota Statutes 1994, section 256B.69, is
amended by adding a subdivision to read:
Subd. 5a. [MANAGED CARE CONTRACTS.] Managed care contracts
under this section, section 256.9363, and section 256D.03, shall
be entered into or renewed on a calendar year basis beginning
January 1, 1996. Managed care contracts which were in effect on
June 30, 1995, and set to renew on July 1, 1995, shall be
renewed for the period July 1, 1995 through December 31, 1995 at
the same terms that were in effect on June 30, 1995.
Sec. 95. Minnesota Statutes 1994, section 256B.69, is
amended by adding a subdivision to read:
Subd. 5b. [PROSPECTIVE REIMBURSEMENT RATES.] For prepaid
medical assistance and general assistance medical care program
contract rates effective January 1, 1996, through December 31,
1996, capitation rates for nonmetropolitan counties shall on a
weighted average be no less than 85 percent of the capitation
rates for metropolitan counties, excluding Hennepin county.
Sec. 96. Minnesota Statutes 1994, section 256B.69,
subdivision 6, is amended to read:
Subd. 6. [SERVICE DELIVERY.] (a) Each demonstration
provider shall be responsible for the health care coordination
for eligible individuals. Demonstration providers:
(1) shall authorize and arrange for the provision of all
needed health services including but not limited to the full
range of services listed in sections 256B.02, subdivision 8, and
256B.0625 and for children eligible for medical assistance under
section 256B.055, subdivision 12, home care services and
personal care assistant services in order to ensure appropriate
health care is delivered to enrollees;
(2) shall accept the prospective, per capita payment from
the commissioner in return for the provision of comprehensive
and coordinated health care services for eligible individuals
enrolled in the program;
(3) may contract with other health care and social service
practitioners to provide services to enrollees; and
(4) shall institute recipient grievance procedures
according to the method established by the project, utilizing
applicable requirements of chapter 62D. Disputes not resolved
through this process shall be appealable to the commissioner as
provided in subdivision 11.
(b) Demonstration providers must comply with the standards
for claims settlement under section 72A.201, subdivisions 4, 5,
7, and 8, when contracting with other health care and social
service practitioners to provide services to enrollees. A
demonstration provider must pay a clean claim, as defined in
Code of Federal Regulations, title 42, section 447.45(b), within
30 business days of the date of acceptance of the claim.
Sec. 97. Minnesota Statutes 1994, section 256B.69,
subdivision 9, is amended to read:
Subd. 9. [REPORTING.] Each demonstration provider shall
submit information as required by the commissioner, including
data required for assessing client satisfaction, quality of
care, cost, and utilization of services for purposes of project
evaluation. The commissioner shall also develop methods of data
collection from county advocacy activities in order to provide
aggregate enrollee information on encounters and outcomes to
determine access and quality assurance. Required information
shall be specified before the commissioner contracts with a
demonstration provider.
Sec. 98. Minnesota Statutes 1994, section 256B.69, is
amended by adding a subdivision to read:
Subd. 18. [SERVICES PENDING APPEAL.] If the recipient
appeals in writing to the state agency on or before the tenth
day after the decision of the prepaid health plan to reduce,
suspend, or terminate services which the recipient had been
receiving, and the treating physician or another plan physician
orders the services to be continued at the previous level, the
prepaid health plan must continue to provide services at a level
equal to the level ordered by the plan's physician until the
state agency renders its decision.
Sec. 99. Minnesota Statutes 1994, section 256B.69, is
amended by adding a subdivision to read:
Subd. 19. [LIMITATION ON REIMBURSEMENT TO PROVIDERS NOT
AFFILIATED WITH A PREPAID HEALTH PLAN.] A prepaid health plan
may limit any reimbursement it may be required to pay to
providers not employed by or under contract with the prepaid
health plan to the medical assistance rates for medical
assistance enrollees, and the general assistance medical care
rates for general assistance medical care enrollees, paid by the
commissioner of human services to providers for services to
recipients not enrolled in a prepaid health plan.
Sec. 100. Minnesota Statutes 1994, section 256B.69, is
amended by adding a subdivision to read:
Subd. 20. [OMBUDSPERSON.] The commissioner shall designate
an ombudsperson to advocate for persons required to enroll in
prepaid health plans under this section. The ombudsperson shall
advocate for recipients enrolled in prepaid health plans through
complaint and appeal procedures and ensure that necessary
medical services are provided either by the prepaid health plan
directly or by referral to appropriate social services. At the
time of enrollment in a prepaid health plan, the local agency
shall inform recipients about the ombudsperson program and their
right to a resolution of a complaint by the prepaid health plan
if they experience a problem with the plan or its providers.
Sec. 101. Minnesota Statutes 1994, section 256B.69, is
amended by adding a subdivision to read:
Subd. 21. [PREPAYMENT COORDINATOR.] The local agency shall
designate a prepayment coordinator to assist the state agency in
implementing this section and section 256D.03, subdivision 4.
Assistance must include educating recipients about available
health care options, enrolling recipients under subdivision 5,
providing necessary eligibility and enrollment information to
health plans and the state agency, and coordinating complaints
and appeals with the ombudsman established in subdivision 18.
Sec. 102. Minnesota Statutes 1994, section 256B.69, is
amended by adding a subdivision to read:
Subd. 22. [IMPACT ON PUBLIC OR TEACHING HOSPITALS AND
COMMUNITY CLINICS.] (a) 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, provided
the terms of participation in the program are competitive with
the terms of other participants.
(b) Prepaid health plans serving counties with a nonprofit
community clinic or community health services agency must
contract with the clinic or agency to provide services to
clients who choose to receive services from the clinic or
agency, if the clinic or agency agrees to payment rates that are
competitive with rates paid to other health plan providers for
the same or similar services.
Sec. 103. [256B.691] [RISK-BASED TRANSPORTATION PAYMENTS.]
Any contract with a prepaid health plan under the medical
assistance, general assistance medical care, or MinnesotaCare
program that requires the health plan to cover transportation
services for obtaining medical care for eligible individuals who
are ambulatory must provide for payment for those services on a
risk basis.
Sec. 104. Minnesota Statutes 1994, 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
spenddown 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. No asset
test shall be applied to children and their parents living in
the same household. 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 60 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), except that it also means services
rendered because of suspected or actual pesticide poisoning.
Sec. 105. Minnesota Statutes 1994, section 256D.03,
subdivision 3b, is amended to read:
Subd. 3b. [COOPERATION.] General assistance or general
assistance medical care applicants and recipients must cooperate
with the state and local agency to identify potentially liable
third-party payors and assist the state in obtaining third-party
payments. Cooperation includes identifying any third party who
may be liable for care and services provided under this chapter
to the applicant, recipient, or any other family member for whom
application is made and providing relevant information to assist
the state in pursuing a potentially liable third party. General
assistance medical care applicants and recipients must cooperate
by providing information about any group health plan in which
they may be eligible to enroll. They must cooperate with the
state and local agency in determining if the plan is
cost-effective. If the plan is determined cost-effective and
the premium will be paid by the state or local agency or is
available at no cost to the person, they must enroll or remain
enrolled in the group health plan. Cost-effective insurance
premiums approved for payment by the state agency and paid by
the local agency are eligible for reimbursement according to
subdivision 6.
Sec. 106. Minnesota Statutes 1994, 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;
(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; and
(22) 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 nurse'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, and for contracts beginning on or
after July 1, 1995, shall be discounted ten percent from
comparable fee for service payments. 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.
Notwithstanding the provisions of subdivision 3, an individual
who becomes ineligible for general assistance medical care
because of failure to submit income reports or recertification
forms in a timely manner, shall remain enrolled in the prepaid
health plan and shall remain eligible for general assistance
medical care coverage through the last day of the month in which
the enrollee became ineligible for general assistance medical
care.
(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. 107. Minnesota Statutes 1994, section 256D.425, is
amended by adding a subdivision to read:
Subd. 4. [COOPERATION.] To be eligible for the Minnesota
supplemental aid program, applicants and recipients must
cooperate with the state and local agency to identify
potentially liable third-party payors and assist the state in
obtaining third-party payments. Cooperation includes
identifying any third party who may be liable for benefits
provided under this chapter to the applicant, recipient, or any
other family member for whom application is made, and providing
relevant information to assist the state in pursuing a
potentially liable third party.
Sec. 108. Minnesota Statutes 1994, section 501B.89,
subdivision 1, is amended to read:
Subdivision 1. [TRUSTS CONTAINING LIMITATIONS LINKED TO
ELIGIBILITY FOR PUBLIC ASSISTANCE.] (a) Except as allowed by
subdivision 2 or 3, a provision in a trust that provides for the
suspension, termination, limitation, or diversion of the
principal, income, or beneficial interest of a beneficiary if
the beneficiary applies for, is determined eligible for, or
receives public assistance or benefits under a public health
care program is unenforceable as against the public policy of
this state, without regard to the irrevocability of the trust or
the purpose for which the trust was created.
(b) This subdivision applies to trust provisions created
after July 1, 1992. For purposes of this section, a trust
provision is created on the date of execution of the first
instrument that contains the provision, even though the trust
provision is later amended or reformed or the trust is not
funded until a later date.
Sec. 109. Minnesota Statutes 1994, section 501B.89, is
amended by adding a subdivision to read:
Subd. 3. [SUPPLEMENTAL NEEDS TRUSTS UNDER FEDERAL LAW.] A
trust created on or after August 11, 1993, which qualifies as a
supplemental needs trust for a person with a disability under
United States Code, title 42, section 1396p(c)(2)(B)(iv) or
1396p(d), as amended by section 13611(b) of the Omnibus Budget
Reconciliation Act of 1993, Public Law Number 103-66, commonly
known as OBRA 1993, is enforceable, and the courts of this state
may authorize creation and funding of a trust which so qualifies.
Sec. 110. [TEFRA FEE STUDY.]
The commissioner of human services shall study and report
to the legislature by January 15, 1996, recommendations to
modify the fee structure for the parents of children eligible
for medical assistance under Minnesota Statutes, section
256B.055, subdivision 12. The report shall include a comparison
of the fee schedule for these parents with fee schedules in the
social services, MinnesotaCare, and sliding fee child care
programs. The commissioner shall appoint an advisory committee
to assist with the study which must include parents, advocates,
and other interested persons.
Sec. 111. [IMPLEMENTATION PLAN FOR HOME CARE SERVICES.]
The commissioner of human services, in conjunction with the
commissioner of education, shall require the provision of the
following types of home care services equivalent to personal
care assistant services through waivered programs and managed
care programs beginning July 1, 1996:
(1) school-based after school services; and
(2) vacation and summer-only services.
The commissioners shall define program participants, structure,
and activities and shall recommend to the 1996 legislature any
changes in licensing requirements or other law changes necessary
to implement the program. The commissioner of human services
shall require participants in waivered programs and managed care
programs to receive services through these options unless the
requirement would create an undue hardship for recipients.
Sec. 112. [WAIVER.]
The commissioner of human services shall seek a federal
waiver to implement the 60-month period for transfers of assets
under section 256B.0595, subdivision 1, paragraph (g).
Sec. 113. [ADVISORY TASK FORCE TO STANDARDIZE SUPPORTING
DOCUMENTATION FOR PRIOR AUTHORIZATION.]
Subdivision 1. [COMPOSITION OF TASK FORCE.] A six-member
advisory task force on prior authorization for physical therapy,
occupational therapy, speech therapy, or related services
supporting documentation shall be established. The task force
shall be comprised of one licensed physiatrist, one licensed
physical therapist, one licensed occupational therapist, one
licensed speech therapist, one licensed rehabilitation nurse,
and one consumer representative. All licensed task force
members must be actively engaged in the practice of their
profession in Minnesota. The members of the task force shall be
appointed by the commissioner of human services. No more than
three members may be of one gender. All licensed professional
members shall be selected from lists submitted to the
commissioner by the appropriate professional associations. Task
force members who are licensed professionals shall not be
compensated for their service. The consumer representative
member must be compensated for time spent on task force
activities as specified in Minnesota Statutes, section 15.059,
subdivision 3. The task force shall expire on December 31, 1996.
Subd. 2. [DUTIES OF COMMISSIONER AND TASK FORCE.] The task
force shall study the lists of items, specified in the issue of
the medical assistance and general assistance medical care
provider manual which is in effect as of the effective date of
this act, that are required to be submitted by each category of
provider along with the provider's request for prior
authorization. The task force shall recommend to the
commissioner any amendments or refinements needed to clarify the
lists. The commissioner shall use the recommendations of the
task force to develop standardized documentation which a
provider must submit with a prior authorization request. If the
commissioner intends to depart from the recommendations of the
task force, the commissioner shall inform the task force of the
intended departure, provide a written explanation of the reasons
for the departure, and give the task force an opportunity to
comment on the intended departure.
Sec. 114. [MEDICAL ASSISTANCE ASSET TRANSFER AND
ELIGIBILITY REQUIREMENTS.]
The commissioner of human services shall investigate and
pursue all viable options for tightening the medical assistance
asset transfer and eligibility requirements to restore and
preserve the function of the medical assistance program as a
safety net program for low-income Minnesotans who cannot afford
to meet their medical needs with their own resources. Among
other actions, the commissioner shall aggressively pursue
waivers of federal requirements to strengthen restrictions on
transfers of assets for the purposes of gaining eligibility for
medical assistance.
Sec. 115. [CONTINUATION OF PILOT PROJECTS.]
The alternative care pilot projects authorized in Laws
1993, First Special Session chapter 1, article 5, section 133,
shall not expire on June 30, 1995, but shall continue until June
30, 1997, except that the three percent rate increases
authorized in Laws 1993, First Special Session chapter 1,
article 1, section 2, subdivision 4, shall be incorporated in
average monthly cost effective July 1, 1995. The commissioner
shall allow additional counties at their option to implement the
alternative care program within the parameters established in
Laws 1993, First Special Session chapter 1, article 5, section
133. If more than five counties exercise this option, the
commissioner may require counties to make this change on a
phased schedule if necessary in order to implement this
provision within the limit of available resources. For newly
participating counties, the previous fiscal year shall be the
base year.
Sec. 116. [RATE CONSOLIDATION PLAN.]
The commissioner of human services, in cooperation with
counties, shall prepare an implementation plan to consolidate
payment rates for alternative care services, elderly waiver
services, community alternatives for disabled individuals
services, traumatic brain injury services, and comparable
medical assistance services provided after June 30, 1996, that
establishes a statewide rate cap for each individual service
that is equal to the highest rate cap in any program for that
service. The plan must be submitted to the legislature by
October 1, 1995.
Sec. 117. [REIMBURSEMENT INCREASE.]
Notwithstanding statutory provisions to the contrary, the
commissioner of human services shall increase reimbursement
rates for the following by 1.5 percent on April 1, 1996:
(1) personal care services under Minnesota Statutes,
section 256B.0625, subdivision 19a;
(2) home and community-based services waiver for persons
with mental retardation and related conditions under Minnesota
Statutes, section 256B.501;
(3) adult residential program grants, under Minnesota
Rules, parts 9535.2000 to 9535.3000;
(4) adult and family community support grants, under
Minnesota Rules, parts 9535.1700 to 9535.1760;
(5) day training and habilitation services for adults with
mental retardation and related conditions under Minnesota
Statutes, sections 252.40 to 252.47; and
(6) semi-independent living services under Minnesota
Statutes, section 252.275.
Sec. 118. [MANAGED CARE RATE SETTING METHODOLOGY.]
Subdivision 1. [DEVELOPMENT.] The commissioner of human
services, in conjunction with the rate setting task force
established in subdivision 2, shall develop a prospective rate
setting methodology for implementation on January 1, 1998. The
methodology must incorporate the public program risk adjustment
mechanism and, at a minimum, take into account the following
factors:
(1) costs of ensuring appropriate access to health care
services in all counties;
(2) costs of medical education, disproportionate share
payments, provisions for federally qualified health care
centers, rural health clinics, and other adjustors historically
provided for in the fee-for-service payments to specific
providers;
(3) health status;
(4) statistically valid regional utilization patterns as
well as population characteristics;
(5) the benefit set to be provided through the prepaid
medical assistance program; and
(6) utilization demands resulting from program changes and
newly created access to care.
Subd. 2. [RATE SETTING TASK FORCE.] The commissioner shall
establish a task force consisting of representatives of health
plans, public program providers, disproportionate share and
teaching hospitals, independent actuaries, counties, and
consumers, to develop recommendations for a prospective rate
setting methodology with a risk adjustment mechanism to be
implemented by January 1, 1998. The task force shall include at
least one representative of each regional coordinating board
established under section 62J.09. Fifty percent of the
provider, county, and consumer members shall be from non-metro
counties. The commissioner and task force shall jointly deliver
a progress report to the legislature by January 15, 1996, and a
final methodology proposal to the legislature by December 15,
1996.
Sec. 119. [JOINT PURCHASER DEMONSTRATION PROJECTS.]
Subdivision 1. [DEMONSTRATION PROJECTS.] A county or
counties may apply or the commissioner may solicit a
demonstration project or projects for a state-county partnership
as joint purchasers for services provided to eligible
individuals under medical assistance, general assistance medical
care, state health and social service grants, and county funds
for these or other participants. Individual county staff who
are employed by a publicly owned health plan that intends to
respond to the request for proposal are prohibited from
reviewing, critiquing, or approving any proposals submitted in
accordance with this section. As part of this project, the
commissioner, in cooperation with the county boards, must
explore options for various purchasing models including
contracting directly with providers or provider networks. The
commissioner retains total responsibility for the medical
assistance and general assistance medical care contracts.
Subd. 2. [OBJECTIVES.] The objective of the demonstration
project is to promote the development of local provider
networks; further define the county role and authorities in
providing publicly reimbursed health services, including
services reimbursed by the county; to provide better
coordination of services; and to identify costs and methods to
reduce cost-shifting.
Subd. 3. [PARTICIPATING COUNTIES.] Carlton, Cook,
Koochiching, Lake, and Saint Louis counties shall be allowed to
participate in joint purchasing demonstration projects at the
option of their county boards. Any county may also participate
in a joint purchasing demonstration project, which may include
county employees, at the option of the county board.
