Office of the Revisor of Statutes
Minnesota Session Laws - 1996, Regular Session
Key: (1) language to be deleted (2) new language
KEY: stricken = old language to be removed
underscored = new language to be added
CHAPTER 451-H.F.No. 1584
An act relating to human services; changing provisions
to health and continuing care related to MA and GAMC;
changing provisions to long term care; changing
provisions to health plan regulations; making
technical and policy changes for the department of
human services; requiring the commissioner of human
services to study and make recommendations on the
administration of the community alternative care
program, and to study and report on the effect on
medical assistance waiver programs of medically
fragile children in foster care; appropriating money;
amending Minnesota Statutes 1994, sections 62D.04,
subdivision 5; 62N.10, subdivision 4; 62Q.075,
subdivision 2; 144.0722, by adding a subdivision;
144.572; 144.71, subdivisions 1 and 2; 144.72,
subdivisions 1 and 2; 144.73, subdivision 1; 144.74;
144A.04, by adding a subdivision; 144A.09, subdivision
1; 144A.20, subdivision 2; 145.61, subdivision 5;
148.235, by adding a subdivision; 148C.01, by adding a
subdivision; 148C.09, by adding a subdivision;
245.462, subdivision 4; 245.4871, subdivision 4;
245.94, subdivisions 2a and 3; 245.95, subdivision 2;
245.97, subdivision 6; 246.57, by adding a
subdivision; 253B.11, subdivision 2; 256.482, by
adding a subdivision; 256.73, subdivision 1, and by
adding a subdivision; 256.9355, subdivision 3;
256B.03, by adding a subdivision; 256B.056,
subdivisions 1 and 1a; 256B.0595, by adding
subdivisions; 256B.0627, subdivisions 1, as amended,
4, as amended, 5, as amended, and by adding a
subdivision; 256B.0913, subdivision 7, and by adding
subdivisions; 256B.0915, subdivision 1b, and by adding
subdivisions; 256B.15, by adding subdivisions;
256B.35, subdivision 1; 256B.37, subdivision 5;
256B.49, by adding a subdivision; 256B.501, by adding
subdivisions; 256B.69, by adding a subdivision;
256G.01, subdivision 3, and by adding subdivisions;
256G.02, subdivisions 4 and 6; 256G.03; 256G.06;
256G.07, subdivisions 1 and 2; 256G.08, subdivision 1;
256G.09, subdivision 2; 256G.10; 256I.04, subdivision
1; 256I.05, subdivision 1c, and by adding a
subdivision; 325F.71, subdivision 2; 327.14,
subdivision 8; 524.2-403; and 524.3-801; Minnesota
Statutes 1995 Supplement, sections 62Q.03, subdivision
8; 62Q.19, subdivisions 1 and 5; 62R.17; 144.122;
144.9503, subdivisions 6, 8, and 9; 144.9504,
subdivisions 2, 7, and 8; 144.9505, subdivision 4;
144A.071, subdivisions 3 and 4a; 148C.01, subdivisions
12 and 13; 148C.02, subdivisions 1 and 2; 148C.03,
subdivision 1; 148C.04, subdivisions 3, 4, and by
adding a subdivision; 148C.05, subdivision 1; 148C.06;
148C.11, subdivisions 1 and 3; 157.011, subdivision 1;
157.15, subdivisions 4, 5, 6, 9, 12, 13, 14, and by
adding subdivisions; 157.16; 157.17, subdivision 2;
157.20, subdivision 1, and by adding a subdivision;
157.21; 252.27, subdivision 2a; 256.045, subdivision
3; 256.969, subdivisions 1, 2b, 9, and 10; 256B.055,
subdivision 12; 256B.0575; 256B.0595, subdivisions 1,
2, 3, and 4; 256B.0625, subdivisions 17, 19a, and 30;
256B.0628, subdivision 2; 256B.0913, subdivisions 5
and 15a; 256B.0915, subdivisions 3 and 3a; 256B.093,
subdivision 3; 256B.15, subdivision 5; 256B.431,
subdivision 25; 256B.432, subdivision 2; 256B.434,
subdivision 10; 256B.49, subdivisions 6 and 7;
256B.501, subdivisions 5b and 5c; 256B.69,
subdivisions 3a, 4, 5b, 6, and 21; 256D.02,
subdivision 12a; 256D.03, subdivision 4; 256D.045; and
256I.04, subdivisions 2b and 3; Laws 1995, chapter
207, article 1, section 2, subdivision 4; proposing
coding for new law in Minnesota Statutes, chapters
62J; 144; 145; 252; 256; 256B; and 299A; proposing
coding for new law as Minnesota Statutes, chapter
252B; repealing Minnesota Statutes 1994, sections
144.691, subdivision 4; 146.14; and 146.20; Minnesota
Statutes 1995 Supplement, sections 157.03; 157.15,
subdivision 2; 157.18; 157.19; 256B.15, subdivision 5;
256B.69, subdivision 4a; 256G.05, subdivision 1; and
256G.07, subdivision 3a; Minnesota Rules, part
9505.5230.
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
BIENNIAL
1996 1997 TOTAL
General $ (118,284,000) $ (57,253,000) $(175,537,000)
State Government
Special Revenue 50,000 300,000 350,000
TOTAL $ (118,234,000) $ (56,953,000) $(175,187,000)
APPROPRIATIONS
Available for the Year
Ending June 30
1996 1997
Sec. 2. COMMISSIONER OF
HUMAN SERVICES
Subdivision 1. Total
Appropriation (118,284,000) (59,533,000)
This reduction is taken from the
appropriation in Laws 1995, chapter
207, article 1, section 2.
The amounts that are added to or
reduced from the appropriation for each
program are specified in the following
subdivisions.
[DHS SPENDING CAP.] The 1998-1999
general fund spending in the department
of human services is limited to
$2,602,561,000 in fiscal year 1998 and
$2,823,204,000 in fiscal year 1999.
Policy changes made to meet this
spending cap will include the effects
on both revenues and expenditures.
Changes from end of session revenue
estimates shall be counted against this
expenditures limit. Expenditures in
the department may exceed these
estimates only if forecast caseloads
increase. After consultation with the
legislature, the commissioner of
finance may also adjust these limits to
recognize any errors or omissions in
the workpapers used to generate the
figure.
Subd. 2. Life Skills
Self-Sufficiency
(3,462,000) 90,000
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) Chemical Dependency
Consolidated Treatment
(3,462,000) (1,346,000)
(b) Deaf and Hard-of-Hearing
Services Grants
-0- 100,000
(c) Community Social Services Grants
-0- 36,000
(d) Aging Grants
-0- 1,050,000
(e) Administration and Other Grants
-0- 250,000
[DEAF AND HARD-OF-HEARING PROGRAMS.] Of
this appropriation, $100,000 in fiscal
year 1997 is for a grant to a nonprofit
agency that is currently serving deaf
and hard-of-hearing adults with mental
illness through residential programs
and supported housing outreach
activities. The grant must be used to
expand the services provided by the
nonprofit agency to include community
support services for deaf and
hard-of-hearing adults with mental
illness. This appropriation shall not
become part of the base for the
1998-1999 biennial budget.
[ADULT DAY CARE.] Of this
appropriation, $250,000 in fiscal year
1997 is for grants to counties to
expand or upgrade adult day care
services and adult day care
facilities. This appropriation is
available until expended but shall not
become part of the base appropriation
for the biennium beginning July 1,
1997. The commissioner shall
distribute grants to counties outside
the metropolitan area where there is a
need for expanded or improved services,
facilities, or other capital assets,
including vans for transporting
clients, and the commissioner shall
require a ten percent local match from
the adult day care agency. The county
shall award grants to nonprofit or
loans to for-profit adult day care
agencies in order for the agency to
physically upgrade the facility, which
will result in the expansion of the
number of clients served in adult day
care, expand the type of services
offered, or enable programs to service
persons with greater needs. For-profit
adult day care agencies eligible for
funds under this section receive funds
as a loan. If a county elects to
provide a loan to a for-profit agency,
the county shall make provisions for
the repayment of the loan within five
years, and redistribute the funds for
additional expansion or upgrading. A
grant or loan to an adult day care
nonprofit or for-profit agency,
respectively, may not exceed $10,000.
These funds shall not be used to pay
for service costs.
[SENIOR PROGRAMS.] For fiscal year
1997, of this appropriation, $150,000
is for volunteer programs for retired
senior citizens established under
Minnesota Statutes, section 256.9753,
$150,000 is for the foster grandparent
program established under Minnesota
Statutes, section 256.976, and $150,000
is for the senior companion program
established under Minnesota Statutes,
section 256.977.
[SENIOR NUTRITION PROGRAM.] Of this
appropriation, $600,000 in fiscal year
1997 is for senior nutrition programs
under Minnesota Statutes, section
256.9752. Not less than $400,000 of
this appropriation shall be used for
congregate dining sites and
home-delivered meals, and not more than
$200,000 shall be used for nutritional
support services.
Subd. 3. Children's Program -0- 2,400,000
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) Subsidized Adoption Grants
-0- 1,500,000
(b) Other Families With Children
Services Administration
-0- 900,000
[SOCIAL SERVICES INFORMATION SYSTEM.]
Of this appropriation, $850,000 in
fiscal year 1997 is for the social
services information system. This
appropriation shall not become part of
the base for the 1998-1999 biennial
budget.
[CHILD WELFARE TECHNOLOGY GRANT.] Of
this appropriation, $50,000 is for
purposes of developing an integrated
child welfare computer system to
connect tribal social services,
counties, nonprofit organizations, and
state agencies that are involved with
child welfare issues, including
adoption, foster care, and out-of-home
placement issues. The appropriation
will be provided to the commissioner
when the commissioner applies for and
receives a technology grant through the
United States Department of Commerce,
Division of National Technology
Information Administration, to develop
and implement the child welfare
network. This $50,000 in state funding
is part of the 50 percent match that is
necessary in order to be eligible for
the federal technology grant.
Subd. 4. Economic Self-Sufficiency
General
(13,668,000) (14,350,000)
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) AFDC Grants
(13,196,000) (16,000,000)
(b) General Assistance Grants
878,000 2,593,000
(c) Minnesota Supplemental Aid
(262,000) (328,000)
(d) Minnesota Family Investment
Plan (MFIP) Grants
-0- 64,000
(e) Child Care Fund Entitlement Grants
(1,258,000) (1,321,000)
(f) Administration and Other Grants
170,000 642,000
[RESIDENCY REQUIREMENT ADMINISTRATIVE
COSTS.] (a) Of this appropriation,
$225,000 in fiscal year 1997 is to
reimburse the counties for the verified
administrative costs of implementing
the 30-day residency requirement in the
general assistance and general
assistance medical care programs.
(b) The commissioner of finance shall
include in the department of human
services biennial budget recommendation
for the 1998-1999 biennium an
appropriation sufficient to reimburse
the counties for the verified
administrative costs of implementing
the 30-day residency requirement in the
medical assistance, aid to families
with dependent children, general
assistance, and general assistance
medical care programs.
[COMBINED MANUAL PRODUCTION COSTS.] For
the biennium ending June 30, 1997, the
commissioner may increase the fee
charged to, and may retain money
received from, individuals and private
entities in order to recover the
difference between the costs of
producing the department of human
services combined manual and the
subsidized price charged to individuals
and private entities on January 1,
1996. This provision does not apply to
government agencies and nonprofit
agencies serving the legal or social
service needs of clients.
Subd. 5. Health Care
General
(100,714,000) (47,590,000)
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) Group Residential Housing Grants
(4,562,000) (3,874,000)
(b) MA Long-Term Care Facilities
(24,640,000) 3,231,000
(c) MA Long-Term Care Waivers
and Home Care
(5,945,000) 2,422,000
(d) MA Managed Care and
Fee-for-Service
(2,164,000) (2,733,000)
(e) General Assistance Medical Care
(63,873,000) (47,276,000)
(f) Administration and Other Grants
470,000 640,000
[NEW ICF/MR.] A newly constructed or
newly established intermediate care
facility for persons with mental
retardation that is developed and
financed during fiscal year 1997 shall
not be subject to the equity
requirements in Minnesota Statutes,
section 256B.501, subdivision 11,
paragraph (d), or 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.] If a facility
which is in receivership under
Minnesota Statutes, section 245A.12 or
245A.13, is sold during fiscal year
1997 to an unrelated organization: (1)
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 (2) 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.
[ICF/MR RATE EXEMPTION.] If the
commissioner of human services is
unable to complete the rulemaking
revisions to the ICF/MR reimbursement
rule by September 30, 1996, for the
rate year beginning October 1, 1996,
the commissioner shall exempt ICF/MR
facilities from reductions to the
payment rates under Minnesota Statutes,
section 256B.501, subdivision 5b,
paragraph (d), clause (6), if the
facility: (1) has had a settle-up
payment rate established in the
reporting year preceding the rate year
for the one-time rate adjustment; (2)
is a newly established facility; (3) is
an A to B conversion under the
reimbursement rule; (4) has a payment
rate subject to a community conversion
project under Minnesota Statutes,
section 252.292; (5) has a payment rate
established under Minnesota Statutes,
section 245A.12 or 245A.13; or (6) is a
facility created by the relocation of
more than 25 percent of the capacity of
a related facility during the reporting
year.
[COUNTY WAIVERED SERVICES RESERVE.]
Notwithstanding the provisions of
Minnesota Statutes, section 256B.092,
subdivision 4, and Minnesota Rules,
part 9525.1830, subpart 2, the
commissioner may approve written
procedures and criteria for the
allocation of home- and community-based
waivered services funding for persons
with mental retardation or related
conditions which enables a county to
maintain a reserve resource account.
The reserve resource account may not
exceed five percent of the county
agency's total annual allocation of
home- and community-based waivered
services funds. The reserve may be
utilized to ensure the county's ability
to meet the changing needs of current
recipients, to ensure the health and
safety needs of current recipients, or
to provide short-term emergency
intervention care to eligible waiver
recipients.
[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 1996 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.
[SERVICE ALLOWANCE TRANSFER.] For the
fiscal year ending June 30, 1997, the
commissioner may transfer $848,000 from
the medical assistance grants account
to the alternative care grants account
for allocation as service allowances to
counties under Minnesota Statutes 1995
Supplement, section 256B.0913,
subdivision 15.
[HIV/AIDS DRUG REIMBURSEMENT PROGRAM.]
Of this appropriation, $150,000 in
fiscal year 1997 is for the HIV/AIDS
drug reimbursement program and shall be
added to federal funds available for
that program.
[ICF/MR ALTERNATIVE RATE STRUCTURE.]
The commissioner, in conjunction with
ICF/MR service providers, shall present
to the legislature by January 31, 1997,
recommendations for an alternative rate
structure that recognizes the small
size and individual needs of ICFs/MR.
The system proposed must recognize
costs incurred, must not penalize
facilities converted since 1990 as part
of the A to B conversion project, and
must reimburse the costs associated
with federal active treatment
standards. As part of developing these
recommendations the commissioner shall
also examine issues related to the
relative size and cost of these
facilities and shall develop
recommendations regarding whether
allowing the development of larger
facilities can be a high-quality,
cost-efficient service option.
[TEFRA CRITERIA MODIFICATIONS.] The
commissioner shall report to the
legislature by February 1, 1997, on the
number of children found eligible for
medical assistance under the TEFRA
option as a result of the modifications
in Minnesota Statutes, section
256B.055, subdivision 12, paragraph
(e), adopted in this chapter. The
report must include information on the
medical condition of the children found
eligible and on the services provided
to them. The report must include
recommendations on any changes in these
criteria developed in consultation with
interested family, client, provider,
and county representatives.
[TEFRA DENIALS.] Effective the day
following final enactment, for children
found ineligible for medical assistance
under the TEFRA option under criteria
in Minnesota Statutes, section
256B.055, subdivision 12, established
in Laws 1995, chapter 207, article 6,
if the reason for denial is lack of
information on the child's condition,
the commissioner shall notify the
family of the lack of documentation at
least 60 days prior to termination of
eligibility for notices sent between
April 1 and July 1, l996. All TEFRA
ineligibility notices sent between
April 1 and July 1, 1996, must contain
the telephone number of a department of
human services staff person whom the
family can contact about alternative
sources of health coverage, including
MinnesotaCare, the Minnesota
comprehensive health association,
services for children with special
health care needs, and other types of
assistance for children with
disabilities or chronic illnesses.
[PUBLIC HEALTH NURSE ASSESSMENT.]
Effective for public health nurse
visits on or after July 1, 1996, the
reimbursement for public health nurse
visits relating to the provision of
personal care assistant services under
Minnesota Statutes, sections 256B.0625,
subdivision 19a, and 256B.0627, is
$204.36 for the initial assessment
visit and $102.18 for each reassessment
visit.
[NF PAYMENT INCREASE.] For the rate
year beginning July 1, 1996, the
commissioner shall increase each
nursing facility's payment rate for
those facilities whose rates are
determined under Minnesota Statutes,
section 256B.431, subdivision 25, by
$0.06 per resident per day.
Subd. 6. Community Mental Health
and State-Operated Services
General
(440,000) (83,000)
The amounts that are reduced from this
appropriation for each purpose are as
follows:
(a) Mental Health Grants - Children
(400,000) 277,000
(b) Mental Health Grants - Adults
(40,000) (360,000)
[CRISIS SERVICES.] Crisis services for
developmentally disabled persons in
each regional center catchment area,
including crisis beds and mobile
intervention teams, shall be at
Brainerd, Cambridge, Fergus Falls, St.
Peter, and Willmar regional centers in
accordance with the agreement reached
in 1989, and codified in Minnesota
Statutes, section 252.025. The program
design must be negotiated and agreed to
by the affected exclusive
representatives. The parties also must
meet and discuss ways to provide the
highest quality services, while
maintaining or increasing cost
effectiveness.
[COMPULSIVE GAMBLING.] For the fiscal
year beginning July 1, 1996, the state
lottery board shall deposit $800,000 in
the general fund for use by the
commissioner of human services to pay
for compulsive gambling services as
follows: $500,000 is allocated for
treatment of compulsive gamblers;
$150,000 is allocated for the
compulsive gambling treatment pilot
project for treating individual
compulsive gamblers; and $150,000 is
allocated for education and prevention
efforts, of which $50,000 is for a
grant to a compulsive gambling council
located in St. Louis county for the
extension of the information gathering
and dissemination network and the
establishment of training
scholarships. The amount deposited by
the board shall be deducted from the
lottery prize fund established under
Minnesota Statutes, section 349A.10,
subdivision 2. The amount deposited is
appropriated to the commissioner of
human services for this purpose. None
of the amount appropriated for
compulsive gambling services under this
section may be used to pay
administrative costs of the department
of human services.
[COMPULSIVE GAMBLING GRANT FOR
ADOLESCENT PROGRAMS.] Of this
appropriation, $40,000 in fiscal year
1997 is for a grant to a compulsive
gambling council located in St. Louis
county for a compulsive gambling
prevention and education project for
adolescents. This appropriation shall
not become part of the base level
funding for the 1998-1999 biennial
budget. The appropriation in Laws
1995, chapter 207, article 1, section
2, subdivision 7, for compulsive
gambling programs for fiscal year 1996
is reduced by $40,000.
[RTC DENTAL SERVICES REPORT.] The
commissioner shall report to the chairs
of the house health and human services
committee and the senate health care
committee by November 1, 1996, on the
implementation of Minnesota Statutes,
section 246,57, subdivision 6.
Sec. 3. COMMISSIONER OF HEALTH
Subdivision 1. Total
Appropriation -0- 2,280,000
Summary by Fund
General -0- 2,080,000
State Government
Special Revenue -0- 200,000
This appropriation is added to the
appropriation in Laws 1995, chapter
207, article 1, section 3.
The amounts that may be spent from this
appropriation for each program are
specified in the following subdivisions.
Subd. 2. Health Systems and
Special Populations -0- 1,985,000
Summary by Fund
General -0- 1,785,000
State Government
Special Revenue -0- 200,000
[CORE PUBLIC HEALTH FUNCTIONS.] Of this
appropriation, $1,500,000 in fiscal
year 1997 is for core public health
functions. Of this amount, up to five
percent is available to the
commissioner for administrative and
technical support of community health
boards. Funds distributed shall not be
used to displace current appropriations
or to provide individual personal
health care services which compete with
or duplicate services otherwise
available through the prepaid medical
assistance program. These funds shall
be distributed on a pro rata basis
according to the existing community
health services subsidy formula to
those community health service areas
which are participating in the state's
prepaid medical assistance program.
This appropriation shall not become
part of the base for the 1998-1999
biennial budget.
[DIRECT CONTRACTING REPORT.] The
commissioners of health and commerce
shall jointly study and report to the
legislative oversight commission on
health care access by December 15,
1996, on the feasibility of allowing
direct provider contracting of health
care services. Included in this report
shall be recommendations on the
consumer protections, reserve
requirements, and protections for
consumers who will not have direct
contracting available to them that the
legislature should consider to ensure
protection of persons receiving health
coverage through networks allowed to
conduct direct provider contracting.
[HOSPITAL CONVERSION; SUPPLEMENTAL
ALLOCATION.] Of the appropriation from
the general fund, for the fiscal year
ending June 30, 1997, 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. This allocation
is in addition to funds authorized by
Laws 1995, article 1, section 3,
subdivision 2.
[MEDICARE INITIAL SURVEYS.] (a)
$200,000 is appropriated to the
commissioner from the general fund for
the fiscal year ending June 30, 1997,
to support initial surveys of Medicare
providers. This appropriation shall be
available until the federal law
prohibiting the collection of fees for
Medicare initial surveys is repealed.
(b) $200,000 is appropriated to the
commissioner from the state government
special revenue fund for the fiscal
year ending June 30, 1997, to support
initial surveys of Medicare providers
once the federal law prohibiting the
collection of fees for this activity is
repealed. Upon repeal of the federal
law, the commissioner shall charge fees
as provided under Minnesota Statutes,
section 144.122, paragraph (e).
[PROJECT REVIEW BEFORE CONSTRUCTION.]
Before construction may commence on the
project authorized in Minnesota
Statutes, section 144A.071, subdivision
4a, paragraph (w), the interagency
long-term care planning committee must
review the project to ascertain the
extent to which the project meets the
objectives of Minnesota Statutes,
section 144A.073, subdivision 4, and
approve the project if it meets the
objectives.
[SHARED ADMINISTRATOR.] Notwithstanding
the provisions of Minnesota Statutes,
section 144A.04, subdivision 5, the
administrator of a county owned nursing
home may serve, until September 30,
1996, as the administrator of a nursing
home located in a county owned hospital
provided that the total number of
nursing home beds in both facilities
does not exceed 153 beds. This
provision is effective the day
following final enactment.
Subd. 3. Health Protection -0- 295,000
[BIRTH DEFECTS REGISTRY.] Of this
appropriation, $195,000 in fiscal year
1997 is for the birth defects registry
system under Minnesota Statutes,
section 144.2215. The startup costs
shall not become part of the base for
the 1998-1999 biennial budget.
[LEAD HAZARD REDUCTION.] Of this
appropriation, $100,000 in fiscal year
1997 is for lead hazard reduction under
Minnesota Statutes, section 144.9504,
subdivisions 1 and 7, and section
144.9503, subdivision 9.
[REPORT ON INSPECTION FEES.] The
commissioner may spend up to $20,000 of
the money appropriated for the fiscal
year ending June 30, 1997, to develop
recommendations for options to reduce
inspection fees for establishments
licensed under Minnesota Statutes,
chapter 157, which are operating in the
category of small establishment with
full menu selection, and which have ten
or fewer employees. The
recommendations must not include the
option of a general fund appropriation
as a way to reduce inspection fees.
The commissioner must report the
recommendations to the legislature by
October 1, 1996.
Sec. 4. VETERANS NURSING
HOMES BOARD -0- 125,000
This appropriation is added to the
appropriation in Laws 1995, chapter
207, article 1, section 4.
[VETERANS NURSING HOMES BOARD.]
$125,000 is appropriated from the
general fund to the veterans nursing
homes board for the fiscal year ending
June 30, 1997, for the nursing home in
Fergus Falls. This appropriation is to
fund positions and support services, to
coordinate and oversee the construction
of the facility, and to begin planning
for the opening of the facility.
Sec. 5. HEALTH-RELATED BOARDS
Subdivision 1. Total
Appropriation 50,000 175,000
Summary by Fund
General -0- 75,000
State Government
Special Revenue 50,000 100,000
This appropriation is added to the
appropriation in Laws 1995, chapter
207, article 1, section 5.
Subd. 2. Emergency Medical Services
Regulatory Board
General Fund -0- 75,000
[EMS TRANSFER EXPENSES.] $75,000 is
appropriated to the emergency medical
services regulatory board from the
general fund for the fiscal year ending
June 30, 1997, for expenses incurred in
transferring regulatory authority from
the commissioner of health to the board
under Laws 1995, chapter 207, article
9. This appropriation shall not become
part of the base for the 1998-1999
biennial budget.
Subd. 3. Board of Medical
Practice
State Government Special
Fund 50,000 100,000
[MEDICAL PRACTICE BOARD.] $50,000 in
fiscal year 1996 and $100,000 in fiscal
year 1997 is appropriated from the
state government special revenue fund
to the board of medical practice for
the health professionals services
program, and is added to the
appropriation in Laws 1995, chapter
207, article 1, section 5, subdivision
6.
[STATE GOVERNMENT SPECIAL REVENUE
FUND.] The appropriations in this
subdivision 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 subdivision 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.
Sec. 6. [CARRYOVER LIMITATION.]
None of the appropriations in this
article 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 1998-1999
biennial budget, unless specifically
directed by the legislature.
Sec. 7. [SUNSET OF UNCODIFIED
LANGUAGE.]
All uncodified language contained in
this article expires on June 30, 1997,
unless a different expiration is
explicit.
ARTICLE 2
HEALTH AND CONTINUING CARE RELATED TO
MEDICAL ASSISTANCE AND GENERAL ASSISTANCE MEDICAL CARE
Section 1. Minnesota Statutes 1995 Supplement, section
62Q.19, subdivision 1, is amended to read:
Subdivision 1. [DESIGNATION.] The commissioner shall
designate essential community providers. The criteria for
essential community provider designation shall be the following:
(1) a demonstrated ability to integrate applicable
supportive and stabilizing services with medical care for
uninsured persons and high-risk and special needs populations as
defined in section 62Q.07, subdivision 2, paragraph (e),
underserved, and other special needs populations; and
(2) a commitment to serve low-income and underserved
populations by meeting the following requirements:
(i) has nonprofit status in accordance with chapter 317A;
(ii) has tax exempt status in accordance with the Internal
Revenue Service Code, section 501(c)(3);
(iii) charges for services on a sliding fee schedule based
on current poverty income guidelines; and
(iv) does not restrict access or services because of a
client's financial limitation; or
(3) status as a local government unit as defined in section
62D.02, subdivision 11, an Indian tribal government, an Indian
health service unit, or community health board as defined in
chapter 145A; or
(4) a former state hospital that specializes in the
treatment of cerebral palsy, spina bifida, epilepsy, closed head
injuries, specialized orthopedic problems, and other disabling
conditions.
