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                            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.