Sec. 120. [DEMONSTRATION PROJECT TO TEST ALTERNATIVES TO
DELIVERY OF SERVICES TO HIGH-RISK MEDICAL ASSISTANCE
RECIPIENTS.]
Subdivision 1. [AUTHORIZATION FOR DEMONSTRATION PROJECTS.]
Counties may propose demonstration projects to test alternatives
to the delivery of health services to high risk populations.
The commissioner of human services shall review and may approve
demonstration project proposals and shall seek federal waivers
as applicable for approved demonstration projects.
Subd. 2. [PROGRAM DESIGN AND IMPLEMENTATION.] (a) The
demonstration projects shall be established jointly by the
commissioners and participating county boards to design and plan
an improved health services delivery system for high-risk
medical assistance recipients who also receive services under
other publicly funded health, human services, or corrections
programs. In counties where prepaid medical assistance programs
have been implemented, health plan companies participating in
the prepaid program shall be included in the program design. In
the proposal, the county must delineate exactly which
populations would be served and what enrollment procedures would
be used. The projects must address one or more of the following:
(1) provide an array of health and social services that are
better coordinated for persons and families now served by
multiple, uncoordinated programs;
(2) be based on purchasing strategies that improve access
and coordinate services without cost shifting;
(3) coordinate between provider networks or health plan
companies and the community health and human services
infrastructure through creative partnerships with local vendors;
and
(4) utilize existing categorical funding streams and
reimbursement sources in coordinated and creative ways.
(b) All projects must complete their planning phase and be
operational by June 30, 1997.
Subd. 3. [PROGRAM EVALUATION.] Evaluation of each project
will be based on outcome evaluation criteria negotiated with
each project prior to implementation.
Subd. 4. [NOTICE OF PROJECT DISCONTINUATION.] Each project
may be discontinued for any reason by the county board or the
commissioner of human services, after 90 days' written notice to
the other party.
Subd. 5. [PLANNING FOR DEMONSTRATION PROJECTS.] Each local
plan for a demonstration project must be developed under the
direction of the county board, or multiple county boards acting
jointly, as the local health and human services authority. The
planning process for each demonstration shall include, but not
be limited to, advocates, providers, and the departments of
health and human services.
Subd. 6. [DUTIES OF COMMISSIONER.] (a) For purposes of the
demonstration projects, the commissioner of human services shall
facilitate coordination of funds or other resources as needed
and requested by each project. These resources may include:
medical assistance, general assistance medical care,
MinnesotaCare, and other categorical state and federal funds if
requested by the county boards, and if the commissioner
determines this would be consistent with the state's overall
health care reform efforts.
(b) The commissioner shall consider the following criteria
in awarding start-up and implementation grants for the
demonstration projects:
(1) the ability of the proposed projects to accomplish the
objectives described in subdivision 2;
(2) the size of the target population to be served; and
(3) geographical distribution.
(c) The commissioner shall review overall status of the
projects at least every two years and recommend any legislative
changes needed by January 15 of each odd-numbered year.
(d) The county board may seek a waiver of administrative
procedural rules under Minnesota Statutes, section 465.797.
(e) The commissioner may exempt the participating counties
from state fiscal sanctions for noncompliance with requirements
in laws and rules which are incompatible with the implementation
of the demonstration project.
(f) The commissioner may award grants to a county board or
group of county boards to pay for start-up, implementation, and
evaluation costs of the demonstration project.
Subd. 7. [DUTIES OF COUNTY BOARD.] The county board, or
other entity which is approved to administer a demonstration
project, shall:
(1) administer the project in a manner which is consistent
with the objectives described in subdivision 2 and the planning
process described in subdivision 5;
(2) ensure that no one is denied services for which they
would otherwise be eligible; and
(3) provide the commissioner of human services with timely
and pertinent information through the following methods:
(i) submission of community health services act, maternal
and child health act, and community social services act plans
and plan amendments;
(ii) submission of health and social services expenditure
and grant reconciliation reports, based on a coding format to be
determined by mutual agreement between the project's managing
entity and the commissioner; and
(iii) submission of data and participation in an evaluation
of the demonstration projects, to be designed cooperatively by
the commissioner and the projects.
Sec. 121. [TASK FORCE FOR HOME CARE SERVICES.]
The commissioner shall appoint a home care services task
force to recommend changes to medical assistance home care
services as alternatives to the home care changes to take effect
July 1, 1996, Minnesota Statutes, sections 256B.0625,
subdivisions 6a, 7, and 19a; 256B.0627; and 256B.0628, which
will reduce projected growth for the 1996-1997 biennium to no
more than five percent over 1995 projected expenditures as
described in the November 1994 medical assistance forecast,
department of human services. The recommendations shall include:
proposals for independent delivery models for personal care
assistant services; county assessment, service plan, and care
plan development; coordination, including coordination with
mental health services; streamlining of assessment and reporting
processes to achieve administrative cost efficiencies; and
alternative ways to serve segments of this population with
needed services. The task force shall be comprised of home care
services recipients, providers, advocates, staff from counties,
the departments of human services, health, finance, the attorney
general's office, in addition to the chairs of the health and
human services finance committees of both houses of the
legislature or their representatives. The recommendations shall
be completed by December 1, 1995, except that the
recommendations relating to county assessment and streamlining
of assessment and reporting processes shall be completed by
October 1, 1995, and presented to the next session, including a
special session, of the Minnesota legislature.
By January 15, 1996, the commissioner of human services,
jointly with counties, shall develop a plan for presentation to
the legislature at their next session, including any special
session, to allow counties to assume the prior authorization for
home care services at the option of the county. The plan must
provide participating counties with the funding, flexibility,
authority, and accountability to administer both the assessment
and prior authorization functions for medical assistance
reimbursement for services under section 256B.0627, subdivision
2.
The plan shall also make a recommendation for adequate
reimbursement of county administrative responsibilities of
assessment, case management and appeals activities. In
developing the plan and recommendations, the commissioner of
human services shall involve the counties, consumers, and
providers and include the development of standards, criteria and
outcomes to foster local authority and flexibility, while
defining quality expectations, budgetary incentives and
sanctions, and promoting consistency.
Sec. 122. [INSURANCE STUDY.]
The Minnesota health care commission shall report to the
legislature by January 15, 1996, recommendations to improve
coverage through private health plans, the Minnesota
comprehensive health association, and other public or private
programs for children and adults with disabilities.
Sec. 123. [TEFRA MANAGED CARE ADVISORY COMMITTEE AND
PROGRESS REPORT.]
Subdivision 1. [ADVISORY COMMITTEE.] The commissioner
shall appoint an advisory committee to assist with the
development of managed care for children eligible for medical
assistance under Minnesota Statutes, section 256B.055,
subdivision 12. The advisory committee shall include
representatives of parents, advocates, health plan companies,
health care providers serving the children, counties, and other
other interested persons.
Subd. 2. [PROGRESS REPORT.] The commission shall report to
the legislature by December 15, 1995, regarding progress toward
implementing managed care. The report shall make
recommendations regarding the following: any law changes needed
for effective implementation; how to coordinate with other
insurance coverage the families may have; how managed care plans
would operate as to varying coverage; what services would be
available, including any gaps under managed care plans; and
whether going to managed care results in cost savings to the
state. The report shall also provide information by county and
major diagnoses of children found eligible and ineligible for
TEFRA, the services and amounts paid by the medical assistance
program, name of health insurance plan, family income, and total
number of TEFRA eligible children in each county.
Sec. 124. [REPEALER.]
Minnesota Statutes 1994, sections 252.27, subdivision 2c;
and 256.969, subdivision 24, are repealed.
Minnesota Rules, part 9500.1452, subpart 2, item B, is
repealed.
Sec. 125. [EFFECTIVE DATE.]
Subdivision 1. Sections 79 and 80, the amendments to
section 256B.15, subdivisions 1a and 2, relating only to the age
of a medical assistance recipient for purposes of estate claims,
are effective for persons who are between the ages of 55 and 64
on or after July 1, 1995, for the total amount of medical
assistance rendered on or after July 1, 1995.
Subd. 2. Sections 34 to 37, section 256B.0595,
subdivisions 1, 2, 3, and 4, are effective retroactive to August
11, 1993, except that portion amending subdivision 2, paragraph
(c), is effective retroactive to transfers of income or assets
made on or after September 1994.
Subd. 3. Sections 28, 108, and 109, sections 256B.056,
subdivision 3b, and 501B.89, subdivisions 1 and 3, are effective
retroactive to August 11, 1993.
Subd. 4. Sections 14, 49, 84, and 86, sections 256.9657,
subdivision 3, 256B.0625, subdivision 38, 256B.19, subdivision
1d, and 256B.431, subdivision 23, are effective the day
following final enactment.
Subd. 5. Section 30, the amendment to section 256B.0575,
paragraph (a), clause (5), is effective retroactive to January
1, 1994.
Subd. 6. Section 91, the amendment to section 256B.69,
subdivision 4, requiring children eligible for medical
assistance under section 256B.055, subdivision 12, to
participate in managed care, is effective July 1, 1996.
Subd. 7. Section 96, the amendment to section 256B.69,
subdivision 6, expanding services under managed care to include
home care services and personal care assistant services for
certain recipients, is effective July 1, 1996.
Subd. 8. Section 48, section 256B.0625, subdivision 19a,
is effective July 1, 1996.
Subd. 9. Section 52, section 256B.0627, subdivision 1,
paragraph (c), is effective January 1, 1996; paragraph (d) is
effective January 1, 1996, except the deletions relating to
responsible party are effective July 1, 1996; and the stricken
paragraph (d), the deletion of the definition of responsible
party, is effective July 1, 1996.
Subd. 10. Section 53, section 256B.0627, subdivision 2,
clause (6), is effective January 1, 1996.
Subd. 11. Section 54, section 256B.0627, subdivision 4,
paragraph (a), is effective July 1, 1996; and paragraph (b),
clauses (2) and (3), are effective January 1, 1996; and the
stricken language in clause (1) and the stricken language in the
stricken clause (4), are effective July 1, 1996.
Subd. 12. Section 55, section 256B.0627, subdivision 5,
paragraph (a), clause (2), is effective January 1, 1996;
paragraph (d) is effective January 1, 1996; paragraph (e),
clause (2)(i), the new language relating to the registered nurse
supervision is effective January 1, 1996; paragraph (e), clause
(2)(i)A, B, C, D, and E, are effective July 1, 1996; paragraph
(e), clause (2)(ii), is effective July 1, 1996; paragraph (e),
clause (2)(iii), the new language relating to county public
health nurse, is effective January 1, 1996, and the stricken
language relating to the seizure activity provision, is
effective July 1, 1996; paragraph (e), clause (2), the language
striking items (v) to (viii), is effective July 1, 1996;
paragraph (h), is effective January 1, 1996; and paragraph (i),
clause (2), the stricken language relating to the foster care
license holder, and the language in the stricken clause (3)
relating to the responsible party, is effective July 1, 1996.
ARTICLE 7
LONG-TERM CARE
Section 1. Minnesota Statutes 1994, section 144.0723,
subdivision 1, is amended to read:
Subdivision 1. [CLIENT REIMBURSEMENT CLASSIFICATIONS.] The
commissioner of health shall establish reimbursement
classifications based upon the assessment of each client in
intermediate care facilities for the mentally retarded conducted
after December 31, 1988 1992, under section 256B.501,
subdivision 3g, or under rules established by the commissioner
of human services under section 256B.501, subdivision 3j.
The reimbursement classifications established by the
commissioner must conform to the section 256B.501, subdivision
3g, and subsequent rules established by the commissioner of
human services to set payment rates for intermediate care
facilities for the mentally retarded beginning on or after
October 1, 1990.
Sec. 2. Minnesota Statutes 1994, section 144.0723,
subdivision 2, is amended to read:
Subd. 2. [NOTICE OF CLIENT REIMBURSEMENT CLASSIFICATION.]
The commissioner of health shall notify each client and
intermediate care facility for the mentally retarded in which
the client resides of the reimbursement classification
classifications established under subdivision 1 for each client
residing in the facility. The notice must inform the
client intermediate care facility for the mentally retarded of
the classification classifications that was are assigned, the
opportunity to review the documentation supporting the
classification, the opportunity to obtain clarification from the
commissioner, and the opportunity to request a reconsideration
of the classification any classifications assigned. The notice
of classification must be sent by first-class mail. The
individual client notices may be sent to the client's
intermediate care facility for the mentally retarded for
distribution to the client. The facility must distribute the
notice to the client's case manager and to the client or to the
client's representative. This notice must be distributed within
three working days after the facility receives the notices from
the department. For the purposes of this section,
"representative" includes the client's legal representative as
defined in Minnesota Rules, part 9525.0015, subpart 18, the
person authorized to pay the client's facility expenses, or any
other individual designated by the client.
Sec. 3. Minnesota Statutes 1994, section 144.0723,
subdivision 3, is amended to read:
Subd. 3. [REQUEST FOR RECONSIDERATION.] The client,
client's representative, or the intermediate care facility for
the mentally retarded may request that the commissioner
reconsider the assigned classification. The request for
reconsideration must be submitted in writing to the commissioner
within 30 days after the receipt of the notice of client
classification. The request for reconsideration must include
the name of the client, the name and address of the facility in
which the client resides, the reasons for the reconsideration,
the requested classification changes, and documentation
supporting the requested classification. The documentation
accompanying the reconsideration request is limited to
documentation establishing that the needs of the client and
services provided to the client at the time of the assessment
resulting in the disputed classification justify a change of
classification.
Sec. 4. Minnesota Statutes 1994, section 144.0723,
subdivision 4, is amended to read:
Subd. 4. [ACCESS TO INFORMATION.] Annually, at the
interdisciplinary team meeting, the intermediate care facility
for the mentally retarded shall inform the client or the
client's representative and case manager of the client's most
recent classification as determined by the department of
health. Upon written request, the intermediate care facility
for the mentally retarded must give the client's case manager,
the client, or the client's representative a copy of the
assessment form and the other documentation that was given to
the department to support the assessment findings. The facility
shall also provide access to and a copy of other information
from the client's record that has been requested by or on behalf
of the client to support a client's reconsideration request. A
copy of any requested material must be provided within three
working days after the facility receives a written request for
the information. If the facility fails to provide the material
within this time, it is subject to the issuance of a correction
order and penalty assessment. Notwithstanding this section, any
order issued by the commissioner under this subdivision must
require that the facility immediately comply with the request
for information and that as of the date the order is issued, the
facility shall forfeit to the state a $100 fine the first day of
noncompliance, and an increase in the $100 fine by $50
increments for each day the noncompliance continues.
Sec. 5. Minnesota Statutes 1994, section 144.0723,
subdivision 6, is amended to read:
Subd. 6. [RECONSIDERATION.] The commissioner's
reconsideration must be made by individuals not involved in
reviewing the assessment that established the disputed
classification. The reconsideration must be based upon the
initial assessment and upon the information provided to the
commissioner under subdivisions subdivision 3 and 5. If
necessary for evaluating the reconsideration request, the
commissioner may conduct on-site reviews. At the commissioner's
discretion, the commissioner may review the reimbursement
classifications assigned to all clients in the facility. Within
15 working days after receiving the request for reconsideration,
the commissioner shall affirm or modify the original client
classification. The original classification must be modified if
the commissioner determines that the assessment resulting in the
classification did not accurately reflect the status of the
client at the time of the assessment. The client and the
intermediate care facility for the mentally retarded shall be
notified within five working days after the decision is made.
The commissioner's decision under this subdivision is the final
administrative decision of the agency.
Sec. 6. Minnesota Statutes 1994, section 144.56, is
amended by adding a subdivision to read:
Subd. 2b. [BOARDING CARE HOMES.] The commissioner shall
not adopt or enforce any rule that limits a certified boarding
care home from providing nursing services in accordance with the
home's medicaid certification.
Sec. 7. Minnesota Statutes 1994, section 144.562,
subdivision 2, is amended to read:
Subd. 2. [ELIGIBILITY FOR LICENSE CONDITION.] A hospital
is not eligible to receive a license condition for swing beds
unless (1) it either has a licensed bed capacity of less than 50
beds defined in the federal Medicare regulations, Code of
Federal Regulations, title 42, section 482.66, or it has a
licensed bed capacity of 50 beds or more and has swing beds that
were approved for Medicare reimbursement before May 1, 1985, or
it has a licensed bed capacity of less than 65 beds and, as of
the effective date, the available nursing homes within 50 miles
have had, in the aggregate, an average occupancy rates rate of
96 percent or higher in the past most recent two years as
documented on the statistical reports to the department of
health; and (2) it is located in a rural area as defined in the
federal Medicare regulations, Code of Federal Regulations, title
42, section 482.66; and (3) it agrees to utilize no more than
four hospital beds as swing beds at any one time, except that
the commissioner may approve the utilization of up to three
additional beds at the request of a hospital if. Eligible
hospitals are allowed a total of 1,460 days of swing bed use per
year, provided that no more than ten hospital beds are used as
swing beds at any one time. The commissioner of health must
approve swing bed use beyond 1,460 days as long as there are no
Medicare certified skilled nursing facility beds are available
within 25 miles of that hospital.
Sec. 8. [144.6505] [SUBACUTE CARE WAIVERS.]
Subdivision 1. [SUBACUTE CARE; WAIVER FROM STATE AND
FEDERAL RULES AND REGULATIONS.] The commissioners of health and
human services shall work with providers to examine state and
federal rules and regulations governing the provision of care in
nursing facilities and apply for federal waivers and pursue
state law changes to any impediments to the provision of
subacute care in skilled nursing facilities.
Subd. 2. [DEFINITION OF SUBACUTE CARE.] (a) For the
purpose of this section, "subacute care" means comprehensive
inpatient care, as further defined in this subdivision, designed
for persons who:
(1) have or have had an acute illness or accident, or an
acute exacerbation of a chronic illness, and who require a
moderate level of service intensity;
(2) do not require, or no longer require, technologically
intensive diagnosis or management;
(3) have concurrent medical, nursing, and discharge and/or
nondischarge oriented rehabilitation objectives that are
expected to be achieved within a specified time; and
(4) require interdisciplinary management.