Prior to designation, the commissioner shall publish the
names of all applicants in the State Register. The public shall
have 30 days from the date of publication to submit written
comments to the commissioner on the application. No designation
shall be made by the commissioner until the 30-day period has
expired.
The commissioner may designate an eligible provider as an
essential community provider for all the services offered by
that provider or for specific services designated by the
commissioner.
For the purpose of this subdivision, supportive and
stabilizing services include at a minimum, transportation, child
care, cultural, and linguistic services where appropriate.
Sec. 2. Minnesota Statutes 1995 Supplement, section
62Q.19, subdivision 5, is amended to read:
Subd. 5. [CONTRACT PAYMENT RATES.] An essential community
provider and a health plan company may negotiate the payment
rate for covered services provided by the essential community
provider. This rate must be at least the same rate per unit of
service as is paid to other health plan providers for the same
or similar services.
Sec. 3. Minnesota Statutes 1995 Supplement, 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 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 150 percent
of poverty, but not over $50,000, ten percent;
(2) on the amount of adjusted gross income over 150 percent
of poverty and over $50,000 but not over $60,000, 12 percent;
(3) on the amount of adjusted gross income over 150 percent
of poverty, and over $60,000 but not over $75,000, 14 percent;
and
(4) on all adjusted gross income amounts over 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.
(i) The contribution under paragraph (b) shall be reduced
by $300 per fiscal year if, in the 12 months prior to July 1;
(1) the parent applied for insurance for the child,
(2) the insurer denied insurance,
(3) the parents submitted a complaint or appeal, in writing
to the insurer, submitted a complaint or appeal, in writing, to
the commissioner of health or the commissioner of commerce, or
litigated the complaint or appeal, and
(4) as a result of the dispute, the insurer reversed its
decision and granted insurance.
For purposes of this section, insurance has the meaning
given in paragraph (h).
A parent who has requested a reduction in the contribution
amount under this paragraph shall submit proof in the form and
manner prescribed by the commissioner or county agency,
including, but not limited to, the insurer's denial of
insurance, the written letter or complaint of the parents, court
documents, and the written response of the insurer approving
insurance. The determinations of the commissioner or county
agency under this paragraph are not rules subject to chapter 14.
Sec. 4. [252.53] [DAY TRAINING AND HABILITATION SERVICES.]
Day training and habilitation license holders are exempt
from the requirements of Minnesota Rules, part 9525.1630,
subparts 3 (review of progress toward individual habilitation
plan goals), 4 (initial assessment), and 5 (reassessment), for
persons for whom progress reviews, initial assessments, and
reassessments are completed by the license holder according to
requirements established in the person's individual service plan
developed by the county case manager under Minnesota Statutes,
section 256B.092, subdivision 1b.
Sec. 5. Minnesota Statutes 1995 Supplement, 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 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, 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 was the primary hospital
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: $505,000 due on the 15th of each month
after noon, beginning July 15, 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. 6. [256.9692] [EFFECT OF INTEGRATION AGREEMENT ON
DIVISION OF COST.]
Beginning in the first calendar month after there is a
definitive integration agreement affecting the University of
Minnesota hospital and clinics and Fairview hospital and health
care services, Fairview hospital and health care services shall
pay the University of Minnesota $505,000 on the 15th of each
month, after receiving the state payment, provided that the
University of Minnesota has fulfilled the requirements of
section 256B.19, subdivision 1c.
Sec. 7. Minnesota Statutes 1995 Supplement, 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 the child requires a level of care provided in
a hospital, nursing 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 under this section is not more than the amount that
medical assistance would pay for if the child resides in an
institution. Eligibility under this section must be determined
annually After the child is determined to be eligible under this
section, the commissioner shall review the child's disability
under United States Code, title 42, section 1382c(a) and level
of care defined under this section no more often than annually
and may elect, based on the recommendation of health care
professionals under contract with the state medical review team,
to extend the review of disability and level of care up to a
maximum of four years. The commissioner's decision on the
frequency of continuing review of disability and level of care
is not subject to administrative appeal under section 256.045.
Nothing in this subdivision shall be construed as affecting
other redeterminations of medical assistance eligibility under
chapter 256B and annual cost effective reviews under this
section.
(b) For purposes of this subdivision, "hospital" means an
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 . 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, "nursing 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 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 the
level of care provided in a nursing facility if the person
requires 24-hour monitoring or supervision and a plan of mental
health treatment because of specific symptoms or functional
impairments associated with a serious mental illness or disorder
diagnosis, which meet severity criteria for mental health
established by the commissioner based on standards developed for
the Wisconsin Katie Beckett program published in July 1994.
(f) 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 parent or guardian, the
child's physician or physicians, 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) (g) If a child meets the conditions in paragraph (b),
(c), or (d), or (e), 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) or (e),
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. 8. Minnesota Statutes 1994, section 256B.056,
subdivision 1, is amended to read:
Subdivision 1. [RESIDENCY.] To be eligible for medical
assistance, a person must reside have resided in Minnesota for
at least 30 days, or, if absent from the state, be deemed to be
a resident of Minnesota in accordance with the rules of the
state agency.
A person who has resided in the state for less than 30 days
is considered to be a Minnesota resident if the person:
(1) was born in the state;
(2) has in the past resided in the state for at least 365
consecutive days;
(3) has come to the state to join a close relative, which,
for purposes of this subdivision means a parent, grandparent,
brother, sister, spouse, or child; or
(4) has come to this state to accept a bona fide offer of
employment for which the person is eligible.
A county agency shall waive the 30-day residency
requirement in cases of medical emergency or where unusual
hardship would result from denial of assistance. The county
agency must report to the commissioner within 30 days on any
waiver granted under this section. The county shall not deny an
application solely because the applicant does not meet at least
one of the criteria in this subdivision, but shall continue to
process the application and leave the application pending until
the residency requirement is met or until eligibility or
ineligibility is established.
Sec. 9. Minnesota Statutes 1994, section 256B.056,
subdivision 1a, is amended to read:
Subd. 1a. [INCOME AND ASSETS GENERALLY.] Unless
specifically required by state law or rule or federal law or
regulation, the methodologies used in counting income and assets
to determine eligibility for medical assistance for persons
whose eligibility category is based on blindness, disability, or
age of 65 or more years, the methodologies for the supplemental
security income program shall be used, except that payments made
pursuant to a court order for the support of children shall be
excluded from income in an amount not to exceed the difference
between the applicable income standard used in the state's
medical assistance program for aged, blind, and disabled persons
and the applicable income standard used in the state's medical
assistance program for families with children. Exclusion of
court-ordered child support payments is subject to the condition
that if there has been a change in the financial circumstances
of the person with the legal obligation to pay support since the
support order was entered, the person with the legal obligation
to pay support has petitioned for modification of the support
order. For families and children, which includes all other
eligibility categories, the methodologies for the aid to
families with dependent children program under section 256.73
shall be used. Effective upon federal approval, in-kind
contributions to, and payments made on behalf of, a recipient,
by an obligor, in satisfaction of or in addition to a temporary
or permanent order for child support or maintenance, shall be
considered income to the recipient. For these purposes, a
"methodology" does not include an asset or income standard, or
accounting method, or method of determining effective dates.
Sec. 10. Minnesota Statutes 1995 Supplement, 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 to the extent that the deduction is
not included in the personal needs allowance under section
256B.35, subdivision 1, as child support garnished under a court
order;
(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. 11. Minnesota Statutes 1995 Supplement, 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 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 after August 10, 1993, 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, 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
long-term care services, any transfer of such assets within 36
months before or any time after an institutionalized person
applies for medical assistance, 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 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. 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, 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 the person's spouse, transfers to 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 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 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. 12. Minnesota Statutes 1994, section 256B.0595, is
amended by adding a subdivision to read:
Subd. 1a. [PROHIBITED TRANSFERS.] (a) Notwithstanding any
contrary provisions of this section, this subdivision applies to
transfers involving recipients of medical assistance that are
made on or after its effective date and to all transfers
involving persons who apply for medical assistance on or after
its effective date if the transfer occurred within 72 months
before the person applies for medical assistance, except that
this subdivision does not apply to transfers made prior to March
1, 1996. 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 the person's spouse, may not give away, sell, dispose
of, or reduce ownership or control of any income, asset, or
interest therein for less than fair market value for the purpose
of establishing or maintaining medical assistance eligibility
for the person. For purposes of determining eligibility for
medical assistance services, any transfer of such income or
assets for less than fair market value within 72 months before
or any time after a person applies for medical assistance 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 medical assistance
services for the period of time determined under subdivision 2a,
unless the person furnishes convincing evidence to establish
that the transaction was exclusively for another purpose, or
unless the transfer is permitted under subdivision 3a or 4a.
(b) This section applies to transfers of income or assets
for less than fair market value, 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.
(c) This section applies to payments for care or personal
services provided by a relative, unless the compensation was
stipulated in a notarized, written agreement which was in
existence when the service was performed, the care or services
directly benefited the person, and the payments made represented
reasonable compensation for the care or services provided. A
notarized written agreement is not required if payment for the
services was made within 60 days after the service was provided.
(d) This section applies to the portion of any income,
asset, or interest therein that 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 the person's spouse, transfers to
any annuity that exceeds the value of the benefit likely to be
returned to the person or spouse while alive, based on estimated
life expectancy of adults entering long-term care. The
commissioner shall adopt rules establishing life expectancies of
adults entering long-term care.
Sec. 13. Minnesota Statutes 1995 Supplement, 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 after August 10, 1993,
the number of months of ineligibility for 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. 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. 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 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 not
included in an existing penalty period does not exceed
$1,000 $500, then such transfers shall be disregarded for each
month prior to the month of application for or during receipt of
medical assistance.
Sec. 14. Minnesota Statutes 1994, section 256B.0595, is
amended by adding a subdivision to read:
Subd. 2a. [PERIOD OF INELIGIBILITY.] (a) Notwithstanding
any contrary provisions of this section, this subdivision
applies to transfers involving recipients of medical assistance
that are made on or after its effective date and to all
transfers involving persons who apply for medical assistance on
or after its effective date, regardless of when the transfer
occurred, except that this subdivision does not apply to
transfers made prior to March 1, 1996. For any uncompensated
transfer occurring within 72 months prior to the date of
application, at any time after application, or while eligible,
the number of months of cumulative ineligibility for medical
assistance services shall be the total uncompensated value of
the assets and income transferred divided by the statewide
average per person nursing facility payment made by the state in
effect on the date of application. The amount used to calculate
the average per person payment shall be adjusted each July 1 to
reflect average payments for the previous calendar year. For
applicants, the period of ineligibility begins with the month in
which the person applied for medical assistance and satisfied
all other requirements for eligibility, or the month the local
agency becomes aware of the transfer, if later. For recipients,
the period of ineligibility begins in the month the agency
becomes aware of the transfer, except that penalty periods for
transfers made during a period of ineligibility as determined
under this section shall begin in the month following the
existing period of ineligibility. 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 that was not recovered from the transferor through the
implementation of a penalty period under this subdivision,
whichever is less. The action may be brought by the state or
the local agency responsible for providing medical assistance
under chapter 256G. The total uncompensated value is the fair
market value of the income or asset at the time it was given
away, sold, or disposed of, less the amount of compensation
received. No cause of action exists for a transfer, unless:
(1) the transferee knew or should have known that the transfer
was being made by a person who was a resident of a long-term
care facility or was receiving that level of care in the
community at the time of the transfer; (2) the transferee knew
or should have known that the transfer was being made to assist
the person to qualify for or retain medical assistance
eligibility; or (3) the transferee actively solicited the
transfer with intent to assist the person to qualify for or
retain eligibility for medical assistance.
(b) If a calculation of a penalty period results in a
partial month, payments for medical assistance 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 not
included in an existing penalty period does not exceed $500,
then such transfers shall be disregarded for each month prior to
the month of application for or during receipt of medical
assistance.
Sec. 15. Minnesota Statutes 1995 Supplement, 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, as certified by the
individual's attending physician, 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 a penalty
resulting from a transfer for less than fair market value
because denial of eligibility would cause undue hardship for the
individual, based on imminent threat to the individual's health
and well-being. Whenever an applicant or recipient is denied
eligibility because of a transfer for less than fair market
value, the local agency shall notify the applicant or recipient
that they may request a waiver of the penalty if the denial of
eligibility will cause undue hardship. In evaluating a waiver,
the local agency shall take into account whether the individual
was the victim of financial exploitation, whether the individual
has made reasonable efforts to recover the transferred property
or resource, and other factors relevant to a determination of
hardship. If the local agency does not approve a hardship
waiver, the local agency shall issue a written notice to the
individual stating the reasons for the denial and the process
for appealing the local agency's decision.
(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 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 shall be brought by the state or unless the state delegates
this responsibility to the local agency responsible for
providing medical assistance under chapter 256G.
Sec. 16. Minnesota Statutes 1994, section 256B.0595, is
amended by adding a subdivision to read:
Subd. 3a. [HOMESTEAD EXCEPTION TO TRANSFER PROHIBITION.]
(a) This subdivision applies to transfers involving recipients
of medical assistance that are made on or after its effective
date and to all transfers involving persons who apply for
medical assistance on or after its effective date, regardless of
when the transfer occurred, except that this subdivision does
not apply to transfers made prior to March 1, 1996. A person is
not ineligible for medical assistance services due to a transfer
of assets for less than fair market value as described in
subdivision 1a if the asset transferred was a homestead and:
(1) title to the homestead was transferred to the
individual's relatives who are residing in the homestead and are
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, as certified by the
individual's attending physician, 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 a penalty resulting
from a transfer for less than fair market value because denial
of eligibility would cause undue hardship for the individual and
there exists an imminent threat to the individual's health and
well-being. Whenever an applicant or recipient is denied
eligibility because of a transfer for less than fair market
value, the local agency shall notify the applicant or recipient
that they may request a waiver of the penalty if the denial of
eligibility will cause undue hardship. In evaluating a waiver,
the local agency shall take into account whether the individual
was the victim of financial exploitation, whether the individual
has made reasonable efforts to recover the transferred property
or resource, and other factors relevant to a determination of
hardship. If the local agency does not approve a hardship
waiver, the local agency shall issue a written notice to the
individual stating the reasons for the denial and the process
for appealing the local agency's decision.
(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 medical assistance
services granted within 72 months of the date the transferor
applied for medical assistance and satisfied all other
requirements for eligibility, or the amount of the uncompensated
transfer, whichever is less, together with the costs incurred
due to the action. The action shall be brought by the state
unless the state delegates this responsibility to the local
agency responsible for providing medical assistance under
chapter 256G.
Sec. 17. Minnesota Statutes 1995 Supplement, section
256B.0595, subdivision 4, is amended to read:
Subd. 4. [OTHER EXCEPTIONS TO TRANSFER PROHIBITION.] 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 individual's spouse
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 a penalty resulting from a
transfer for less than fair market value based on an imminent
threat to the individual's health and well-being. Whenever an
applicant or recipient is denied eligibility because of a
transfer for less than fair market value, the local agency shall
notify the applicant or recipient that they may request a waiver
of the penalty if the denial of eligibility will cause undue
hardship. In evaluating a waiver, the local agency shall take
into account whether the individual was the victim of financial
exploitation, whether the individual has made reasonable efforts
to recover the transferred property or resource, and other
factors relevant to a determination of hardship. If the local
agency does not approve a hardship waiver, the local agency
shall issue a written notice to the individual stating the
reasons for the denial and the process for appealing the local
agency's decision. 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 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 shall be brought by the state or unless the state delegates
this responsibility to 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.
Sec. 18. Minnesota Statutes 1994, section 256B.0595, is
amended by adding a subdivision to read:
Subd. 4a. [OTHER EXCEPTIONS TO TRANSFER PROHIBITION.] This
subdivision applies to transfers involving recipients of medical
assistance that are made on or after its effective date and to
all transfers involving persons who apply for medical assistance
on or after its effective date, regardless of when the transfer
occurred, except that this subdivision does not apply to
transfers made prior to March 1, 1996. A person or a person's
spouse who has made a transfer prohibited by subdivision 1a is
not ineligible for medical assistance services if one of the
following conditions applies:
(1) the assets or income were transferred to the
individual's spouse or to another for the sole benefit of the
spouse, except that after eligibility is established, transfers
to a spouse are permitted only to comply with the provisions of
section 256B.059; or
(2) the institutionalized spouse, prior to being
institutionalized, transferred assets or income to a spouse,
provided that the spouse to whom the assets or income were
transferred does not then transfer those assets or income 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 or income were transferred to a trust for
the sole benefit of the individual's child who is blind or
permanently and totally disabled as determined in the
supplemental security income program and the trust reverts to
the state upon the disabled child's death to the extent medical
assistance has paid for services for the child. This paragraph
paragraph applies to a trust established after the commissioner
publishes a notice in the State Register that the commissioner
has been authorized to implement this paragraph due to a change
in federal law or the approval of a federal waiver; or
(4) a satisfactory showing is made that the individual
intended to dispose of the assets or income 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 a penalty resulting from a transfer for less
than fair market value because there exists an imminent threat
to the individual's health and well-being. Whenever an
applicant or recipient is denied eligibility because of a
transfer for less than fair market value, the local agency shall
notify the applicant or recipient that they may request a waiver
of the penalty if the denial of eligibility will cause undue
hardship. In evaluating a waiver, the local agency shall take
into account whether the individual was the victim of financial
exploitation, whether the individual has made reasonable efforts
to recover the transferred property or resource, and other
factors relevant to a determination of hardship. If the local
agency does not approve a hardship waiver, the local agency
shall issue a written notice to the individual stating the
reasons for the denial and the process for appealing the local
agency's decision. 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 within
72 months of the date the transferor applied for medical
assistance and satisfied all other requirements for eligibility,
or the amount of the uncompensated transfer, whichever is less,
together with the costs incurred due to the action. The action
shall be brought by the state unless the state delegates this
responsibility to the local agency responsible for providing
medical assistance under this chapter.
Sec. 19. Minnesota Statutes 1994, section 256B.0595, is
amended by adding a subdivision to read:
Subd. 7. [NOTICE OF RIGHTS.] If a period of ineligibility
is imposed under subdivision 2 or 2a, the local agency shall
inform the applicant or recipient subject to the penalty of the
person's rights under section 325F.71, subdivision 2.
Sec. 20. Minnesota Statutes 1995 Supplement, 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 or responsible parties
must be able to identify their the recipient's needs, direct and
evaluate task accomplishment, and assure their provide for
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. 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, or the responsible
party or the foster care provider of a recipient who cannot
direct the recipient's own care unless, in the case of a foster
care provider, a county or state case manager visits the
recipient as needed, but not 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. 21. Minnesota Statutes 1995 Supplement, 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 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;
(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 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.; and
(6) assure that all liable third-party payers including
Medicare have been used prior to medical assistance for home
care services, including but not limited to, home health agency,
elected hospice benefit, waivered services, alternative care
program services, and personal 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. 22. [256B.071] [MEDICARE MAXIMIZATION PROGRAM.]
Subdivision 1. [DEFINITION.] (a) "Dual entitlees" means
recipients eligible for either the medical assistance program or
the alternative care program who are also eligible for the
federal Medicare program.
(b) For purposes of this section "home care services" means
home health agency services, private duty nursing services,
personal care assistant services, waivered services, alternative
care program services, hospice services, rehabilitation therapy
services, and medical supplies and equipment.
Subd. 2. [TECHNICAL ASSISTANCE TO PROVIDERS.] (a) The
commissioner shall establish a technical assistance program to
require providers of services and equipment under this section
to maximize collections from the federal Medicare program. The
technical assistance may include the provision of materials to
help providers determine those services and equipment likely to
be reimbursed by Medicare. The technical assistance may also
include the provision of computer software to providers to
assist in this process. The commissioner may expand the
technical assistance program to include providers of other
services under this chapter.
(b) Any provider of home care services enrolled in the
medical assistance program, or county public health nursing
agency responsible for personal care assessments, or county case
managers for alternative care or medical assistance waiver
programs, is required to use the method developed and supplied
by the department of human services for determining Medicare
coverage for home care equipment and services provided to dual
entitlees to ensure appropriate billing of Medicare. The method
will be developed in two phases; the first phase is a manual
system effective July 1, 1996, and the second phase will
automate the manual procedure by expanding the current Medicaid
Management Information System (MMIS) effective January 1, 1997.
Both methods will determine Medicare coverage for the dates of
service, Medicare coverage for home care services, and create an
audit trail including reports. Both methods will be linked to
prior authorization, therefore, either method must be used
before home care services are authorized and when there is a
change of condition affecting medical assistance authorization.
The department will conduct periodic reviews of participant
performance with the method and upon demonstrating appropriate
referral and billing of Medicare, participants may be determined
exempt from regular performance audits.
Subd. 3. [REFERRALS TO MEDICARE CERTIFIED PROVIDERS
REQUIRED.] Non-Medicare certified and nonparticipating Medicare
certified home care service providers must refer dual eligible
recipients to Medicare certified providers when Medicare is
determined to be the appropriate payer for supplies and
equipment or services. Non-Medicare certified and
nonparticipating Medicare certified home care service providers
will be terminated from participation in the medical assistance
program for failure to make such referrals.
Subd. 4. [MEDICARE CERTIFICATION REQUIREMENT.] Medicare
certification is required of all medical assistance enrolled
home care service providers as defined in subdivision 1 within
one year of the date the Minnesota department of health gives
notice to the department that initial Medicare surveys will
resume.
Subd. 5. [ADVISORY COMMITTEE.] The commissioner shall
establish an advisory committee comprised of home care services
recipients, providers, county public health nurses, home care
and county nursing associations, and department of human
services staff to make recommendations to the Medicare
maximization program. The recommendations shall include:
nursing practice issues as they relate to home care services
funded by Medicare and medical assistance; and streamlining
assessment, prior authorization, and up-front payer
determination processes to achieve administrative efficiencies.
Sec. 23. Minnesota Statutes 1995 Supplement, section
256B.0913, subdivision 15a, is amended 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 effective
January 1, 1996, Anoka county may pay vendors, and the
commissioner shall reimburse the county, for actual costs up to
a limit which is the maximum rate in effect on December 31,
1995, plus half the difference between that rate and the maximum
allowed state county's maximum allowed rate for home health aide
services per 15-minute unit is $4.39, and its maximum allowed
rate for homemaker services per 15-minute unit is $2.90. Any
adjustments in fiscal year 1997 to the maximum allowed rates for
home health aide or homemaker services for Anoka county shall be
calculated from the maximum rate in effect on January 1, 1996.
Sec. 24. Minnesota Statutes 1994, section 256B.0913, is
amended by adding a subdivision to read:
Subd. 15b. [REIMBURSEMENT RATE; AITKIN COUNTY.]
Notwithstanding subdivision 14, paragraph (e), effective April
1, 1996, Aitkin county's maximum allowed rate for in-home
respite care services is $6.62 per 30-minute unit. Any
adjustments in fiscal year 1997 to the maximum allowed rate for
in-home respite care services for Aitkin county shall be
calculated from the maximum rate in effect on April 1, 1996.
Sec. 25. Minnesota Statutes 1994, section 256B.0913, is
amended by adding a subdivision to read:
Subd. 15c. [REIMBURSEMENT RATE; POLK AND PENNINGTON
COUNTIES.] Notwithstanding subdivision 14, paragraph (e),
effective July 1, 1996, Polk and Pennington counties' maximum
allowed rate for homemaker services is $6.18 per 30-minute
unit. Any adjustments in fiscal year 1997 to the maximum
allowed rate for homemaker services for Polk and Pennington
counties shall be calculated from the maximum rate in effect on
July 1, 1996.
Sec. 26. Minnesota Statutes 1995 Supplement, section
256B.0915, subdivision 3a, is amended 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 effective
January 1, 1996, Anoka county may pay vendors, and the
commissioner shall reimburse the county, for actual costs up to
a limit which is the maximum rate in effect on December 31,
1995, plus half the difference between that rate and the maximum
allowed state county's maximum allowed rate for home health aide
services per 15-minute unit is $4.43, and its maximum allowed
rate for homemaker services per 15-minute unit is $2.93. Any
adjustments in fiscal year 1997 to the maximum allowed rates for
home health aide or homemaker services for Anoka county shall be
calculated from the maximum rate in effect on January 1, 1996.
Sec. 27. Minnesota Statutes 1994, section 256B.0915, is
amended by adding a subdivision to read:
Subd. 3b. [REIMBURSEMENT RATE; AITKIN COUNTY.]
Notwithstanding subdivision 3, paragraph (h), effective April 1,
1996, Aitkin county's maximum allowed rate for in-home respite
care services is $6.67 per 30-minute unit. Any adjustments in
fiscal year 1997 to the maximum allowed rate for in-home respite
care services for Aitkin county shall be calculated from the
maximum rate in effect on April 1, 1996.
Sec. 28. Minnesota Statutes 1994, section 256B.0915, is
amended by adding a subdivision to read:
Subd. 3c. [REIMBURSEMENT RATE; POLK AND PENNINGTON
COUNTIES.] Notwithstanding subdivision 3, paragraph (h),
effective July 1, 1996, Polk and Pennington counties' maximum
allowed rate for homemaker services is $6.25 per 30-minute
unit. Any adjustments in fiscal year 1997 to the maximum
allowed rate for homemaker services for Polk and Pennington
counties shall be calculated from the maximum rate in effect on
July 1, 1996.
Sec. 29. Minnesota Statutes 1994, section 256B.15, is
amended by adding a subdivision to read:
Subd. 1b. [CLAIMS ON THE ESTATE OF A PREDECEASED
SPOUSE.] Upon the death of a spouse who did not receive medical
assistance and who predeceases a spouse who did or does receive
medical assistance, a claim for the total amount paid for
medical assistance rendered for the surviving spouse through the
date the deceased spouse died shall be filed against the
deceased spouse's estate in the court having jurisdiction to
probate the estate. The claim shall be filed if medical
assistance was rendered for the surviving spouse under any one
of the circumstances in subdivision 1a, paragraphs (a), (b), or
(c). Claims under this subdivision shall have the same priority
for purposes of section 524.3-805, and the same exceptions with
respect to statutes of limitations as claims under subdivision
1a.
Sec. 30. Minnesota Statutes 1994, section 256B.15, is
amended by adding a subdivision to read:
Subd. 2a. [LIMITATIONS ON CLAIMS ON THE ESTATE OF A
PREDECEASED SPOUSE.] A claim under subdivision 1b shall include
only the total amount of medical assistance rendered after age
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 spouse who did not receive medical
assistance who predeceases the spouse who did receive medical
assistance, for medical assistance rendered for the 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. 31. Minnesota Statutes 1994, section 256B.35,
subdivision 1, is amended to read:
Subdivision 1. [PERSONAL NEEDS ALLOWANCE.] (a)
Notwithstanding any law to the contrary, welfare allowances for
clothing and personal needs for individuals receiving medical
assistance while residing in any skilled nursing home,
intermediate care facility, or medical institution including
recipients of supplemental security income, in this state shall
not be less than $45 per month from all sources. When benefit
amounts for social security or supplemental security income
recipients are increased pursuant to United States Code, title
42, sections 415(i) and 1382f, the commissioner shall, effective
in the month in which the increase takes effect, increase by the
same percentage to the nearest whole dollar the clothing and
personal needs allowance for individuals receiving medical
assistance while residing in any skilled nursing home, medical
institution, or intermediate care facility. The commissioner
shall provide timely notice to local agencies, providers, and
recipients of increases under this provision.
