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Minnesota Session Laws - 1999, Regular Session
Key: (1) language to be deleted (2) new language
CHAPTER 245-S.F.No. 2225
An act relating to the operation of state government;
modifying provisions relating to health; health
department; human services; human services department;
long-term care; medical assistance; general assistance
medical care; MinnesotaCare; senior drug program; home
and community-based waivers; services for persons with
disabilities; medical assistance reimbursement for
special education and other services; county-based
purchasing; group residential housing; state-operated
services; chemical dependency; mental health;
Minnesota family investment program; general
assistance program; child support enforcement;
adoption; recreational licenses; paternity; children
in need of protection or services; termination of
parental rights; child protection; veterans nursing
homes board; health-related licensing boards;
emergency medical services regulatory board; Minnesota
state council on disability; ombudsman for mental
health and mental retardation; ombudsman for families;
creating a medical education endowment fund and a
tobacco use prevention and local public health
endowment fund; establishing the state board of
physical therapy; modifying fees; providing penalties;
requiring reports; appropriating money; amending
Minnesota Statutes 1998, sections 13.46, subdivision
2; 13.99, subdivision 38a, and by adding a
subdivision; 15.059, subdivision 5a; 16C.10,
subdivision 5; 62A.045; 62E.11, by adding a
subdivision; 62J.04, subdivision 3; 62J.06; 62J.07,
subdivisions 1 and 3; 62J.09, subdivision 8; 62J.2930,
subdivision 3; 62Q.03, subdivision 5a; 62Q.075;
62R.06, subdivision 1; 116L.02; 122A.09, subdivision
4; 125A.08; 125A.744, subdivision 3; 125A.76,
subdivision 2; 144.05, by adding a subdivision;
144.065; 144.121, by adding a subdivision; 144.148;
144.1483; 144.1492, subdivision 3; 144.1761,
subdivision 1; 144.413, subdivision 2; 144.414,
subdivision 1; 144.4165; 144.56, subdivision 2b;
144.99, subdivision 1, and by adding a subdivision;
144A.073, subdivision 5; 144A.10, by adding
subdivisions; 144A.46, subdivision 2; 144A.4605,
subdivision 2; 144D.01, subdivision 4; 144E.001, by
adding subdivisions; 144E.10, subdivision 1; 144E.11,
by adding a subdivision; 144E.16, subdivision 4;
144E.18; 144E.27, by adding subdivisions; 144E.50, by
adding a subdivision; 145.924; 145.9255, subdivisions
1 and 4; 145A.02, subdivision 10; 148.5194,
subdivisions 2, 3, 4, and by adding a subdivision;
148.66; 148.67; 148.70; 148.705; 148.71; 148.72,
subdivisions 1, 2, and 4; 148.73; 148.74; 148.75;
148.76; 148.78; 198.003, by adding a subdivision;
214.01, subdivision 2; 245.462, subdivisions 4 and 17;
245.4711, subdivision 1; 245.4712, subdivision 2;
245.4871, subdivisions 4 and 26; 245.4881, subdivision
1; 245A.04, subdivision 3a; 245A.08, subdivision 5;
245A.30; 245B.05, subdivision 7; 245B.07, subdivisions
5, 8, and 10; 246.18, subdivision 6; 252.28,
subdivision 1; 252.291, by adding a subdivision;
252.32, subdivision 3a; 252.46, subdivision 6;
253B.045, by adding subdivisions; 253B.07, subdivision
1; 253B.185, by adding a subdivision; 254B.01, by
adding a subdivision; 254B.03, subdivision 2; 254B.04,
subdivision 1; 254B.05, subdivision 1; 256.01,
subdivisions 2, 6, and by adding a subdivision;
256.014, by adding a subdivision; 256.015,
subdivisions 1 and 3; 256.485; 256.87, subdivision 1a;
256.955, subdivisions 3, 4, 7, 8, and 9; 256.9685,
subdivision 1a; 256.969, subdivision 1; 256.978,
subdivision 1; 256B.04, subdivision 16, and by adding
a subdivision; 256B.042, subdivisions 1, 2, and 3;
256B.055, subdivision 3a; 256B.056, subdivision 4;
256B.057, subdivision 3, and by adding a subdivision;
256B.0575; 256B.061; 256B.0625, subdivisions 6a, 8,
8a, 13, 19c, 20, 26, 28, 30, 32, 35, and by adding
subdivisions; 256B.0627, subdivisions 1, 2, 4, 5, 8,
and by adding subdivisions; 256B.0635, subdivision 3;