(b) Subacute care includes goal-oriented treatment rendered
immediately after, as an appropriate alternative to, acute
hospitalization with the goal of transitioning patients towards
increased independence or lower acuity level in a cost-effective
environment, to treat one or more specific active complex
medical conditions or to administer one or more technically
complex treatments, in the context of a patient's underlying
long-term conditions and overall situation.
(c) Subacute care does not generally depend heavily on high
technology monitoring or complex diagnostic procedures.
(d) Subacute care requires the coordinated services of an
interdisciplinary team including physicians, nurses, and other
relevant professional disciplines, who are trained and
knowledgeable to assess and manage these specific conditions and
perform the necessary procedures.
(e) Subacute care is provided as part of a specifically
defined program.
(f) Subacute care includes more intensive care than
traditional nursing facility care and less intensive care than
acute care and may be provided at a variety of sites, including
hospitals and skilled nursing facilities.
(g) Subacute care requires recurrent patient assessment on
a daily to weekly basis and review of the clinical course and
treatment plan for a limited time period ranging from several
days to several months, until the condition is stabilized or a
predetermined treatment course is completed.
Sec. 9. Minnesota Statutes 1994, section 144A.071,
subdivision 2, is amended to read:
Subd. 2. [MORATORIUM.] The commissioner of health, in
coordination with the commissioner of human services, shall deny
each request for new licensed or certified nursing home or
certified boarding care beds except as provided in subdivision 3
or 4a, or section 144A.073. "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 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.
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 damaged by fire, lightning,
groundshifts, or other such hazards, including environmental
hazards, provided that the provisions of subdivision 4a, clause
(a), are met;
(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 1a, clause (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 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 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.
Sec. 10. Minnesota Statutes 1994, section 144A.071,
subdivision 3, is amended to read:
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 license or certify a new bed in place of one
decertified after 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. 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 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
(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; or
(d) to certify two existing beds in a facility with 66
licensed beds on January 1, 1994, that had an average occupancy
rate of 98 percent or higher in both calendar years 1992 and
1993, and which began construction of four attached assisted
living units in April 1993.
Sec. 11. Minnesota Statutes 1994, section 144A.071,
subdivision 4a, is amended to read:
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 1997;
(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;
(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;
(q) to license and certify beds in a renovation and
remodeling project to convert 13 three-bed wards into 13 two-bed
rooms and 13 single-bed rooms, expand space, and add
improvements in a nursing home that, as of January 1, 1994, met
the following conditions: the nursing home was located in
Ramsey county; was not owned by a hospital corporation; had a
licensed capacity of 64 beds; and had been ranked among the top
15 applicants by the 1993 moratorium exceptions advisory review
panel. The total project construction cost estimate for this
project must not exceed the cost estimate submitted in
connection with the 1993 moratorium exception process; or
(r) to license and certify beds in a renovation and
remodeling project to convert 12 four-bed wards into 24 two-bed
rooms, expand space, and add improvements in a nursing home
that, as of January 1, 1994, met the following conditions: the
nursing home was located in Ramsey county; had a licensed
capacity of 154 beds; and had been ranked among the top 15
applicants by the 1993 moratorium exceptions advisory review
panel. The total project construction cost estimate for this
project must not exceed the cost estimate submitted in
connection with the 1993 moratorium exception process.;
(s) to license and certify up to 117 beds that are
relocated from a licensed and certified 138-bed nursing facility
located in St. Paul to a hospital with 130 licensed hospital
beds located in South St. Paul, provided that the nursing
facility and hospital are owned by the same or a related
organization and that prior to the date the relocation is
completed the hospital ceases operation of its inpatient
hospital services at that hospital. After relocation, the
nursing facility's status under section 256B.431, subdivision 2,
shall be the same as it was prior to relocation. The nursing
facility's property-related payment rate resulting from the
project authorized in this paragraph shall become effective no
earlier than April 1, 1996. For purposes of calculating the
incremental change in the facility's rental per diem resulting
from this project, the allowable appraised value of the nursing
facility portion of the existing health care facility physical
plant prior to the renovation and relocation may not exceed
$2,490,000;
(t) to license and certify two beds in a facility to
replace beds that were voluntarily delicensed and decertified on
June 28, 1991;
(u) to allow 16 licensed and certified beds located on July
1, 1994, in a 142-bed nursing home and 21-bed boarding care home
facility in Minneapolis, notwithstanding the licensure and
certification after July 1, 1995, of the Minneapolis facility as
a 147-bed nursing home facility after completion of a
construction project approved in 1993 under section 144A.073, to
be laid away upon 30 days' prior written notice to the
commissioner. Beds on layaway status shall have the same status
as voluntarily delicensed or decertified beds except that they
shall remain subject to the surcharge in section 256.9657. The
16 beds on layaway status may be relicensed as nursing home beds
and recertified at any time within five years of the effective
date of the layaway upon relocation of some or all of the beds
to a licensed and certified facility located in Watertown,
provided that the total project construction costs related to
the relocation of beds from layaway status for the Watertown
facility 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.
The property-related payment rate of the 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 the 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 five years after the date the layaway status became
effective must be removed from layaway status and immediately
delicensed and decertified; or
(v) to license and certify beds that are moved within an
existing area of a facility or to a newly-constructed addition
which is built for the purpose of eliminating three- and
four-bed rooms and adding space for dining, lounge areas,
bathing rooms, and ancillary service areas in a nursing home
that, as of January 1, 1995, was located in Fridley and had a
licensed capacity of 129 beds.
Sec. 12. Minnesota Statutes 1994, section 144A.071, is
amended by adding a subdivision to read:
Subd. 5a. [COST ESTIMATE OF A MORATORIUM EXCEPTION
PROJECT.] (a) For the purposes of this section and section
144A.073, the cost estimate of a moratorium exception project
shall include the effects of the proposed project on the costs
of the state subsidy for community-based services, nursing
services, and housing in institutional and noninstitutional
settings. The commissioner of health, in cooperation with the
commissioner of human services, shall define the method for
estimating these costs in the permanent rule implementing
section 144A.073. The commissioner of human services shall
prepare an estimate of the total state annual long-term costs of
each moratorium exception proposal.
(b) The interest rate to be used for estimating the cost of
each moratorium exception project proposal shall be the lesser
of either the prime rate plus two percentage points, or the
posted yield for standard conventional fixed rate mortgages of
the Federal Home Loan Mortgage Corporation plus two percentage
points as published in the Wall Street Journal and in effect 56
days prior to the application deadline. If the applicant's
proposal uses this interest rate, the commissioner of human
services, in determining the facility's actual property-related
payment rate to be established upon completion of the project
must use the actual interest rate obtained by the facility for
the project's permanent financing up to the maximum permitted
under subdivision 6.
The applicant may choose an alternate interest rate for
estimating the project's cost. If the applicant makes this
election, the commissioner of human services, in determining the
facility's actual property-related payment rate to be
established upon completion of the project, must use the lesser
of the actual interest rate obtained for the project's permanent
financing or the interest rate which was used to estimate the
proposal's project cost. For succeeding rate years, the
applicant is at risk for financing costs in excess of the
interest rate selected.
Sec. 13. Minnesota Statutes 1994, section 144A.073,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITIONS.] For purposes of this
section, the following terms have the meanings given them:
(a) "Conversion" means the relocation of a nursing home bed
from a nursing home to an attached hospital.
(b) "Relocation" means the movement of licensed nursing
home beds or certified boarding care beds as permitted under
subdivision 4, clause (3), and subdivision 5.
(c) "Renovation" means extensive remodeling of, or
construction of an addition to, a facility on an existing site
with a total cost exceeding ten percent of the appraised value
of the facility or $200,000, whichever is less.
(c) (d) "Replacement" means the demolition or, delicensure,
reconstruction, or construction of an addition to all or part of
an existing facility.
(d) (e) "Upgrading" means a change in the level of
licensure of a bed from a boarding care bed to a nursing home
bed in a certified boarding care facility.
Sec. 14. Minnesota Statutes 1994, section 144A.073,
subdivision 2, is amended to read:
Subd. 2. [REQUEST FOR PROPOSALS.] At the intervals
specified in rules authorization by the legislature of
additional medical assistance expenditures for exceptions to the
moratorium on nursing homes, 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 4a, clause (c). The public notice of this
funding and the request for proposals must specify how the
approval criteria will be prioritized by the advisory review
panel, the interagency long-term care planning committee, and
the commissioner. 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 the interagency committee
shall publish a notice to that effect, and no proposals shall be
requested. If money is appropriated, the interagency committee
shall initiate the application and review process described in
this section at least twice each biennium and up to four times
each biennium, according to dates established by rule.
Authorized funds shall be allocated proportionally to the number
of processes. Funds not encumbered by an earlier process within
a biennium shall carry forward to subsequent iterations of the
process. Authorization for expenditures does not carry forward
into the following biennium. To be considered for approval, a
proposal must include the following information:
(1) whether the request is for renovation, replacement,
upgrading, or conversion, or relocation;
(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 of the nursing facility
proposal, including initial construction and remodeling costs,;
site preparation costs,; financing costs, including the current
estimated long-term financing costs of the proposal, which
consists of estimates of the amount and sources of money,
reserves if required under the proposed funding mechanism,
annual payments schedule, interest rates, length of term,
closing costs and fees, insurance costs, and any completed
marketing study or underwriting review; 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) a statement of any licensure or certification issues,
such as certification survey deficiencies;
(9) the proposed relocation plan for current residents if
beds are to be closed so that the department of human services
can estimate the total costs of a proposal; and
(10) other information required by permanent rule of the
commissioner of health in accordance with subdivisions 4 and 8.
Sec. 15. Minnesota Statutes 1994, 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 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 advisory review
panel, the committee, and the commissioner of health shall base
their recommendations, approvals, or disapprovals on a
comparison and ranking of proposals using only the criteria in
subdivision 4 and in emergency and permanent rules adopted by
the commissioner. 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 1a, paragraph (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. 16. Minnesota Statutes 1994, section 144A.073, is
amended by adding a subdivision to read:
Subd. 3c. [COST NEUTRAL RELOCATION PROJECTS.] (a)
Notwithstanding subdivision 3, the interagency committee may at
any time accept proposals, or amendments to proposals previously
approved under this section, for relocations that are cost
neutral with respect to state costs as defined in section
144A.071, subdivision 5a. The committee shall review these
applications and make recommendations to the commissioner within
90 days. The committee must evaluate proposals according to
subdivision 4, clauses (1), (2), and (3), and other criteria
established in rule. The commissioner shall approve or
disapprove a project within 30 days of receiving the committee's
recommendation. Proposals and amendments approved under this
subdivision are not subject to the six-mile limit in subdivision
5, paragraph (e).
(b) For the purposes of paragraph (a), cost neutrality
shall be measured over the first three 12-month periods of
operation after completion of the project.
Sec. 17. Minnesota Statutes 1994, section 144A.073,
subdivision 4, is amended to read:
Subd. 4. [CRITERIA FOR REVIEW.] (a) The following criteria
must shall be used in a consistent manner to compare and,
evaluate, and rank all proposals submitted. Except for the
criteria specified in clause (3), the application of criteria
listed under this subdivision shall not reflect any distinction
based on the geographic location of the proposed project:
(1) the extent to which the average occupancy rate of the
facility supports the need for the proposed project;
(2) the extent to which the average occupancy rate of all
facilities in the county in which the applicant is located,
together with all contiguous Minnesota counties, supports the
need for the proposed project;
(3) the extent to which the proposal furthers state
long-term care goals, including the goals stated in section
144A.31, and including the goal of enhancing the availability
and use of alternative care services and the goal of reducing
the number of long-term care resident rooms with more than two
beds;
(4) the cost-effectiveness of the proposal, including (2)
the proposal's long-term effects on the state costs of the
medical assistance program, as determined by the commissioner of
human services; and including the cost estimate of the project
according to section 144A.071, subdivision 5a;
(5) other factors developed in rule by the commissioner of
health that evaluate and assess how the proposed project will
further promote or protect the health, safety, comfort,
treatment, or well-being of the facility's residents.
(b) In addition to the criteria in paragraph (a), the
following criteria must be used to evaluate, compare, and rank
proposals involving renovation or replacement:
(3) the extent to which the proposal promotes equitable
access to long-term care services in nursing homes through
redistribution of the nursing home bed supply, as measured by
the number of beds relative to the population 85 or older,
projected to the year 2000 by the state demographer, and
according to items (i) to (iv):
(i) reduce beds in counties where the supply is high,
relative to the statewide mean, and increase beds in counties
where the supply is low, relative to the statewide mean;
(ii) adjust the bed supply so as to create the greatest
benefits in improving the distribution of beds;
(iii) adjust the existing bed supply in counties so that
the bed supply in a county moves toward the statewide mean; and
(iv) adjust the existing bed supply so that the
distribution of beds as projected for the year 2020 would be
consistent with projected need, based on the methodology
outlined in the interagency long-term care committee's 1993
nursing home bed distribution study;
(1) (4) the extent to which the project improves conditions
that affect the health or safety of residents, such as narrow
corridors, narrow door frames, unenclosed fire exits, and wood
frame construction, and similar provisions contained in fire and
life safety codes and licensure and certification rules;
(2) (5) the extent to which the project improves conditions
that affect the comfort or quality of life of residents in a
facility or the ability of the facility to provide efficient
care, such as a relatively high number of residents in a room;
inadequate lighting or ventilation; poor access to bathing or
toilet facilities; a lack of available ancillary space for
dining rooms, day rooms, or rooms used for other activities;
problems relating to heating, cooling, or energy efficiency;
inefficient location of nursing stations; narrow corridors; or
other provisions contained in the licensure and certification
rules;
(6) the extent to which the applicant demonstrates the
delivery of quality care, as defined in state and federal
statutes and rules, to residents as evidenced by the two most
recent state agency certification surveys and the applicants'
response to those surveys;
(7) the extent to which the project removes the need for
waivers or variances previously granted by either the licensing
agency, certifying agency, fire marshal, or local government
entity; and
(8) other factors that may be developed in permanent rule
by the commissioner of health that evaluate and assess how the
proposed project will further promote or protect the health,
safety, comfort, treatment, or well-being of the facility's
residents.
Sec. 18. Minnesota Statutes 1994, section 144A.073,
subdivision 5, is amended to read:
Subd. 5. [REPLACEMENT RESTRICTIONS.] (a) Proposals
submitted or approved under this section involving replacement
must provide for replacement of the facility on the existing
site except as allowed in this subdivision.
(b) Facilities located in a metropolitan statistical area
other than the Minneapolis-St. Paul seven-county metropolitan
area may relocate to a site within the same census tract or a
contiguous census tract.
(c) Facilities located in the Minneapolis-St. Paul
seven-county metropolitan area may relocate to a site within the
same or contiguous health planning area as adopted in March 1982
by the metropolitan council.
(d) Facilities located outside a metropolitan statistical
area may relocate to a site within the same city or township, or
within a contiguous township.
(e) A facility relocated to a different site under
paragraph (b), (c), or (d) must not be relocated to a site more
than six miles from the existing site.
(f) The relocation of part of an existing first facility to
a second location, under paragraphs (d) and (e), may include the
relocation to the second location of up to four beds from part
of an existing third facility located in a township contiguous
to the location of the first facility. The six-mile limit in
paragraph (e) does not apply to this relocation from the third
facility.
(g) For proposals approved on January 13, 1994, under this
section involving the replacement of 102 licensed and certified
beds, the relocation of the existing first facility to the
second and third locations under paragraphs (d) and (e) may
include the relocation of up to 50 percent of the beds of the
existing first facility to each of the locations. The six-mile
limit in paragraph (e) does not apply to this relocation to the
third location. Notwithstanding subdivision 3, construction of
this project may be commenced any time prior to January 1, 1996.
Sec. 19. Minnesota Statutes 1994, section 144A.073,
subdivision 8, is amended to read:
Subd. 8. [RULEMAKING.] The commissioner of health shall
adopt emergency or permanent rules to implement this
section. The permanent rules must be in accordance with and
implement only the criteria listed in this section. The
authority to adopt emergency permanent rules continues until
December 30, 1988 July 1, 1996.
Sec. 20. Minnesota Statutes 1994, section 198.003,
subdivision 3, is amended to read:
Subd. 3. [USE OF FACILITIES CAMPUS.] The board may allow
veterans organizations or public or private social service,
educational, or rehabilitation agencies or organizations and
their clients to use surplus facilities space on a home's
campus, staff, and other resources of the board and may require
the participating agencies or organizations to pay for that use.
Sec. 21. Minnesota Statutes 1994, section 198.003,
subdivision 4, is amended to read:
Subd. 4. [VETERANS HOMES RESOURCES ACCOUNT.] Money
received by the board under subdivision 3 must be deposited in
the state treasury and credited to a veterans homes resources
account in the special revenue fund. Money in the account is
appropriated to the board to operate, maintain, and repair
facilities make repairs at the campus used under subdivision 3,
and to pay including payment of associated legal fees and
expenses.
Sec. 22. Minnesota Statutes 1994, section 256B.0641,
subdivision 1, is amended to read:
Subdivision 1. [RECOVERY PROCEDURES; SOURCES.]
Notwithstanding section 256B.72 or any law or rule to the
contrary, when the commissioner or the federal government
determines that an overpayment has been made by the state to any
medical assistance vendor, the commissioner shall recover the
overpayment as follows:
(1) if the federal share of the overpayment amount is due
and owing to the federal government under federal law and
regulations, the commissioner shall recover from the medical
assistance vendor the federal share of the determined
overpayment amount paid to that provider using the schedule of
payments required by the federal government; and
(2) if the overpayment to a medical assistance vendor is
due to a retroactive adjustment made because the medical
assistance vendor's temporary payment rate was higher than the
established desk audit payment rate or because of a department
error in calculating a payment rate, the commissioner shall
recover from the medical assistance vendor the total amount of
the overpayment within 120 days after the date on which written
notice of the adjustment is sent to the medical assistance
vendor or according to a schedule of payments approved by the
commissioner; and
(3) a medical assistance vendor is liable for the
overpayment amount owed by a long-term care provider if the
vendors or their owners are under common control or ownership.