(b) The personal needs allowance may be paid as part of the
Minnesota supplemental aid program, notwithstanding the
provisions of section 256D.37, subdivision 2, and payments to
recipients of Minnesota supplemental aid may be made once each
three months covering liabilities that accrued during the
preceding three months.
(c) The personal needs allowance shall be increased to
include income garnished for child support under a court order,
up to a maximum of $250 per month but only to the extent that
the amount garnished is not deducted as a monthly allowance for
children under section 256B.0575, paragraph (a), clause (5).
Sec. 32. Minnesota Statutes 1994, section 256B.37,
subdivision 5, is amended to read:
Subd. 5. [PRIVATE BENEFITS TO BE USED FIRST.] Private
accident and health care coverage including Medicare for medical
services is primary coverage and must be exhausted before
medical assistance is paid for medical services including home
health care, personal care assistant services, hospice, or
services covered under a Health Care Financing Administration
(HCFA) waiver. When a person who is otherwise eligible for
medical assistance has private accident or health care coverage,
including Medicare or a prepaid health plan, the private health
care benefits available to the person must be used first and to
the fullest extent.
Sec. 33. Minnesota Statutes 1995 Supplement, section
256B.69, subdivision 3a, is amended to read:
Subd. 3a. [COUNTY AUTHORITY.] (a) 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. The commissioner in conjunction with the county board,
shall actively seek to develop a mutually agreeable timetable
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. At least 90 days before enrollment in the medical
assistance and general assistance medical care prepaid programs
begins in a county in which the prepaid programs have not been
established, the commissioner shall provide a report to the
chairs of senate and house committees having jurisdiction over
state health care programs which verifies that the commissioner
complied with the requirements for county involvement that are
specified in this subdivision.
(b) The commissioner shall seek a federal waiver to allow a
fee-for-service plan option to MinnesotaCare enrollees. The
commissioner shall develop an increase of the premium fees
required under section 256.9356 up to 20 percent of the premium
fees for the enrollees who elect the fee-for-service option.
Prior to implementation, the commissioner shall submit this fee
schedule to the chair and ranking minority member of the senate
health care committee, the senate health care and family
services funding division, the house of representatives health
and human services committee, and the house of representatives
health and human services finance division.
Sec. 34. Minnesota Statutes 1995 Supplement, 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; (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, or (iii) unless
they reside in Itasca county or they reside in a county in which
the commissioner conducts a pilot project under a waiver granted
pursuant to section 1115 of the Social Security Act; (3)
recipients who currently have private coverage through a health
maintenance organization; (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); (6) children who are both
determined to be severely emotionally disturbed and receiving
case management services according to section 256B.0625,
subdivision 20; and (7) adults who are both determined to be
seriously and persistently mentally ill and received case
management services according to section 256B.0625, subdivision
20. Children under age 21 who are in foster placement may
enroll in the project on an elective basis. Individuals excluded
under clauses (6) and (7) may choose to enroll 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. Beginning on or after July 1, 1997, the
commissioner may require those individuals to enroll in the
prepaid medical assistance program who otherwise would have been
excluded under clauses (1) and (3) and under Minnesota Rules,
part 9500.1452, subpart 2, items H, K, and L. Before limitation
of choice is implemented, eligible individuals shall be notified
and after notification, shall be allowed to choose only among
demonstration providers. The commissioner may assign an
individual with private coverage through a health maintenance
organization, to the same health maintenance organization for
medical assistance coverage, if the health maintenance
organization is under contract for medical assistance in the
individual's county of residence. 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. 35. Minnesota Statutes 1995 Supplement, section
256B.69, subdivision 5b, is amended to read:
Subd. 5b. [PROSPECTIVE REIMBURSEMENT RATES.] For prepaid
medical assistance and general assistance medical care program
contract rates set by the commissioner under subdivision 5 and
effective on or after January 1, 1996 1997, through December 31,
1996 1998, 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. 36. Minnesota Statutes 1995 Supplement, section
256B.69, subdivision 21, is amended to read:
Subd. 21. [PREPAYMENT COORDINATOR.] The local agency
county board 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. 37. Minnesota Statutes 1994, section 256B.69, is
amended by adding a subdivision to read:
Subd. 24. [SOCIAL SERVICE AND PUBLIC HEALTH COSTS.] The
commissioner shall report on recommendations to the legislature
by January 15, 1997, identifying county social services and
public health administrative costs for each target population
that should be excluded from the overall capitation rate.
Sec. 38. Minnesota Statutes 1995 Supplement, section
256D.02, subdivision 12a, is amended to read:
Subd. 12a. [RESIDENT.] (a) For purposes of eligibility for
general assistance under section 256D.05, and payments under
section 256D.051 and general assistance medical care, a
"resident" is a person living in the state for at least 30 days
with the intention of making the person's home here and not for
any temporary purpose. All applicants for these programs are
required to demonstrate the requisite intent and can do so in
any of the following ways:
(1) by showing that the applicant maintains a residence at
a verified address, other than a place of public accommodation.
An applicant may verify a residence address by presenting a
valid state driver's license, a state identification card, a
voter registration card, a rent receipt, a statement by the
landlord, apartment manager, or homeowner verifying that the
individual is residing at the address, or other form of
verification approved by the commissioner; or
(2) by providing written documentation verifying residence
in accordance with Minnesota Rules, part 9500.1219, subpart 3,
item (c).
(b) An applicant who has been in the state for less than 30
days shall be considered a resident if the applicant can provide
documentation:
(1) that the applicant came to was born in the state in
response to an offer of employment;
(3) by providing verification (2) that the applicant has
been a long-time resident of the state or was formerly a
resident of the state for at least 365 days and is returning to
the state from a temporary absence, as those terms are defined
in rules to be adopted by the commissioner;
(3) that the applicant has come to the state to join a
close relative which, for purposes of this subdivision, means a
parent, grandparent, brother, sister, spouse, or child; or
(4) by providing other persuasive evidence to show that the
applicant is a resident of the state, according to rules adopted
by the commissioner that the applicant has come to this state to
accept a bona fide offer of employment for which the applicant
is eligible.
A county agency shall waive the 30-day residency
requirement in cases of emergencies, including medical
emergencies, or where unusual hardship would result from denial
of general assistance medical care. A county may waive the
30-day residency requirement in cases of emergencies, including
medical emergencies, or where unusual hardship would result from
denial of general assistance. The county agency must report to
the commissioner within 30 days on any waiver granted under this
section. The county shall not deny an application solely
because the applicant does not meet at least one of the criteria
in this subdivision, but shall continue to process the
application and leave the application pending until the
residency requirement is met or until eligibility or
ineligibility is established.
Sec. 39. Minnesota Statutes 1995 Supplement, section
256D.045, is amended to read:
256D.045 [SOCIAL SECURITY NUMBER REQUIRED.]
To be eligible for general assistance under sections
256D.01 to 256D.21, an individual must provide the individual's
social security number to the county agency or submit proof that
an application has been made. The provisions of this section do
not apply to the determination of eligibility for emergency
general assistance under section 256D.06, subdivision 2. This
provision applies to eligible children under the age of 18
effective July 1, 1997.
Sec. 40. Minnesota Statutes 1994, section 256G.01,
subdivision 3, is amended to read:
Subd. 3. [PROGRAM COVERAGE.] This chapter applies to
all social service programs administered by the commissioner in
which residence is the determining factor in establishing
financial responsibility. These include, but are not limited
to: aid to families with dependent children; medical
assistance; general assistance; work readiness; general
assistance medical care; Minnesota supplemental aid; commitment
proceedings, including voluntary admissions; emergency holds;
poor relief funded wholly through local agencies; and social
services, including title XX, IV-E and other components of the
community social services act, sections 256E.01 to 256E.12;
social services programs funded wholly through the resources of
county agencies; social services provided under the Minnesota
Indian family preservation act, sections 257.35 to 257.356;
costs for delinquency confinement under section 393.07,
subdivision 2; service responsibility for these programs; and
group residential housing.
Sec. 41. Minnesota Statutes 1994, section 256G.01, is
amended by adding a subdivision to read:
Subd. 4. [ADDITIONAL COVERAGE.] The provisions in sections
256G.02, subdivision 4, paragraphs (a) to (d); 256G.02,
subdivisions 5 to 8; 256G.03; 256G.04; 256G.05; and 256G.07,
subdivisions 1 to 3, apply to the following programs: aid to
families with dependent children; medical assistance; general
assistance; family general assistance; general assistance
medical care; and Minnesota supplemental aid.
Sec. 42. Minnesota Statutes 1994, section 256G.01, is
amended by adding a subdivision to read:
Subd. 5. [SCOPE AND EFFECT.] Unless stated otherwise, the
provisions of this chapter also apply to disputes involving
financial responsibility for social services when another
definition of the county of financial responsibility has been
created in Minnesota Statutes.
Sec. 43. Minnesota Statutes 1994, section 256G.02,
subdivision 4, is amended to read:
Subd. 4. [COUNTY OF FINANCIAL RESPONSIBILITY.] (a) "County
of financial responsibility" has the meanings in paragraphs (b)
to (h).
(b) For an applicant who resides in the state and is not in
a facility described in subdivision 6, it means the county in
which the applicant resides at the time of application.
(c) For an applicant who resides in a facility described in
subdivision 6, it means the county in which the applicant last
resided in nonexcluded status immediately before entering the
facility.
(d) For an applicant who has not resided in this state for
any time other than the excluded time, and subject to the
limitations in section 256G.03, subdivision 2, it means the
county in which the applicant resides at the time of making
application.
(e) For medical assistance purposes only, and for an infant
who has resided only in an excluded time facility, it means the
county that would have been responsible for the infant if
eligibility had been established, based on that of the birth
mother, at the time of application.
(f) Notwithstanding paragraphs (b) to (d), the county of
financial responsibility for medical assistance recipients is
the county from which a recipient is receiving a maintenance
grant or money payment under the program of aid to families with
dependent children or Minnesota supplemental aid.
(g) Notwithstanding paragraphs (b) to (f), the county of
financial responsibility for social services for a person
receiving aid to families with dependent children, general
assistance, general assistance medical care, medical assistance,
or Minnesota supplemental aid is the county from which that
person is receiving the aid or assistance. If more than one
named program is open concurrently For an individual already
having a social service case open in one county, financial
responsibility for any additional social services attaches to
the program case that has the earliest date of application and
has been open without interruption.
(h) (f) Notwithstanding paragraphs (b) to (g) (e), the
county of financial responsibility for semi-independent living
services provided under section 252.275, and Minnesota Rules,
parts 9525.0500 to 9525.0660, is the county of residence in
nonexcluded status immediately before the placement into or
request for those services.
Sec. 44. Minnesota Statutes 1994, section 256G.02,
subdivision 6, is amended to read:
Subd. 6. [EXCLUDED TIME.] "Excluded time" means:
(a) any period an applicant spends in a hospital,
sanitarium, nursing home, shelter other than an emergency
shelter, halfway house, foster home, semi-independent living
domicile or services program, residential facility offering
care, board and lodging facility or other institution for the
hospitalization or care of human beings, as defined in section
144.50, 144A.01, or 245A.02, subdivision 14; or in a maternity
home, battered women's shelter, or correctional facility.
"Excluded time" also means that time during which an applicant
participates in a rehabilitation facility as defined in section
268A.01, or is receiving personal care assistant services
pursuant to section 256B.0625, subdivision 19.; or any facility
based on an emergency hold under sections 253B.05, subdivisions
1 and 2, and 253B.07, subdivision 6;
(b) any period an applicant spends on a placement basis in
a training and habilitation program, including a rehabilitation
facility or work or employment program as defined in section
268A.01; or receiving personal care assistant services pursuant
to section 256B.0627, subdivision 4; semi-independent living
services provided under section 252.275, and Minnesota Rules,
parts 9525.0500 to 9525.0660; day training and habilitation
programs, and community-based services and assisted living
services; and
(c) any placement for a person with an indeterminate
commitment, including independent living.
Sec. 45. Minnesota Statutes 1994, section 256G.03, is
amended to read:
256G.03 [ESTABLISHING RESIDENCE.]
Subdivision 1. [STATE RESIDENCE.] For purposes of this
chapter, a resident of any Minnesota county is considered a
state resident. For purposes of eligibility for general
assistance or work readiness, residency must be substantiated
according to section 256D.02, subdivision 12a.
Subd. 2. [NO DURATIONAL TEST.] Except as otherwise
provided in sections 256.73, subdivisions 1 and 1b; 256B.056,
subdivision 1; and 256D.02, subdivision 12a, for purposes of
this chapter, no waiting period is required before securing
county or state residence. A person cannot, however, gain
residence while physically present in an excluded time facility
unless otherwise specified in this chapter or in a federal
regulation controlling a federally funded human service program.
Subd. 3. [USE OF CODE OF FEDERAL REGULATIONS.] In the
event that federal legislation eliminates the federal regulatory
basis for medical assistance, the state shall continue to
determine eligibility for Minnesota's medical assistance program
using the provisions of Code of Federal Regulations, title 42,
as construed on the day prior to their federal repeal, except as
expressly superseded in chapter 256B, or as superseded by
federal law, or as modified by state rule or by regulatory
waiver granted to the state.
Sec. 46. Minnesota Statutes 1994, section 256G.06, is
amended to read:
256G.06 [DETOXIFICATION SERVICES.]
The county of financial responsibility for detoxification
services is the county where the client is physically present
when the need for services is identified. If that need is
identified while the client is a resident of a chemical
dependency facility, the provisions of section 256G.02,
subdivision 4, paragraphs (b), (c), and (e) (d), apply.
Sec. 47. Minnesota Statutes 1994, section 256G.07,
subdivision 1, is amended to read:
Subdivision 1. [EFFECT OF MOVING.] Except as provided in
subdivision 4, a person who has applied for and is receiving
services or assistance under a program governed by this chapter,
in any county in this state, and who moves to another county in
this state, is entitled to continue to receive that assistance
service from the county from which that person has moved until
that person has resided in nonexcluded status for two full
calendar months in the county to which that person has
moved. For purposes of general assistance and general
assistance medical care, this time period is, however, one full
calendar month.
Sec. 48. Minnesota Statutes 1994, section 256G.07,
subdivision 2, is amended to read:
Subd. 2. [TRANSFER OF RECORDS.] Before the person has
resided in nonexcluded status for two calendar months or one
calendar month in the case of general assistance and general
assistance medical care, in the county to which that person has
moved, the local agency of the county from which the person has
moved shall complete an eligibility review and transfer all
necessary records relating to that person to the local agency of
the county to which the person has moved.
Sec. 49. Minnesota Statutes 1994, section 256G.08,
subdivision 1, is amended to read:
Subdivision 1. [COMMITMENTS COMMITMENT ACT PROCEEDINGS.]
In cases of voluntary admission or commitment to state or other
institutions, the committing county shall initially pay for all
costs. This includes the expenses of the taking into custody,
confinement, emergency holds under sections 253B.05,
subdivisions 1 and 2, and 253B.07, examination, commitment,
conveyance to the place of detention, and rehearing.
Sec. 50. Minnesota Statutes 1994, section 256G.09,
subdivision 2, is amended to read:
Subd. 2. [FINANCIAL DISPUTES.] (a) If the county receiving
the transmittal does not believe it is financially responsible,
it should provide to the department and the initially
responsible county a statement of all facts and documents
necessary for the department to make the requested determination
of financial responsibility. The submission must clearly state
the program area in dispute and must state the specific basis
upon which the submitting county is denying financial
responsibility.
(b) The initially responsible county then has 15 calendar
days to submit its position and any supporting evidence to the
department. The absence of a submission by the initially
responsible county does not limit the right of the department to
issue a binding opinion based on the evidence actually submitted.
(c) A case must not be submitted until the local agency
taking the application or making the commitment has made an
initial determination about eligibility and financial
responsibility, and services or assistance has have been
initiated. This paragraph does not prohibit the submission of
closed cases that otherwise meet the applicable statute of
limitations.
Sec. 51. Minnesota Statutes 1994, section 256G.10, is
amended to read:
256G.10 [DERIVATIVE SETTLEMENT ELIMINATED.]
Except as described in section 256G.02, subdivision 4,
paragraph (e), residence under this chapter must be determined
independently for each applicant. The residence of the parent
of a minor child, with whom that child last lived in a
nonexcluded time setting, or guardian does not of a ward shall
determine the residence of the child or ward for all social
services governed by this chapter.
For purposes of this chapter, a minor child is defined as
being under 18 years of age unless otherwise specified in a
program administered by the commissioner.
Physical or legal custody has no bearing on residence
determinations. This section does not, however, apply to
situations involving another state or, limit the application of
an interstate compact, or apply to situations involving state
wards where the commissioner is defined by law as the guardian.
Sec. 52. Minnesota Statutes 1994, section 256I.05, is
amended by adding a subdivision to read:
Subd. 7c. [DEMONSTRATION PROJECT.] The commissioner is
authorized to pursue a demonstration project under federal food
stamp regulation for the purpose of gaining federal
reimbursement of food and nutritional costs currently paid by
the state group residential housing program.
Sec. 53. Minnesota Statutes 1994, section 325F.71,
subdivision 2, is amended to read:
Subd. 2. [SUPPLEMENTAL CIVIL PENALTY.] (a) In addition to
any liability for a civil penalty pursuant to Minnesota
Statutes, sections 325D.43 to 325D.48, regarding deceptive trade
practices; 325F.67, regarding false advertising; and 325F.68 to
325F.70, regarding consumer fraud; a person who engages in any
conduct prohibited by those statutes, and whose conduct is
perpetrated against one or more senior citizens or handicapped
persons, is liable for an additional civil penalty not to exceed
$10,000 for each violation, if one or more of the factors in
paragraph (b) are present.
(b) In determining whether to impose a civil penalty
pursuant to paragraph (a), and the amount of the penalty, the
court shall consider, in addition to other appropriate factors,
the extent to which one or more of the following factors are
present:
(1) whether the defendant knew or should have known that
the defendant's conduct was directed to one or more senior
citizens or handicapped persons;
(2) whether the defendant's conduct caused senior citizens
or handicapped persons to suffer: loss or encumbrance of a
primary residence, principal employment, or source of income;
substantial loss of property set aside for retirement or for
personal or family care and maintenance; substantial loss of
payments received under a pension or retirement plan or a
government benefits program; or assets essential to the health
or welfare of the senior citizen or handicapped person;
(3) whether one or more senior citizens or handicapped
persons are more vulnerable to the defendant's conduct than
other members of the public because of age, poor health or
infirmity, impaired understanding, restricted mobility, or
disability, and actually suffered physical, emotional, or
economic damage resulting from the defendant's conduct; or
(4) whether the defendant's conduct caused senior citizens
or handicapped persons to make an uncompensated asset transfer
that resulted in the person being found ineligible for medical
assistance.
Sec. 54. Minnesota Statutes 1994, section 524.2-403, is
amended to read:
524.2-403 [EXEMPT PROPERTY.]
(a) If there is a surviving spouse, then, in addition to
the homestead and family allowance, the surviving spouse is
entitled from the estate to:
(1) property not exceeding $10,000 in value in excess of
any security interests therein, in household furniture,
furnishings, appliances, and personal effects, subject to an
award of sentimental value property under section 525.152; and
(2) one automobile, if any, without regard to value.
(b) If there is no surviving spouse, the decedent's
children are entitled jointly to the same property as provided
in paragraph (a).
(c) If encumbered chattels are selected and the value in
excess of security interests, plus that of other exempt
property, is less than $10,000, or if there is not $10,000 worth
of exempt property in the estate, the surviving spouse or
children are entitled to other personal property of the estate,
if any, to the extent necessary to make up the $10,000 value.
(d) Rights to exempt property and assets needed to make up
a deficiency of exempt property have priority over all claims
against the estate, but the right to any assets to make up a
deficiency of exempt property abates as necessary to permit
earlier payment of the family allowance.
(e) The rights granted by this section are in addition to
any benefit or share passing to the surviving spouse or children
by the decedent's will, unless otherwise provided by intestate
succession or by way of elective share.
(f) A claim under section 246.53, 261.04, 256B.15, or
256D.16 takes precedence over any rights granted to a decedent's
adult children under this section.
Sec. 55. Minnesota Statutes 1994, section 524.3-801, is
amended to read:
524.3-801 [NOTICE TO CREDITORS.]
(a) Unless notice has already been given under this
section, upon appointment of a general personal representative
in informal proceedings or upon the filing of a petition for
formal appointment of a general personal representative, notice
thereof, in the form prescribed by court rule, shall be given
under the direction of the court administrator by publication
once a week for two successive weeks in a legal newspaper in the
county wherein the proceedings are pending giving the name and
address of the general personal representative and notifying
creditors of the estate to present their claims within four
months after the date of the court administrator's notice which
is subsequently published or be forever barred, unless they are
entitled to further service of notice under paragraph (b) or (c).
(b)(1) Within three months after: (i) the date of the
first publication of the notice; or (ii) June 16, 1989,
whichever is later, the personal representative may determine,
in the personal representative's discretion, that it is or is
not advisable to conduct a reasonably diligent search for
creditors of the decedent who are either not known or not
identified. If the personal representative determines that a
reasonably diligent search is advisable, the personal
representative shall conduct the search.
(2) If the notice is first published after June 16, 1989,
the personal representative shall, within three months after the
date of the first publication of the notice, serve a copy of the
notice upon each then known and identified creditor in the
manner provided in paragraph (c). If the decedent or a
predeceased spouse of the decedent received assistance for which
a claim could be filed under section 246.53, 256B.15, 256D.16,
or 261.04, the personal representative shall serve a copy of the
notice on the commissioner of human services in the manner
provided in paragraph (c) on or before the date of the first
publication of the notice. The copy of the notice served on the
commissioner of human services shall include the full name, date
of birth, and social security number of the decedent or the
predeceased spouse who received assistance for which a claim
could be filed under any of the sections listed in this
paragraph. Notwithstanding any will or other instrument or law
to the contrary, except as allowed in this paragraph no property
subject to administration by the estate may be distributed by
the estate or the personal representative until 70 days after
the date the notice is served upon the commissioner, as provided
in paragraph (c) unless the local agency consents. An affidavit
of service shall be prima facie evidence of service and, if it
contains a legal description of the affected real property, may
be filed or recorded in the office of the county recorder or
registrar of titles to establish compliance with the notice
requirement established in this paragraph. This restriction on
distribution does not apply to the personal representative's
sale of real or personal property while the estate is open but
does apply to the net proceeds the estate receives from the
sale. If notice was first published under the applicable
provisions of law under the direction of the court administrator
before June 16, 1989, and if a personal representative is
empowered to act at any time after June 16, 1989, the personal
representative shall, within three months after June 16, 1989,
serve upon the then known and identified creditors in the manner
provided in paragraph (c) a copy of the notice as published,
together with a supplementary notice requiring each of the
creditors to present any claim within one month after the date
of the service of the notice or be forever barred.
(3) Under this section, a creditor is "known" if: (i) the
personal representative knows that the creditor has asserted a
claim that arose during the decedent's life against either the
decedent or the decedent's estate; or (ii) the creditor has
asserted a claim that arose during the decedent's life and the
fact is clearly disclosed in accessible financial records known
and available to the personal representative. Under this
section, a creditor is "identified" if the personal
representative's knowledge of the name and address of the
creditor will permit service of notice to be made under
paragraph (c).
(c) The personal representative shall serve a copy of any
notice and any supplementary notice required by paragraph (b),
clause (1) or (2), upon each creditor of the decedent who is
then known to the personal representative and identified, except
a creditor whose claim has either been presented to the personal
representative or paid, either by delivery of a copy of the
required notice to the creditor, or by mailing a copy of the
notice to the creditor by certified, registered, or ordinary
first class mail addressed to the creditor at the creditor's
office or place of residence.
Sec. 56. [INDIVIDUAL COMPULSIVE GAMBLING TREATMENT PILOT
PROJECT.]
Subdivision 1. [ESTABLISHMENT.] The commissioner of human
services shall establish a pilot project in the southeast area
of the state to provide compulsive gambling treatment services
to individuals seeking treatment. The pilot project shall
directly reimburse qualified providers for treatment to
individuals on a case-by-case basis. The pilot project shall
seek to utilize existing qualified providers and shall provide
treatment reimbursement to the maximum number of persons who
qualify for treatment.
Subd. 2. [PLAN.] The commissioner shall submit to the
legislature by December 15, 1996, a plan for expansion of the
treatment pilot project to all areas of the state. The plan
shall include the necessary legislative changes needed to move
from a treatment center model to a provider reimbursement model.
Sec. 57. [REPORT ON COMPENSATING CLIENTS ON PUBLIC HEALTH
CARE PROGRAMS.]
The commissioner of human services shall study and report
to the legislature by January 15, 1997, the advisability and
feasibility of compensating clients on the public health care
programs if a client has successfully reversed a private
insurer's denial of health insurance. The report shall also
include recommendations on reducing the parental fees under
Minnesota Statutes, section 252.27, subdivision 2a, if a parent
has successfully reversed a private insurer's denial of
insurance. The commissioner shall ask clients, advocates, other
interested persons, and the parental fee advisory committee to
assist with the study.
Sec. 58. [WAIVER AUTHORITY.]
The commissioner of human services shall seek federal
waivers as necessary to implement section 8.
Sec. 59. [SEVERABILITY.]
If any provision of sections 8 and 39 are found to be
unconstitutional or void by a court of competent jurisdiction,
all remaining provisions of the law shall remain valid and shall
be given full effect.
Sec. 60. [AUGMENTATIVE COMMUNICATION DEVICES.]
Augmentative communication devices that are prior
authorized through pass through vendors during the period July
1, 1995, to December 31, 1996, and have not been delivered shall
be paid under the medical assistance program at the actual price
charged the pass through vendor for the device as limited to the
suggested retail price on March 1, 1996. For retroactive
periods in which a state plan had not been submitted to reflect
this payment, the state shall not seek a federal share. The
governor's advisory council on technology for people with
disabilities, in consultation with the commissioner of human
services, shall study alternatives to this payment approach and
make recommendations to the legislature by December 31, 1996,
related to effective methods of cost control and the following:
(1) comparative payment equity between augmentative
communication device vendors and other provider groups that
provide equipment to medical assistance recipients;
(2) methods, including competitive bidding, that create
incentives for dealers and manufacturers to provide augmentative
communication devices at a price that is discounted from retail;
(3) substitution between augmentative communication devices
and alternative methods of access by recipients to augmentative
communication devices; and
(4) payment equity between pass through vendors and
distributors of augmentative communication devices.
Sec. 61. [REPEALER.]
Minnesota Statutes 1995 Supplement, sections 256B.15,
subdivision 5; 256G.05, subdivision 1; and 256G.07, subdivision
3a, are repealed.
Sec. 62. [EFFECTIVE DATE; APPLICATION.]
(a) Sections 12, 14, 16, 18, 29, 30, and the portion of
section 61 that repeals section 256B.15, subdivision 5, are
effective the day following final enactment to the extent
permitted by federal law. If any provisions of these sections
are prohibited by federal law, the provisions shall become
effective when federal law is changed to permit their
application or a waiver is received. The commissioner of human
services shall notify the revisor of statutes when federal law
is enacted or a waiver is received and publish a notice in the
State Register. The commissioner must include the notice in the
first State Register published after the effective date of the
federal changes.
(b) If, by July 1, 1996, any provisions of the sections
mentioned in paragraph (a) are not effective because of
prohibitions in federal law, the commissioner shall apply to the
federal government for a waiver of those prohibitions, and those
provisions shall become effective upon receipt of a federal
waiver, notification to the revisor of statutes, and publication
of a notice in the State Register to that effect. If the
commissioner applies for a waiver of the lookback period, the
commissioner shall seek the longest lookback period the health
care financing administration will approve, not to exceed 72
months.
(c) Section 54 applies to estates of decedents dying on or
after its effective date. Section 55 applies to estates where
the notice under Minnesota Statutes, section 524.3-801,
paragraph (a), was first published on or after its effective
date. Section 55 does not affect any right or duty to provide
notice to known creditors, including a local agency, before its
effective date.
(d) Sections 7, 13, 15, 17, 33, 34, 35, 38, and 60 are
effective the day following final enactment.
(e) Section 11 is effective retroactive to October 1, 1993.
(f) Sections 8, 22, subdivision 3, and 34 are effective
upon federal approval.
(g) Sections 10 and 31 are effective upon receipt of
federal approval, retroactive to January 1, 1996.
ARTICLE 3
LONG-TERM CARE
Section 1. Minnesota Statutes 1995 Supplement, 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;
(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; or
(e) to certify four existing beds in a facility in Winona
with 139 beds, of which 129 beds are certified.
Sec. 2. Minnesota Statutes 1995 Supplement, 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, 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;
(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
2j, 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; or
(w) to relocate 36 beds in Crow Wing county and four beds
from Hennepin county to a 160-bed facility in Crow Wing county,
provided all the affected beds are under common ownership.
Sec. 3. Minnesota Statutes 1995 Supplement, section
256B.431, subdivision 25, is amended to read:
Subd. 25. [CHANGES TO NURSING FACILITY REIMBURSEMENT
BEGINNING JULY 1, 1995.] The nursing facility reimbursement
changes in paragraphs (a) to (g) (h) 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 clauses (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).
(h) A nursing facility licensed for 302 beds on September
30, 1993, that was approved under the moratorium exception
process in section 144A.073 for a partial replacement, and
completed the replacement project in December 1994, is exempt
from paragraphs (b) to (d) for rate years beginning on or after
July 1, 1995.
(i) Notwithstanding section 11, paragraph (h), for the rate
years beginning on July 1, 1996, July 1, 1997, and July 1, 1998,
a nursing facility licensed for 40 beds effective May 1, 1992,
with a subsequent increase of 20 Medicare/Medicaid certified
beds, effective January 26, 1993, in accordance with an increase
in licensure is exempt from paragraphs (b) to (d).
Sec. 4. Minnesota Statutes 1995 Supplement, section
256B.501, subdivision 5b, is amended to read:
Subd. 5b. [ICF/MR OPERATING COST LIMITATION AFTER
SEPTEMBER 30, 1995.] (a) For the rate years year beginning on
October 1, 1995, and October 1, 1996 and for rate years
beginning on or after October 1, 1997, 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). Facilities that have undergone a class A to
class B conversion since January 1, 1990, are exempt from the
limitations in this clause for six years after the completion of
the conversion process.
(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).
(g) For the rate year beginning on October 1, 1996, the
commissioner shall exempt a facility from the reductions in this
subdivision if the facility is involved in a bed relocation
project where more than 25 percent of the facility's beds are
transferred to another facility, the relocated beds are six or
fewer, there is no change in the total number of ICF/MR beds for
the parent organization of the facility, and the relocation is
not part of an interim or settle-up rate.
Sec. 5. Minnesota Statutes 1995 Supplement, section
256B.501, subdivision 5c, is amended to read:
Subd. 5c. [OPERATING COSTS AFTER SEPTEMBER 30, 1997 1999.]
(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 may 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. The commissioner may also consider the findings of
projects examining services to persons with developmental
disabilities, including outcome-based quality assurance methods,
and the inclusion of persons with developmental disabilities in
managed care alternative service delivery models.
(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 1998, 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 1999.
(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 1998. By January 15, 1997 1999, 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 1999.
Sec. 6. Minnesota Statutes 1994, section 256B.501, is
amended by adding a subdivision to read:
Subd. 5d. [ADJUSTMENT FOR OUTREACH CRISIS SERVICES.] An
ICF/MR with crisis services developed under the authority of
Laws 1992, chapter 513, article 9, section 40, shall have its
operating cost per diem calculated according to paragraphs (a)
and (b).
(a) Effective for services rendered from April 1, 1996, to
September 30, 1996, and for rate years beginning on or after
October 1, 1996, the maintenance limitation in Minnesota Rules,
part 9553.0050, subpart 1, item A, subitem (2), shall be
calculated to reflect capacity as of October 1, 1992. The
maintenance limit shall be the per diem limitation otherwise in
effect adjusted by the ratio of licensed capacity days as of
October 1, 1992, divided by resident days in the reporting year
ending December 31, 1993.
(b) Effective for rate years beginning on or after October
1, 1996, the operating cost per service unit, for purposes of
the cost per service unit limit in section 256B.501, subdivision
5b, paragraph (d), clauses (7) and (8), shall be calculated
after excluding the costs directly identified to the provision
of outreach crisis services and a four-bed crisis unit.
(c) The efficiency incentive paid to an ICF/MR shall not be
increased as a result of this subdivision.
Sec. 7. Minnesota Statutes 1994, section 256B.501, is
amended by adding a subdivision to read:
Subd. 5e. [RATE ADJUSTMENT FOR CARE PROVIDED TO A
MEDICALLY FRAGILE INDIVIDUAL.] Beginning July 1, 1996, the
commissioner shall increase reimbursement rates for a facility
located in Chisholm and licensed as an intermediate care
facility for persons with mental retardation and related
conditions since 1972, to cover the cost to the facility for
providing 24-hour licensed practical nurse care to a medically
fragile individual admitted on March 8, 1996. The commissioner
shall include in this higher rate a temporary adjustment to
reimburse the facility for costs incurred between March 8, 1996,
and June 30, 1996. Once this resident is discharged, the
commissioner shall reduce the facility's payment rate by the
amount of the cost of the 24-hour licensed practical nurse care.
Sec. 8. Minnesota Statutes 1994, section 256I.05,
subdivision 1c, is amended to read:
Subd. 1c. [RATE INCREASES.] A county agency may not
increase the rates negotiated for group residential housing
above those in effect on June 30, 1993, except: as provided in
paragraphs (a) to (g).
(a) A county may increase the rates for group residential
housing settings to the MSA equivalent rate for those settings
whose current rate is below the MSA equivalent rate.
(b) A county agency may increase the rates for residents in
adult foster care whose difficulty of care has increased. The
total group residential housing rate for these residents must
not exceed the maximum rate specified in subdivisions 1 and 1a.
County agencies must not include nor increase group residential
housing difficulty of care rates for adults in foster care whose
difficulty of care is eligible for funding by home and
community-based waiver programs under title XIX of the Social
Security Act.
(c) The room and board rates will be increased each year
when the MSA equivalent rate is adjusted for SSI cost-of-living
increases by the amount of the annual SSI increase, less the
amount of the increase in the medical assistance personal needs
allowance under section 256B.35.
(d) When a group residential housing rate is used to pay
for an individual's room and board, or other costs necessary to
provide room and board, the rate payable to the residence must
continue for up to 18 calendar days per incident that the person
is temporarily absent from the residence, not to exceed 60 days
in a calendar year, if the absence or absences have received the
prior approval of the county agency's social service staff.
Prior approval is not required for emergency absences due to
crisis, illness, or injury.
(e) For facilities meeting substantial change criteria
within the prior year. Substantial change criteria exists if
the group residential housing establishment experiences a 25
percent increase or decrease in the total number of its beds, if
the net cost of capital additions or improvements is in excess
of 15 percent of the current market value of the residence, or
if the residence physically moves, or changes its licensure, and
incurs a resulting increase in operation and property costs.
(f) Until June 30, 1994, a county agency may increase by up
to five percent the total rate paid for recipients of assistance
under sections 256D.01 to 256D.21 or 256D.33 to 256D.54 who
reside in residences that are licensed by the commissioner of
health as a boarding care home, but are not certified for the
purposes of the medical assistance program. However, an
increase under this clause must not exceed an amount equivalent
to 65 percent of the 1991 medical assistance reimbursement rate
for nursing home resident class A, in the geographic grouping in
which the facility is located, as established under Minnesota
Rules, parts 9549.0050 to 9549.0058.
(g) For the rate year beginning July 1, 1996, a county
agency may increase the total rate paid for recipients of
assistance under sections 256D.01 to 256D.21 or 256D.33 to
256D.54 who reside in a residence that meets the following
criteria:
(1) it is licensed by the commissioner of health as a
boarding care home;
(2) it is not certified for the purposes of the medical
assistance program;
(3) at least 50 percent of its residents have a primary
diagnosis of mental illness;
(4) it has at least 17 beds; and
(5) it provides medication administration to residents.
The rate following an increase under this paragraph must not
exceed an amount equivalent to the average 1995 medical
assistance payment for nursing home resident class A under the
age of 65, in the geographic grouping in which the facility is
located, as established under Minnesota Rules, parts 9549.0010
to 9549.0080.
Sec. 9. [VENDOR RATE ADJUSTMENT.]
Notwithstanding the requirements of Minnesota Statutes,
section 252.46, subdivisions 3 and 6, the commissioner of human
services shall, at the request of the responsible board of
county commissioners and subject to conditions the commissioner
finds appropriate consistent with the service principles in
Minnesota Statutes, section 252.42, grant a variance to the
payment rate for vendors defined in Minnesota Statutes, section
252.41, subdivision 9, and located in Hennepin county that serve
persons with very severe self-injurious or assaultive behavior,
as those terms are used in Minnesota Statutes, section 252.46,
subdivision 4, paragraph (b). The adjusted rate shall:
(1) be limited to provisions of services to no more than 42
such persons;
(2) not exceed 200 percent of the statewide average rate as
calculated in accordance with Minnesota Statutes, section
252.46, subdivision 4, paragraph (b);
(3) become effective July 1, 1996; and
(4) be used as the basis for calculating the rate maximum
for that vendor for calendar year 1997 in accordance with the
requirements of Minnesota Statutes, section 252.46, subdivision
3.
Sec. 10. [DOWNSIZING PILOT PROJECT.]
(a) The commissioner of human services shall establish a
pilot project in Pennington county to downsize to 11 beds an
existing 15-bed intermediate care facility for persons with
mental retardation or related conditions, and develop a four-bed
supportive living service facility utilizing the conversion of
ICF/MR slots to medical assistance waiver conversion slots for
the displaced residents. The project must be approved by the
commissioner under Minnesota Statutes, section 252.28, and must
include criteria for determining how individuals are selected
for alternative services and the use of a request for proposal
process in selecting the vendors for alternative services. The
project must include:
(1) alternative services for the residents being relocated;
(2) timelines for resident relocation and decertification
of beds; and
(3) adjustment of the facility's operating cost rate under
Minnesota Rules, part 9553.0075, as necessary to implement the
project.
(b) The facility's aggregate investment-per-bed limit in
effect before downsizing must be the facility's
investment-per-bed limit after downsizing. The facility's total
revenues after downsizing must not increase as a result of the
downsizing project. The facility's total revenues before
downsizing are determined by multiplying the payment rate in
effect the day before the downsizing is effective by the number
of resident days for the reporting year preceding the downsizing
project. For the purpose of this project, the average medical
assistance rate for home and community-based services must not
exceed the rate made available under Laws 1995, chapter 207,
article 8, section 34.
Sec. 11. [NURSING FACILITY REIMBURSEMENT FOR FISCAL YEAR
1997.]
(a) Notwithstanding any contrary provisions of Minnesota
Statutes, section 256B.431, subdivision 25, the provisions of
this section shall apply for the rate year beginning July 1,
1996.
(b) The commissioner of human services 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
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 Minnesota Statutes, section
256B.431, subdivision 2b, paragraph (h). For those nursing
facilities in each grouping whose case mix A operating cost per
diem:
(1) is at or above the median plus 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 (d), or the current reporting year's
corresponding allowable operating cost per diem;
(2) is between .5 standard deviation and 1.0 standard
deviation above 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 (d), increase by one
percentage point, or the current reporting year's corresponding
allowable operating cost per diem; or
(3) is equal to or below .5 standard deviation above 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 (d), increased by two percentage
points, or the current reporting year's corresponding allowable
operating cost per diem.
(c) For the rate year beginning July 1, 1996, the
provisions of Minnesota Statutes, section 256B.431, subdivision
25, paragraph (d), shall not apply.
(d) For the rate year beginning July 1, 1996, the
forecasted index for operating cost limits referred to in
Minnesota Statutes, section 256B.431, subdivision 21, paragraph
(b), shall be based on the change in the nursing home market
basket as forecasted by Data Resources Inc., for the 12-month
period between the midpoints of the two reporting years
preceding the rate year.
(e) For the rate year beginning July 1, 1996, the operating
cost limits established in Minnesota Statutes, section 256B.431,
subdivisions 2b, 2i, and 3c, and any previously effective
corresponding limits in law or rule shall not apply, except that
these cost limits shall still be calculated for purposes of
determining efficiency incentive per diems.
(f) For the rate year beginning July 1, 1996, the
commissioner shall exempt all rule 80 facilities from any limits
described in Minnesota Statutes, section 256B.431, subdivision
25, paragraph (b), clause (2), that affect care-related
operating per diems. For the rate year beginning July 1, 1996,
the operating cost per diem referred to in paragraph (b), clause
(2), is the sum of the care-related and other operating cost per
diems for a given case mix class.
(g) Any reductions to the combined operating per diem shall
be divided proportionately between the care-related and other
operating per diems.
(h) Notwithstanding paragraphs (a) to (f), the commissioner
must also compute nursing facility payment rates based on the
laws in effect on March 1, 1996, and use the resulting allowable
care-related and other operating cost per diems as the basis for
the spend-up limits for the rate year beginning July 1, 1997.
Sec. 12. [ICF/MR REIMBURSEMENT OCTOBER 1, 1996, TO OCTOBER
1, 1997.]
(a) Notwithstanding any contrary provisions of Minnesota
Statutes, section 256B.501, for the rate year beginning October
1, 1996, the commissioner of human services shall, for purposes
of the spend-up limit, array facilities within each grouping in
Minnesota Statutes, section 256B.501, subdivision 5b, paragraph
(d), clause (4), by each facility's cost per resident day. A
facility's cost per resident day shall be determined by dividing
its allowable historical general operating cost for the
reporting year by the facility's resident days for that
reporting year. Facilities with a cost per resident day at or
above the median shall be limited to the lesser of: (1) the
current reporting year's cost per resident day; or (2) the prior
reporting year's cost per resident day plus the inflation factor
as established in Minnesota Statutes, section 256B.501,
subdivision 3c, clause (2), increased by three percentage points.
However, in no case shall the amount of this reduction exceed:
three percent for a facility with a licensed capacity greater
than 16 beds; two percent for a facility with a licensed
capacity of nine to 16 beds; and one percent for a facility with
a licensed capacity of eight or fewer beds.
(b) The commissioner must not apply the limits in Minnesota
Statutes, section 256B.501, subdivision 5b, paragraph (d),
clause (8), for the rate year beginning October 1, 1996.
(c) Notwithstanding paragraphs (a) and (b), the
commissioner must also compute facility payment rates based on
the laws in effect on March 1, 1996, and use the resulting
allowable operating cost per diems as the basis for the spend-up
limits for the rate year beginning October 1, 1997.
ARTICLE 4
HEALTH DEPARTMENT AND
HEALTH PLAN REGULATIONS
Section 1. [62J.69] [MEDICAL EDUCATION AND RESEARCH TRUST
FUND.]
Subdivision 1. [DEFINITIONS.] For purposes of this
section, the following definitions apply:
(a) "Medical education" means the accredited clinical
training of physicians (medical students and residents),
dentists, advanced practice nurses (clinical nurse specialist,
certified registered nurse anesthetists, nurse practitioners,
and certified nurse midwives), and physician assistants.
(b) "Clinical training" means accredited training that
occurs in both inpatient and ambulatory care settings.
(c) "Trainee" means students involved in an accredited
clinical training program for medical education as defined in
paragraph (a).
(d) "Health care research" means approved clinical,
outcomes, and health services investigations that are funded by
patient out-of-pocket expenses or a third-party payer.
(e) "Commissioner" means the commissioner of health.
(f) "Teaching institutions" means any hospital, medical
center, clinic, or other organization that currently sponsors or
conducts accredited medical education programs or clinical
research in Minnesota.
Subd. 2. [ALLOCATION AND FUNDING FOR MEDICAL EDUCATION AND
RESEARCH.] (a) The commissioner may establish a trust fund for
the purposes of funding medical education and research
activities in the state of Minnesota.
(b) By January 1, 1997, the commissioner may appoint an
advisory committee to provide advice and oversight on the
distribution of funds from the medical education and research
trust fund. If a committee is appointed, the commissioner
shall: (1) consider the interest of all stakeholders when
selecting committee members; (2) select members that represent
both urban and rural interest; and (3) select members that
include ambulatory care as well as inpatient perspectives. The
commissioner shall appoint to the advisory committee
representatives of the following groups: medical researchers,
public and private academic medical centers, managed care
organizations, Blue Cross and Blue Shield of Minnesota,
commercial carriers, Minnesota Medical Association, Minnesota
Nurses Association, medical product manufacturers, employers,
and other relevant stakeholders, including consumers. The
advisory committee is governed by Minnesota Statutes, section
15.059, for membership terms and removal of members and will
sunset on June 30, 1999.
(c) Eligible applicants for funds are accredited medical
education teaching institutions, consortia, and programs.
Applications must be received by September 30 of each year for
distribution by January 1 of the following year. An application
for funds must include the following:
(1) the official name and address of the institution,
facility, or program that is applying for funding;
(2) the name, title, and business address of those persons
responsible for administering the funds;
(3) the total number, type, and specialty orientation of
eligible trainees in each accredited medical education program
applying for funds;
(4) audited clinical training costs per trainee for each
medical education program;
(5) a description of current sources of funding for medical
education costs including a description and dollar amount of all
state and federal financial support;
(6) other revenue received for the purposes of clinical
training;
(7) a statement identifying unfunded costs; and
(8) other supporting information the commissioner, with
advice from the advisory committee, determines is necessary for
the equitable distribution of funds.
(d) The commissioner shall distribute medical education
funds to all qualifying applicants based on the following basic
criteria: (1) total medical education funds available; (2)
total trainees in each eligible education program; and (3) the
statewide average cost per trainee, by type of trainee, in each
medical education program. Funds distributed shall not be used
to displace current funding appropriations from federal or state
sources.
(e) Medical education programs receiving funds from the
trust fund must submit annual cost and program reports based on
criteria established by the commissioner. The reports must
include:
(1) the total number of eligible trainees in the program;
(2) the type of programs and residencies funded;
(3) the average cost per trainee and a detailed breakdown
of the components of those costs;
(4) other state or federal appropriations received for the
purposes of clinical training;
(5) other revenue received for the purposes of clinical
training; and
(6) other information the commissioner, with advice from
the advisory committee, deems appropriate to evaluate the
effectiveness of the use of funds for clinical training.
The commissioner, with advice from the advisory committee,
will provide an annual summary report to the legislature on
program implementation due February 15 of each year.
(f) The commissioner is authorized to distribute funds made
available through:
(1) voluntary contributions by employers or other entities;
(2) allocations for the department of human services to
support medical education and research; and
(3) other sources as identified and deemed appropriate by
the legislature for inclusion in the trust fund.
(g) The advisory committee shall continue to study and make
recommendations on:
(1) the funding of medical research consistent with work
currently mandated by the legislature and under way at the
department of health; and
(2) the costs and benefits associated with medical
education and research.
Sec. 2. Minnesota Statutes 1995 Supplement, section
62Q.03, subdivision 8, is amended to read:
Subd. 8. [GOVERNANCE.] (a) The association shall be
governed by an interim 19-member board as follows: one provider
member appointed by the Minnesota Hospital Association; one
provider member appointed by the Minnesota Medical Association;
one provider member appointed by the governor; three members
appointed by the Minnesota Council of HMOs to include an HMO
with at least 50 percent of total membership enrolled through a
public program; three members appointed by Blue Cross and Blue
Shield of Minnesota, to include a member from a Blue Cross and
Blue Shield of Minnesota affiliated health plan with fewer than
50,000 enrollees and located outside the Minneapolis-St. Paul
metropolitan area; two members appointed by the Insurance
Federation of Minnesota; one member appointed by the Minnesota
Association of Counties; and three public members appointed by
the governor, to include at least one representative of a public
program. The commissioners of health, commerce, human services,
and employee relations shall be nonvoting ex officio members.
(b) The board may elect officers and establish committees
as necessary.
(c) A majority of the members of the board constitutes a
quorum for the transaction of business.
(d) Approval by a majority of the board members present is
required for any action of the board.
(e) Interim board members shall be appointed by July 1,
1994, and shall serve until a new board is elected according to
the plan of operation developed by the association.
(f) A member may designate a representative to act as a
member of the interim board in the member's absence according to
the plan of operation as established in subdivision 8a of this
section.
Sec. 3. Minnesota Statutes 1994, section 62Q.075,
subdivision 2, is amended to read:
Subd. 2. [REQUIREMENT.] Beginning July 1, 1995 October 31,
1997, all managed care organizations shall annually file
biennially with the action plans required under section 62Q.07 a
plan describing the actions the managed care organization has
taken and those it intends to take to contribute to achieving
public health goals for each service area in which an enrollee
of the managed care organization resides. This plan must be
jointly developed in collaboration with the local public health
units, appropriate regional coordinating boards, and other
community organizations providing health services within the
same service area as the managed care organization. Local
government units with responsibilities and authority defined
under chapters 145A and 256E may designate individuals to
participate in the collaborative planning with the managed care
organization to provide expertise and represent community needs
and goals as identified under chapters 145A and 256E.
Sec. 4. Minnesota Statutes 1995 Supplement, section
62R.17, is amended to read:
62R.17 [PROVIDER COOPERATIVE DEMONSTRATION.]
(a) A health provider cooperative incorporated and having
adopted bylaws before May 1, 1995, that has members who provide
services in Sibley, Nicollet, Blue Earth, Brown, Watonwan,
Martin, Faribault, Waseca, and LeSueur counties, may contract
with a qualified employer or self-insured employer plan to
provide health care services in accordance with sections 62R.17
to 62R.26.
(b) A health provider cooperative incorporated and having
adopted bylaws before July 1, 1995, that has members who provide
services in Big Stone, Chippewa, Cottonwood, Jackson, Kandiyohi,
Lac Qui Parle, Lincoln, Lyon, McLeod, Meeker, Murray, Nobles,
Pipestone, Redwood, Renville, Rock, Swift, and Yellow Medicine
counties, may contract with a qualified employer or self-insured
employer plan to provide health care services in accordance with
sections 62R.17 to 62R.26.
(c) A health provider cooperative incorporated and having
adopted bylaws before March 1, 1995, that has members who
provide services in Big Stone, Chippewa, Cottonwood, Jackson,
Kandiyohi, Lac Qui Parle, Lincoln, Lyon, Murray, Nobles,
Pipestone, Redwood, Renville, Rock, Swift, and Yellow Medicine
counties, may contract with a qualified employer or self-insured
employer plan to provide health care services in accordance with
sections 62R.17 to 62R.26.
(d) The health provider cooperative, the qualified
employer, or the self-insured employer plan shall not, solely on
account of that contract, be subject to any provision of
Minnesota Statutes relating to health carriers except as
provided in section 62R.21. The grant of contracting power
under this section shall not be interpreted to permit or
prohibit any other lawful arrangement between a health care
provider and a self-insured employee welfare benefit plan or its
sponsor.
Sec. 5. Minnesota Statutes 1995 Supplement, section
144.122, is amended to read:
144.122 [LICENSE AND PERMIT FEES.]
(a) The state commissioner of health, by rule, may
prescribe reasonable procedures and fees for filing with the
commissioner as prescribed by statute and for the issuance of
original and renewal permits, licenses, registrations, and
certifications issued under authority of the commissioner. The
expiration dates of the various licenses, permits,
registrations, and certifications as prescribed by the rules
shall be plainly marked thereon. Fees may include application
and examination fees and a penalty fee for renewal applications
submitted after the expiration date of the previously issued
permit, license, registration, and certification. The
commissioner may also prescribe, by rule, reduced fees for
permits, licenses, registrations, and certifications when the
application therefor is submitted during the last three months
of the permit, license, registration, or certification period.
Fees proposed to be prescribed in the rules shall be first
approved by the department of finance. All fees proposed to be
prescribed in rules shall be reasonable. The fees shall be in
an amount so that the total fees collected by the commissioner
will, where practical, approximate the cost to the commissioner
in administering the program. All fees collected shall be
deposited in the state treasury and credited to the state
government special revenue fund unless otherwise specifically
appropriated by law for specific purposes.
(b) The commissioner may charge a fee for voluntary
certification of medical laboratories and environmental
laboratories, and for environmental and medical laboratory
services provided by the department, without complying with
paragraph (a) or chapter 14. Fees charged for environment and
medical laboratory services provided by the department must be
approximately equal to the costs of providing the services.
(c) The commissioner may develop a schedule of fees for
diagnostic evaluations conducted at clinics held by the services
for children with handicaps program. All receipts generated by
the program are annually appropriated to the commissioner for
use in the maternal and child health program.
(d) The commissioner, for fiscal years 1996 and beyond,
shall set license fees for hospitals and nursing homes that are
not boarding care homes at the following levels:
Joint Commission on Accreditation of Healthcare
Organizations (JCAHO hospitals) $1,017
Non-JCAHO hospitals $762 plus $34 per bed
Nursing home $78 plus $19 per bed
For fiscal years 1996 and beyond, the commissioner shall
set license fees for outpatient surgical centers, boarding care
homes, and supervised living facilities at the following levels:
Outpatient surgical centers $517
Boarding care homes $78 plus $19 per bed
Supervised living facilities $78 plus $19 per bed.