Sec. 23. Minnesota Statutes 1994, section 256B.431,
subdivision 2j, is amended to read:
Subd. 2j. [HOSPITAL-ATTACHED NURSING FACILITY STATUS.] (a)
For the purpose of setting rates under Minnesota Rules, parts
9549.0010 to 9549.0080, for rate years beginning after June 30,
1989, a hospital-attached nursing facility means a nursing
facility which meets the requirements of clauses (1) to (3):
(1) the nursing facility is recognized by the federal
Medicare program to be a hospital-based nursing facility for
purposes of being subject to higher cost limits accorded
hospital-based nursing facilities under the Medicare program,
or, prior to June 30, 1983, was classified as a
hospital-attached nursing facility under Minnesota Rules, parts
9510.0010 to 9510.0480, provided that;
(2) the nursing facility's cost report filed under
Minnesota Rules, parts 9549.0010 to 9549.0080, shall use the
same cost allocation principles and methods used in the reports
filed for the Medicare program except as provided in clause (3);
and
(3) direct identification of costs to the nursing facility
cost center will be permitted only when the comparable hospital
costs have also been directly identified to a cost center which
is not allocated to the nursing facility.
(b) For rate years beginning after June 30, 1989, a nursing
facility and hospital, which have applied for hospital-based
nursing facility status under the federal Medicare program
during the reporting year or the nine-month period following the
nursing facility's reporting year, shall be considered a
hospital-attached nursing facility for purposes of setting
payment rates under Minnesota Rules, parts 9549.0010 to
9549.0080, for the rate year following the reporting year or the
nine-month period in which the facility made its Medicare
application. The nursing facility must file its cost report or
an amended cost report for that reporting year before the
following rate year using Medicare principles and Medicare's
recommended cost allocation methods had the Medicare program's
hospital-based nursing facility status been granted to the
nursing facility. For each subsequent rate year, the nursing
facility must meet the definition requirements in paragraph
(a). If the nursing facility is denied hospital-based nursing
facility status under the Medicare program, the nursing
facility's payment rates for the rate years the nursing facility
was considered to be a hospital-attached nursing facility
pursuant to this paragraph shall be recalculated treating the
nursing facility as a non-hospital-attached nursing facility.
(c) For rate years beginning on or after July 1, 1995, a
nursing facility shall be considered a hospital attached nursing
facility for purposes of setting payment rates under Minnesota
Rules, parts 9549.0010 to 9549.0080 and this section if it meets
the requirements of paragraphs (a) and (b), and
(1) the hospital and nursing facility are physically
attached or connected by a tunnel or skyway; or
(2) the nursing facility was recognized by the Medicare
program as hospital attached as of January 1, 1995, and this
status has been maintained continuously.
Sec. 24. Minnesota Statutes 1994, 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) (e).
(a) Notwithstanding Minnesota Rules, part 9549.0060,
subpart 12, the costs of acquiring any of the following items
not included in the equity incentive computations under
subdivision 16 or reported as a capital asset addition under
subdivision 18, paragraph (b), including cash payment for equity
investment and principal and interest expense for debt
financing, shall must 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; and
(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) repair or replacement of capital assets not included in
the equity incentive computations under subdivision 16.
(b) Notwithstanding Minnesota Rules, part 9549.0060,
subpart 12, the repair or replacement of a capital asset not
included in the equity incentive computations under subdivision
16 or reported as a capital asset addition under subdivision 18,
paragraph (b), must be reported under this subdivision when the
cost of the item exceeds $500, or in the plant operations and
maintenance cost category when the cost of the item is equal to
or less than $500.
(c) 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) (d) 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) (e) 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. 25. Minnesota Statutes 1994, section 256B.431,
subdivision 17, is amended to read:
Subd. 17. [SPECIAL PROVISIONS FOR MORATORIUM EXCEPTIONS.]
(a) Notwithstanding Minnesota Rules, part 9549.0060, subpart 3,
for rate periods beginning on October 1, 1992, and for rate
years beginning after June 30, 1993, a nursing facility that (1)
has completed a construction project approved under section
144A.071, subdivision 4a, clause (m); (2) has completed a
construction project approved under section 144A.071,
subdivision 4a and effective after June 30, 1995; or (3) has
completed a renovation, replacement, or upgrading project
approved under the moratorium exception process in section
144A.073 shall be reimbursed for costs directly identified to
that project as provided in subdivision 16 and this subdivision.
(b) Notwithstanding Minnesota Rules, part 9549.0060,
subparts 5, item A, subitems (1) and (3), and 7, item D,
allowable interest expense on debt shall include:
(1) interest expense on debt related to the cost of
purchasing or replacing depreciable equipment, excluding
vehicles, not to exceed six percent of the total historical cost
of the project; and
(2) interest expense on debt related to financing or
refinancing costs, including costs related to points, loan
origination fees, financing charges, legal fees, and title
searches; and issuance costs including bond discounts, bond
counsel, underwriter's counsel, corporate counsel, printing, and
financial forecasts. Allowable debt related to items in this
clause shall not exceed seven percent of the total historical
cost of the project. To the extent these costs are financed,
the straight-line amortization of the costs in this clause is
not an allowable cost; and
(3) interest on debt incurred for the establishment of a
debt reserve fund, net of the interest earned on the debt
reserve fund.
(c) Debt incurred for costs under paragraph (b) is not
subject to Minnesota Rules, part 9549.0060, subpart 5, item A,
subitem (5) or (6).
(d) The incremental increase in a nursing facility's rental
rate, determined under Minnesota Rules, parts 9549.0010 to
9549.0080, and this section, resulting from the acquisition of
allowable capital assets, and allowable debt and interest
expense under this subdivision shall be added to its
property-related payment rate and shall be effective on the
first day of the month following the month in which the
moratorium project was completed.
(e) Notwithstanding subdivision 3f, paragraph (a), for rate
periods beginning on October 1, 1992, and for rate years
beginning after June 30, 1993, the replacement-costs-new per bed
limit to be used in Minnesota Rules, part 9549.0060, subpart 4,
item B, for a nursing facility that has completed a renovation,
replacement, or upgrading project that has been approved under
the moratorium exception process in section 144A.073, or that
has completed an addition to or replacement of buildings,
attached fixtures, or land improvements for which the total
historical cost exceeds the lesser of $150,000 or ten percent of
the most recent appraised value, must be $47,500 per licensed
bed in multiple-bed rooms and $71,250 per licensed bed in a
single-bed room. These amounts must be adjusted annually as
specified in subdivision 3f, paragraph (a), beginning January 1,
1993.
(f) A nursing facility that completes a project identified
in this subdivision and, as of April 17, 1992, has not been
mailed a rate notice with a special appraisal for a completed
project, or completes a project after April 17, 1992, but before
September 1, 1992, may elect either to request a special
reappraisal with the corresponding adjustment to the
property-related payment rate under the laws in effect on June
30, 1992, or to submit their capital asset and debt information
after that date and obtain the property-related payment rate
adjustment under this section, but not both.
(g) For purposes of this paragraph, a total replacement
means the complete replacement of the nursing facility's
physical plant through the construction of a new physical plant
or the transfer of the nursing facility's license from one
physical plant location to another. For total replacement
projects completed on or after July 1, 1992, the commissioner
shall compute the incremental change in the nursing facility's
rental per diem, for rate years beginning on or after July 1,
1995, by replacing its appraised value, including the historical
capital asset costs, and the capital debt and interest costs
with the new nursing facility's allowable capital asset costs
and the related allowable capital debt and interest costs. If
the new nursing facility has decreased its licensed capacity,
the aggregate investment per bed limit in subdivision 3a,
paragraph (d), shall apply. If the new nursing facility has
retained a portion of the original physical plant for nursing
facility usage, then a portion of the appraised value prior to
the replacement must be retained and included in the calculation
of the incremental change in the nursing facility's rental per
diem. For purposes of this part, the original nursing facility
means the nursing facility prior to the total replacement
project. The portion of the appraised value to be retained
shall be calculated according to clauses (1) to (3):
(1) The numerator of the allocation ratio shall be the
square footage of the area in the original physical plant which
is being retained for nursing facility usage.
(2) The denominator of the allocation ratio shall be the
total square footage of the original nursing facility physical
plant.
(3) Each component of the nursing facility's allowable
appraised value prior to the total replacement project shall be
multiplied by the allocation ratio developed by dividing clause
(1) by clause (2).
In the case of either type of total replacement as
authorized under section 144A.071 or 144A.073, the provisions of
this subdivision shall also apply. For purposes of the
moratorium exception authorized under section 144A.071,
subdivision 4a, paragraph (s), if the total replacement involves
the renovation and use of an existing health care facility
physical plant, the new allowable capital asset costs and
related debt and interest costs shall include first the
allowable capital asset costs and related debt and interest
costs of the renovation, to which shall be added the allowable
capital asset costs of the existing physical plant prior to the
renovation, and if reported by the facility, the related
allowable capital debt and interest costs.
Sec. 26. Minnesota Statutes 1994, section 256B.431, is
amended by adding a subdivision to read:
Subd. 25. [CHANGES TO NURSING FACILITY REIMBURSEMENT
BEGINNING JULY 1, 1995.] The nursing facility reimbursement
changes in paragraphs (a) to (g) shall apply in the sequence
specified to Minnesota Rules, parts 9549.0010 to 9549.0080, and
this section, beginning July 1, 1995.
(a) The eight-cent adjustment to care-related rates in
subdivision 22, paragraph (e), shall no longer apply.
(b) For rate years beginning on or after July 1, 1995, the
commissioner shall limit a nursing facility's allowable
operating per diem for each case mix category for each rate year
as in clauses (1) to (3).
(1) For the rate year beginning July 1, 1995, the
commissioner shall group nursing facilities into two groups,
freestanding and nonfreestanding, within each geographic group,
using their operating cost per diem for the case mix A
classification. A nonfreestanding nursing facility is a nursing
facility whose other operating cost per diem is subject to the
hospital attached, short length of stay, or the rule 80 limits.
All other nursing facilities shall be considered freestanding
nursing facilities. The commissioner shall then array all
nursing facilities in each grouping by their allowable case mix
A operating cost per diem. In calculating a nursing facility's
operating cost per diem for this purpose, the commissioner shall
exclude the raw food cost per diem related to providing special
diets that are based on religious beliefs, as determined in
subdivision 2b, paragraph (h). For those nursing facilities in
each grouping whose case mix A operating cost per diem:
(i) is at or below the median minus 1.0 standard deviation
of the array, the commissioner shall limit the nursing
facility's allowable operating cost per diem for each case mix
category to the lesser of the prior reporting year's allowable
operating cost per diems plus the inflation factor as
established in paragraph (f), clause (2), increased by six
percentage points, or the current reporting year's corresponding
allowable operating cost per diem;
(ii) is between minus .5 standard deviation and minus 1.0
standard deviation below the median of the array, the
commissioner shall limit the nursing facility's allowable
operating cost per diem for each case mix category to the lesser
of the prior reporting year's allowable operating cost per diems
plus the inflation factor as established in paragraph (f),
clause (2), increased by four percentage points, or the current
reporting year's corresponding allowable operating cost per
diem; or
(iii) is equal to or above minus .5 standard deviation
below the median of the array, the commissioner shall limit the
nursing facility's allowable operating cost per diem for each
case mix category to the lesser of the prior reporting year's
allowable operating cost per diems plus the inflation factor as
established in paragraph (f), clause (2), increased by three
percentage points, or the current reporting year's corresponding
allowable operating cost per diem.
(2) For the rate year beginning on July 1, 1996, the
commissioner shall limit the nursing facility's allowable
operating cost per diem for each case mix category to the lesser
of the prior reporting year's allowable operating cost per diems
plus the inflation factor as established in paragraph (f),
clause (2), increased by one percentage point or the current
reporting year's corresponding allowable operating cost per
diems; and
(3) For rate years beginning on or after July 1, 1997, the
commissioner shall limit the nursing facility's allowable
operating cost per diem for each case mix category to the lesser
of the reporting year prior to the current reporting year's
allowable operating cost per diems plus the inflation factor as
established in paragraph (f), clause (2), or the current
reporting year's corresponding allowable operating cost per
diems.
(c) For rate years beginning on July 1, 1995, the
commissioner shall limit the allowable operating cost per diems
for high cost nursing facilities. After application of the
limits in paragraph (b) to each nursing facility's operating
cost per diems, the commissioner shall group nursing facilities
into two groups, freestanding or nonfreestanding, within each
geographic group. A nonfreestanding nursing facility is a
nursing facility whose other operating cost per diems are
subject to hospital attached, short length of stay, or rule 80
limits. All other nursing facilities shall be considered
freestanding nursing facilities. The commissioner shall then
array all nursing facilities within each grouping by their
allowable case mix A operating cost per diems. In calculating a
nursing facility's operating cost per diem for this purpose, the
commissioner shall exclude the raw food cost per diem related to
providing special diets that are based on religious beliefs, as
determined in subdivision 2b, paragraph (h). For those nursing
facilities in each grouping whose case mix A operating cost per
diem exceeds 1.0 standard deviation above the median, the
commissioner shall reduce their allowable operating cost per
diems by two percent. For those nursing facilities in each
grouping whose case mix A operating cost per diem exceeds 0.5
standard deviation above the median but is less than or equal to
1.0 standard deviation above the median, the commissioner shall
reduce their allowable operating cost per diems by one percent.
(d) For rate years beginning on or after July 1, 1996, the
commissioner shall limit the allowable operating cost per diems
for high cost nursing facilities. After application of the
limits in paragraph (b) to each nursing facility's operating
cost per diems, the commissioner shall group nursing facilities
into two groups, freestanding or nonfreestanding, within each
geographic group. A nonfreestanding nursing facility is a
nursing facility whose other operating cost per diems are
subject to hospital attached, short length of stay, or rule 80
limits. All other nursing facilities shall be considered
freestanding nursing facilities. The commissioner shall then
array all nursing facilities within each grouping by their
allowable case mix A operating cost per diems. In calculating a
nursing facility's operating cost per diem for this purpose, the
commissioner shall exclude the raw food cost per diem related to
providing special diets that are based on religious beliefs, as
determined in subdivision 2b, paragraph (h). In those nursing
facilities in each grouping whose case mix A operating cost per
diem exceeds 1.0 standard deviation above the median, the
commissioner shall reduce their allowable operating cost per
diems by three percent. For those nursing facilities in each
grouping whose case mix A operating cost per diem exceeds 0.5
standard deviation above the median but is less than or equal to
1.0 standard deviation above the median, the commissioner shall
reduce their allowable operating cost per diems by two percent.
(e) For rate years beginning on or after July 1, 1995, the
commissioner shall determine a nursing facility's efficiency
incentive by first computing the allowable difference, which is
the lesser of $4.50 or 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
compute the efficiency incentive by:
(1) subtracting the allowable difference from $4.50 and
dividing the result by $4.50;
(2) multiplying 0.20 by the ratio resulting from clause
(1), and then;
(3) adding 0.50 to the result from clause (2); and
(4) multiplying the result from clause (3) times the
allowable difference.
The nursing facility's efficiency incentive payment shall
be the lesser of $2.25 or the product obtained in clause (4).
(f) For rate years beginning on or after July 1, 1995, the
forecasted price index for a nursing facility's allowable
operating cost per diems shall be determined under clause (1) to
(3) using the change in the Consumer Price Index-All Items
(United States city average) (CPI-U) or the change in the
Nursing Home Market Basket, both as forecasted by Data Resources
Inc. whichever is applicable. The commissioner shall use the
indices as forecasted in the fourth quarter of the calendar year
preceding the rate year, subject to subdivision 2l, paragraph
(c). If, as a result of federal legislative or administrative
action, the methodology used to calculate the Consumer Price
Index-All Items (United States city average) (CPI-U) changes,
the commissioner shall develop a conversion factor or other
methodology to convert the CPI-U index factor that results from
the new methodology to an index factor that approximates, as
closely as possible, the index factor that would have resulted
from application of the original CPI-U methodology prior to any
changes in methodology. The commissioner shall use the
conversion factor or other methodology to calculate an adjusted
inflation index. The adjusted inflation index must be used to
calculate payment rates under this section instead of the CPI-U
index specified in paragraph (d). If the commissioner is
required to develop an adjusted inflation index, the
commissioner shall report to the legislature as part of the next
budget submission the fiscal impact of applying this index.
(1) The CPI-U forecasted index for allowable operating cost
per diems shall be based on the 21-month period from the
midpoint of the nursing facility's reporting year to the
midpoint of the rate year following the reporting year.
(2) The Nursing Home Market Basket forecasted index for
allowable operating costs and per diem limits shall be based on
the 12-month period between the midpoints of the two reporting
years preceding the rate year.
(3) For rate years beginning on or after July 1, 1996, the
forecasted index for operating cost limits referred to in
subdivision 21, paragraph (b), shall be based on the CPI-U for
the 12-month period between the midpoints of the two reporting
years preceding the rate year.
(g) After applying these provisions for the respective rate
years, the commissioner shall index these allowable operating
costs per diems by the inflation factor provided for in
paragraph (f), clause (1), and add the nursing facility's
efficiency incentive as computed in paragraph (e).
Sec. 27. Minnesota Statutes 1994, section 256B.432,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITIONS.] For purposes of this
section, the following terms have the meanings given them.
(a) "Management agreement" means an agreement in which one
or more of the following criteria exist:
(1) the central, affiliated, or corporate office has or is
authorized to assume day-to-day operational control of the
long-term care nursing facility for any six-month period within
a 24-month period. "Day-to-day operational control" means that
the central, affiliated, or corporate office has the authority
to require, mandate, direct, or compel the employees of the
long-term care nursing facility to perform or refrain from
performing certain acts, or to supplant or take the place of the
top management of the long-term care nursing facility.
"Day-to-day operational control" includes the authority to hire
or terminate employees or to provide an employee of the central,
affiliated, or corporate office to serve as administrator of the
long-term care nursing facility;
(2) the central, affiliated, or corporate office performs
or is authorized to perform two or more of the following: the
execution of contracts; authorization of purchase orders;
signature authority for checks, notes, or other financial
instruments; requiring the long-term care nursing facility to
use the group or volume purchasing services of the central,
affiliated, or corporate office; or the authority to make annual
capital expenditures for the long-term care nursing facility
exceeding $50,000, or $500 per licensed bed, whichever is less,
without first securing the approval of the long-term care
nursing facility board of directors;
(3) the central, affiliated, or corporate office becomes or
is required to become the licensee under applicable state law;
(4) the agreement provides that the compensation for
services provided under the agreement is directly related to any
profits made by the long-term care nursing facility; or
(5) the long-term care nursing facility entering into the
agreement is governed by a governing body that meets fewer than
four times a year, that does not publish notice of its meetings,
or that does not keep formal records of its proceedings.