(e) Unless prohibited by federal law, the commissioner of
health shall charge applicants the following fees to cover the
cost of any initial certification surveys required to determine
a provider's eligibility to participate in the Medicare or
Medicaid program:
Prospective payment surveys for $ 900
hospitals
Swing bed surveys for nursing homes $1200
Psychiatric hospitals $1400
Rural health facilities $1100
Portable X-ray providers $ 500
Home health agencies $1800
Outpatient therapy agencies $ 800
End stage renal dialysis providers $2100
Independent therapists $ 800
Comprehensive rehabilitation $1200
outpatient facilities
Hospice providers $1700
Ambulatory surgical providers $1800
Hospitals $4200
Other provider categories or Actual surveyor costs:
additional resurveys required average surveyor cost x
to complete initial certification number of hours for the
survey process.
These fees shall be submitted at the time of the
application for federal certification and shall not be
refunded. All fees collected after the date that the imposition
of fees is not prohibited by federal law shall be deposited in
the state treasury and credited to the state government special
revenue fund.
Sec. 6. [144.2215] [BIRTH DEFECTS REGISTRY SYSTEM.]
The commissioner of health shall develop a statewide birth
defects registry system to provide for the collection, analysis,
and dissemination of birth defects information. The
commissioner shall consult with representatives and experts in
epidemiology, medicine, insurance, health maintenance
organizations, genetics, consumers, and voluntary organizations
in developing the system and may phase in the implementation of
the system.
Sec. 7. Minnesota Statutes 1994, section 144.572, is
amended to read:
144.572 [INSTITUTIONS EXCEPTED.]
No rule nor requirement shall be made, nor standard
established under sections 144.50 to 144.56 for any sanitarium,
conducted in accordance with the practice and principles of the
body known as the Church of Christ, Scientist by and for the
adherents of any recognized church or religious denomination for
the purpose of providing care and treatment for those who select
and depend upon spiritual means through prayer alone, in lieu of
medical care, for healing, except as to the sanitary and safe
condition of the premises, cleanliness of operation, and its
physical equipment.
Sec. 8. Minnesota Statutes 1994, section 144.71,
subdivision 1, is amended to read:
Subdivision 1. [HEALTH AND SAFETY.] The purpose of
sections 144.71 to 144.74 is to protect the health and safety of
children persons in attendance at children's youth camps.
Sec. 9. Minnesota Statutes 1994, section 144.71,
subdivision 2, is amended to read:
Subd. 2. [DEFINITION.] For the purpose of such sections
a children's youth camp is defined as a parcel or parcels of
land with permanent buildings, tents or other structures
together with appurtenances thereon, established or maintained
as living quarters where both food and beverage service and
lodging or the facilities therefor are provided for ten or more
people, operated continuously for a period of five days or more
each year for educational, recreational or vacation purposes,
and the use of the camp is offered to minors free of charge or
for payment of a fee.
Sec. 10. Minnesota Statutes 1994, section 144.72,
subdivision 1, is amended to read:
Subdivision 1. [PERMITS.] The state commissioner of health
is authorized to issue permits for the operation of such
children's youth camps and such camps which are required to
obtain such the permits.
Sec. 11. Minnesota Statutes 1994, section 144.72,
subdivision 2, is amended to read:
Subd. 2. [APPLICATION.] On or before June first annually,
every person, partnership, limited liability company or
corporation, operating or seeking to operate a children's youth
camp, shall make application in writing to the commissioner for
a permit to conduct a children's youth camp. Such application
shall be in such form and shall contain such information as the
commissioner may find necessary to determine that the children's
youth camp will be operated and maintained in such a manner as
to protect and preserve the health and safety of the persons
using the camp. Where a person, partnership, limited liability
company or corporation operates or is seeking to operate more
than one children's youth camp, a separate application shall be
made for each camp.
Sec. 12. Minnesota Statutes 1994, section 144.73,
subdivision 1, is amended to read:
Subdivision 1. [INSPECTION OF CAMPS.] It shall be the duty
of the state commissioner of health to make an annual inspection
of each children's youth camp, and where, upon inspection it is
found that there is a failure to protect the health and safety
of the persons using the camp, or a failure to comply with the
camp rules prescribed by the commissioner, the commissioner
shall give notice to the camp operator of such failure, which
notice shall set forth the reason or reasons for such failure.
Sec. 13. Minnesota Statutes 1994, section 144.74, is
amended to read:
144.74 [RULES, STANDARDS.]
The state commissioner of health is authorized to adopt and
enforce such reasonable rules and standards as the commissioner
determines necessary to protect the health and safety of
children persons in attendance at children's youth camps. Such
rules and standards may include reasonable restrictions and
limitations on the following:
(1) Camp sites and buildings, including location, layout,
lighting, ventilation, heating, plumbing, drainage and sleeping
quarters;
(2) Sanitary facilities, including water supply, toilet and
shower facilities, sewage and excreta disposal, waste and
garbage disposal, and the control of insects and rodents, and
(3) Food service, including storage, refrigeration,
sanitary preparation and handling of food, the cleanliness of
kitchens and the proper functioning of equipment.
Sec. 14. Minnesota Statutes 1995 Supplement, section
144.9503, subdivision 6, is amended to read:
Subd. 6. [VOLUNTARY LEAD HAZARD REDUCTION.] The
commissioner shall monitor the lead hazard reduction methods
adopted under section 144.9508 in cases of voluntary lead hazard
reduction. All contractors hired to do voluntary lead hazard
reduction must be licensed lead contractors. If a property
owner does not use a lead contractor for voluntary lead hazard
reduction, the property owner shall provide the commissioner
with a plan for lead hazard reduction at least ten working days
before beginning the lead hazard reduction. The plan must
include the details required in section 144.9505, and notice as
to when lead hazard reduction activities will begin. Within the
limits of appropriations, the commissioner shall review plans
and shall approve or disapprove them as to compliance with the
requirements in section 144.9505. No penalty shall be assessed
against a property owner for discontinuing voluntary lead hazard
reduction before completion of the plan, provided that the
property owner discontinues the plan in a manner that leaves the
property in a condition no more hazardous than its condition
before the plan implementation.
Sec. 15. Minnesota Statutes 1995 Supplement, section
144.9503, subdivision 8, is amended to read:
Subd. 8. [CERTIFICATION FOR LEAD-SAFE HOUSING.] The
commissioner shall propose to the legislature a program to
certify residences as lead safe by February 15, 1996 1997.
Sec. 16. Minnesota Statutes 1995 Supplement, section
144.9503, subdivision 9, is amended to read:
Subd. 9. [LANDLORD TENANT STUDY.] Within the limits of
appropriations, the commissioner of health shall conduct or
contract for a study of the legal responsibilities of tenants
and landlords in the prevention of lead hazards, and shall
report the findings to the legislature, along with
recommendations as to any changes needed to clarify or modify
current law by January 15, 1996. In conducting the study, the
commissioner shall convene any public meetings necessary to hear
the testimony and recommendations of interested parties, and
shall invite and consider written public comments.
Sec. 17. Minnesota Statutes 1995 Supplement, section
144.9504, subdivision 2, is amended to read:
Subd. 2. [LEAD INSPECTION.] (a) An inspecting agency shall
conduct a lead inspection of a residence according to the venous
blood lead level and time frame set forth in clauses (1) to (4)
for purposes of secondary prevention:
(1) within 48 hours of a child or pregnant female in the
residence being identified to the agency as having a venous
blood lead level equal to or greater than 70 micrograms of lead
per deciliter of whole blood;
(2) within five working days of a child or pregnant female
in the residence being identified to the agency as having a
venous blood lead level equal to or greater than 45 micrograms
of lead per deciliter of whole blood;
(3) within ten working days of a child or pregnant female
in the residence being identified to the agency as having a
venous blood lead level equal to or greater than 20 micrograms
of lead per deciliter of whole blood; or
(4) within ten working days of a child or pregnant female
in the residence being identified to the agency as having a
venous blood lead level that persists in the range of 15 to 19
micrograms of lead per deciliter of whole blood for 90 days
after initial identification.
(b) Within the limits of available state and federal
appropriations, an inspecting agency may also conduct a lead
inspection for children with any elevated blood lead level.
(c) In a building with two or more dwelling units, an
inspecting agency shall inspect the individual unit in which the
conditions of this section are met and shall also inspect all
common areas. If a child visits one or more other sites such as
another residence, or a residential or commercial child care
facility, playground, or school, the inspecting agency shall
also inspect the other sites. The inspecting agency shall have
one additional day added to the time frame set forth in this
subdivision to complete the lead inspection for each additional
site.
(d) Within the limits of appropriations, the inspecting
agency shall identify the known addresses for the previous 12
months of the child or pregnant female with elevated blood lead
levels; notify the property owners, landlords, and tenants at
those addresses that an elevated blood lead level was found in a
person who resided at the property; and give them a copy of the
lead inspection guide. This information shall be classified as
private data on individuals as defined under section 13.02,
subdivision 12.
(e) The inspecting agency shall conduct the lead inspection
according to rules adopted by the commissioner under section
144.9508. An inspecting agency shall have lead inspections
performed by lead inspectors licensed by the commissioner
according to rules adopted under section 144.9508. If a
property owner refuses to allow an inspection, the inspecting
agency shall begin legal proceedings to gain entry to the
property and the time frame for conducting a lead inspection set
forth in this subdivision no longer applies. An inspector or
inspecting agency may observe the performance of lead hazard
reduction in progress and shall enforce the provisions of this
section under section 144.9509. Deteriorated painted surfaces,
bare soil, dust, and drinking water must be tested with
appropriate analytical equipment to determine the lead content,
except that deteriorated painted surfaces or bare soil need not
be tested if the property owner agrees to engage in lead hazard
reduction on those surfaces.
(f) A lead inspector shall notify the commissioner and the
board of health of all violations of lead standards under
section 144.9508, that are identified in a lead inspection
conducted under this section.
(g) Each inspecting agency shall establish an
administrative appeal procedure which allows a property owner to
contest the nature and conditions of any lead order issued by
the inspecting agency. Inspecting agencies must consider
appeals that propose lower cost methods that make the residence
lead safe.
(h) Sections 144.9501 to 144.9509 neither authorize nor
prohibit an inspecting agency from charging a property owner for
the cost of a lead inspection.
Sec. 18. Minnesota Statutes 1995 Supplement, section
144.9504, subdivision 7, is amended to read:
Subd. 7. [RELOCATION OF RESIDENTS.] (a) An Within the
limits of appropriations, the inspecting agency shall ensure
that residents are relocated from rooms or dwellings during a
lead hazard reduction process that generates leaded dust, such
as removal or disruption of lead-based paint or plaster that
contains lead. Residents shall not remain in rooms or dwellings
where the lead hazard reduction process is occurring. An
inspecting agency is not required to pay for relocation unless
state or federal funding is available for this purpose. The
inspecting agency shall make an effort to assist the resident in
locating resources that will provide assistance with relocation
costs. Residents shall be allowed to return to the residence or
dwelling after completion of the lead hazard reduction process.
An inspecting agency shall use grant funds under section
144.9507 if available, in cooperation with local housing
agencies, to pay for moving costs and rent for a temporary
residence for any low-income resident temporarily relocated
during lead hazard reduction. For purposes of this section,
"low-income resident" means any resident whose gross household
income is at or below 185 percent of federal poverty level.
(b) A resident of rental property who is notified by an
inspecting agency to vacate the premises during lead hazard
reduction, notwithstanding any rental agreement or lease
provisions:
(1) shall not be required to pay rent due the landlord for
the period of time the tenant vacates the premises due to lead
hazard reduction;
(2) may elect to immediately terminate the tenancy
effective on the date the tenant vacates the premises due to
lead hazard reduction; and
(3) shall not, if the tenancy is terminated, be liable for
any further rent or other charges due under the terms of the
tenancy.
(c) A landlord of rental property whose tenants vacate the
premises during lead hazard reduction shall:
(1) allow a tenant to return to the dwelling unit after
lead hazard reduction and clearance inspection, required under
this section, is completed, unless the tenant has elected to
terminate the tenancy as provided for in paragraph (b); and
(2) return any security deposit due under section 504.20
within five days of the date the tenant vacates the unit, to any
tenant who terminates tenancy as provided for in paragraph (b).
Sec. 19. Minnesota Statutes 1995 Supplement, section
144.9504, subdivision 8, is amended to read:
Subd. 8. [PROPERTY OWNER RESPONSIBILITY.] Property owners
shall comply with lead orders issued under this section within
60 days or be subject to enforcement actions as provided under
section 144.9509. For orders or portions of orders concerning
external lead hazards, property owners shall comply within 60
days, or as soon thereafter as weather permits. If the property
owner does not use a lead contractor for compliance with the
lead orders, the property owner shall submit a plan for approval
by to the inspecting agency within 30 days after receiving the
orders. The plan must include the details required in section
144.9505 as to how the property owner intends to comply with the
lead orders and notice as to when lead hazard reduction
activities will begin. Within the limits of appropriations, the
commissioner shall review plans and shall approve or disapprove
them as to compliance with the requirements in section 144.9505,
subdivision 5.
Sec. 20. Minnesota Statutes 1995 Supplement, section
144.9505, subdivision 4, is amended to read:
Subd. 4. [NOTICE OF LEAD ABATEMENT OR LEAD HAZARD
REDUCTION WORK.] (a) At least five working days before starting
work at each lead abatement or lead hazard reduction worksite,
the person performing the lead abatement or lead hazard
reduction work shall give written notice and an approved work
plan as required in this section to the commissioner and the
appropriate board of health. Within the limits of
appropriations, the commissioner shall review plans and shall
approve or disapprove them as to compliance with the
requirements in section 144.9505, subdivision 5.
(b) This provision does not apply to swab team workers
performing work under an order of an inspecting agency.
Sec. 21. Minnesota Statutes 1994, section 144A.04, is
amended by adding a subdivision to read:
Subd. 7a. [DIRECTOR OF NURSING SERVICES.] Except as
otherwise provided by this subdivision, a nursing home must have
a full-time director of nursing services who is assigned full
time to the nursing services of the nursing home. For purposes
of this requirement, "full time" means working at least 35 hours
per week. The director of nursing services of a nursing home
may also serve as the director of nursing services of a
physically attached hospital if:
(1) the hospital has an average daily census of ten
patients or less in the most recent reporting year for which
data is available;
(2) the total combined beds of the hospital and nursing
home do not exceed 100; and
(3) the management of the two facilities is under the
control and direction of the same governing body.
Sec. 22. Minnesota Statutes 1994, section 144A.09,
subdivision 1, is amended to read:
Subdivision 1. [CHURCH OF CHRIST, SCIENTIST SPIRITUAL
MEANS FOR HEALING.] No rule established under sections 144A.01
to 144A.16 other than a rule relating to sanitation and safety
of premises, to cleanliness of operation or to physical
equipment, shall apply to a nursing home conducted in accordance
with the teachings of the body known as the Church of Christ,
Scientist by and for the adherents of any recognized church or
religious denomination for the purpose of providing care and
treatment for those who select and depend upon spiritual means
through prayer alone, in lieu of medical care, for healing.
Sec. 23. Minnesota Statutes 1994, section 144A.20,
subdivision 2, is amended to read:
Subd. 2. [EXCEPTION.] Notwithstanding any law to the
contrary, no person desiring to be licensed to administer a
nursing home operated exclusively in accordance with the
teachings of the body known as the Church of Christ,
Scientist by and for the adherents of any recognized church or
religious denomination for the purpose of providing care and
treatment for those who select and depend upon spiritual means
through prayer alone, in lieu of medical care, for healing,
shall be required to demonstrate proficiency in any medical
technique or meet any medical educational qualification or
medical standard which is not in accord with the type of
remedial care and treatment provided in a nursing home operated
exclusively in accordance with the teachings of that body.
Sec. 24. Minnesota Statutes 1994, section 145.61,
subdivision 5, is amended to read:
Subd. 5. "Review organization" means a nonprofit
organization acting according to clause (k) or a committee whose
membership is limited to professionals, administrative staff,
and consumer directors, except where otherwise provided for by
state or federal law, and which is established by one or more of
the following: a hospital, a clinic, a nursing home, one or
more state or local associations of professionals, an
organization of professionals from a particular area or medical
institution, a health maintenance organization as defined in
chapter 62D, a nonprofit health service plan corporation as
defined in chapter 62C, a preferred provider organization, a
professional standards review organization established pursuant
to United States Code, title 42, section 1320c-1 et seq., a
medical review agent established to meet the requirements of
section 256B.04, subdivision 15, or 256D.03, subdivision 7,
paragraph (b), the department of human services, a health
provider cooperative operating under sections 62R.17 to 62R.26,
or a corporation organized under chapter 317A that owns,
operates, or is established by one or more of the above
referenced entities, to gather and review information relating
to the care and treatment of patients for the purposes of:
(a) evaluating and improving the quality of health care
rendered in the area or medical institution or by the entity or
organization that established the review organization;
(b) reducing morbidity or mortality;
(c) obtaining and disseminating statistics and information
relative to the treatment and prevention of diseases, illness
and injuries;
(d) developing and publishing guidelines showing the norms
of health care in the area or medical institution or in the
entity or organization that established the review organization;
(e) developing and publishing guidelines designed to keep
within reasonable bounds the cost of health care;
(f) reviewing the quality or cost of health care services
provided to enrollees of health maintenance organizations,
health service plans, preferred provider organizations, and
insurance companies;
(g) acting as a professional standards review organization
pursuant to United States Code, title 42, section 1320c-1 et
seq.;
(h) determining whether a professional shall be granted
staff privileges in a medical institution, membership in a state
or local association of professionals, or participating status
in a nonprofit health service plan corporation, health
maintenance organization, preferred provider organization, or
insurance company, or whether a professional's staff privileges,
membership, or participation status should be limited, suspended
or revoked;
(i) reviewing, ruling on, or advising on controversies,
disputes or questions between:
(1) health insurance carriers, nonprofit health service
plan corporations, health maintenance organizations,
self-insurers and their insureds, subscribers, enrollees, or
other covered persons;
(2) professional licensing boards and health providers
licensed by them;
(3) professionals and their patients concerning diagnosis,
treatment or care, or the charges or fees therefor;
(4) professionals and health insurance carriers, nonprofit
health service plan corporations, health maintenance
organizations, or self-insurers concerning a charge or fee for
health care services provided to an insured, subscriber,
enrollee, or other covered person;
(5) professionals or their patients and the federal, state,
or local government, or agencies thereof;
(j) providing underwriting assistance in connection with
professional liability insurance coverage applied for or
obtained by dentists, or providing assistance to underwriters in
evaluating claims against dentists;
(k) acting as a medical review agent under section 256B.04,
subdivision 15, or 256D.03, subdivision 7, paragraph (b);
(l) providing recommendations on the medical necessity of a
health service, or the relevant prevailing community standard
for a health service;
(m) reviewing a provider's professional practice as
requested by the data analysis unit under section 62J.32;
(n) providing quality assurance as required by United
States Code, title 42, sections 1396r(b)(1)(b) and
1395i-3(b)(1)(b) of the Social Security Act;
(o) providing information to group purchasers of health
care services when that information was originally generated
within the review organization for a purpose specified by this
subdivision; or
(p) providing information to other, affiliated or
nonaffiliated review organizations, when that information was
originally generated within the review organization for a
purpose specified by this subdivision, and as long as that
information will further the purposes of a review organization
as specified by this subdivision.
Sec. 25. [145.951] [CHILDREN HELPED IN LONG-TERM
DEVELOPMENT; IMPLEMENTATION PLAN.]
The commissioner of health, in consultation with the
commissioners of children, families, and learning; corrections;
public safety; and human services, and with the directors of the
office of strategic and long-range planning, the council on
disability, and the councils and commission under Minnesota
Statutes, sections 3.922 to 3.9226, may develop an
implementation plan for the establishment of a statewide program
to assist families in developing the full potential of their
children. The program must be designed to strengthen the
family, to reduce the risk of abuse to children, and to promote
the long-term development of children in their home
environments. The program must also be designed to use
volunteers to provide support to parents, and to link parents
with existing public health, education, and social services as
appropriate.
Sec. 26. [145.952] [DEFINITIONS.]
Subdivision 1. [SCOPE.] The definitions in this section
apply to sections 145.951 to 145.957.
Subd. 2. [ABUSE.] "Abuse" means physical abuse, sexual
abuse, neglect, mental injury, and threatened injury, as those
terms are defined in section 626.556, subdivision 2.
Subd. 3. [CHILD PROGRAM OR PROGRAM.] "CHILD program" or
"program" means the children helped in long-term development
program that the commissioner shall plan to be implemented under
sections 145.951 to 145.957.
Subd. 4. [COMMISSIONER.] "Commissioner" means the
commissioner of health or the commissioner's designee.
Subd. 5. [LOCAL ORGANIZATION.] "Local organization" means
an organization that contracts with the commissioner under
section 145.953, subdivision 1, to administer the CHILD program
on a local level.
Sec. 27. [145.953] [PROGRAM STRUCTURE.]
Subdivision 1. [LOCAL ADMINISTRATION OF PROGRAM.] The
implementation plan must require the commissioner to contract
with appropriate private nonprofit and governmental
organizations to administer the CHILD program on a local level.
The local organization, in collaboration and coordination with
the department of health, shall be responsible for recruiting,
screening training, and overseeing volunteers for the program.
Subd. 2. [VOLUNTEER COMPONENT.] The implementation plan
must provide that a volunteer will be matched with a family to
provide ongoing support in parenting. The volunteer shall
provide the family with information on the CHILD program and
other social services available. Through home visits and
frequent contact, the volunteer shall provide support and
guidance on raising the child and coping with stresses that may
increase the risk of abuse. The volunteer shall also assist the
family in obtaining other needed services from existing social
services programs.
Sec. 28. [145.954] [STANDARDS FOR PROGRAM.]
In planning for the implementation of the program, the
commissioner shall:
(1) establish mechanisms to encourage families to
participate in the CHILD program;
(2) establish mechanisms to identify families who may wish
to participate in the CHILD program and to match volunteers with
these families either before or as soon as possible after a
child is born;
(3) ensure that local organizations coordinate with
services already provided by the departments of health, human
services, and children, families, and learning to ensure that
participating families receive a continuum of care;
(4) coordinate with local social services agencies, local
health boards, and community health boards;
(5) ensure that services provided through the program are
community-based and that the special needs of minority
communities are addressed;
(6) develop and implement appropriate systems to gather
data on participating families and to monitor and evaluate their
progress; and
(7) evaluate the program's effectiveness.
Sec. 29. [145.955] [DUTIES OF LOCAL ORGANIZATION.]
The implementation plan shall require the local
organizations to:
(1) recruit and train volunteers to serve families under
the program, according to section 145.956;
(2) provide ongoing supervision and consultation to
volunteers; and
(3) develop resource and referral booklets that volunteers
can distribute to families served by the program. The booklets
shall contain comprehensive information on the spectrum of
services available to assist the family and to reduce the risk
of abuse.
Sec. 30. [145.956] [TRAINING AND RECRUITMENT OF
VOLUNTEERS.]
Subdivision 1. [TRAINING REQUIREMENTS.] (a) The
implementation plan shall require the local organization to
carefully screen and train volunteers to provide program
services. Training must prepare volunteers to:
(1) identify signs of abuse or other indications that a
child may be at risk of abuse;
(2) help families develop communications skills;
(3) teach and reinforce healthy discipline techniques;
(4) provide other support a family needs to cope with
stresses that increase the risk of abuse; and
(5) refer the family to other appropriate public health,
education, and social services.
(b) The implementation plan shall also include procedures
whereby the local agency will provide ongoing support,
supervision, and training for all volunteers. Training must be
culturally appropriate and community-based, and must incorporate
input from parents who will be using the program's services.
Subd. 2. [RECRUITMENT OF VOLUNTEERS.] The implementation
plan must require that the local organization recruit minority
volunteers to serve communities of color.
Sec. 31. [145.957] [ELIGIBILITY.]
The implementation plan must ensure that all residents of
Minnesota are eligible for services under the program. The plan
must make services available on a sliding fee basis. The
commissioner shall develop a sliding fee scale for the program.
Sec. 32. Minnesota Statutes 1995 Supplement, section
148C.01, subdivision 12, is amended to read:
Subd. 12. [SUPERVISED ALCOHOL AND DRUG COUNSELING
EXPERIENCE.] Except during the transition period, "supervised
alcohol and drug counseling experience" means practical
experience gained by a student, volunteer, or intern, and
supervised by a person either licensed under this chapter or
exempt under its provisions; either before, during, or after the
student completes a program from an accredited school
or education educational program of alcohol and drug counseling.
Sec. 33. Minnesota Statutes 1995 Supplement, section
148C.01, subdivision 13, is amended to read:
Subd. 13. [ALCOHOL AND DRUG COUNSELING PRACTICUM.]
"Alcohol and drug counseling practicum" means formal experience
gained by a student and supervised by a person either licensed
under this chapter or exempt under its provisions, in an
accredited school or educational program of alcohol and drug
counseling as part of the education requirements of this chapter.
Sec. 34. Minnesota Statutes 1994, section 148C.01, is
amended by adding a subdivision to read:
Subd. 17. [ALCOHOL AND DRUG COUNSELOR
INTERNSHIP.] "Alcohol and drug counselor internship" means
supervised, practical, on-the-job training as an intern,
volunteer, or employee in alcohol and drug counseling.
Sec. 35. Minnesota Statutes 1995 Supplement, section
148C.02, subdivision 1, is amended to read:
Subdivision 1. [MEMBERSHIP.] The alcohol and drug
counselors licensing advisory council consists of 13 members.
The commissioner shall appoint:
(1) except for those members initially appointed, seven
members who must be licensed alcohol and drug dependency
counselors;
(2) three members who must be public members as defined by
section 214.02;
(3) one member who must be a director or coordinator of an
accredited alcohol and drug dependency training program; and
(4) one member who must be a former consumer of alcohol and
drug dependency counseling service and who must have received
the service more than three years before the person's
appointment.
The American Indian advisory committee to the department of
human services chemical dependency office shall appoint the
remaining member.
Sec. 36. Minnesota Statutes 1995 Supplement, section
148C.02, subdivision 2, is amended to read:
Subd. 2. [DUTIES.] (a) The advisory council shall:
(1) provide advice and recommendations to the commissioner
on the development of rules for the licensure of alcohol and
drug counselors;
(2) provide advice and recommendations to the commissioner
on the development of standards and procedures for the
competency testing, licensing, and review of alcohol and drug
counselors' professional conduct;
(3) provide advice and recommendations to the commissioner
in disciplinary cases in the areas of counselor competency
issues, counselor practice issues, and counselor impairment
issues.
(b) The advisory council shall form an education committee,
including a chair, and shall advise the commissioner on the
administration of education requirements in section 148C.05,
subdivision 2.