(b) "Consulting agreement" means any agreement the purpose
of which is for a central, affiliated, or corporate office to
advise, counsel, recommend, or suggest to the owner or operator
of the nonrelated long-term care nursing facility measures and
methods for improving the operations of the long-term care
nursing facility.
(c) "Long-term care Nursing facility" means a nursing
facility whose medical assistance rates are determined according
to section 256B.431 or an intermediate care facility for persons
with mental retardation and related conditions whose medical
assistance rates are determined according to section 256B.501.
Sec. 28. Minnesota Statutes 1994, section 256B.432,
subdivision 2, is amended to read:
Subd. 2. [EFFECTIVE DATE.] For rate years beginning on or
after July 1, 1990, the central, affiliated, or corporate office
cost allocations in subdivisions 3 to 6 must be used when
determining medical assistance rates under sections 256B.431 and
256B.501 256B.50.
Sec. 29. Minnesota Statutes 1994, section 256B.432,
subdivision 3, is amended to read:
Subd. 3. [ALLOCATION; DIRECT IDENTIFICATION OF COSTS OF
LONG-TERM CARE NURSING FACILITIES; MANAGEMENT AGREEMENT.] All
costs that can be directly identified with a specific long-term
care nursing facility that is a related organization to the
central, affiliated, or corporate office, or that is controlled
by the central, affiliated, or corporate office under a
management agreement, must be allocated to that long-term care
nursing facility.
Sec. 30. Minnesota Statutes 1994, 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 nursing facility operations
and the other activities or facilities unrelated to
the long-term care nursing facility operations based on the
ratio of 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 nursing 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 nursing facility;
(2) for a central, affiliated, or corporate office
providing goods or services to related organizations that are
not long-term care nursing 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 nonnursing
facility related organizations;
(3) for a central, affiliated, or corporate office
providing goods or services to unrelated long-term care nursing
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 nursing 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. 31. Minnesota Statutes 1994, section 256B.432,
subdivision 6, is amended to read:
Subd. 6. [COST ALLOCATION BETWEEN LONG-TERM CARE NURSING
FACILITIES.] (a) Those long-term care nursing operations that
have long-term care nursing facilities both in Minnesota and
comparable facilities outside of Minnesota must allocate
the long-term care nursing operation's central, affiliated, or
corporate office costs identified in subdivision 5 to Minnesota
based on the ratio of total resident days in Minnesota long-term
care nursing facilities to the total resident days in all
facilities.
(b) The Minnesota long-term care nursing operation's
central, affiliated, or corporate office costs identified in
paragraph (a) must be allocated to each Minnesota long-term care
nursing facility on the basis of resident days.
Sec. 32. [256B.434] [CONTRACTUAL ALTERNATIVE PAYMENT
DEMONSTRATION PROJECT FOR NURSING HOMES.]
Subdivision 1. [ALTERNATIVE PAYMENT DEMONSTRATION PROJECT
ESTABLISHED.] The commissioner of human services shall establish
a contractual alternative payment demonstration project for
paying for nursing facility services under the medical
assistance program. A nursing facility may apply to be paid
under the contractual alternative payment demonstration project
instead of the cost-based payment system established under
section 256B.431. A nursing facility electing to use the
alternative payment demonstration project must enter into a
contract with the commissioner. Payment rates and procedures
for facilities electing to use the alternative payment
demonstration project are determined and governed by this
section and by the terms of the contract. The commissioner may
negotiate different contract terms for different nursing
facilities.
Subd. 2. [REQUESTS FOR PROPOSALS.] (a) No later than
August 1, 1995, the commissioner shall publish in the State
Register a request for proposals to provide nursing facility
services according to this section. The commissioner shall
issue two additional requests for proposals prior to July 1,
1997, based upon a timetable established by the commissioner.
The commissioner must respond to all proposals in a timely
manner.
(b) The commissioner may reject any proposal if, in the
judgment of the commissioner, a contract with a particular
facility is not in the best interests of the residents of the
facility or the state of Minnesota. The commissioner may accept
up to the number of proposals that can be adequately supported
with available state resources, as determined by the
commissioner, except that the commissioner shall not contract
with more than 40 nursing facilities as part of any request for
proposals. The commissioner may accept proposals from a single
nursing facility or from a group of facilities through a
managing entity. The commissioner shall seek to ensure that
nursing facilities under contract are located in all geographic
areas of the state. The commissioner shall present
recommendations to the legislature by February 1, 1996, on the
number of nursing facility contracts that may be entered into by
the commissioner as a result of a request for proposals.
(c) In issuing the request for proposals, the commissioner
may develop reasonable requirements which, in the judgment of
the commissioner, are necessary to protect residents or ensure
that the contractual alternative payment demonstration project
furthers the interest of the state of Minnesota. The request
for proposals may include, but need not be limited to, the
following:
(1) a requirement that a nursing facility make reasonable
efforts to maximize Medicare payments on behalf of eligible
residents;
(2) requirements designed to prevent inappropriate or
illegal discrimination against residents enrolled in the medical
assistance program as compared to private paying residents;
(3) requirements designed to ensure that admissions to a
nursing facility are appropriate and that reasonable efforts are
made to place residents in home and community-based settings
when appropriate;
(4) a requirement to agree to participate in a project to
develop data collection systems and outcome-based standards for
managed care contracting for long-term care services. Among
other requirements specified by the commissioner, each facility
entering into a contract may be required to pay an annual fee in
an amount determined by the commissioner not to exceed $50 per
bed. Revenue generated from the fees is appropriated to the
commissioner and must be used to contract with a qualified
consultant or contractor to develop data collection systems and
outcome-based contracting standards;
(5) a requirement that contractors agree to maintain
Medicare cost reports and to submit them to the commissioner
upon request or at times specified by the commissioner;
(6) a requirement for demonstrated willingness and ability
to develop and maintain data collection and retrieval systems to
be used in measuring outcomes; and
(7) a requirement to provide all information and assurances
required by the terms and conditions of the federal waiver or
federal approval.
(d) In addition to the information and assurances contained
in the submitted proposals, the commissioner may consider the
following in determining whether to accept or deny a proposal:
(1) the facility's history of compliance with federal and
state laws and rules;
(2) whether the facility has a record of excessive
licensure fines or sanctions or fraudulent cost reports;
(3) financial history and solvency; and
(4) other factors identified by the commissioner that the
commissioner deems relevant to a determination that a contract
with a particular facility is not in the best interests of the
residents of the facility or the state of Minnesota.
(e) If the commissioner rejects the proposal of a nursing
facility, the commissioner shall provide written notice to the
facility of the reason for the rejection, including the factors
and evidence upon which the rejection was based.
Subd. 3. [DURATION AND TERMINATION OF CONTRACTS.] (a)
Subject to available resources, the commissioner may begin to
execute contracts with nursing facilities November 1, 1995.
(b) All contracts entered into under this section are for a
term of four years. Either party may terminate a contract
effective July 1 of any year by providing written notice to the
other party no later than April 1 of that year. If neither
party provides written notice of termination by April 1, the
contract is automatically renewed for the next rate year. The
parties may voluntarily renegotiate the terms of the contract at
any time by mutual agreement.
(c) If a nursing facility fails to comply with the terms of
a contract, the commissioner shall provide reasonable notice
regarding the breach of contract and a reasonable opportunity
for the facility to come into compliance. If the facility fails
to come into compliance or to remain in compliance, the
commissioner may terminate the contract. If a contract is
terminated, the contract payment remains in effect for the
remainder of the rate year in which the contract was terminated,
but in all other respects the provisions of this section do not
apply to that facility effective the date the contract is
terminated. The contract shall contain a provision governing
the transition back to the cost-based reimbursement system
established under section 256B.431, subdivision 25, and
Minnesota Rules, parts 9549.0010 to 9549.0080. A contract
entered into under this section may be amended by mutual
agreement of the parties.
Subd. 4. [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For
nursing facilities which have their payment rates determined
under this section rather than section 256B.431, subdivision 25,
the commissioner shall establish a rate under this subdivision.
The nursing facility must enter into a written contract with the
commissioner.
(b) A nursing facility's case mix payment rate for the
first rate year of a facility's contract under this section is
the payment rate the facility would have received under section
256B.431, subdivision 25.
(c) A nursing facility's case mix payment rates for the
second and subsequent years of a facility's contract under this
section are the previous rate year's contract payment rates plus
an inflation adjustment. The index for the inflation adjustment
must be based on the change in the Consumer Price Index-All
Items (United States City average) (CPI-U) forecasted by Data
Resources, Inc., as forecasted in the fourth quarter of the
calendar year preceding the rate year. The inflation adjustment
must be based on the 12-month period from the midpoint of the
previous rate year to the midpoint of the rate year for which
the rate is being determined.
(d) The commissioner may develop additional incentive-based
payments of up to five percent above the standard contract rate
for achieving outcomes specified in each contract. The
incentive system may be implemented for contract rate years
beginning on or after July 1, 1996. The specified outcomes must
be measurable and must be based on criteria to be developed by
the commissioner. The commissioner may establish, for each
contract, various levels of achievement within an outcome.
After the outcomes have been specified the commissioner shall
assign various levels of payment associated with achieving the
outcome. Any incentive-based payment cancels if there is a
termination of the contract. In establishing the specified
outcomes and related criteria the commissioner shall consider
the following state policy objectives:
(1) improved cost effectiveness and quality of life as
measured by improved clinical outcomes;
(2) successful diversion or discharge to community
alternatives;
(3) decreased acute care costs;
(4) improved consumer satisfaction;
(5) the achievement of quality; or
(6) any additional outcomes the commissioner finds
desirable.
Subd. 5. [PRIVATE PAY RATES.] (a) Notwithstanding section
256B.48, subdivision 1, paragraph (a), the commissioner shall
determine the maximum private pay case mix payment rates for
nursing facilities that have entered into an alternative payment
demonstration contract under this section as specified in this
subdivision. Nothing in this section shall limit the exceptions
for private pay rates authorized under section 256B.48,
subdivision 1, paragraph (a).
(b) The maximum private pay rate for short-stay private
paying residents who are discharged from the facility less than
101 days after admission is an amount equal to the greater of
the Medicare payment rate for that facility or the resident's
medical assistance case mix payment rate. For the first year of
an alternative payment demonstration project contract the
commissioner shall establish a maximum private paying rate for
short-stay residents that is based on a nursing facility's
estimated Medicare payment rate. When actual Medicare final
rates are determined, the nursing facility shall retroactively
adjust a private paying resident's rates and provide a refund or
credit if the amount actually paid by the resident exceeds the
amount that would have been paid using Medicare rates.
(c) When a private paying resident is admitted, a nursing
facility shall determine, based on the resident's care plan,
whether the resident is likely to be discharged less than 101
days after admission. If the resident is likely to be
discharged less than 101 days after admission, the nursing
facility may charge a short-stay private pay rate up to the
maximum specified in paragraph (b). If the resident remains in
the facility for longer than 100 days, the facility shall
retroactively reduce the resident's payments to the maximum
long-term rate specified in subdivision 4 effective from the
date of admission and shall reimburse the resident for the
overpayment. At the resident's option, the facility may
reimburse residents for overpayments by providing a refund or a
credit to be applied to future payments, or a combination of
both, subject to the facility's right to offset for past-due
payments. If the facility determines, based on the care plan,
that the resident is likely to remain in the facility for longer
than 100 days, the facility shall not charge a private pay rate
greater than the maximum rate specified in subdivision 4.
(d) The provisions of paragraphs (b) and (c) do not apply
to short-stay residents admitted prior to the effective date of
a demonstration project contract.
Subd. 6. [CONTRACT PAYMENT RATES; APPEALS.] If an appeal
is pending concerning the cost-based payment rates that are the
basis for the calculation of the payment rate under the
alternative payment demonstration project, the commissioner and
the nursing facility may agree on an interim contract rate to be
used until the appeal is resolved. When the appeal is resolved,
the contract rate must be adjusted retroactively in accordance
with the appeal decision.
Subd. 7. [CASE MIX ASSESSMENTS.] The commissioner may
allow a contract facility to develop and implement a case mix
assessment using the federal minimum data set resident
assessment.
Subd. 8. [OPTIONAL HIGHER PAYMENTS FOR FIRST 100
DAYS.] The commissioner may include in the contract with a
nursing facility under this section a higher rate for the first
100 days after admission than for subsequent days. The rate for
the subsequent days must be reduced so that the estimated total
cost to the medical assistance program will not exceed the
estimated cost without the differential payment rates.
Subd. 9. [MANAGED CARE CONTRACTS FOR OTHER
SERVICES.] Beginning July 1, 1995, the commissioner may contract
with nursing facilities that have entered into alternative
payment demonstration project contracts under this section to
provide medical assistance services other than nursing facility
care to residents of the facility under a prepaid, managed care
payment system. For purposes of contracts entered into under
this subdivision, the commissioner may waive one or more of the
requirements for payment for ancillary services in section
256B.433. Managed care contracts for other services may be
entered into at any time during the duration of a nursing
facility's alternative payment demonstration project contract,
and the terms of the managed care contracts need not coincide
with the terms of the alternative payment demonstration project
contract.
Subd. 10. [EXEMPTIONS.] (a) To the extent permitted by
federal law, (1) a facility that has entered into a contract
under this section is not required to file a cost report, as
defined in Minnesota Rules, part 9549.0020, subpart 13, for any
year after the base year that is the basis for the calculation
of the contract payment rate for the first rate year of the
alternative payment demonstration project contract; and (2) a
facility under contract is not subject to audits of historical
costs or revenues, or paybacks or retroactive adjustments based
on these costs or revenues, except audits, paybacks, or
adjustments relating to the cost report that is the basis for
calculation of the first rate year under the contract.
(b) A facility that is under contract with the commissioner
under this section is not subject to the moratorium on licensure
or certification of new nursing home beds in section 144A.071,
unless the project results in a net increase in bed capacity or
involves relocation of beds from one site to another. Contract
payment rates must not be adjusted to reflect any additional
costs that a nursing facility incurs as a result of a
construction project undertaken under this paragraph. In
addition, as a condition of entering into a contract under this
section, a nursing facility must agree that any future medical
assistance payments for nursing facility services will not
reflect any additional costs attributable to the sale of a
nursing facility under this section and to construction
undertaken under this paragraph that otherwise would not be
authorized under the moratorium in sections 144A.071 and
144A.073. Nothing in this section prevents a nursing facility
participating in the alternative payment demonstration project
under this section from seeking approval of an exception to the
moratorium through the process established in section 144A.071,
and if approved the facility's rates shall be adjusted to
reflect the cost of the project.
(c) Notwithstanding section 256B.48, subdivision 6,
paragraphs (c), (d), and (e), and pursuant to any terms and
conditions contained in the facility's contract, a nursing
facility that is under contract with the commissioner under this
section is in compliance with section 256B.48, subdivision 6,
paragraph (b), if the facility is Medicare certified.
(d) Notwithstanding paragraph (a), if by April 1, 1996, the
health care financing administration has not approved a required
waiver, or the health care financing administration otherwise
requires cost reports to be filed prior to the waiver's
approval, the commissioner shall require a cost report for the
rate year.
Subd. 11. [CONSUMER PROTECTION.] As a condition of
entering into a contract under this section, a nursing facility
must agree to establish resident grievance procedures that are
similar to those required under section 256.045, subdivision 3.
The commissioner may also require nursing facilities to
establish expedited grievance procedures to resolve complaints
made by short-stay residents. The facility must notify its
resident council of its intent to enter into a contract and must
consult with the council regarding any changes in operation
expected as a result of the contract.
Subd. 12. [CONTRACTS ARE VOLUNTARY.] Participation of
nursing facilities in the alternative payment demonstration
project is voluntary. The terms and procedures governing the
alternative payment demonstration project are determined under
this section and through negotiations between the commissioner
and nursing facilities that have submitted a letter of intent to
participate in the alternative demonstration project. For
purposes of developing requests for proposals and contract
requirements, and negotiating the terms, conditions, and
requirements of contracts the commissioner is exempt from the
rulemaking requirements in chapter 14.
Subd. 13. [PAYMENT SYSTEM REFORM ADVISORY COMMITTEE.] (a)
The commissioner, in consultation with an advisory committee,
shall study options for reforming the regulatory and
reimbursement system for nursing facilities to reduce the level
of regulation, reporting, and procedural requirements, and to
provide greater flexibility and incentives to stimulate
competition and innovation. The advisory committee shall
include, at a minimum, representatives from the long-term care
provider community, the department of health, and consumers of
long-term care services. The advisory committee sunsets on June
30, 1997. Among other things, the commissioner shall consider
the feasibility and desirability of changing from a
certification requirement to an accreditation requirement for
participation in the medical assistance program, options to
encourage early discharge of short-term residents through the
provision of intensive therapy, and further modifications needed
in rate equalization. The commissioner shall also include
detailed recommendations for a permanent managed care payment
system to replace the contractual alternative payment
demonstration project authorized under this section. The
commissioner shall submit a report with findings and
recommendations to the legislature by January 15, 1997.
(b) If a permanent managed care payment system has not been
enacted into law by July 1, 1997, the commissioner shall develop
and implement a transition plan to enable nursing facilities
under contract with the commissioner under this section to
revert to the cost-based payment system at the expiration of the
alternative payment demonstration project. The commissioner
shall include in the alternative payment demonstration project
contracts entered into under this section a provision to permit
an amendment to the contract to be made after July 1, 1997,
governing the transition back to the cost-based payment system.
The transition plan and contract amendments are not subject to
rulemaking requirements.
Subd. 14. [FEDERAL REQUIREMENTS.] The commissioner shall
implement the contractual alternative payment demonstration
project subject to any required federal waivers or approval and
in a manner that is consistent with federal requirements. If a
provision of this section is inconsistent with a federal
requirement the federal requirement supersedes the inconsistent
provision. The commissioner shall seek federal approval and
request waivers as necessary to implement this section.
Subd. 15. [EXTERNAL REVIEW PANEL.] The commissioner may
establish an external review panel consisting of persons
appointed by the commissioner for their expertise on issues
relating to nursing facility services, quality, payment systems,
and other matters, to advise the commissioner on the development
and implementation of the contractual alternative payment
demonstration project and to assist the commissioner in
assessing the quality of care provided and evaluating a
facility's compliance with performance standards specified in a
contract. The external review panel must include, among other
members, representatives of nursing facilities.
Subd. 16. [ALTERNATIVE CONTRACTS.] The commissioner may
also contract with nursing facilities in other ways through
requests for proposals, including contracts on a risk or nonrisk
basis, with nursing facilities or consortia of nursing
facilities, to provide comprehensive long-term care coverage on
a premium or capitated basis.
Subd. 17. [REPORT.] The commissioner shall report to the
legislature by January 15, 1997, regarding the impact of the
alternative payment demonstration project. In assessing the
impact, the commissioner may examine elements of the project
including consumer satisfaction, quality of care, adequacy of
services, timeliness in the delivery of services, and other
elements determined appropriate by the commissioner. In
developing this report, the commissioner may involve appropriate
consumer advocate groups as needed to assist in monitoring and
evaluating changes in a nursing facility's behavior, including
the monitoring and evaluation of issues involving resident
protection. The report must include recommendations for
reimbursement of nursing homes after June 30, 1997, based on
experience with the demonstration project.
Sec. 33. Minnesota Statutes 1994, section 256B.501,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITIONS.] For the purposes of this
section, the following terms have the meaning given them.
(a) "Commissioner" means the commissioner of human services.
(b) "Facility" means a facility licensed as a mental
retardation residential facility under section 252.28, licensed
as a supervised living facility under chapter 144, and certified
as an intermediate care facility for persons with mental
retardation or related conditions. The term does not include a
state regional treatment center.
(c) "Waivered service" means home or community-based
service authorized under United States Code, title 42, section
1396n(c), as amended through December 31, 1987, and defined in
the Minnesota state plan for the provision of medical assistance
services. Waivered services include, at a minimum, case
management, family training and support, developmental training
homes, supervised living arrangements, semi-independent living
services, respite care, and training and habilitation services.
Sec. 34. Minnesota Statutes 1994, section 256B.501,
subdivision 3, is amended to read:
Subd. 3. [RATES FOR INTERMEDIATE CARE FACILITIES FOR
PERSONS WITH MENTAL RETARDATION OR RELATED CONDITIONS.] The
commissioner shall establish, by rule, procedures for
determining rates for care of residents of intermediate care
facilities for persons with mental retardation or related
conditions. The procedures shall 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 residents in
efficiently and economically operated facilities. In developing
the procedures, the commissioner shall include:
(a) cost containment measures that assure efficient and
prudent management of capital assets and operating cost
increases which do not exceed increases in other sections of the
economy;
(b) limits on the amounts of reimbursement for property,
general and administration, and new facilities;
(c) requirements to ensure that the accounting practices of
the facilities conform to generally accepted accounting
principles;
(d) incentives to reward accumulation of equity;
(e) a revaluation on sale between unrelated organizations
for a facility that, for at least three years before its use as
an intermediate care facility, has been used by the seller as a
single family home and been claimed by the seller as a
homestead, and was not revalued immediately prior to or upon
entering the medical assistance program, provided that the
facility revaluation not exceed the amount permitted by the
Social Security Act, section 1902(a)(13); and rule revisions
which:
(1) combine the program, maintenance, and administrative
operating cost categories, and professional liability and real
estate insurance expenses into one general operating cost
category;
(2) eliminate the maintenance and administrative operating
cost category limits and account for disallowances under the
rule existing on the effective date of this section in the
revised rule. If this provision is later invalidated, the total
administrative cost disallowance shall be deducted from
economical facility payments in clause (3);
(3) establish an economical facility incentive that rewards
facilities that provide all appropriate services in a
cost-effective manner and penalizes reductions of either direct
service wages or standardized hours of care per resident;
(4) establish a best practices award system that is based
on outcome measures and that rewards quality, innovation, cost
effectiveness, and staff retention;
(5) establish compensation limits for employees on the
basis of full-time employment and the developmentally disabled
client base of a provider group or facility. The commissioner
may consider the inclusion of hold harmless provisions;
(6) establish overall limits on a high cost facility's
general operating costs. The commissioner shall consider
groupings of facilities that account for a significant variation
in cost. The commissioner may differentiate in the application
of these limits between high and very high cost facilities. The
limits, once established, shall be indexed for inflation and may
be rebased by the commissioner;
(7) utilize the client assessment information obtained from
the application of the provisions in subdivision 3g for the
revisions in clauses (3), (4), and (6); and
(8) develop cost allocation principles which are based on
facility expenses; and
(f) appeals procedures that satisfy the requirements of
section 256B.50 for appeals of decisions arising from the
application of standards or methods pursuant to Minnesota Rules,
parts 9510.0500 to 9510.0890, 9553.0010 to 9553.0080, and 12
MCAR 2.05301 to 2.05315 (temporary).
In establishing rules and procedures for setting rates for
care of residents in intermediate care facilities for persons
with mental retardation or related conditions, the commissioner
shall consider the recommendations contained in the February 11,
1983, Report of the Legislative Auditor on Community Residential
Programs for the Mentally Retarded and the recommendations
contained in the 1982 Report of the Department of Public Welfare
Rule 52 Task Force. Rates paid to supervised living facilities
for rate years beginning during the fiscal biennium ending June
30, 1985, shall not exceed the final rate allowed the facility
for the previous rate year by more than five percent.
Sec. 35. Minnesota Statutes 1994, section 256B.501,
subdivision 3c, is amended to read:
Subd. 3c. [COMPOSITE FORECASTED INDEX.] For rate years
beginning on or after October 1, 1988, the commissioner shall
establish a statewide composite forecasted index to take into
account economic trends and conditions between the midpoint of
the facility's reporting year and the midpoint of the rate year
following the reporting year. The statewide composite index
must incorporate the forecast by Data Resources, Inc. of
increases in the average hourly earnings of nursing and personal
care workers indexed in Standard Industrial Code 805 in
"Employment and Earnings," published by the Bureau of Labor
Statistics, United States Department of Labor. This portion of
the index must be weighted annually by the proportion of total
allowable salaries and wages to the total allowable operating
costs in the program, maintenance, and administrative operating
cost categories for all facilities.
For adjustments to the other operating costs in the
program, maintenance, and administrative operating cost
categories, the statewide index must incorporate the Data
Resources, Inc. forecast for increases in the national CPI-U.
This portion of the index must be weighted annually by the
proportion of total allowable other operating costs to the total
allowable operating costs in the program, maintenance, and
administrative operating cost categories for all facilities.
The commissioner shall use the indices as forecasted by Data
Resources, Inc., in the fourth quarter of the reporting year.
For rate years beginning on or after October 1, 1990, the
commissioner shall index a facility's allowable operating costs
in the program, maintenance, and administrative operating cost
categories by using Data Resources, Inc., forecast for change in
the Consumer Price Index-All Items (U.S. city average) (CPI-U).
The commissioner shall use the indices as forecasted by Data
Resources, Inc., in the first quarter of the calendar year in
which the rate year begins. For fiscal years beginning after
June 30, 1993, the commissioner shall not provide automatic
inflation adjustments for intermediate care facilities for
persons with mental retardation. The commissioner of finance
shall include annual inflation adjustments in operating costs
for intermediate care facilities for persons with mental
retardation and related conditions as a budget change request in
each biennial detailed expenditure budget submitted to the
legislature under section 16A.11. The commissioner shall use
the Consumer Price Index-All Items (United States city average)
(CPI-U) as forecasted by Data Resources, Inc., to take into
account economic trends and conditions for changes in facility
allowable historical general operating costs and limits. The
forecasted index shall be established for allowable historical
general operating costs as follows:
(1) the CPI-U forecasted index for allowable historical
general operating costs shall be determined in the first quarter
of the calendar year in which the rate year begins, and shall be
based on the 21-month period from the midpoint of the facility's
reporting year to the midpoint of the rate year following the
reporting year; and
(2) for rate years beginning on or after October 1, 1995,
the CPI-U forecasted index for the overall operating cost limits
and for the individual compensation limit shall be determined in
the first quarter of the calendar year in which the rate year
begins, and shall be based on the 12-month period between the
midpoints of the two reporting years preceding the rate year.
Sec. 36. Minnesota Statutes 1994, section 256B.501,
subdivision 3g, is amended to read:
Subd. 3g. [ASSESSMENT OF RESIDENTS CLIENTS.] (a) To
establish the service characteristics of residents clients,
the quality assurance and review teams in the department of
health Minnesota department of health case mix review program
shall assess all residents clients annually. beginning January
1, 1989, using a uniform assessment instrument developed by the
commissioner. This instrument shall include assessment of the
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. 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. The facility's qualified mental retardation
professional (QMRP) with primary responsibility for the client's
individual program plan, in conjunction with the
interdisciplinary team, shall assess each client who is newly
admitted to a facility. This assessment must occur within 30
days from the date of admission during the interdisciplinary
team meeting.
(b) All client assessments must be conducted as set forth
in the manual, Minnesota ICF/MR Client Assessment Manual,
February 1995, hereinafter referred to in this subdivision as
the manual. Client assessments completed by the case mix review
program and the facility QMRP must be recorded on assessment
forms developed by the commissioner of health. The facility
QMRP must complete the assessment form, submit it to the case
mix review program, and mail a copy to the client's case manager
within ten working days following the interdisciplinary team
meeting.
(c) The case mix review program shall score assessments
according to attachment E of the manual in the assessment
domains of personal interaction, independence, and integration,
challenging behaviors and preventive practice, activities of
daily living, and special treatments. Scores must be based on
information from the assessment form. A client's score from
each assessment domain shall be used to determine that client's
classification.
(d) The commissioner of health shall determine and assign
classifications for each client using the procedures specified
in attachment F of the manual. The commissioner of health shall
assign the client classification within 15 working days after
receiving the completed assessment form submitted by the case
mix review program team or the facility QMRP. The
classification for a newly admitted client is effective
retroactive to the date of the client's admission. If a
facility QMRP submits an incomplete assessment form, the case
mix review program shall inform the facility QMRP of the need to
submit additional information necessary for assigning a
classification. The facility QMRP must mail the additional
information to the case mix review program no later than five
working days after receiving the request for the information.
If a facility QMRP fails to submit a completed client assessment
for a client who is newly admitted to the facility, that
client's first assessment in the facility conducted by the case
mix review program shall be used to establish a client
classification retroactive to the date of the client's
admission. Any change in classification due to annual
assessment by the case mix review program will be effective on
the first day of the month following completion of the case mix
review program's annual assessment of all the facility's
clients. A client who has resided in the facility less than 30
days must be assessed by the case mix review program during the
annual assessment, but must not have a client classification
assigned based on the case mix review program's assessment
unless the facility QMRP fails to submit a completed client
assessment and the client goes on to reside in the facility for
more than 30 days.
(e) The facility QMRP may request a reclassification for a
client by completing a new client assessment if the facility
QMRP believes that the client's status has changed since the
case mix review program's annual assessment and that these
changes will result in a change in the client's classification.
Client assessments for purposes of reclassification will be
governed by the following:
(1) The facility QMRP that requests reclassification of a
client must provide the case mix review program with evidence to
determine a change in the client's classification. Evidence
must include photocopies of documentation from the client's
record, as specified in the documentation requirements sections
of the manual.
(2) A reclassification assessment must occur between the
third and the ninth month following the case mix review
program's annual assessment of the client. The facility QMRP
can request only one reclassification for each client annually.
(3) Any change in classification approved by the case mix
review program shall be effective on the first day of the month
following the date when the facility QMRP assessed the client
for the reclassification.
(4) The case mix review program shall determine
reclassification based on the documentation submitted by the
facility QMRP. If there is not sufficient information submitted
to justify a change to a higher classification, the case mix
review program may request additional information necessary to
complete a reclassification.
(5) If the facility QMRP does not provide sufficient
documentation to support a change in classification, the
classification shall remain at the level assessed by the case
mix review program at the last inspection of care.
(f) The case mix review program shall conduct desk audits
or on-site audits of assessments performed by facility QMRPs.
Case mix review program staff shall conduct desk audits of any
assessment believed to be inaccurate. The case mix review
program may request the facility to submit additional
information needed to conduct a desk audit. The facility shall
mail the requested information within five working days after
receiving the request.
(g) The case mix review program may conduct on-site audits
of at least ten percent of the total assessments submitted by
facility QMRPs in the previous year and may also conduct special
audits if it determines that circumstances exist that could
change or affect the validity of assigned classifications. The
facility shall grant the case mix review program staff access to
the client records during regular business hours for the purpose
of conducting an audit. For assessments submitted for new
clients, the case mix review program shall consider
documentation in the client's record up to and including the
date the client was assessed by the facility QMRP. For audits
of reclassification assessments, the case mix review program
shall consider documentation in the client's record from three
months preceding the assessment up to and including the date the
client was assessed by the facility QMRP. If the audit reveals
that the facility's assessment does not accurately reflect the
client's status for the time period and the appropriate
supporting documentation cannot be produced by the facility, the
case mix review program shall change the classification so that
it is consistent with the results of the audit. Any change in
client classification that results from an audit must be
retroactive to the effective date of the client assessment that
was audited. Case mix review program staff shall not discuss
preliminary audit findings with the facility's staff. Within 15
working days after completing the audit, the case mix review
program shall mail a notice of the results of the audit to the
facility.
(h) Requests for reconsideration of client classifications
shall be made under section 144.0723 and must be submitted
according to section IV of the manual. A reconsideration must
be reviewed by case mix review program staff not involved in
completing the assessment that established the disputed
classification. The reconsideration must be based upon the
information provided to the case mix review program. Within 15
working days after receiving the request for reconsideration,
the case mix review program shall affirm or modify the original
classification. The original classification must be modified if
the case mix review program determines that the assessment
resulting in the classification did not accurately reflect the
status of the client at the time of the assessment. The
department of health's decision on reconsiderations is the final
administrative decision of the department. The classification
assigned by the department of health must be the classification
that applies to the client while the request for reconsideration
is pending. A change in a classification resulting from a
reconsideration must be retroactive to the effective date of the
client assessment for which a reconsideration was requested.
(i) The commissioner of human services shall assign weights
to each client's classification according to the following table:
Classification Classification Weight
1S 1.00
1I 1.04
2S 1.36
2I 1.52
3S 1.58
3I 1.68
4S 1.87
4I 2.02
5S 2.09
5I 2.26
6S 2.26
6I 2.52
7S 2.10
7I 2.37
8S 2.26
8I 2.52
Sec. 37. Minnesota Statutes 1994, section 256B.501, is
amended by adding a subdivision to read:
Subd. 5b. [ICF/MR OPERATING COST LIMITATION AFTER
SEPTEMBER 30, 1995.] (a) For rate years beginning on October 1,
1995, and October 1, 1996, the commissioner shall limit the
allowable operating cost per diems, as determined under this
subdivision and the reimbursement rules, for high cost
ICF's/MR. Prior to indexing each facility's operating cost per
diems for inflation, the commissioner shall group the facilities
into eight groups. The commissioner shall then array all
facilities within each grouping by their general operating cost
per service unit per diems.
(b) The commissioner shall annually review and adjust the
general operating costs incurred by the facility during the
reporting year preceding the rate year to determine the
facility's allowable historical general operating costs. For
this purpose, the term general operating costs means the
facility's allowable operating costs included in the program,
maintenance, and administrative operating costs categories, as
well as the facility's related payroll taxes and fringe
benefits, real estate insurance, and professional liability
insurance. A facility's total operating cost payment rate shall
be limited according to paragraphs (c) and (d) as follows:
(c) A facility's total operating cost payment rate shall be
equal to its allowable historical operating cost per diems for
program, maintenance, and administrative cost categories
multiplied by the forecasted inflation index in subdivision 3c,
clause (1), subject to the limitations in paragraph (d).
(d) For the rate years beginning on or after October 1,
1995, the commissioner shall establish maximum overall general
operating cost per service unit limits for facilities according
to clauses (1) to (8). Each facility's allowable historical
general operating costs and client assessment information
obtained from client assessments completed under subdivision 3g
for the reporting year ending December 31, 1994 (the base year),
shall be used for establishing the overall limits. If a
facility's proportion of temporary care resident days to total
resident days exceeds 80 percent, the commissioner must exempt
that facility from the overall general operating cost per
service unit limits in clauses (1) to (8). For this purpose,
"temporary care" means care provided by a facility to a client
for less than 30 consecutive resident days.
(1) The commissioner shall determine each facility's
weighted service units for the reporting year by multiplying its
resident days in each client classification level as established
in subdivision 3g, paragraph (d), by the corresponding weights
for that classification level, as established in subdivision 3g,
paragraph (i), and summing the results. For the reporting year
ending December 31, 1994, the commissioner shall use the service
unit score computed from the client classifications determined
by the Minnesota department of health's annual review, including
those of clients admitted during that year.
(2) The facility's service unit score is equal to its
weighted service units as computed in clause (1), divided by the
facility's total resident days excluding temporary care resident
days, for the reporting year.
(3) For each facility, the commissioner shall determine the
facility's cost per service unit by dividing its allowable
historical general operating costs for the reporting year by the
facility's service unit score in clause (2) multiplied by its
total resident days, or 85 percent of the facility's capacity
days times its service unit score in clause (2), if the
facility's occupancy is less than 85 percent of licensed
capacity. If a facility reports temporary care resident days,
the temporary care resident days shall be multiplied by the
service unit score in clause (2), and the resulting weighted
resident days shall be added to the facility's weighted service
units in clause (1) prior to computing the facility's cost per
service unit under this clause.