Sec. 37. Minnesota Statutes 1995 Supplement, section
148C.03, subdivision 1, is amended to read:
Subdivision 1. [GENERAL.] The commissioner shall, after
consultation with the advisory council or a subcommittee or the
special licensing criteria committee established under section
148C.11, subdivision 3, paragraph (b):
(a) adopt and enforce rules for licensure of alcohol and
drug counselors, including establishing standards and methods of
determining whether applicants and licensees are qualified under
section 148C.04. The rules must provide for examinations and
establish standards for the regulation of professional conduct.
The rules must be designed to protect the public;
(b) hold or contract for the administration of examinations
at least twice a year to assess applicants' knowledge and
skills. The examinations must be written and oral and may be
administered by the commissioner or by a private organization
under contract with the commissioner to administer the licensing
examinations. Examinations must minimize cultural bias and must
be balanced in various theories relative to practice of alcohol
and drug counseling;
(c) issue licenses to individuals qualified under sections
148C.01 to 148C.11;
(d) issue copies of the rules for licensure to all
applicants;
(e) adopt rules to establish and implement procedures,
including a standard disciplinary process and rules of
professional conduct;
(f) carry out disciplinary actions against licensees;
(g) establish, with the advice and recommendations of the
advisory council, written internal operating procedures for
receiving and investigating complaints and for taking
disciplinary actions as appropriate. Establishment of the
operating procedures are not subject to rulemaking procedures
under chapter 14;
(h) educate the public about the existence and content of
the rules for chemical dependency alcohol and drug counselor
licensing to enable consumers to file complaints against
licensees who may have violated the rules;
(i) evaluate the rules in order to refine and improve the
methods used to enforce the commissioner's standards;
(j) set, collect, and adjust license fees for alcohol and
drug counselors so that the total fees collected will as closely
as possible equal anticipated expenditures during the biennium,
as provided in section 16A.1285; fees for initial and renewal
application and examinations; late fees for counselors who
submit license renewal applications after the renewal deadline;
and a surcharge fee. The surcharge fee must include an amount
necessary to recover, over a five-year period, the
commissioner's direct expenditures for the adoption of the rules
providing for the licensure of alcohol and drug counselors. All
fees received shall be deposited in the state treasury and
credited to the special revenue fund; and
(k) prepare reports on activities related to the licensure
of alcohol and drug counselors according to this subdivision by
October 1 of each even-numbered year. Copies of the reports
shall be delivered to the legislature in accordance with section
3.195 and to the governor. The reports shall contain the
following information on the commissioner's activities relating
to the licensure of chemical dependency alcohol and drug
counselors, for the two-year period ending the previous June 30:
(1) a general statement of the activities;
(2) the number of staff hours spent on the activities;
(3) the receipts and disbursements of funds;
(4) the names of advisory council members and their
addresses, occupations, and dates of appointment and
reappointment;
(5) the names and job classifications of employees;
(6) a brief summary of rules proposed or adopted during the
reporting period with appropriate citations to the State
Register and published rules;
(7) the number of persons having each type of license
issued by the commissioner as of June 30 in the year of the
report;
(8) the locations and dates of the administration of
examinations by the commissioner;
(9) the number of persons examined by the commissioner with
the persons subdivided into groups showing age categories, sex,
and states of residency;
(10) the number of persons licensed by the commissioner
after taking the examinations referred to in clause (8) with the
persons subdivided by age categories, sex, and states of
residency;
(11) the number of persons not licensed by the commissioner
after taking the examinations referred to in clause (8) with the
persons subdivided by age categories, sex, and states of
residency;
(12) the number of persons not taking the examinations
referred to in clause (8) who were licensed by the commissioner
or who were denied licensing, the reasons for the licensing or
denial, and the persons subdivided by age categories, sex, and
states of residency;
(13) the number of persons previously licensed by the
commissioner whose licenses were revoked, suspended, or
otherwise altered in status with brief statements of the reasons
for the revocation, suspension, or alteration;
(14) the number of written and oral complaints and other
communications received by the commissioner which allege or
imply a violation of a statute or rule which the commissioner is
empowered to enforce;
(15) a summary, by specific category, of the substance of
the complaints and communications referred to in clause (14)
and, for each specific category, the responses or dispositions;
and
(16) any other objective information which the commissioner
believes will be useful in reviewing the commissioner's
activities.
Sec. 38. Minnesota Statutes 1995 Supplement, section
148C.04, subdivision 3, is amended to read:
Subd. 3. [LICENSING REQUIREMENTS FOR ALCOHOL AND DRUG
COUNSELORS; EVIDENCE FOR THE FIRST FIVE YEARS.] (a) For five
years after the effective date of the rules authorized in
section 148C.03, the applicant, unless qualified for initial
licensure under this subdivision under section 148C.06 during
the two-year period authorized therein, under section 148C.07,
or under subdivision 4, must furnish evidence satisfactory to
the commissioner that the applicant has met all the requirements
in clauses (1) to (3). The applicant must have:
(1) Except as provided in subdivision 4, the applicant must
have received an associate degree including 270 clock hours of
alcohol and drug counseling education from an accredited school
or educational program and 880 clock hours of chemical
dependency alcohol and drug counseling practicum;
(2) The applicant must have completed a written case
presentation and satisfactorily passed an oral examination that
demonstrates competence in the core functions; and
(3) The applicant must have satisfactorily passed a written
examination as established by the commissioner.
(b) Unless the applicant qualifies for licensure under this
subdivision, an applicant must furnish evidence satisfactory to
the commissioner that the applicant has met the requirements of
paragraph (a), clauses (1) to (3).
Beginning two years after the effective date of the rules
authorized in section 148C.03, subdivision 1, no person may be
licensed without meeting the requirements in section 148C.04,
subdivision 4, paragraph (a), clauses (2) and (3), or the
special licensing criteria established pursuant to section
148C.11, subdivision 4.
Sec. 39. Minnesota Statutes 1995 Supplement, section
148C.04, subdivision 4, is amended to read:
Subd. 4. [ADDITIONAL LICENSING REQUIREMENTS AFTER FIVE
YEARS.] Beginning five years after the effective date of the
rules authorized in section 148C.03, subdivision 1, an applicant
for licensure must have received submit evidence to the
commissioner that the applicant has met one of the following
requirements:
(1) The applicant must have:
(i) received a bachelor's degree from an accredited school
or educational program, and must have completed including 480
clock hours of alcohol and drug counseling education from an
accredited school or educational program and 880 clock hours of
alcohol and drug counseling practicum,
(ii) completed a written case presentation and
satisfactorily passed an oral examination that demonstrates
competence in the core functions, and
(iii) satisfactorily passed a written examination as
established by the commissioner; or
(2) The applicant must meet the requirements of section
148C.07.
Sec. 40. Minnesota Statutes 1995 Supplement, section
148C.04, is amended by adding a subdivision to read:
Subd. 5. [ADDITIONAL LICENSING REQUIREMENTS.] Applicants
must also meet the special licensing requirements in section
148C.11, subdivision 4, and in the rules authorized in section
148C.03, subdivision 1, when applicable.
Sec. 41. Minnesota Statutes 1995 Supplement, section
148C.05, subdivision 1, is amended to read:
Subdivision 1. [RENEWAL REQUIREMENTS.] To renew a license,
an applicant must:
(1) annually complete a renewal application every two years
on a form provided by the commissioner and submit the annual
biennial renewal fee by the deadline; and
(2) submit additional information if requested by the
commissioner to clarify information presented in the renewal
application. This information must be submitted within 30 days
of the commissioner's request.
Sec. 42. Minnesota Statutes 1995 Supplement, section
148C.06, is amended to read:
148C.06 [TRANSITION PERIOD.]
For two years from the effective date of the rules
authorized in section 148C.03, subdivision 1, the commissioner
shall issue a license to an applicant if the applicant meets one
of the following qualifications:
(a) is credentialed as a certified chemical dependency
counselor (CCDC) or certified chemical dependency counselor
reciprocal (CCDCR) by the Institute for Chemical Dependency
Professionals of Minnesota, Inc.;
(b) has 6,000 hours of supervised alcohol and drug
counselor experience as defined by the core functions, 270 clock
hours of alcohol and drug training with a minimum of 60 hours of
this training occurring within the past five years, 300 hours of
alcohol and drug practicum counselor internship, and has
successfully completed the requirements in section 148C.04,
subdivision 3, paragraph (a), clauses (2) and (3);
(c) has 10,000 hours of supervised alcohol and drug
counselor experience as defined by the core functions, 270 clock
hours of alcohol and drug training with a minimum of 60 hours of
this training occurring within the past five years, and has
successfully completed the requirements in section 148C.04,
subdivision 3, paragraph (a), clause (2) or (3), or is
credentialed as a certified chemical dependency practitioner
(CCDP) by the Institute for Chemical Dependency Professionals of
Minnesota, Inc.;
(d) has 14,000 hours of supervised alcohol and drug
counselor experience as defined by the core functions and 270
clock hours of alcohol and drug training with a minimum of 60
hours of this training occurring within the past five years; or
(e) has met the special licensing criteria established
pursuant to section 148C.11.
Sec. 43. Minnesota Statutes 1994, section 148C.09, is
amended by adding a subdivision to read:
Subd. 1a. [BACKGROUND INVESTIGATION.] The applicant must
sign a release authorizing the commissioner to obtain
information from the bureau of criminal apprehension, the
Federal Bureau of Investigation, the office of mental health
practice, the department of human services, the office of health
facilities complaints, and other agencies specified in the
rules. After the commissioner has given written notice to an
individual who is the subject of a background investigation, the
agencies shall assist the commissioner with the investigation by
giving the commissioner criminal conviction data, reports about
abuse or neglect of clients, and other information specified in
the rules.
Sec. 44. Minnesota Statutes 1995 Supplement, section
148C.11, subdivision 1, is amended to read:
Subdivision 1. [OTHER PROFESSIONALS.] Nothing in sections
148C.01 to 148C.10 shall prevent members of other professions or
occupations from performing functions for which they are
qualified or licensed. This exception includes, but is not
limited to, licensed physicians, registered nurses, licensed
practical nurses, licensed psychological practitioners, members
of the clergy, American Indian medicine men and women, licensed
attorneys, probation officers, licensed marriage and family
therapists, licensed social workers, licensed professional
counselors, school counselors employed by a school district
while acting within the scope of their employment as a school
counselor, and registered occupational therapists or certified
occupational therapist therapy assistants. These persons must
not, however, use a title incorporating the words "alcohol and
drug counselor" or "licensed alcohol and drug counselor" or
otherwise hold themselves out to the public by any title or
description stating or implying that they are licensed to engage
in the practice of alcohol and drug counseling.
Sec. 45. Minnesota Statutes 1995 Supplement, section
148C.11, subdivision 3, is amended to read:
Subd. 3. [FEDERALLY RECOGNIZED TRIBES.] (a) Alcohol and
drug counselors licensed to practice alcohol and drug counseling
according to standards established by federally recognized
tribes, while practicing under tribal jurisdiction, are exempt
from the requirements of this chapter. In practicing alcohol
and drug counseling under tribal jurisdiction, individuals
licensed under that authority shall be afforded the same rights,
responsibilities, and recognition as persons licensed pursuant
to this chapter.
(b) The commissioner shall develop special licensing
criteria for issuance of a license to alcohol and drug
counselors who: (1) are members of ethnic minority groups; or
(2) are employed by private, nonprofit agencies, including
agencies operated by private, nonprofit hospitals, whose primary
agency service focus addresses ethnic minority populations.
These licensing criteria may differ from the licensing criteria
specified in section 148C.04. To develop these criteria, the
commissioner shall establish a committee comprised of but not
limited to representatives from the council on hearing impaired,
the council on affairs of Spanish-speaking people, the council
on Asian-Pacific Minnesotans, the council on Black Minnesotans,
and the Indian affairs council.
Sec. 46. Minnesota Statutes 1995 Supplement, section
157.011, subdivision 1, is amended to read:
Subdivision 1. [ESTABLISHMENTS.] The commissioner shall
adopt rules establishing standards for food, and beverage
service establishments, and hotels, motels, lodging
establishments, and resorts.
Sec. 47. Minnesota Statutes 1995 Supplement, section
157.15, subdivision 4, is amended to read:
Subd. 4. [BOARDING ESTABLISHMENT.] "Boarding
establishment" means a building, structure, enclosure, or any
part thereof used as, maintained as, advertised as, or held out
to be a place food and beverage service establishment where food
or nonalcoholic beverages, or both, are furnished to five or
more regular boarders, whether with or without sleeping
accommodations, for periods of one week or more.
Sec. 48. Minnesota Statutes 1995 Supplement, section
157.15, subdivision 5, is amended to read:
Subd. 5. [FOOD AND BEVERAGE SERVICE ESTABLISHMENT.] "Food
and beverage service establishment" means a restaurant,
alcoholic beverage establishment, boarding establishment, mobile
food unit, seasonal food stand, food cart, or special event food
stand building, structure, enclosure, or any part of a building,
structure, or enclosure used as, maintained as, advertised as,
or held out to be an operation that prepares, serves, or
otherwise provides food or beverages, or both, for human
consumption.
Sec. 49. Minnesota Statutes 1995 Supplement, section
157.15, subdivision 6, is amended to read:
Subd. 6. [FOOD CART.] "Food cart" means a food and
beverage service establishment that is a nonmotorized vehicle
limited to serving food that is not defined by rule as
potentially hazardous food, except precooked frankfurters and
other ready-to-eat link sausages self-propelled by the operator.
Sec. 50. Minnesota Statutes 1995 Supplement, section
157.15, subdivision 9, is amended to read:
Subd. 9. [MOBILE FOOD UNIT.] "Mobile food unit" means a
food and beverage service establishment that is a vehicle
mounted unit, either motorized or trailered, operating no more
than 14 days annually at any one place or is operated in
conjunction with a permanent business at the site of the
permanent business by the same individual or company, and
readily movable, without disassembling, for transport to another
location and remaining for no more than 14 days, annually, at
any one place.
Sec. 51. Minnesota Statutes 1995 Supplement, section
157.15, subdivision 12, is amended to read:
Subd. 12. [RESTAURANT.] "Restaurant" means a building,
structure, enclosure, or any part thereof used as, maintained
as, advertised as, or held out to be a place where food or
nonalcoholic beverages are served or prepared for service to the
public food and beverage service establishment, whether the
establishment serves alcoholic or nonalcoholic beverages, which
operates from a location for more than 14 days annually.
Restaurant does not include a food cart or a mobile food unit.
Sec. 52. Minnesota Statutes 1995 Supplement, section
157.15, is amended by adding a subdivision to read:
Subd. 13a. [SEASONAL PERMANENT FOOD STAND.] "Seasonal
permanent food stand" means a food and beverage service
establishment which is a permanent food service stand or
building, but which operates no more than 14 days annually.
Sec. 53. Minnesota Statutes 1995 Supplement, section
157.15, subdivision 13, is amended to read:
Subd. 13. [SEASONAL TEMPORARY FOOD STAND.] "Seasonal
temporary food stand" means a food and beverage service
establishment that is a food stand that which is disassembled
and moved from location to location, remaining but which
operates no more than 14 days, annually, at any one place; or a
permanent food service stand or building that operates no more
than 14 days annually location.
Sec. 54. Minnesota Statutes 1995 Supplement, section
157.15, subdivision 14, is amended to read:
Subd. 14. [SPECIAL EVENT FOOD STAND.] "Special event food
stand" means a food and beverage service establishment which is
used in conjunction with celebrations and special events, used
not more than twice annually, and remaining and which operates
once or twice annually for no more than three consecutive seven
total days at any one location.
Sec. 55. Minnesota Statutes 1995 Supplement, section
157.15, is amended by adding a subdivision to read:
Subd. 15. [SPECIAL EVENT FOOD STAND-LIMITED.] "Special
event food stand-limited" means a fee category where food is
served at special events that is prepared at another licensed
location and is only held and served with no additional
preparation at the serving site of the special event, and which
operates once or twice annually for no more than seven total
days.
Sec. 56. Minnesota Statutes 1995 Supplement, section
157.16, is amended to read:
157.16 [LICENSES REQUIRED; FEES.]
Subdivision 1. [LICENSE REQUIRED ANNUALLY.] A license is
required annually for every person, firm, or corporation engaged
in the business of conducting a food and beverage service
establishment hotel, motel, restaurant, alcoholic beverage
establishment, boarding establishment, lodging establishment, or
resort, mobile food unit, seasonal food stand, food cart, or
special event food stand or who thereafter engages in conducting
any such business. Any person wishing to operate a place of
business licensed in this section shall first make application,
pay the required fee specified in this section, and receive
approval for operation, including plan review approval.
Seasonal and temporary food stands and special event food stands
are not required to submit plans. Application shall be made on
forms provided by the commissioner and shall require the
applicant to state the full name and address of the owner of the
building, structure, or enclosure, the lessee and manager of the
food and beverage service establishment, hotel, motel,
restaurant, alcoholic beverage establishment, boarding
establishment, lodging establishment, or resort, mobile food
unit, seasonal food stand, food cart, or special event food
stand; the name under which the business is to be conducted; and
any other information as may be required by the commissioner to
complete the application for license.
Subd. 2. [LICENSE RENEWAL.] Initial and renewal licenses
for all food and beverage service establishments, hotels,
motels, restaurants, alcoholic beverage establishments, lodging
establishments, boarding establishments, and resorts, mobile
food units, seasonal food stands, and food carts shall be issued
for the calendar year for which application is made and shall
expire on December 31 of such year. Any person who operates a
place of business after the expiration date of a license or
without having submitted an application and paid the fee shall
be deemed to have violated the provisions of this chapter and
shall be subject to enforcement action, as provided in the
health enforcement consolidation act, sections 144.989 to
144.993. In addition, a penalty of $25 shall be added to the
total of the license fee for any food and beverage service
establishment operating without a license as a mobile food unit,
a seasonal temporary or seasonal permanent food stand, and food
cart operating without a license or a special event food stand,
and a penalty of $50 shall be added to the total of the license
fee for all other food, beverage, and restaurants, food carts,
hotels, motels, lodging establishments, and resorts operating
without a license.
Subd. 3. [ESTABLISHMENT FEES; DEFINITIONS.] For the
purposes of establishing food, beverage, and lodging
establishment fees, the following definitions have the meanings
given them. (a) The following fees are required for food and
beverage service establishments, hotels, motels, lodging
establishments, and resorts licensed under this chapter. Food
and beverage service establishments must pay the highest
applicable fee under paragraph (e), clause (1), (2), (3), or
(4), and establishments serving alcohol must pay the highest
applicable fee under paragraph (e), clause (6) or (7).
(b) All food and beverage service establishments, except
special event food stands, and all hotels, motels, lodging
establishments, and resorts shall pay an annual base fee of $100.
(c) A special event food stand shall pay a flat fee of $60
annually. "Special event food stand" means a fee category where
food is prepared or served in conjunction with celebrations,
county fairs, or special events from a special event food stand
as defined in section 157.15.
(d) A special event food stand-limited shall pay a flat fee
of $30.
(e) In addition to the base fee in paragraph (b), each food
and beverage service establishment, other than a special event
food stand, and each hotel, motel, lodging establishment, and
resort shall pay an additional annual fee for each fee category
as specified in this paragraph:
(1) Limited food menu selection, $30.
(a) "Limited food menu selection" means a fee category that
provides one or more of the following:
(1) (i) prepackaged food that receives heat treatment and
is served in the package;
(2) (ii) frozen pizza that is heated and served;
(3) (iii) a continental breakfast such as rolls, coffee,
juice, milk, and cold cereal;
(4) (iv) soft drinks, coffee, or nonalcoholic beverages; or
(5) does not prepare food on site, however serves food that
was prepared elsewhere and provides (v) cleaning of for eating,
drinking, or cooking utensils, when the only food served is
prepared off site.
(2) Small menu selection with limited equipment, including
boarding establishments, $55.
(b) "Small menu selection with limited equipment" means a
fee category that has no salad bar and provides meets one or
more of the following:
(1) (i) possesses food service equipment that is limited to
consists of no more than a deep fat fryer, a grill, two hot
holding containers, and one or more microwave ovens;
(2) service of (ii) serves dipped ice cream or soft serve
frozen desserts;
(3) service of (iii) serves breakfast in an owner-occupied
bed and breakfast establishment; or
(4) (iv) is a boarding establishment.
(3) Small establishment with full menu selection, $150.
(c) "Small establishment with full menu selection" means a
fee category that provides meets one or more of the following:
(1) (i) possesses food service equipment that includes a
range, oven, steam table, salad bar, or salad preparation area;
(2) (ii) possesses food service equipment that includes
more than one deep fat fryer, one grill, or two hot holding
containers; or
(3) (iii) is an establishment where food is prepared at one
location and served at one or more separate locations.
(4) Large establishment with full menu selection, $250.
(d) "Large establishment with full menu selection" means
either:
(i) a fee category that (1) meets the criteria in paragraph
(c), clause (1) or (2) clause (3), subclause (i) or (ii), for a
small establishment with full menu selection and: (1), (2) seats
more than 175 people; (2), and (3) offers the full menu
selection an average of five or more days a week during the
weeks of operation; or means
(ii) a service fee category that (1) meets the criteria in
paragraph (c), clause (3), subclause (iii), for a small
establishment with full menu selection;, and (3) (2) prepares
and serves 500 or more meals per day.
(e) "Temporary food service" means a fee category where
food is prepared and served from a mobile food unit, seasonal
food stand, or food cart.
(f) "Alcohol service from bar" means a fee category where
alcoholic mixed drinks are served, or where beer or wine are
served from a bar.
(5) Other food and beverage service, including food carts,
mobile food units, seasonal temporary food stands, and seasonal
permanent food stands, $30.
(6) Beer or wine table service, $30.
(g) "Beer or wine table service" means a fee category where
the only alcoholic beverage service is beer or wine, served to
customers seated at tables.
(h) "Individual water" means a fee category with a water
supply other than a community public water supply as defined in
Minnesota Rules, chapter 4720.
(i) "Individual sewer" means a fee category with an
individual sewage treatment system which uses subsurface
treatment and disposal.
(7) Alcoholic beverage service, other than beer or wine
table service, $75.
"Alcohol service other than beer or wine table service"
means a fee category where alcoholic mixed drinks are served or
where beer or wine are served from a bar.
(8) Lodging per sleeping accommodation unit, $4, including
hotels, motels, lodging establishments, and resorts, up to a
maximum of $400.
(j) "Lodging per sleeping accommodation unit" means a fee
category including the number of guest rooms, cottages, or other
rental units of a hotel, motel, lodging establishment, or
resort; or the number of beds in a dormitory.
(9) First public swimming pool, $100; each additional
public swimming pool, $50.
(k) "Public swimming pool" means a fee category that has
the meaning given in Minnesota Rules, part 4717.0250, subpart 8.
(10) First spa, $50; each additional spa, $25.
(l) "Spa pool" means a fee category that has the meaning
given in Minnesota Rules, part 4717.0250, subpart 9.
(m) "Special event food stand" means a fee category where
food is prepared and served in conjunction with celebrations or
special events, but not more than twice annually, and where the
facility is used no more than three consecutive days per event.
(11) Private sewer or water, $30.
"Individual private water" means a fee category with a
water supply other than a community public water supply as
defined in Minnesota Rules, chapter 4720. "Individual private
sewer" means a fee category with an individual sewage treatment
system which uses subsurface treatment and disposal.
(f) A fee is not required for a food and beverage service
establishment operated by a school as defined in sections 120.05
and 120.101.
(g) A fee of $150 for review of the construction plans must
accompany the initial license application for food and beverage
service establishments, hotels, motels, lodging establishments,
or resorts.
(h) When existing food and beverage service establishments,
hotels, motels, lodging establishments, or resorts are
extensively remodeled, a fee of $150 must be submitted with the
remodeling plans.
(i) Seasonal temporary food stands, special event food
stands, and special event food stands-limited are not required
to submit construction or remodeling plans for review.
Subd. 4. [POSTING REQUIREMENTS.] Every food and beverage
service establishment, hotel, motel, lodging establishment, or
resort must have the license posted in a conspicuous place at
the establishment.
Sec. 57. Minnesota Statutes 1995 Supplement, section
157.17, subdivision 2, is amended to read:
Subd. 2. [REGISTRATION.] At the time of licensure or
license renewal, a board boarding and lodging establishment or a
lodging establishment that provides supportive services or
health supervision services must register be registered with the
commissioner, and must register annually thereafter. The
registration must include the name, address, and telephone
number of the establishment, the name of the operator, the types
of services that are being provided, a description of the
residents being served, the type and qualifications of staff in
the facility, and other information that is necessary to
identify the needs of the residents and the types of services
that are being provided. The commissioner shall develop and
furnish to the boarding and lodging establishment or lodging
establishment the necessary form for submitting the
registration. The requirement for registration is effective
until the rules required by sections 144B.01 to 144B.17 are
effective.
Sec. 58. Minnesota Statutes 1995 Supplement, section
157.20, subdivision 1, is amended to read:
Subdivision 1. [INSPECTIONS.] It shall be the duty of the
commissioner to inspect, or cause to be inspected, every food
and beverage service establishment, hotel, motel, restaurant,
alcoholic beverage establishment, boarding establishment,
lodging establishment, or resort, mobile food unit, seasonal
food stand, food cart, and special event food stand in this
state. For the purpose of conducting inspections, the
commissioner shall have the right to enter and have access
thereto at any time during the conduct of business.
Sec. 59. Minnesota Statutes 1995 Supplement, section
157.20, is amended by adding a subdivision to read:
Subd. 2a. [RISK CATEGORIES.] (a) [HIGH-RISK
ESTABLISHMENT.] "High-risk establishment" means any food and
beverage service establishment, hotel, motel, lodging
establishment, or resort that:
(1) serves potentially hazardous foods that require
extensive processing on the premises, including manual handling,
cooling, reheating, or holding for service;
(2) prepares foods several hours or days before service;
(3) serves menu items that epidemologic experience has
demonstrated to be common vehicles of food-borne illness;
(4) has a public swimming pool; or
(5) draws its drinking water from a surface water supply.
(b) [MEDIUM-RISK ESTABLISHMENT.] "Medium-risk establishment"
means a food and beverage service establishment, hotel, motel,
lodging establishment, or resort that:
(1) serves potentially hazardous foods but with minimal
holding between preparation and service; or
(2) serves foods, such as pizza, that require extensive
handling followed by heat treatment.
(c) [LOW-RISK ESTABLISHMENT.] "Low-risk establishment"
means a food and beverage service establishment, hotel, motel,
lodging establishment, or resort that is not a high-risk or
medium-risk establishment.
(d) [RISK EXCEPTIONS.] Mobile food units, seasonal
permanent and seasonal temporary food stands, food carts, and
special event food stands are not inspected on an established
schedule and therefore are not defined as high-risk,
medium-risk, or low-risk establishments.
Sec. 60. Minnesota Statutes 1995 Supplement, section
157.21, is amended to read:
157.21 [INSPECTION RECORDS.]