(4) The commissioner shall group facilities based on class
A or class B licensure designation, number of licensed beds, and
geographic location. For purposes of this grouping, facilities
with six beds or less shall be designated as small facilities
and facilities with more than six beds shall be designated as
large facilities. If a facility has both class A and class B
licensed beds, the facility shall be considered a class A
facility for this purpose if the number of class A beds is more
than half its total number of ICF/MR beds; otherwise the
facility shall be considered a class B facility. The
metropolitan geographic designation shall include Anoka, Carver,
Dakota, Hennepin, Ramsey, Scott, and Washington counties. All
other Minnesota counties shall be designated as the
nonmetropolitan geographic group. These characteristics result
in the following eight groupings:
(i) small class A metropolitan;
(ii) large class A metropolitan;
(iii) small class B metropolitan;
(iv) large class B metropolitan;
(v) small class A nonmetropolitan;
(vi) large class A nonmetropolitan;
(vii) small class B nonmetropolitan; and
(viii) large class B nonmetropolitan.
(5) The commissioner shall array facilities within each
grouping in clause (4) by each facility's cost per service unit
as determined in clause (3).
(6) In each array established under clause (5), facilities
with a cost per service unit at or above the median shall be
limited to the lesser of: (i) the current reporting year's cost
per service unit; or (ii) the prior reporting year's allowable
historical general operating cost per service unit plus the
inflation factor as established in subdivision 3c, clause (2),
increased by three percentage points.
(7) The overall operating cost per service unit limit for
each group shall be established as follows:
(i) each array established under clause (5) shall be
arrayed again after the application of clause (6);
(ii) in each array established in clause (5), two general
operating cost limits shall be determined. The first cost per
service unit limit shall be established at 0.5 and less than or
equal to 1.0 standard deviation above the median of that array.
The second cost per service unit limit shall be established at
1.0 standard deviation above the median of the array; and
(iii) the overall operating cost per service unit limits
shall be indexed for inflation annually beginning with the
reporting year ending December 31, 1995, using the forecasted
inflation index in subdivision 3c, clause (2).
(8) Annually, facilities shall be arrayed using the method
described in clauses (5) and (7). Each facility with a cost per
service unit at or above its group's first cost per service unit
limit, but less than the second cost per service unit limit for
that group, shall be limited to 98 percent of its total
operating cost per diems then add the forecasted inflation index
in subdivision 3c, clause (1). Each facility with a cost per
service unit at or above the second cost per service unit limit
will be limited to 97 percent of its total operating cost per
diems, then add the forecasted inflation index in subdivision
3c, clause (1).
(9) The commissioner may rebase these overall limits, using
the method described in this subdivision, but no more frequently
than once every three years.
(e) For rate years beginning on or after October 1, 1995,
the facility's efficiency incentive shall be determined as
provided in the reimbursement rule.
(f) The total operating cost payment rate shall be the sum
of paragraphs (c) and (e).
Sec. 38. Minnesota Statutes 1994, section 256B.501, is
amended by adding a subdivision to read:
Subd. 5c. [OPERATING COSTS AFTER SEPTEMBER 30, 1997.] (a)
In general, the commissioner shall establish maximum standard
rates for the prospective reimbursement of facility costs. The
maximum standard rates must take into account the level of
reimbursement which is adequate to cover the base-level costs of
economically operated facilities. In determining the base-level
costs, the commissioner shall consider geographic location,
types of facilities (class A or class B), minimum staffing
standards, resident assessment under subdivision 3g, and other
factors as determined by the commissioner.
(b) The commissioner shall also develop additional
incentive-based payments which, if achieved for specified
outcomes, will be added to the maximum standard rates. The
specified outcomes must be measurable and shall be based on
criteria to be developed by the commissioner during fiscal year
1996. The commissioner may establish various levels of
achievement within an outcome. Once the outcomes are
established, the commissioner shall assign various levels of
payment associated with achieving the outcome. In establishing
the specified outcomes and the related criteria, the
commissioner shall consider the following state policy
objectives: (1) resident transitioned into cost-effective
community alternatives; (2) the results of a uniform consumer
satisfaction survey; (3) the achievement of no major licensure
or certification deficiencies; or (4) any other outcomes the
commissioner finds desirable.
(c) In developing the maximum standard rates and the
incentive-based payments, desirable outcomes, and related
criteria, the commissioner, in collaboration with the
commissioner of health, shall form an advisory committee. The
membership of the advisory committee shall include
representation from the consumers advocacy groups (3), the two
facility trade associations (3 each), counties (3), commissioner
of finance (1), the legislature (2 each from both the house and
senate), and others the commissioners find appropriate.
(d) Beginning July 1, 1996, the commissioner shall collect
the data from the facilities, the department of health, or
others as necessary to determine the extent to which a facility
has met any of the outcomes and related criteria. Payment rates
under this subdivision shall be effective October 1, 1997.
(e) The commissioner shall report to the legislature on the
progress of the advisory committee by January 31, 1996, any
necessary changes to the reimbursement methodology proposed
under this subdivision. By January 15, 1997, the commissioner
shall recommend to the legislature legislation which will
implement this reimbursement methodology for rate years
beginning on or after the proposed effective date of October 1,
1997.
Sec. 39. Minnesota Statutes 1994, section 256B.501,
subdivision 8, is amended to read:
Subd. 8. [PAYMENT FOR PERSONS WITH SPECIAL NEEDS.] The
commissioner shall establish by December 31, 1983, procedures to
be followed by the counties to seek authorization from the
commissioner for medical assistance reimbursement for very
dependent persons with special needs in an amount in excess of
the rates allowed pursuant to subdivision 2, including rates
established under section 252.46 when they apply to services
provided to residents of intermediate care facilities for
persons with mental retardation or related conditions, and
procedures to be followed for rate limitation exemptions for
intermediate care facilities for persons with mental retardation
or related conditions. Rate payments under subdivision 8a are
eligible for a rate exception under this subdivision. No excess
payment approved by the commissioner after June 30, 1991, shall
be authorized unless:
(1) the need for specific level of service is documented in
the individual service plan of the person to be served;
(2) the level of service needed can be provided within the
rates established under section 252.46 and Minnesota Rules,
parts 9553.0010 to 9553.0080, without a rate exception within 12
months;
(3) staff hours beyond those available under the rates
established under section 252.46 and Minnesota Rules, parts
9553.0010 to 9553.0080, necessary to deliver services do not
exceed 1,440 hours within 12 months;
(4) there is a basis for the estimated cost of services;
(5) the provider requesting the exception documents that
current per diem rates are insufficient to support needed
services;
(6) estimated costs, when added to the costs of current
medical assistance-funded residential and day training and
habilitation services and calculated as a per diem, do not
exceed the per diem established for the regional treatment
centers for persons with mental retardation and related
conditions on July 1, 1990, indexed annually by the urban
consumer price index, all items, as forecasted by Data Resources
Inc., for the next fiscal year over the current fiscal year;
(7) any contingencies for an approval as outlined in
writing by the commissioner are met; and
(8) any commissioner orders for use of preferred providers
are met.
The commissioner shall evaluate the services provided
pursuant to this subdivision through program and fiscal audits.
The commissioner may terminate the rate exception at any
time under any of the conditions outlined in Minnesota Rules,
part 9510.1120, subpart 3, for county termination, or by reason
of information obtained through program and fiscal audits which
indicate the criteria outlined in this subdivision have not
been, or are no longer being, met.
The commissioner may approve no more than one rate
exception, up to 12 months duration, for an eligible client.
Sec. 40. Minnesota Statutes 1994, section 256B.501, is
amended by adding a subdivision to read:
Subd. 8a. [PAYMENT FOR PERSONS WITH SPECIAL NEEDS FOR
CRISIS INTERVENTION SERVICES.] State-operated, community-based
crisis services provided in accordance with section 252.50,
subdivision 7, to a resident of an intermediate care facility
for persons with mental retardation (ICF/MR) reimbursed under
this section shall be paid by medical assistance in accordance
with the paragraphs (a) to (h).
(a) "Crisis services" means the specialized services listed
in clauses (1) to (3) provided to prevent the recipient from
requiring placement in a more restrictive institutional setting
such as an inpatient hospital or regional treatment center and
to maintain the recipient in the present community setting.
(1) The crisis services provider shall assess the
recipient's behavior and environment to identify factors
contributing to the crisis.
(2) The crisis services provider shall develop a
recipient-specific intervention plan in coordination with the
service planning team and provide recommendations for revisions
to the individual service plan if necessary to prevent or
minimize the likelihood of future crisis situations. The
intervention plan shall include a transition plan to aid the
recipient in returning to the community-based ICF/MR if the
recipient is receiving residential crisis services.
(3) The crisis services provider shall consult with and
provide training and ongoing technical assistance to the
recipient's service providers to aid in the implementation of
the intervention plan and revisions to the individual service
plan.
(b) "Residential crisis services" means crisis services
that are provided to a recipient admitted to the crisis services
foster care setting because the ICF/MR receiving reimbursement
under this section is not able, as determined by the
commissioner, to provide the intervention and protection of the
recipient and others living with the recipient that is necessary
to prevent the recipient from requiring placement in a more
restrictive institutional setting.
(c) Crisis services providers must be licensed by the
commissioner under section 245A.03 to provide foster care, must
exclusively provide short-term crisis intervention, and must not
be located in a private residence.
(d) Payment rates are determined annually for each crisis
services provider based on cost of care for each provider as
defined in section 246.50. Interim payment rates are calculated
on a per diem basis by dividing the projected cost of providing
care by the projected number of contact days for the fiscal
year, as estimated by the commissioner. Final payment rates are
calculated by dividing the actual cost of providing care by the
actual number of contact days in the applicable fiscal year.
(e) Payment shall be made for each contact day. "Contact
day" means any day in which the crisis services provider has
face-to-face contact with the recipient or any of the
recipient's medical assistance service providers for the purpose
of providing crisis services as defined in paragraph (c).
(f) Payment for residential crisis services is limited to
21 days, unless an additional period is authorized by the
commissioner. The additional period may not exceed 21 days.
(g) Payment for crisis services shall be made only for
services provided while the ICF/MR receiving reimbursement under
this section:
(1) has a shared services agreement with the crisis
services provider in effect in accordance with section 246.57;
(2) has reassigned payment for the provision of the crisis
services under this subdivision to the commissioner in
accordance with Code of Federal Regulations, title 42, section
447.10(e); and
(3) has executed a cooperative agreement with the crisis
services provider to implement the intervention plan and
revisions to the individual service plan as necessary to prevent
or minimize the likelihood of future crisis situations, to
maintain the recipient in the present community setting, and to
prevent the recipient from requiring a more restrictive
institutional setting.
(h) Payment to the ICF/MR receiving reimbursement under
this section shall be made for up to 18 therapeutic leave days
during which the recipient is receiving residential crisis
services, if the ICF/MR is otherwise eligible to receive payment
for a therapeutic leave day under Minnesota Rules, part
9505.0415. Payment under this paragraph shall be terminated if
the commissioner determines that the ICF/MR is not meeting the
terms of the cooperative agreement under paragraph (g) or that
the recipient will not return to the ICF/MR.
Sec. 41. Minnesota Statutes 1994, section 256B.69, is
amended by adding a subdivision to read:
Subd. 23. [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES;
ELDERLY AND DISABLED PERSONS.] (a) The commissioner may
implement demonstration projects to create alternative
integrated delivery systems for acute and long-term care
services to elderly and disabled persons that provide increased
coordination, improve access to quality services, and mitigate
future cost increases. The commissioner may seek federal
authority to combine Medicare and Medicaid capitation payments
for the purpose of such demonstrations. Medicare funds and
services shall be administered according to the terms and
conditions of the federal waiver and demonstration provisions.
For the purpose of administering medical assistance funds,
demonstrations under this subdivision are subject to
subdivisions 1 to 17. The provisions of Minnesota Rules, parts
9500.1450 to 9500.1464, apply to these demonstrations, with the
exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457,
subpart 1, items B and C, which do not apply to elderly persons
enrolling in demonstrations under this section. An initial open
enrollment period may be provided. Persons who disenroll from
demonstrations under this subdivision remain subject to
Minnesota Rules, parts 9500.1450 to 9500.1464. When a person is
enrolled in a health plan under these demonstrations and the
health plan's participation is subsequently terminated for any
reason, the person shall be provided an opportunity to select a
new health plan and shall have the right to change health plans
within the first 60 days of enrollment in the second health
plan. Persons required to participate in health plans under
this section who fail to make a choice of health plan shall not
be randomly assigned to health plans under these demonstrations.
Notwithstanding section 256.9363, subdivision 5, and Minnesota
Rules, part 9505.5220, subpart 1, item A, if adopted, for the
purpose of demonstrations under this subdivision, the
commissioner may contract with managed care organizations to
serve only elderly persons eligible for medical assistance,
elderly and disabled persons, or disabled persons only.
Before implementation of a demonstration project for
disabled persons, the commissioner must provide information to
appropriate committees of the house of representatives and
senate and must involve representatives of affected disability
groups in the design of the demonstration projects.
(b) A nursing facility reimbursed under the alternative
reimbursement methodology in section 256B.434 may, in
collaboration with a hospital, clinic, or other health care
entity provide services under paragraph (a). The commissioner
shall amend the state plan and seek any federal waivers
necessary to implement this paragraph.
Sec. 42. [ICF/MR RULE REVISION RECORDKEEPING.]
The commissioner shall consider various time record and
time distribution recordkeeping requirements when developing
rule revisions for cost allocation regarding intermediate care
facilities for persons with mental retardation or related
conditions. The commissioner shall consider information from
the public, including providers, provider associations,
advocates, and counties when developing rule amendments in the
area of cost allocation.
From July 1, 1995, until June 30, 1996, all employees and
consultants of ICFs/MR, including any individual for whom any
portion of that individual's compensation is reported for
reimbursement under Minnesota Rules, parts 9553.0010 to
9553.0080, shall document their service to all sites according
to paragraphs (a) to (c). For this purpose, and for paragraphs
(a) to (c), "employee" means an individual who is compensated by
a facility or provider group for necessary services on any
hourly or salaried basis. Employees and consultants for whom no
portion of that individual's total compensation is reported for
reimbursement in Minnesota Rules, parts 9553.0010 to 9553.0080,
are exempt from the recordkeeping requirements in paragraphs (a)
to (c).
(a) Time and attendance records are required for all
employees and consultants as set forth in Minnesota Statutes,
section 256B.432, subdivision 8.
(b) Employees and consultants shall keep time records on a
daily basis showing the actual time spent on various activities,
as required by Minnesota Rules, part 9553.0030, except that
employees with multiple duties must not use a sampling method.
(c) All employees and consultants who work for the benefit
of more than one site shall keep a record of where work is
performed. This record must specify the time in which work
performed at a site solely benefits that site. The amount of
time reported for work performed at a site for the sole benefit
of that site does not need to be adjusted for brief, infrequent
telephone interruptions, time spent away from the site when
accompanying clients from that site, and time away from the site
for shopping or errands if the shopping or errands benefit
solely that site.
For recordkeeping purposes, "site" means a Minnesota
ICF/MR, waivered services location, semi-independent living
service arrangement, day training and habilitation operation, or
similar out-of-state service operation for persons with
developmental disabilities. Site also means any
nondevelopmental disability service location or any business
operation owned or operated by a provider group, either in or
outside of Minnesota, whether or not that operation provides a
service to persons with developmental disabilities.
Sec. 43. [REPEALER.]
Subdivision 1. Minnesota Statutes 1994, sections 144.0723,
subdivision 5, 144A.073, subdivision 3a, 252.47, and 256B.501,
subdivision 3f, are repealed.
Subd. 2. Minnesota Statutes 1994, section 256B.501,
subdivisions 3d and 3e, is repealed for rate years beginning
after September 30, 1996.
Sec. 44. [EFFECTIVE DATES.]
Subdivision 1. Sections 12 (144A.071, subdivision 5a), 13,
16, 17, and 18 (144A.073, subdivisions 1, 3c, 4, and 5), are
effective the day following final enactment.
Subd. 2. Sections 39 and 40 (256B.501, subdivisions 8 and
8a) are effective upon publication in the State Register by the
commissioner of human services that federal approval has been
received.
Subd. 3. Sections 27 to 31 (256B.432, subdivisions 1, 2,
3, 5, and 6) are effective for ICF/MR rate years beginning after
September 30, 1996.
ARTICLE 8
COMMUNITY MENTAL HEALTH AND REGIONAL
TREATMENT CENTERS
Section 1. Minnesota Statutes 1994, section 245.041, is
amended to read:
245.041 [PROVISION OF FIREARMS BACKGROUND CHECK
INFORMATION.]
Notwithstanding section 253B.23, subdivision 9, the
commissioner of human services shall provide commitment
information to local law enforcement agencies on an individual
request basis by means of electronic data transfer from the
department of human services through the Minnesota crime
information system for the sole purpose of facilitating a
firearms background check under section 624.7131, 624.7132, or
624.714. The information to be provided is limited to whether
the person has been committed under chapter 253B and, if so, the
type of commitment.
Sec. 2. Minnesota Statutes 1994, section 245.4871,
subdivision 12, is amended to read:
Subd. 12. [EARLY MENTAL HEALTH IDENTIFICATION AND
INTERVENTION SERVICES.] "Early Mental health identification and
intervention services" means services that are designed to
identify children who are at risk of needing or who need mental
health services and that arrange for intervention and treatment.
Sec. 3. Minnesota Statutes 1994, section 245.4871,
subdivision 33a, is amended to read:
Subd. 33a. [SPECIAL CULTURALLY INFORMED MENTAL HEALTH
CONSULTANT.] "Special Culturally informed mental health
consultant" is a mental health practitioner or professional with
special expertise in treating children from a particular
cultural or racial minority group person who is recognized by
the culture as one who has knowledge of a particular culture and
its definition of health and mental health; and who is used as
necessary to assist the county board and its mental health
providers in assessing and providing appropriate mental health
services for children from that particular cultural, linguistic,
or racial heritage and their families.
Sec. 4. Minnesota Statutes 1994, section 245.4871, is
amended by adding a subdivision to read:
Subd. 35. [TRANSITION SERVICES.] "Transition services"
means mental health services, designed within an outcome
oriented process that promotes movement from school to
postschool activities, including post-secondary education,
vocational training, integrated employment including supported
employment, continuing and adult education, adult mental health
and social services, other adult services, independent living,
or community participation.
Sec. 5. Minnesota Statutes 1994, section 245.4873,
subdivision 6, is amended to read:
Subd. 6. [PRIORITIES.] By January 1, 1992, the
commissioner shall require that each of the treatment services
and management activities described in sections 245.487 to
245.4888 be developed for children with emotional disturbances
within available resources based on the following ranked
priorities. The commissioner shall reassign agency staff and
use consultants as necessary to meet this deadline:
(1) the provision of locally available mental health
emergency services;
(2) the provision of locally available mental health
services to all children with severe emotional disturbance;
(3) the provision of early mental health identification and
intervention services to children who are at risk of needing or
who need mental health services;
(4) the provision of specialized mental health services
regionally available to meet the special needs of all children
with severe emotional disturbance, and all children with
emotional disturbances;
(5) the provision of locally available services to children
with emotional disturbances; and
(6) the provision of education and preventive mental health
services.
Sec. 6. Minnesota Statutes 1994, section 245.4874, is
amended to read:
245.4874 [DUTIES OF COUNTY BOARD.]
The county board in each county shall use its share of
mental health and community social services act funds allocated
by the commissioner according to a biennial children's mental
health component of the community social services plan required
under section 245.4888, and approved by the commissioner. The
county board must:
(1) develop a system of affordable and locally available
children's mental health services according to sections 245.487
to 245.4888;
(2) establish a mechanism providing for interagency
coordination as specified in section 245.4875, subdivision 6;
(3) develop a biennial children's mental health component
of the community social services plan required under section
256E.09 which considers the assessment of unmet needs in the
county as reported by the local children's mental health
advisory council under section 245.4875, subdivision 5,
paragraph (b), clause (3). The county shall provide, upon
request of the local children's mental health advisory council,
readily available data to assist in the determination of unmet
needs;
(4) assure that parents and providers in the county receive
information about how to gain access to services provided
according to sections 245.487 to 245.4888;
(5) coordinate the delivery of children's mental health
services with services provided by social services, education,
corrections, health, and vocational agencies to improve the
availability of mental health services to children and the
cost-effectiveness of their delivery;
(6) assure that mental health services delivered according
to sections 245.487 to 245.4888 are delivered expeditiously and
are appropriate to the child's diagnostic assessment and
individual treatment plan;
(7) provide the community with information about predictors
and symptoms of emotional disturbances and how to access
children's mental health services according to sections 245.4877
and 245.4878;
(8) provide for case management services to each child with
severe emotional disturbance according to sections 245.486;
245.4871, subdivisions 3 and 4; and 245.4881, subdivisions 1, 3,
and 5;
(9) provide for screening of each child under section
245.4885 upon admission to a residential treatment facility,
acute care hospital inpatient treatment, or informal admission
to a regional treatment center;
(10) prudently administer grants and purchase-of-service
contracts that the county board determines are necessary to
fulfill its responsibilities under sections 245.487 to 245.4888;
(11) assure that mental health professionals, mental health
practitioners, and case managers employed by or under contract
to the county to provide mental health services are qualified
under section 245.4871;
(12) assure that children's mental health services are
coordinated with adult mental health services specified in
sections 245.461 to 245.486 so that a continuum of mental health
services is available to serve persons with mental illness,
regardless of the person's age; and
(13) assure that special culturally informed mental health
consultants are used as necessary to assist the county board in
assessing and providing appropriate treatment for children of
cultural or racial minority heritage.
Sec. 7. Minnesota Statutes 1994, section 245.4875,
subdivision 2, is amended to read:
Subd. 2. [CHILDREN'S MENTAL HEALTH SERVICES.] The
children's mental health service system developed by each county
board must include the following services:
(1) education and prevention services according to section
245.4877;
(2) early mental health identification and intervention
services according to section 245.4878;
(3) emergency services according to section 245.4879;
(4) outpatient services according to section 245.488;
(5) family community support services according to section
245.4881;
(6) day treatment services according to section 245.4884,
subdivision 2;
(7) residential treatment services according to section
245.4882;
(8) acute care hospital inpatient treatment services
according to section 245.4883;
(9) screening according to section 245.4885;
(10) case management according to section 245.4881;
(11) therapeutic support of foster care according to
section 245.4884, subdivision 4; and
(12) professional home-based family treatment according to
section 245.4884, subdivision 4.
Sec. 8. Minnesota Statutes 1994, section 245.4875, is
amended by adding a subdivision to read:
Subd. 8. [TRANSITION SERVICES.] The county board may
continue to provide mental health services as defined in
sections 245.487 to 245.4888 to persons over 18 years of age,
but under 21 years of age, if the person was receiving case
management or family community support services prior to age 18,
and if one of the following conditions is met:
(1) the person is receiving special education services
through the local school district; or
(2) it is in the best interest of the person to continue
services defined in sections 245.487 to 245.4888.
Sec. 9. Minnesota Statutes 1994, section 245.4878, is
amended to read:
245.4878 [EARLY MENTAL HEALTH IDENTIFICATION AND
INTERVENTION.]
By January 1, 1991, early mental health identification and
intervention services must be available to meet the needs of all
children and their families residing in the county, consistent
with section 245.4873. Early Mental health identification and
intervention services must be designed to identify children who
are at risk of needing or who need mental health services. The
county board must provide intervention and offer treatment
services to each child who is identified as needing mental
health services. The county board must offer intervention
services to each child who is identified as being at risk of
needing mental health services.
Sec. 10. Minnesota Statutes 1994, section 245.4882,
subdivision 5, is amended to read:
Subd. 5. [SPECIALIZED RESIDENTIAL TREATMENT SERVICES.] The
commissioner of human services shall 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 1997, 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. Minnesota Statutes 1994, section 245.4885,
subdivision 2, is amended to read:
Subd. 2. [QUALIFICATIONS.] No later than July 1, 1991,
screening of children for residential and inpatient services
must be conducted by a mental health professional. Where
appropriate and available, special culturally informed mental
health consultants must participate in the screening. Mental
health professionals providing screening for inpatient and
residential services must not be financially affiliated with any
acute care inpatient hospital, residential treatment facility,
or regional treatment center. The commissioner may waive this
requirement for mental health professional participation after
July 1, 1991, if the county documents that:
(1) mental health professionals or mental health
practitioners are unavailable to provide this service; and
(2) services are provided by a designated person with
training in human services who receives clinical supervision
from a mental health professional.
Sec. 12. Minnesota Statutes 1994, section 245.4886, is
amended by adding a subdivision to read:
Subd. 3. [GRANTS FOR ADOLESCENT SERVICES.] The
commissioner may make grants for community-based services for
adolescents who have serious emotional disturbance and exhibit
violent behavior. The commissioner may administer these grants
as a supplement to the grants for children's community-based
mental health services under subdivision 1. The same
administrative requirements shall apply to these grants as the
grants under subdivision 1, except that these grants:
(1) shall be primarily for areas with the greatest need for
services;
(2) may be used for assessment, family community support
services, specialized treatment approaches, specialized
adolescent community-based residential treatment, and community
transition services for adolescents and preadolescents who have
serious emotional disturbance and exhibit violent behavior;
(3) shall emphasize intensive services as an alternative to
placement;
(4) shall not be used to supplant existing funds;
(5) shall require grantees to continue base level funding
as defined in section 245.492, subdivision 2;
(6) must, wherever possible, be administered under the
auspices of a children's mental health collaborative established
under section 245.491 if the collaborative chooses to serve the
target population;
(7) must be used for mental health services that are
integrated with other services whenever possible; and
(8) must be based on a proposal submitted to the
commissioner by a children's mental health collaborative or a
county board that is based on guidelines published by the
commissioner. The guidelines must require that proposed
services be based on treatment methods that have proven
effective, or that show promise, in meeting the needs of this
population. The guidelines may incorporate preferences for
proposals that would convert existing residential treatment beds
for children in the county or collaborative's service area to
community-based mental health services, encourage the active
participation of the children's families in the treatment plans
of these children, or promote the integration of these children
into school, home, and community. The commissioner shall
consult with parents, educators, mental health professionals,
county mental health staff, and representatives of the
children's subcommittee of the state advisory board on mental
health in developing the guidelines and evaluating proposals.
Sec. 13. Minnesota Statutes 1994, section 245.492,
subdivision 2, is amended to read:
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
1995 for children's mental health services or, for special
education services, and for other services for children with
emotional or behavioral disturbances and their families.
In subsequent years, base level funding may be adjusted to
reflect decreases in the numbers of children in the target
population.
Sec. 14. Minnesota Statutes 1994, section 245.492,
subdivision 6, is amended to read:
Subd. 6. [INITIAL OPERATIONAL TARGET POPULATION.] "Initial
Operational 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 fall within the
criteria for the target population. The initial operational
target population may be less than the target population.
Sec. 15. Minnesota Statutes 1994, section 245.492,
subdivision 9, is amended to read:
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 individualized rehabilitation 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.
Sec. 16. Minnesota Statutes 1994, section 245.492,
subdivision 23, is amended to read:
Subd. 23. [WRAPAROUND INDIVIDUALIZED REHABILITATION
SERVICES.] "Wraparound Individualized rehabilitation 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 Individualized
rehabilitation 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. 17. Minnesota Statutes 1994, section 245.493,
subdivision 2, is amended to read:
Subd. 2. [GENERAL DUTIES OF THE LOCAL CHILDREN'S MENTAL
HEALTH COLLABORATIVES.] Each local children's mental health
collaborative must:
(1) notify the commissioner of human services within ten
days of formation by signing a collaborative agreement and
providing the commissioner with a copy of the signed agreement;
(2) identify a service delivery area and an initial
operational target population within that service delivery area.
The initial operational 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 operational target
population must also be economically viable for the service
delivery area;
(2) (3) seek to maximize federal revenues available to
serve children in the target population by designating local
expenditures for mental health services for these children and
their families that can be matched with federal dollars;
(3) (4) 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 that
meets the requirements for state and federal reimbursement and
develop interagency agreements necessary to implement the
system;
(4) (5) 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 in the
target population and their families;
(5) (6) create or designate a management structure for
fiscal and clinical responsibility and outcome evaluation;
(6) (7) spend funds generated by the local children's
mental health collaborative as required in sections 245.491 to
245.496; and
(7) (8) 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.;
(9) submit its integrated service system design to the
state coordinating council for approval within one year of
notifying the commissioner of human services of its formation;
(10) provide an annual report that includes the elements
listed in section 245.494, subdivision 2, and the
collaborative's planned timeline to expand its operational
target population to the state coordinating council; and
(11) expand its operational target population.
Each local children's mental health collaborative may
contract with the commissioner of human services to become a
medical assistance provider of mental health services according
to section 245.4933.
Sec. 18. Minnesota Statutes 1994, section 245.4932,
subdivision 1, is amended to read:
Subdivision 1. [PROVIDER COLLABORATIVE RESPONSIBILITIES.]
The children's mental health collaborative shall have the
following authority and responsibilities regarding federal
revenue enhancement:
(1) the collaborative must establish an integrated fund;
(2) the collaborative shall designate a lead county or
other qualified entity as the fiscal agency for reporting,
claiming, and receiving payments;
(2) (3) 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) (4) the collaborative shall use any enhanced revenue
attributable to the activities of the collaborative, including
administrative and service revenue, solely to provide mental
health services or to expand the operational target population.
The lead county or other qualified entity may not use enhanced
federal revenue for any other purpose;
(5) the members of the collaborative must continue the base
level of expenditures, as defined in section 245.492,
subdivision 2, 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) (6) 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 with the commissioner of human services;
(5) (7) the collaborative shall or its members may elect to
pay the nonfederal share of the medical assistance costs for
services designated by the collaborative; and
(6) (8) 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.
Sec. 19. Minnesota Statutes 1994, section 245.4932,
subdivision 2, is amended to read:
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 collaborative 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.
Sec. 20. Minnesota Statutes 1994, section 245.4932,
subdivision 3, is amended to read:
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.
Sec. 21. Minnesota Statutes 1994, section 245.4932,
subdivision 4, is amended to read:
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 individualized rehabilitation 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. 22. [245.4933] [MEDICAL ASSISTANCE PROVIDER STATUS.]
Subdivision 1. [REQUIREMENTS TO SERVE CHILDREN NOT
ENROLLED IN A PREPAID MEDICAL ASSISTANCE OR MINNESOTACARE HEALTH
PLAN.] (a) In order for a local children's mental health
collaborative to become a prepaid provider of medical assistance
services and be eligible to receive medical assistance
reimbursement, the collaborative must:
(1) enter into a contract with the commissioner of human
services to provide mental health services including inpatient,
outpatient, medication management, services under the
rehabilitation option, and related physician services;
(2) meet the applicable federal requirements;
(3) either carry stop-loss insurance or enter into a
risk-sharing agreement with the commissioner of human services;
and
(4) provide medically necessary medical assistance mental
health services to children in the target population who enroll
in the local children's mental health collaborative.
(b) Upon execution of the provider contract with the
commissioner of human services the local children's mental
health collaborative may:
(1) provide mental health services which are not medical
assistance state plan services in addition to the state plan
services described in the contract with the commissioner of
human services; and
(2) enter into subcontracts which meet the requirements of
Code of Federal Regulations, title 42, section 434.6, with other
providers of mental health services including prepaid health
plans established under section 256B.69.
Subd. 2. [REQUIREMENTS TO SERVE CHILDREN ENROLLED IN A
PREPAID HEALTH PLAN.] A children's mental health collaborative
may serve children in the collaborative's target population who
are enrolled in a prepaid health plan under contract with the
commissioner of human services by contracting with one or more
such health plans to provide medical assistance or MinnesotaCare
mental health services to children enrolled in the health plan.
The collaborative and the health plan shall work cooperatively
to ensure the integration of physical and mental health services.
Subd. 3. [REQUIREMENTS TO SERVE CHILDREN WHO BECOME
ENROLLED IN A PREPAID HEALTH PLAN.] A children's mental health
collaborative may provide prepaid medical assistance or
MinnesotaCare mental health services to children who are not
enrolled in prepaid health plans until those children are
enrolled. Publication of a request for proposals in the State
Register shall serve as notice to the collaborative of the
commissioner's intent to execute contracts for medical
assistance and MinnesotaCare services. In order to become or
continue to be a provider of medical assistance or MinnesotaCare
services the collaborative may contract with one or more such
prepaid health plans after the collaborative's target population
is enrolled in a prepaid health plan. The collaborative and the
health plan shall work cooperatively to ensure the integration
of physical and mental health services.
Subd. 4. [COMMISSIONER'S DUTIES.] (a) The commissioner of
human services shall provide to each children's mental health
collaborative that is considering whether to become a prepaid
provider of mental health services the commissioner's best
estimate of a capitated payment rate prior to an actuarial study
based upon the collaborative's operational target population.
The capitated payment rate shall be adjusted annually, if
necessary, for changes in the operational target population.
(b) The commissioner shall negotiate risk adjustment and
reinsurance mechanisms with children's mental health
collaboratives that become medical assistance providers
including those that subcontract with prepaid health plans.
Subd. 5. [NONCONTRACTING COLLABORATIVES.] A local
children's mental health collaborative that does not become a
prepaid provider of medical assistance or MinnesotaCare services
may provide services through individual members of a
noncontracting collaborative who have a medical assistance
provider agreement to eligible recipients who are not enrolled
in the health plan.
Subd. 6. [INDIVIDUALIZED REHABILITATION SERVICES.] A
children's mental health collaborative with an integrated
service system approved by the state coordinating council may
become a medical assistance provider for the purpose of
obtaining prior authorization for and providing individualized
rehabilitation services.
Sec. 23. Minnesota Statutes 1994, section 245.494,
subdivision 1, is amended to read:
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 operational 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.
Sec. 24. Minnesota Statutes 1994, section 245.494,
subdivision 3, is amended to read:
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, in the first quarter of 1994, in
areas where a local children's mental health collaborative has
been established, based on an independent actuarial
analysis, separate identify all medical assistance, general
assistance medical care, and MinnesotaCare resources devoted to
mental health services for children and their families in the
target population including inpatient, outpatient, medication
management, services under the rehabilitation option, and
related physician services from in the total health capitation
from of prepaid plans, including plans established under
contract with the commissioner to provide medical assistance
services 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) (2) assist each children's mental health collaborative
to determine an actuarially feasible operational target
population;
(3) ensure that a prepaid health plan that contracts with
the commissioner to provide medical assistance or MinnesotaCare
services shall pass through the identified resources to a
collaborative or collaboratives upon the collaboratives meeting
the requirements of section 245.4933 to serve the
collaborative's operational target population. The commissioner
shall, through an independent actuarial analysis, specify
differential rates the prepaid health plan must pay the
collaborative based upon severity, functioning, and other risk
factors, taking into consideration the fee-for-service
experience of children excluded from prepaid medical assistance
participation;
(4) ensure that a children's mental health collaborative
that enters into an agreement with a prepaid health plan under
contract with the commissioner shall accept medical assistance
recipients in the operational target population on a first-come,
first-served basis up to the collaborative's operating capacity
or as determined in the agreement between the collaborative and
the commissioner;
(5) ensure that a children's mental health collaborative
that receives resources passed through a prepaid health plan
under contract with the commissioner shall be subject to the
quality assurance standards, reporting of utilization
information, standards set out in sections 245.487 to 245.4888,
and other requirements established in Minnesota Rules, part
9500.1460;
(6) ensure that any prepaid health plan that contracts with
the commissioner, including a plan that contracts under section
256B.69, must enter into an agreement with any collaborative
operating in the same service delivery area that:
(i) meets the requirements of section 245.4933;
(ii) is willing to accept the rate determined by the
commissioner to provide medical assistance services; and
(iii) requests to contract with the prepaid health plan;
(7) ensure that no agreement between a health plan and a
collaborative shall terminate the legal responsibility of the
health plan to assure that all activities under the contract are
carried out. The agreement may require the collaborative to
indemnify the health plan for activities that are not carried
out;
(8) ensure that where a collaborative enters into an
agreement with the commissioner to provide medical assistance
and MinnesotaCare services a separate capitation rate will be
determined through an independent actuarial analysis which is
based upon the factors set forth in clause (3) to be paid to a
collaborative for children in the operational target population
who are eligible for medical assistance but not included in the
prepaid health plan contract with the commissioner;
(9) ensure that in counties where no prepaid health plan
contract to provide medical assistance or MinnesotaC