The commissioner shall keep inspection records for all food
and beverage service establishments, hotels, motels,
restaurants, alcoholic beverage establishments, boarding
establishments, lodging establishments, and resorts, mobile food
units, seasonal food stands, food carts, and special event food
stands, together with the name of the owner and operator.
Sec. 61. Minnesota Statutes 1994, section 327.14,
subdivision 8, is amended to read:
Subd. 8. [RECREATIONAL CAMPING AREA.] "Recreational
camping area" means any area, whether privately or publicly
owned, used on a daily, nightly, weekly, or longer basis for the
accommodation of five or more tents or recreational camping
vehicles free of charge or for compensation. "Recreational
camping area" excludes:
(1) children's camps,;
(2) industrial camps,;
(3) migrant labor camps, as defined in Minnesota Statutes
and state commissioner of health rules,;
(4) United States forest service camps,;
(5) state forest service camps,;
(6) state wildlife management areas or state-owned public
access areas which are restricted in use to picnicking and boat
landing; and
(7) temporary holding areas for self-contained recreational
camping vehicles created by and adjacent to motor sports
facilities, if the chief law enforcement officer of an affected
jurisdiction determines that it is in the interest of public
safety to provide a temporary holding area.
Sec. 62. [REPORT ON IMMUNIZATION LAW AND POLICY.]
By January 15, 1997, the commissioner of health shall
report recommendations to the legislature and governor relating
to Minnesota immunization law and policy regarding
vaccine-preventable diseases for which immunization is not
currently required by law, including, but not limited to,
hepatitis A, hepatitis B, varicella, and other vaccine-
preventable diseases identified by the commissioner.
Sec. 63. [REPORT ON THE BIRTH DEFECTS REGISTRY SYSTEM.]
The commissioner of health shall submit to the legislature
a report by January 31, 1997, on the development of the birth
defects registry system, including recommendations for
additional statutory authority necessary to implement the system.
Sec. 64. [STUDY; PRICE CONTRACT FOR PRESCRIPTION DRUGS.]
The commissioners of health, human services, and
administration shall develop a plan to provide prescription
drugs at significantly discounted prices to individuals 65 years
or older whose income is below 200 percent of the current
federal poverty level. The commissioners shall submit a report
detailing the plan by October 1, 1996, to the chairs of the
house of representatives governmental operations committee, the
house of representatives state government finance division, the
house of representatives health and human services committee,
the senate governmental operations and veterans committee, the
state government division of the senate finance committee, the
senate health care committee, and the senate health care and
family services finance division.
Sec. 65. [MERC STUDY.]
The medical education and research cost advisory task force
shall make recommendations to the commissioner of health and to
the house health and human services committee and both finance
divisions, and the senate health care committee and the senate
health care and family services finance division by December 15,
1996, on potential sources of funding for medical education and
research and on mechanisms for the distribution of such funding
sources.
Sec. 66. [REPORT ON CHILD PROGRAM IMPLEMENTATION PLAN.]
By February 15, 1997, the commissioner of health shall
present to the legislature an implementation plan for the
establishment of a statewide CHILD program. The implementation
plan must incorporate the requirements for program structure and
standards, duties of participating local organizations, training
and recruitment of volunteers, and eligibility, as provided in
Minnesota Statutes, sections 145.953 to 145.957. The report
shall include recommendations about which executive agency is
the most appropriate one within which to house the CHILD program
under Minnesota Statutes, sections 145.951 to 145.957.
Sec. 67. [STUDY; CORPORATE ADULT FOSTER CARE.]
The commissioner of human services shall conduct a study of
the current adult foster care licensure requirements as they are
applied to corporate adult foster care homes, and shall
recommend any appropriate changes to these licensure
requirements following the implementation of the housing with
services contract act under Minnesota Statutes, chapter 144D.
The commissioner shall submit a report with the results and
recommendations of this study to the house health and human
services committee, the house health and human services finance
division, the senate health care committee, and the senate
health care and family services finance division by January 15,
1997.
Sec. 68. [DAKOTA COUNTY ENHANCED AUTOMATION SYSTEM
DEMONSTRATION PROJECT.]
Dakota county may implement a demonstration project to
develop an enhanced automation system to educate public
assistance recipients on their health care options. This
project may include a system that combines interactive touch
screen video, clinic maps, text and audio both in multiple
languages to assist clients in selecting a managed health care
provider. The automated system must be located in kiosks in the
county. Dakota county shall report to the house health and
human services committee, the house health and human services
finance division, the senate health care committee, and the
senate health care and family services finance division by
January 1, 1998, on the results of the demonstration project.
The report shall include, at a minimum, information about
savings realized by the county from the demonstration project.
Sec. 69. [MIGRANT FARMWORKER DATA RESEARCH.]
(a) The commissioner of health shall collect, analyze, and
report information on collaborative resources and nutrition
available to and economic contributions to the state by migrant
farmworkers in Minnesota in consultation with an advisory
committee made up of representatives from migrant-serving
agencies, county economic assistance program staff, and migrant
farmworkers and family members.
(b) The advisory committee members should include
representatives from:
(1) Migrant Health;
(2) Migrant Education;
(3) Migrant Head Start;
(4) Migrant Legal Services;
(5) Midwest Farmworkers Employment and Training;
(6) Women, Infants, and Children's Supplemental Feeding
Program (WIC);
(7) Tri-Valley Opportunity Council;
(8) Minnesota Food Shelf Association;
(9) at least two county economic assistance offices from
counties with large migrant populations during the agricultural
season;
(10) the Spanish Speaking Affairs Council;
(11) the Minnesota department of health; and
(12) at least two migrant community members or advocates.
The advisory committee, in consultation with the department
of health, shall develop the research, collection, and reporting
requirements and ensure that the results are shared among all
members of the advisory committee and all interested parties.
The advisory committee and the department of health shall report
the results of their research to the house health and human
services finance division and the senate health care and family
service finance division by January 15, 1997.
Sec. 70. [INSTRUCTION TO REVISOR.]
In each section of Minnesota Statutes referred to in column
A, the revisor of statutes shall delete the reference in column
B and insert the reference in column C. The references in
column C may be changed by the revisor to the section of
Minnesota Statutes in which the bill sections are compiled.
Column A Column B Column C
28A.15, subdivision 5 157.03 157.16
157.15, subdivision 1 157.03 157.011
160.295, subdivision 3 157.03 157.16
256B.0913, subdivision 5 157.03 157.011
299F.46, subdivision 1 157.03 157.011
Sec. 71. [REPEALER.]
Minnesota Statutes 1994, sections 144.691, subdivision 4;
146.14; and 146.20; Minnesota Statutes 1995 Supplement, sections
157.03; 157.15, subdivision 2; 157.18; and 157.19, are repealed.
Sec 72. [EFFECTIVE DATE.]
Sections 32 to 45, 64, and 68 are effective the day
following final enactment.
ARTICLE 5
DEPARTMENT OF HUMAN SERVICES TECHNICAL AND
POLICY CHANGES
Section 1. Minnesota Statutes 1994, section 62D.04,
subdivision 5, is amended to read:
Subd. 5. [PARTICIPATION; GOVERNMENT PROGRAMS.] Health
maintenance organizations shall, as a condition of receiving and
retaining a certificate of authority, participate in the medical
assistance, general assistance medical care, and MinnesotaCare
programs. The participation required from health maintenance
organizations shall be pursuant to rules adopted under section
256B.0644 A health maintenance organization is required to
submit proposals in good faith to serve individuals eligible for
the above programs in a geographic region of the state if, at
the time of publication of a request for proposal, the
percentage of recipients in the public programs in the region
who are enrolled in the health maintenance organization is less
than the health maintenance organization's percentage of the
total number of individuals enrolled in health maintenance
organizations in the same region. Geographic regions shall be
defined by the commissioner of human services in the request for
proposals.
Sec. 2. Minnesota Statutes 1994, section 62N.10,
subdivision 4, is amended to read:
Subd. 4. [PARTICIPATION; GOVERNMENT PROGRAMS.] Integrated
service networks shall, as a condition of licensure, participate
in the medical assistance, general assistance medical care, and
MinnesotaCare programs. An integrated service network is
required to submit proposals in good faith to serve persons who
are eligible for the above programs if, at the time of
publication of a request for proposal, the percentage of
recipients in the public programs in the region who are enrolled
in the integrated service network is less than the integrated
service network's percentage of the total number of individuals
enrolled in integrated service networks in the same region.
Geographic regions shall be defined by the commissioner of human
services in the request for proposals. The commissioner shall
adopt rules specifying the participation required of the
networks. The rules must be consistent with Minnesota Rules,
parts 9505.5200 to 9505.5260, governing participation by health
maintenance organizations in public health care programs.
Sec. 3. Minnesota Statutes 1994, section 144.0722, is
amended by adding a subdivision to read:
Subd. 2a. [SEMIANNUAL ASSESSMENT BY NURSING
FACILITIES.] Notwithstanding Minnesota Rules, part 9549.0059,
subpart 2, item B, the individual dependencies items 21 to 24
and 28 are required to be completed in accordance with the
Facility Manual for Completing Case Mix Requests for
Classification, July 1987, issued by the Minnesota department of
health.
Sec. 4. Minnesota Statutes 1994, section 245.462,
subdivision 4, is amended to read:
Subd. 4. [CASE MANAGER.] "Case manager" means an
individual employed by the county or other entity authorized by
the county board to provide case management services specified
in section 245.4711. A case manager must have a bachelor's
degree in one of the behavioral sciences or related fields from
an accredited college or university and have at least 2,000
hours of supervised experience in the delivery of services to
adults with mental illness, must be skilled in the process of
identifying and assessing a wide range of client needs, and must
be knowledgeable about local community resources and how to use
those resources for the benefit of the client. The case manager
shall meet in person with a mental health professional at least
once each month to obtain clinical supervision of the case
manager's activities. Case managers with a bachelor's degree
but without 2,000 hours of supervised experience in the delivery
of services to adults with mental illness must complete 40 hours
of training approved by the commissioner of human services in
case management skills and in the characteristics and needs of
adults with serious and persistent mental illness and must
receive clinical supervision regarding individual service
delivery from a mental health professional at least once each
week until the requirement of 2,000 hours of supervised
experience is met. Clinical supervision must be documented in
the client record.
Until June 30, 1996 1999, a refugee who does not have the
qualifications specified in this subdivision may provide case
management services to adult refugees with serious and
persistent mental illness who are members of the same ethnic
group as the case manager if the person: (1) is actively
pursuing credits toward the completion of a bachelor's degree in
one of the behavioral sciences or a related field from an
accredited college or university; (2) completes 40 hours of
training as specified in this subdivision; and (3) receives
clinical supervision at least once a week until the requirements
of obtaining a bachelor's degree and 2,000 hours of supervised
experience are met.
Sec. 5. Minnesota Statutes 1994, section 245.4871,
subdivision 4, is amended to read:
Subd. 4. [CASE MANAGER.] (a) "Case manager" means an
individual employed by the county or other entity authorized by
the county board to provide case management services specified
in subdivision 3 for the child with severe emotional disturbance
and the child's family. A case manager must have experience and
training in working with children.
(b) A case manager must:
(1) have at least a bachelor's degree in one of the
behavioral sciences or a related field from an accredited
college or university;
(2) have at least 2,000 hours of supervised experience in
the delivery of mental health services to children;
(3) have experience and training in identifying and
assessing a wide range of children's needs; and
(4) be knowledgeable about local community resources and
how to use those resources for the benefit of children and their
families.
(c) The case manager may be a member of any professional
discipline that is part of the local system of care for children
established by the county board.
(d) The case manager must meet in person with a mental
health professional at least once each month to obtain clinical
supervision.
(e) Case managers with a bachelor's degree but without
2,000 hours of supervised experience in the delivery of mental
health services to children with emotional disturbance must:
(1) begin 40 hours of training approved by the commissioner
of human services in case management skills and in the
characteristics and needs of children with severe emotional
disturbance before beginning to provide case management
services; and
(2) receive clinical supervision regarding individual
service delivery from a mental health professional at least once
each week until the requirement of 2,000 hours of experience is
met.
(f) Clinical supervision must be documented in the child's
record. When the case manager is not a mental health
professional, the county board must provide or contract for
needed clinical supervision.
(g) The county board must ensure that the case manager has
the freedom to access and coordinate the services within the
local system of care that are needed by the child.
(h) Until June 30, 1996 1999, a refugee who does not have
the qualifications specified in this subdivision may provide
case management services to child refugees with severe emotional
disturbance of the same ethnic group as the refugee if the
person:
(1) is actively pursuing credits toward the completion of a
bachelor's degree in one of the behavioral sciences or related
fields at an accredited college or university;
(2) completes 40 hours of training as specified in this
subdivision; and
(3) receives clinical supervision at least once a week
until the requirements of obtaining a bachelor's degree and
2,000 hours of supervised experience are met.
Sec. 6. [252B.01] [RULE CONSOLIDATION.]
Subdivision 1. [STANDARDS.] For programs or services
licensed pursuant to Minnesota Rules, parts 9525.0215 to
9525.0355; 9525.0500 to 9525.0660; 9525.1500 to 9525.1690; and
9525.2000 to 9525.2140, the following standards apply and
supersede the requirements of the applicable rule parts for
staff qualification, orientation, and training.
Subd. 2. [STAFF QUALIFICATIONS.] (a) The license holder
must ensure that staff is competent through training,
experience, and education to meet the consumer's needs as
written in the individual service plan. The staff
qualifications must be documented.
(b) Delivery and evaluation of services provided by the
license holder to a consumer must be coordinated by a designated
person. This designated person or coordinator must minimally
have a four-year degree in a field related to service provision
and one-year work experience with consumers with mental
retardation or related conditions, a two-year degree in a field
related to service provision, and two years work experience with
consumers with mental retardation or related conditions, or a
certificate of competence from an accredited post-secondary
program in the area of developmental disabilities and two years
work experience with consumers with mental retardation or
related conditions. The coordinator must provide supervision,
support, and evaluation of activities that include:
(1) oversight of the license holder's responsibilities
designated in the individual service plan;
(2) instructions and assistance to staff implementing the
individual service plan areas;
(3) evaluation of the effectiveness of service delivery,
methodologies, and progress on consumer outcomes based on the
condition set for objective change; and
(4) review of incident and emergency reports,
identification of incident patterns, and implementation of
corrective action as necessary to reduce occurrences.
(c) The coordinator is responsible for taking necessary
actions to facilitate the accomplishment of the outcomes for
each consumer as specified in the consumer's individual service
plan.
(d) The license holder must provide for adequate
supervision for direct care staff to ensure implementation of
the individual service plan.
Subd. 3. [STAFF ORIENTATION.] (a) Within 60 days of hiring
staff who provide direct service, the license holder must
provide 30 hours of orientation. Direct care staff must
complete 15 of the 30 hours before providing any direct service
to a consumer without direct supervision. If the staff person
has received orientation training from a license holder licensed
under a program rule identified in this chapter, or provides
semi-independent living services only, the 15-hour requirement
may be reduced to eight hours. The total orientation of 30
hours may be reduced to 15 hours if the staff person has
previously received orientation training from a license holder
licensed by a program rule identified in this chapter.
(b) The 30 hours of orientation must combine supervised
on-the-job training with coverage of the material in clauses (1)
to (8);
(1) review of the consumer's complete individual service
plan to achieve an understanding of the consumer as a unique
individual;
(2) review and instructions regarding the license holder's
policies and procedures including their location and access;
(3) emergency procedures;
(4) explanation of specific job functions including
implementing objectives from the consumer's individual service
plan;
(5) explanation of responsibilities related to sections
626.556 and 626.557, and Minnesota Rules, parts 9555.8000 to
9555.8500, including requirements of rules promulgated
thereunder; sections 245A.01 to 245A.16, the human services
licensing act; and Minnesota Rules, parts 9525.2700 to
9525.2810, governing use of aversive and deprivation procedures;
(6) medication administration as it applies to the
individual consumer;
(7) consumer rights; and
(8) other topics necessary as determined by the consumer's
individual service plan or other areas identified by the license
holder.
(c) The license holder must document each employee's
orientation received.
Subd. 4. [STAFF TRAINING.] (a) The license holder shall
ensure that direct service staff annually complete hours of
training equal to two percent of the number of hours the staff
person worked or one percent for license holders under Minnesota
Rules, parts 9525.0500 to 9525.0660. If direct service staff
have received training from a license holder licensed under a
program rule identified in this chapter, the training may also
count toward training requirements for other services and of
other license holders.
(b) The license holder must document the training completed
by each employee.
(c) Training shall address the staff competencies necessary
to address the consumer needs as identified in the consumer's
individual service plan and ensure consumer health, safety, and
protection of rights. Training may also include other areas
identified by the license holder.
Sec. 7. [252B.02] [RESIDENTIAL BASED HABILITATION
SERVICES.]
Residential service sites controlled by license holders
licensed under Minnesota Rules, parts 9525.2000 to 9525.2140,
for four or fewer adults are exempt from compliance with
Minnesota Rules, parts 9555.5505; 9555.5515; 9555.5605;
9555.5705; 9555.6125, subparts 4 to 6; and 9555.6185. The
provisions of this chapter do not apply to foster care homes
that do not provide residential habilitation services funded
under the home and community-based waiver programs defined in
section 256B.092. The commissioner may approve alternative
methods of providing overnight supervision using the process and
criteria for granting a variance in section 245A.04, subdivision
9.
Sec. 8. Minnesota Statutes 1994, section 253B.11,
subdivision 2, is amended to read:
Subd. 2. [FACILITIES.] Each county or a group of counties
shall maintain or provide by contract a facility for confinement
of persons held temporarily for observation, evaluation,
diagnosis, treatment, and care. When the confinement is
provided at a regional center, the commissioner shall charge the
county of financial responsibility for the costs of confinement
of persons hospitalized under section 253B.05, subdivisions 1
and 2, and section 253B.07, subdivision 6, except that the
commissioner shall bill the responsible prepaid plan for
medically necessary hospitalizations for individuals enrolled in
a prepaid plan under contract to provide medical assistance,
general assistance medical care, or MinnesotaCare services. If
the prepaid plan determines under the terms of the medical
assistance, general assistance medical care, or MinnesotaCare
contract that a hospitalization was not medically necessary, the
county is responsible. "County of financial responsibility"
means the county in which the person resides at the time of
confinement or, if the person has no residence in this state,
the county which initiated the confinement. The charge shall be
based on the commissioner's determination of the cost of care
pursuant to section 246.50, subdivision 5. When there is a
dispute as to which county is the county of financial
responsibility, the county charged for the costs of confinement
shall pay for them pending final determination of the dispute
over financial responsibility. Disputes about the county of
financial responsibility shall be submitted to the commissioner
to be settled in the manner prescribed in section 256G.09.
Sec. 9. Minnesota Statutes 1995 Supplement, section
256.045, subdivision 3, is amended to read:
Subd. 3. [STATE AGENCY HEARINGS.] (a) State agency
hearings are available for the following: (1) 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; (2) any patient or relative aggrieved by
an order of the commissioner under section 252.27; (3) a party
aggrieved by a ruling of a prepaid health plan; or (4) an
applicant aggrieved by an adverse decision to an application for
a hardship waiver under section 256B.15; or (5) any individual
or facility determined by a lead agency to have maltreated a
vulnerable adult under section 626.557 after they have exercised
their right to administrative reconsideration under section
626.557. Individuals and organizations specified in this
section may contest the specified action, decision, or final
disposition 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, decision, or final
disposition, 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.
The hearing for an individual or facility under clause (4)
is the only administrative appeal to the final lead agency
disposition specifically, including a challenge to the accuracy
and completeness of data under section 13.04.
For purposes of this section, bargaining unit grievance
procedures are not an administrative appeal.
(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. 10. Minnesota Statutes 1994, section 256.9355,
subdivision 3, is amended to read:
Subd. 3. [EFFECTIVE DATE OF COVERAGE.] The effective date
of coverage is the first day of the month following the month in
which eligibility is approved and the first premium payment has
been received. The effective date of coverage for eligible
newborns or eligible newly adoptive children added to a family
receiving covered health services is the date of entry into the
family. The effective date of coverage for other new recipients
added to the family receiving covered health services is the
first day of the month following the month in which eligibility
is approved and the first premium payment has been
received. The premium must be received eight working days prior
to the end of the month for coverage to begin the following
month. Benefits are not available until the day following
discharge if an enrollee is hospitalized on the first day of
coverage. Notwithstanding any other law to the contrary,
benefits under sections 256.9351 to 256.9361 are secondary to a
plan of insurance or benefit program under which an eligible
person may have coverage and the commissioner shall use cost
avoidance techniques to ensure coordination of any other health
coverage for eligible persons. The commissioner shall identify
eligible persons who may have coverage or benefits under other
plans of insurance or who become eligible for medical assistance.
Sec. 11. Minnesota Statutes 1995 Supplement, section
256.969, subdivision 1, is amended to read:
Subdivision 1. [HOSPITAL COST INDEX.] (a) The hospital
cost index shall be 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.
(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 through
calendar year 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. 12. Minnesota Statutes 1995 Supplement, 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, medical
assistance, and MinnesotaCare programs 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. 13. Minnesota Statutes 1995 Supplement, 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 of even-numbered years 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.
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. 14. Minnesota Statutes 1994, section 256B.03, is
amended by adding a subdivision to read:
Subd. 3. [AMERICAN INDIAN HEALTH FUNDING.] Notwithstanding
subdivision 1 and sections 256B.0625 and 256D.03, paragraph (f),
the commissioner may make payments to federally recognized
Indian tribes with a reservation in the state to provide medical
assistance to Indians, as defined under federal law, who reside
on or near the reservation. The payments may be made in the
form of a block grant or other payment mechanism determined in
consultation with the tribe. Any alternative payment mechanism
agreed upon by the tribes and the commissioner under this
subdivision is not dependent upon county agreement but is
intended to create a direct payment mechanism between the state
and the tribe for the administration of the medical assistance
program and for covered services.
For purposes of this subdivision, "Indian tribe" means a
tribe, band, or nation, or other organized group or community of
Indians that is recognized as eligible for the special programs
and services provided by the United States to Indians because of
their status as Indians and for which a reservation exists as is
consistent with Public Law Number 100-485, as amended.
Payments under this subdivision may not result in an
increase in expenditures that would not otherwise occur in the
medical assistance program under this chapter or the general
assistance medical care program under chapter 256D.
Sec. 15. Minnesota Statutes 1995 Supplement, 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 has a physical or mental impairment that would prohibit the
recipient from safely access accessing and use using a bus,
taxi, other commercial transportation, or private
automobile. Special transportation includes driver-assisted
service to eligible individuals. Driver-assisted service
includes passenger pickup at and return to the individual's
residence or place of business, assistance with admittance of
the individual to the medical facility, and assistance in
passenger securement or in securing of wheelchairs or stretchers
in the vehicle. 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. 16. Minnesota Statutes 1995 Supplement, section
256B.0625, subdivision 30, is amended to read:
Subd. 30. [OTHER CLINIC SERVICES.] (a) Medical assistance
covers rural health clinic services, federally qualified health
center services, nonprofit community health clinic services,
public health clinic services, and the services of a clinic
meeting the criteria established in rule by the commissioner.
Rural health clinic services and federally qualified health
center services mean services defined in United States Code,
title 42, section 1396d(a)(2)(B) and (C). Payment for rural
health clinic and federally qualified health center services
shall be made according to applicable federal law and regulation.
(b) A federally qualified health center that is beginning
initial operation shall submit an estimate of budgeted costs and
visits for the initial reporting period in the form and detail
required by the commissioner. A federally qualified health
center that is already in operation shall submit an initial
report using actual costs and visits for the initial reporting
period. Within 90 days of the end of its reporting period, a
federally qualified health center shall submit, in the form and
detail required by the commissioner, a report of its operations,
including allowable costs actually incurred for the period and
the actual number of visits for services furnished during the
period, and other information required by the commissioner.
Federally qualified health centers that file Medicare cost
reports shall provide the commissioner with a copy of the most
recent Medicare cost report filed with the Medicare program
intermediary for the reporting year which support the costs
claimed on their cost report to the state.
(c) In order to continue cost-based payment under the
medical assistance program according to paragraphs (a) and (b),
a federally qualified health center or rural health clinic must
apply for designation as an essential community provider within
six months of final adoption of rules by the department of
health according to section 62Q.19, subdivision 7. For those
federally qualified health centers and rural health clinics that
have applied for essential community provider status within the
six-month time prescribed, medical assistance payments will
continue to be made according to paragraphs (a) and (b) for the
first three years of essential community provider status after
application. For federally qualified health centers and rural
health clinics that either do not apply within the time
specified above, that are denied essential community provider
status by the department of health, or who have had essential
community provider status for three years, medical assistance
payments for health services provided by these entities shall be
according to the same rates and conditions applicable to the
same service provided by health care providers that are not
federally qualified health centers or rural health clinics.
This paragraph takes effect only if the Minnesota health care
reform waiver is approved by the federal government, and remains
in effect for as long as the Minnesota health care reform waiver
remains in effect. When the waiver expires, this paragraph
expires, and the commissioner of human services shall publish a
notice in the State Register and notify the revisor of statutes.
Sec. 17. Minnesota Statutes 1994, section 256B.0627,
subdivision 1, as amended by Laws 1995, chapter 207, article 6,
sections 52 and 125, subdivision 9, is amended to read:
Subdivision 1. [DEFINITIONˆ.] (a) "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.
An initial assessment for personal care services is conducted on
individuals who are requesting personal care services or for
those consumers who have never had a public health nurse
assessment. The initial assessment must include: a
face-to-face health status assessment and determination of
baseline need, collection of initial case data, identification
of appropriate services and service plan development,
coordination of initial services, referrals and follow-up to
appropriate payers and community resources, completion of
required reports, obtaining service authorization, and consumer
education. A reassessment visit for personal care services is
conducted at least annually or when there is a significant
change in consumer condition and need for services. The
reassessment visit includes a review of initial baseline data,
evaluation of service outcomes, redetermination of service need,
modification of service plan and appropriate referrals, update
of initial forms, obtaining service authorization, and on-going
consumer education. Assessments for medical assistance home
care services for mental retardation or related conditions and
alternative care services for developmentally disabled home and
community-based waivered recipients may be conducted by the
county public health nurse to ensure coordination and avoid
duplication. 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.
(b) "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.
(c) "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 service 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.
(d) "Medically necessary" has the meaning given in
Minnesota Rules, parts 9505.0170 to 9505.0475.
(e) "Personal care assistant" means a person who: (1) is
at least 18 years old, except for persons 16 to 18 years of age
who participated in a related school-based job training program
or have completed a certified home health aide competency
evaluation; (2) is able to read, write, and speak English,
or effectively communicate with sign language, as well as
communicate with the recipient and personal care provider
organization; (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, responds appropriately to recipient
needs, and reports changes in the recipient's condition to the
supervising registered nurse; (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, unless the individual meets the
rehabilitation criteria specified in Minnesota Rules, part
4668.0020, subpart 15.
(f) "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,
and managerial officials are subject to a criminal history check
background study as provided in section 245A.04 at the time of
application. This applies to currently enrolled personal care
provider organizations and those agencies seeking enrollment as
a personal care provider organization. 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, unless the owner or managerial
official meets the rehabilitation criteria specified in
Minnesota Rules, part 4668.0020, subpart 15; (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.
(g) "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.
(h) "Service plan" means a written description of the
services needed based on the assessment developed by the nurse
who conducts the assessment together with the recipient or
responsible party. The service plan shall include a description
of the covered home care services, frequency and duration of
services, and expected outcomes and goals. The recipient and
the provider chosen by the recipient or responsible party must
be given a copy of the completed service plan within 30 calendar
days of the request for home care services by the recipient or
responsible party.
(i) "Skilled nurse visits" are provided in a recipient's
residence under a plan of care or service plan that specifies a
level of care which the nurse is qualified to provide. These
services are:
(1) nursing services according to the written plan of care
or service plan and accepted standards of medical and nursing
practice in accordance with chapter 148;
(2) services which due to the recipient's medical condition
may only be safely and effectively provided by a registered
nurse or a licensed practical nurse;
(3) assessments performed only by a registered nurse; and
(4) teaching and training the recipient, the recipient's
family, or other caregivers requiring the skills of a registered
nurse or licensed practical nurse.
Sec. 18. Minnesota Statutes 1994, section 256B.0627,
subdivision 4, as amended by Laws 1995, chapter 207, article 6,
sections 54 and 125, subdivision 11, 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) repetitive maintenance range of motion and, muscle
strengthening exercises, and other tasks 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
self-administered;
(9) application and maintenance of prosthetics and
orthotics;
(10) cleaning medical equipment;
(11) dressing or undressing;
(12) assistance with 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
(13) (17).
For purposes of this subdivision, monitoring and observation
means watching for outward visible signs that are likely to
occur and for which there is a covered personal care service or
an appropriate personal care intervention.
(b) The personal care services that are not eligible for
payment are the following:
(1) services not ordered by the physician;
(2) assessments by personal care provider organizations or
by independently enrolled registered nurses;
(3) services that are not in the service plan;
(4) services provided by the recipient's spouse, legal
guardian for an adult or child recipient, or parent of a
recipient under age 18;
(5) 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;
(6) services provided by the residential or program license
holder in a residence for more than four persons;
(6) (7) services that are the responsibility of a
residential or program license holder under the terms of a
service agreement and administrative rules;
(7) (8) sterile procedures;
(8) (9) injections of fluids into veins, muscles, or skin;
(9) (10) 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 or intermittent hours of
care needed, 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) (11) homemaker services that are not an integral part
of a personal care services;
(11) (12) home maintenance, or chore services;
(12) (13) services not specified under paragraph (a); and
(13) (14) services not authorized by the commissioner or
the commissioner's designee.
Sec. 19. Minnesota Statutes 1994, section 256B.0627,
subdivision 5, as amended by Laws 1995, chapter 207, article 6,
sections 55 and 125, subdivision 12, is amended to read:
Subd. 5. [LIMITATION ON PAYMENTS.] Medical assistance
payments for home care services shall be limited according to
this subdivision.
(a) [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) assessments and reassessments (1) any initial
assessment and; (2) up to two reassessments per year done to
determine a recipient's need for personal care services.
(b) [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care
services above the limits in paragraph (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; or
(5) the professional nurse determines an immediate need for
up to 40 skilled nursing or home health aide visits per calendar
year and submits a request for authorization within 20 working
days of the initial service date, and medical assistance is
determined to be the appropriate payer.
(c) [RETROACTIVE AUTHORIZATION.] A request for retroactive
authorization will be evaluated according to the same criteria
applied to prior authorization requests.
(d) [ASSESSMENT AND SERVICE PLAN.] Assessments under
section 256B.0627, subdivision 1, paragraph (a), shall be
conducted initially, and at least annually thereafter, in person
with the recipient and result in a completed service plan using
forms specified by the commissioner. 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 personal care services when the
recipient displays no significant change, the county public
health nurse has the option to review with the commissioner, or
the commissioner's designee, the service plan on record and
receive authorization for up to an additional 12 months at a
time for up to three years.
(e) [PRIOR AUTHORIZATION.] The commissioner, or the
commissioner's designee, shall review the assessment, the
service plan, and any additional information that is submitted.
The commissioner shall, within 30 days after receiving a
complete request, assessment, and service plan, authorize home
care services as follows:
(1) [HOME HEALTH SERVICES.] All home health services
provided by a licensed nurse or a home health aide that exceed
the limits established in paragraph (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 assessments established in paragraph (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 1.75 two times the average number of direct care
hours provided in nursing facilities for the recipient's
comparable case mix level; or
(B) up to 2.625 three times the average number of direct
care hours provided in nursing facilities for recipients who
have complex medical needs or are dependent in at least seven
activities of daily living and need physical assistance with
eating or have a neurological diagnosis 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, for care provided in a regional treatment
center for recipients who have Level I behavior; plus any
inflation adjustment as provided by the legislature for personal
care service; 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
(D) (E) up to the amount medical assistance would reimburse
for facility care for recipients referred to the commissioner by
a preadmission screening team established under section
256B.0911 or 256B.092; and
(E) (F) a reasonable amount of time for the 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,
for the report year 1993, as established by July 11, 1994 May 1,
1992, shall be calculated and incorporated into the home care
limits on July 1, 1996 1992. 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 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 recipients who need home care including children
and adults under 65 years of age. The commissioner shall
establish these forms and protocols under this section 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.
(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. Under no circumstances, other than the
exceptions in paragraph (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 (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.
(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, primary payer coverage determination information as
required, the care service 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.
(h) [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 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, and primary
payer coverage determination information as required.
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.
(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 (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. Requests for home
care services for recipients residing in a foster care setting
must include the foster care placement agreement and
determination of difficulty of care;
(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
(3) (5) home care services when combined with foster care
payments, other than room and board payments that exceed the
total amount that public funds would pay for the recipient's
care in a medical institution.
Sec. 20. Minnesota Statutes 1994, section 256B.0627, is
amended by adding a subdivision to read:
Subd. 7. [NONCOVERED HOME CARE SERVICES.] The following
home care services are not eligible for payment under medical
assistance:
(1) skilled nurse visits for the sole purpose of
supervision of the home health aide;
(2) a skilled nursing visit:
(i) only for the purpose of monitoring medication
compliance with an established medication program for a
recipient; or
(ii) to administer or assist with medication
administration, including injections, prefilling syringes for
injections, or oral medication set-up of an adult recipient,
when as determined and documented by the registered nurse, the
need can be met by an available pharmacy or the recipient is
physically and mentally able to self-administer or prefill a
medication;
(3) home care services to a recipient who is eligible for
covered services including hospice, if elected by the recipient,
under the Medicare program or any other insurance held by the
recipient;
(4) services to other members of the recipient's household;
(5) a visit made by a skilled nurse solely to train other
home health agency workers;
(6) any home care service included in the daily rate of the
community-based residential facility where the recipient is
residing;
(7) nursing and rehabilitation therapy services that are
reasonably accessible to a recipient outside their place of
residence, excluding the assessment, counseling and education,
and personal care;
(8) any home health agency service, excluding personal care
assistant services and private duty nursing services, which are
performed in a place other than the recipient's residence; and
(9) Medicare evaluation or administrative nursing visits on
dual-eligible recipients that do not qualify for Medicare visit
billing.
Sec. 21. Minnesota Statutes 1995 Supplement, 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; and
(18) telemedicine devices to monitor recipients in their
own homes as an alternative to hospital care, nursing home care,
or home visits.
(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 medical supplies and equipment without prior approval
from the commissioner when: (1) there is no other funding
source; (2) the supplies and equipment are specified in the
individual's care plan as medically necessary to enable the
individual to remain in the community according to the criteria
in Minnesota Rules, part 9505.0210, item A; and (3) the supplies
and equipment represent an effective and appropriate use of
alternative care funds. 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.
Assisted living services as defined in this section shall
not be authorized in boarding and lodging establishments
licensed according to sections 157.03 and 157.15 to 157.22.
(i) For the purposes of this section, reimbursement for
assisted living services and residential care services shall be
a monthly rate negotiated 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. For alternative care assisted living projects
established under Laws 1988, chapter 689, article 2, section
256, monthly rates may not exceed 65 percent of 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.
(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.
(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. 22. Minnesota Statutes 1994, section 256B.0913,
subdivision 7, is amended to read:
Subd. 7. [CASE MANAGEMENT.] The lead agency shall appoint
a social worker from the county agency or a registered nurse
from the county public health nursing service of the local board
of health to be the case manager for any person receiving
services funded by the alternative care program. The case
manager must ensure the health and safety of the individual
client and is responsible for the cost-effectiveness of the
alternative care individual care plan. The county may allow a
case manager to delegate certain aspects of the case management
activity to another individual employed by the county provided
there is oversight of the individual by the case manager. The
case manager may not delegate those aspects which require
professional judgment including assessments, reassessments, and
care plan development.
Sec. 23. Minnesota Statutes 1994, section 256B.0915,
subdivision 1b, is amended to read:
Subd. 1b. [PROVIDER QUALIFICATIONS AND STANDARDS.] The
commissioner must enroll qualified providers of elderly case
management services under the home and community-based waiver
for the elderly under section 1915(c) of the Social Security
Act. The enrollment process shall ensure the provider's ability
to meet the qualification requirements and standards in this
subdivision and other federal and state requirements of this
service. An elderly case management provider is an enrolled
medical assistance provider who is determined by the
commissioner to have all of the following characteristics:
(1) the legal authority for alternative care program
administration under section 256B.0913;
(2) the demonstrated capacity and experience to provide the
components of case management to coordinate and link community
resources needed by the eligible population;
(3) administrative capacity and experience in serving the
target population for whom it will provide services and in
ensuring quality of services under state and federal
requirements;
(4) the legal authority to provide preadmission screening
under section 256B.0911, subdivision 4;
(5) a financial management system that provides accurate
documentation of services and costs under state and federal
requirements; and
(6) the capacity to document and maintain individual case
records under state and federal requirements; and
(7) the county may allow a case manager to delegate certain
aspects of the case management activity to another individual
employed by the county provided there is oversight of the
individual by the case manager. The case manager may not
delegate those aspects which require professional judgment
including assessments, reassessments, and care plan development.
Sec. 24. Minnesota Statutes 1995 Supplement, 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, private duty nursing, 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 nursing facility disabled waiver must have the
commissioner's prior approval waivers, a county may purchase
extended supplies and equipment without prior approval from the
commissioner when there is no other funding source and the
supplies and equipment are specified in the individual's care
plan as medically necessary to enable the individual to remain
in the community according to the criteria in Minnesota Rules,
part 9505.0210, items A and B. 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; 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 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.
For alternative care assisted living projects established under
Laws 1988, chapter 689, article 2, section 256, 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. 25. Minnesota Statutes 1995 Supplement, 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) recommending to the commissioner in consultation with
the medical review agent according to Minnesota Rules, parts
9505.0500 to 9505.0540, 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;
(2) coordinating the traumatic brain injury home and
community-based waiver;
(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. 26. Minnesota Statutes 1995 Supplement, section
256B.15, subdivision 5, is amended 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. The commissioner shall have authority
to hear claimant appeals, pursuant to section 256.045, when an
application for a hardship waiver is denied in whole or part.
Sec. 27. Minnesota Statutes 1995 Supplement, 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 section
256B.431 and 256B.50.
Sec. 28. Minnesota Statutes 1995 Supplement, section
256B.434, subdivision 10, is amended to read:
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 section
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
144A.073, 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.
Sec. 29. Minnesota Statutes 1995 Supplement, section
256B.49, subdivision 6, is amended to read:
Subd. 6. [ADMISSION CERTIFICATION.] In determining an
individual's eligibility for the community alternative care (CAC)
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. 30. Minnesota Statutes 1995 Supplement, section
256B.49, subdivision 7, is amended 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 or the traumatic brain injury nursing facility
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. 31. Minnesota Statutes 1994, section 256B.49, is
amended by adding a subdivision to read:
Subd. 8. [CASE MANAGEMENT SERVICES.] The county may allow
a case manager to delegate certain aspects of the case
management activity to another individual employed by the county
provided there is oversight of the individual by the case
manager. The case manager may not delegate those aspects which
require professional judgment including assessments,
reassessments, and care plan development.
Sec. 32. Minnesota Statutes 1995 Supplement, 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. 33. Minnesota Statutes 1995 Supplement, 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, except as
provided in paragraph (c):
(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;
(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) Except as provided in paragraph (c), 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) Gender reassignment surgery and related services are
not covered services under this subdivision unless the
individual began receiving gender reassignment services prior to
July 1, 1995.
(d) 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.
(e) 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.
(f) Any county may, from its own resources, provide medical
payments for which state payments are not made.
(g) Chemical dependency services that are reimbursed under
chapter 254B must not be reimbursed under general assistance
medical care.
(h) 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.
(i) 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. 34. Minnesota Statutes 1994, section 256I.04,
subdivision 1, is amended to read:
Subdivision 1. [INDIVIDUAL ELIGIBILITY REQUIREMENTS.] An
individual is eligible for and entitled to a group residential
housing payment to be made on the individual's behalf if the
county agency has approved the individual's residence in a group
residential housing setting and the individual meets the
requirements in paragraph (a) or (b).
(a) The individual is aged, blind, or is over 18 years of
age and disabled as determined under the criteria used by the
title II program of the Social Security Act, and meets the
resource restrictions and standards of the supplemental security
income program, and the individual's countable income after
deducting the exclusions and disregards of the SSI program and
the medical assistance personal needs allowance under section
256B.35 is less than the monthly rate specified in the county
agency's agreement with the provider of group residential
housing in which the individual resides.
(b) The individual meets a category of eligibility under
section 256D.05, subdivision 1, paragraph (a), and the
individual's resources are less than the standards specified by
section 256D.08, and the individual's countable income as
determined under sections 256D.01 to 256D.21, less the medical
assistance personal needs allowance under section 256B.35 is
less than the monthly rate specified in the county agency's
agreement with the provider of group residential housing in
which the individual resides.
Sec. 35. Minnesota Statutes 1995 Supplement, 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.
Group residential housing agreements may be terminated with or
without cause by either the county or the provider with two
calendar months prior notice.
Sec. 36. Minnesota Statutes 1995 Supplement, 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; (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 or, within the previous six months, has been 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), and receives a
federal Section 8 housing subsidy, 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. A resident in a demonstration
project site who no longer participates in the demonstration
program shall retain eligibility for a group residential housing
payment in an amount determined under section 256I.06,
subdivision 8, using the MSA equivalent rate. Service funding
under section 256I.05, subdivision 1a, must will end June 30,
1997, if federal matching funds are available and the services
can be provided through a managed care entity. If federal
matching funds are not available, then service funding will
continue under section 256I.05, subdivision 1a. 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.
Sec. 37. [RECOMMENDATIONS ON HOME CARE PROVIDED IN FOSTER
CARE SETTINGS.]
The commissioner of human services, in consultation with
counties, home care providers, foster care providers, and
representatives of home care recipients who are both children
and adults, shall review the provision of home care services to
children and adults living in licensed foster care settings. By
November 15, 1996, the commissioner shall report to the
legislature on recommendations for standards to determine home
care service authorization for foster care residents, which will
assure appropriate care for recipients while avoiding
duplication of services and payment.
Sec. 38. [COMMISSIONER'S TASK FORCE TO CONSOLIDATE
MINNESOTA RULES; CONSUMER INFORMATION SYSTEM AND EDUCATIONAL
MATERIALS.]
The commissioner, in consultation with the commissioner of
health and representatives of affected organizations, including
counties, providers, the Minnesota Nurses Association, and
advocacy groups shall develop proposed legislation consolidating
Minnesota Rules, parts 9525.0215 to 9525.0355; 9525.0500 to
9525.0660; 9525.1500 to 9525.1690; and 9525.2000 to 9525.2140,
new regulatory strategies to determine compliance with the new
consolidated standard, and strategies to develop a consumer
information system and educational materials. The purpose of
the rule consolidation and regulatory strategies are to
eliminate duplication, outmoded provisions and unnecessary
paperwork and ensure adequate oversight and monitoring of
medication administration, while protecting safety, health,
rights and protection for persons using the services licensed
under the above parts. The purpose of the consumer information
systems and educational materials are to provide easy access to
information for consumers and interested parties to make
informed choices about service delivery. The commissioner shall
provide recommended legislation to consolidate these rules and
regulate the provisions of the rules more efficiently to the
legislative commission on health care access by November 15,
1996.
Sec. 39. [REPEALER.]
Minnesota Rules, part 9505.5230, is repealed effective July
1, 1996.
Minnesota Statutes 1995 Supplement, section 256B.69,
subdivision 4a, is repealed.
Sec. 40. [EFFECTIVE DATES.]
Sections 1 and 2 are effective for requests for proposals
issued on or after July 1, 1996.
Section 14 is effective October 1, 1996, or upon receipt of
any necessary federal approval, whichever date is later.
ARTICLE 6
MISCELLANEOUS
Section 1. Minnesota Statutes 1994, section 148.235, is
amended by adding a subdivision to read:
Subd. 6. [STANDARDS FOR WRITTEN AGREEMENTS; REVIEW AND
FILING.] Written agreements required by subdivisions 2 and 4
shall be maintained at the primary practice site of the nurse
practitioner, clinical specialist in psychiatric and mental
health nursing and the collaborating physician. The written
agreement does not need to be filed with the board of nursing,
provided that the information required to be filed with the
board, either on initial application for prescribing privileges
or on renewal of privileges, has been submitted.
Sec. 2. Minnesota Statutes 1994, section 245.94,
subdivision 2a, is amended to read:
Subd. 2a. [MANDATORY REPORTING.] Within 24 hours after a
client suffers death or serious injury, the agency, facility, or
program director shall notify the ombudsman of the death or
serious injury.
Sec. 3. Minnesota Statutes 1994, section 245.94,
subdivision 3, is amended to read:
Subd. 3. [COMPLAINTS.] The ombudsman may receive a
complaint from any source concerning an action of an agency,
facility, or program. After completing a review, the ombudsman
shall inform the complainant and the agency, facility, or
program. No client may be punished nor may the general
condition of the client's treatment be unfavorably altered as a
result of an investigation, a complaint by the client, or by
another person on the client's behalf. An agency, facility, or
program shall not retaliate or take adverse action, as defined
in section 626.557, subdivision 17, paragraph (c), against a
client or other person, who in good faith makes a complaint or
assists in an investigation. The ombudsman may classify as
confidential, the identity of a complainant, upon request of the
complainant.
Sec. 4. Minnesota Statutes 1994, section 245.95,
subdivision 2, is amended to read:
Subd. 2. [GENERAL REPORTS.] In addition to whatever
conclusions or recommendations the ombudsman may make to the
governor on an ad hoc basis, the ombudsman shall, at the end of
each year biennium, report to the governor concerning the
exercise of the ombudsman's functions during the preceding year
biennium.
Sec. 5. Minnesota Statutes 1994, section 245.97,
subdivision 6, is amended to read:
Subd. 6. [TERMS, COMPENSATION, AND REMOVAL AND
EXPIRATION.] The membership terms, compensation, and removal of
members of the committee and the filling of membership vacancies
are governed by section 15.0575. The ombudsman committee and
the medical review subcommittee expire on June 30, 1994.
Sec. 6. Minnesota Statutes 1994, section 246.57, is
amended by adding a subdivision to read:
Subd. 6. [DENTAL SERVICES.] The commissioner of human
services shall authorize any regional treatment center or state-
operated nursing home under the commissioner's authority to
provide dental services to disabled persons who are eligible for
medical assistance and are not residing at the regional
treatment center or state-operated nursing home, provided that
the reimbursement received for these services is sufficient to
cover actual costs. To provide these services, regional
treatment centers and state-operated nursing homes may
participate under contract with health networks in their service
area. Notwithstanding section 16B.06, subdivision 2, the
commissioner of human services may delegate the execution of
these dental services contracts to the chief executive officers
of the regional centers or state-operated nursing homes. All
receipts for these dental services shall be retained by the
regional treatment center or state-operated nursing home that
provides the services and shall be in addition to other funding
the regional treatment center or state-operated nursing home
receives.
Sec. 7. Minnesota Statutes 1994, section 256.482, is
amended by adding a subdivision to read:
Subd. 8. [SUNSET.] Notwithstanding section 15.059,
subdivision 5, the council on disability shall not sunset until
June 30, 2001.
Sec. 8. Minnesota Statutes 1994, section 256.73,
subdivision 1, is amended to read:
Subdivision 1. [DEPENDENT CHILDREN.] Assistance shall be
given under sections 256.72 to 256.87 to or on behalf of any
dependent child who:
(1) Resides Has resided in Minnesota for at least 30 days
or, if residing in the state for less than 30 days, the child or
the child's caretaker relative meets one of the criteria
specified in subdivision 1b;
(2) Is otherwise eligible; the child shall not be denied
aid because of conditions of the home in which the child resides.
Sec. 9. Minnesota Statutes 1994, section 256.73, is
amended by adding a subdivision to read:
Subd. 1b. [RESIDENCY CRITERIA.] A child or caretaker
relative who has resided in Minnesota for less than 30 days is
considered to be a Minnesota resident if:
(1) either the child or the caretaker relative was born in
the state;
(2) either the child or the caretaker relative has, in the
past, resided in this state for at least 365 consecutive days;
(3) either the child or the caretaker relative came to this
state to join a close relative who has resided in this state for
at least one year. For purposes of this clause, "close
relative" means a parent, grandparent, brother, sister, spouse,
or child; or
(4) the caretaker relative came to this state to accept a
bona fide offer of employment and was eligible to accept the
employment.
A county agency may waive the 30-day residency requirement
in cases of emergency or where unusual hardship would result
from denial of assistance. The county agency must report to the
commissioner within 30 days on any waiver granted under this
section. The county shall not deny an application solely
because the applicant does not meet at least one of the criteria
in this subdivision, but shall continue to process the
application and leave the application pending until the
residency requirement is met or until eligibility or
ineligibility is established.
Sec. 10. [256.9752] [SENIOR NUTRITION PROGRAMS.]
Subdivision 1. [PROGRAM GOALS.] It is the goal of all
agencies on aging and senior nutrition programs to support the
physical and mental health of seniors living in the community by:
(1) promoting nutrition programs that serve senior citizens
in their homes and communities; and
(2) providing, within the limit of funds available, the
support services that will enable the senior citizen to access
nutrition programs in the most cost-effective and efficient
manner.
Subd. 2. [AUTHORITY.] The Minnesota board on aging shall
allocate to area agencies on aging the federal funds which are
received for the senior nutrition programs of congregate dining
and home-delivered meals in a manner consistent with federal
requirements.
Subd. 3. [NUTRITION SUPPORT SERVICES.] (a) Funds allocated
to an area agency on aging for nutrition support services may be
used for the following:
(1) transportation of home-delivered meals and purchased
food and medications to the residence of a senior citizen;
(2) expansion of home-delivered meals into unserved and
underserved areas;
(3) transportation to supermarkets or delivery of groceries
from supermarkets to homes;
(4) vouchers for food purchases at selected restaurants in
isolated rural areas;
(5) food stamp outreach;
(6) transportation of seniors to congregate dining sites;
(7) nutrition screening assessments and counseling as
needed by individuals with special dietary needs, performed by a
licensed dietitian or nutritionist; and
(8) other appropriate services which support senior
nutrition programs, including new service delivery models.
(b) An area agency on aging may transfer unused funding for
nutrition support services to fund congregate dining services
and home-delivered meals.
Sec. 11. [SAFE HOUSE PROGRAM IN FERGUS FALLS.]
Notwithstanding Minnesota Statutes, section 299A.28,
another similar safe house program, primarily focusing on the
safety and protection of children, may be developed and operate
in the city of Fergus Falls if the program members have
completed a criminal background check satisfactory to the Fergus
Falls police department. However, the commissioner of public
safety is not required to perform the duties listed under
Minnesota Statutes, section 299A.28, subdivision 2, with respect
to the program in Fergus Falls and is not accountable or liable
for any act or failure to act by a member of that program.
Sec. 12. Laws 1995, chapter 207, article 1, section 2,
subdivision 4, is amended to read:
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.
Sec. 13. [PLANNING FOR RESIDENTIAL FACILITY FOR PARENTS
WITH HIV OR AIDS AND THEIR CHILDREN.]
The commissioner of health shall report to the legislature
by January 15, 1997, on the planning activities for HIV housing,
in cooperation with the Coalition for Housing for People with
AIDS, including consideration of appropriate housing options so
that parents with HIV or AIDS may live with their children when
the disease debilitates the parent so that the parent is not
able to care for their children. The report shall also make
appropriate recommendations concerning the development of such
housing.
Sec. 14. [WAIVER AUTHORITY.]
The commissioner of human services shall seek federal
waivers as necessary to implement sections 8 and 9.
Sec. 15. [SEVERABILITY.]
If any provision of sections 8 or 9 is found to be
unconstitutional or void by a court of competent jurisdiction,
all remaining provisions of the law shall remain valid and shall
be given full effect.
Sec. 16. [EFFECTIVE DATE.]
Section 12 is effective the day following final enactment.
ARTICLE 7
STUDIES OF CADI PROGRAM AND OF FOSTER CARE
Section 1. [COMMUNITY ALTERNATIVE CARE PROGRAM; EVALUATION
AND RECOMMENDATIONS.]
The commissioner of human services shall review the
administration of the community alternative care home and
community-based waiver program, and evaluate the extent to which
the program is administered in a consistent manner throughout
the state. The commissioner shall also study and make
recommendations about changing the community alternative care
waiver program to a regionally administered program, following
the model of the traumatic brain injury waiver program. The
commissioner shall submit the evaluation and recommendations
required under this section by February 1, 1997, to the chairs
of the health and human services committee, the health and human
services finance division, the health care committee, and the
health care and family services finance division.
Sec. 2. [STUDY OF FOSTER CARE FOR MEDICALLY FRAGILE AND
TECHNOLOGY-DEPENDENT CHILDREN.]
The commissioner of human services shall utilize staff in
the families with children services division, the long-term care
home and community-based services division, the division for
persons with developmental disabilities, and the quality
services division to examine and report on strategies for
supporting families with medically fragile and
technology-dependent children. The study must examine and
report on the coordination and administration of medical
assistance services, including services through the home and
community-based waiver programs, with respect to the out-of-home
placement of medically fragile and technology-dependent
children. The study must also examine and recommend strategies
for decreasing the number of these children who are
hospitalized, or whose length of stay in a hospital is extended
because appropriate foster care placements are not available or
not affordable under the current reimbursement system for the
medical assistance waiver programs. The commissioner shall
submit the report to the legislature by January 15, 1997.
Presented to the governor April 4, 1996
Signed by the governor April 12, 1996, 10:05 a.m.
Official Publication of the State of Minnesota
Revisor of Statutes