256B.0911, subdivision 6; 256B.0913, subdivisions 5,
10, 12, and 16; 256B.0916; 256B.0917, subdivision 8;
256B.094, subdivisions 3, 5, and 6; 256B.0951,
subdivisions 1 and 3; 256B.0955; 256B.37, subdivision
2; 256B.431, subdivisions 2i, 17, 26, and by adding a
subdivision; 256B.434, subdivisions 3, 4, 13, and by
adding a subdivision; 256B.435; 256B.48, subdivisions
1, 1a, 1b, and 6; 256B.50, subdivision 1e; 256B.501,
subdivision 8a; 256B.5011, subdivisions 1 and 2;
256B.69, subdivisions 3a, 5a, 5b, 5c, 6a, 6b, and by
adding subdivisions; 256B.692, subdivision 2; 256B.75;
256B.76; 256B.77, subdivisions 7a, 8, 10, 14, and by
adding subdivisions; 256D.03, subdivisions 3, 4, and
8; 256D.051, subdivision 2a, and by adding a
subdivision; 256D.053, subdivision 1; 256D.06,
subdivision 5; 256F.03, subdivision 5; 256F.05,
subdivision 8; 256F.10, subdivisions 1, 4, 6, 7, 8, 9,
and 10; 256I.04, subdivision 3; 256I.05, subdivisions
1, 1a, and by adding a subdivision; 256J.02,
subdivision 2; 256J.08, subdivisions 11, 24, 65, 82,
83, 86a, and by adding subdivisions; 256J.11,
subdivisions 2 and 3; 256J.12, subdivisions 1a and 2;
256J.14; 256J.20, subdivision 3; 256J.21, subdivisions
2, 3, and 4; 256J.24, subdivisions 2, 3, 7, 8, 9, and
by adding a subdivision; 256J.26, subdivision 1;
256J.30, subdivisions 2, 7, 8, and 9; 256J.31,
subdivisions 5 and 12; 256J.32, subdivisions 4 and 6;
256J.33; 256J.34, subdivisions 1, 3, and 4; 256J.35;
256J.36; 256J.37, subdivisions 1, 1a, 2, 9, and 10;
256J.38, subdivision 4; 256J.39, subdivision 1;
256J.42, subdivisions 1 and 5; 256J.43; 256J.45,
subdivision 1, and by adding a subdivision; 256J.46,
subdivisions 1, 2, and 2a; 256J.47, subdivision 4;
256J.48, subdivisions 2 and 3; 256J.50, subdivision 1;
256J.515; 256J.52, subdivisions 1, 3, 4, 5, and by
adding a subdivision; 256J.54, subdivision 2; 256J.55,
subdivision 4; 256J.56; 256J.57, subdivision 1;
256J.62, subdivisions 1, 6, 7, 8, 9, and by adding a
subdivision; 256J.67, subdivision 4; 256J.74,
subdivision 2; 256J.76, subdivisions 1, 2, and 4;
256L.03, subdivisions 5 and 6; 256L.04, subdivisions
2, 8, 11, and 13; 256L.05, subdivision 4, and by
adding a subdivision; 256L.06, subdivision 3; 256L.07;
256L.15, subdivisions 1, 1b, and 2; 257.071,
subdivisions 1, 1a, 1c, 1d, 1e, 3, and 4; 257.62,
subdivision 5; 257.66, subdivision 3; 257.75,
subdivision 2; 257.85, subdivisions 2, 3, 4, 5, 6, 7,
9, and 11; 259.67, subdivisions 6 and 7; 259.73;
259.85, subdivisions 2, 3, and 5; 259.89, by adding a
subdivision; 260.011, subdivision 2; 260.012; 260.015,
subdivisions 2a, 13, and 29; 260.131, subdivision 1a;
260.133, subdivisions 1 and 2; 260.135, by adding a
subdivision; 260.155, subdivisions 4 and 8; 260.172,
subdivision 1, and by adding a subdivision; 260.191,
subdivisions 1, 1a, 1b, and 3b; 260.192; 260.221,
subdivisions 1, 1a, 1b, 1c, 3, and 5; 326.40,
subdivisions 2, 4, and 5; 518.10; 518.551, by adding a
subdivision; 518.5851, by adding a subdivision;
518.5853, by adding a subdivision; 518.64, subdivision
2; 548.09, subdivision 1; 548.091, subdivisions 1, 1a,
2a, 3a, 4, 10, 11, 12, and by adding a subdivision;
626.556, subdivisions 2, 3, 4, 7, 10, 10b, 10d, 10e,
10f, 10i, 10j, 11, 11b, 11c, and by adding a
subdivision; 626.558, subdivision 1; Laws 1995,
chapters 178, article 2, section 46, subdivision 10;
207, articles 3, section 21; 8, section 41, as
amended; 257, article 1, section 35, subdivision 1;
Laws 1997, chapters 203, article 9, section 19; 225,
article 4, section 4; and Laws 1998 chapter 407,
article 7, section 2, subdivision 3; proposing coding
for new law in Minnesota Statutes, chapters 16A; 62J;
116L; 127A; 137; 144; 144A; 144E; 148; 214; 245; 246;
252; 254A; 256; 256B; 256J; and 626; repealing
Minnesota Statutes 1998, sections 13.99, subdivision
19m; 62J.69; 62J.77; 62J.78; 62J.79; 144.0723;
144.9507, subdivision 4; 144.9511; 144E.16,
subdivisions 1, 2, 3, and 6; 144E.17; 144E.25;
144E.30, subdivisions 1, 2, and 6; 145.46; 254A.145;
256.973; 256B.434, subdivision 17; 256B.501,
subdivision 3g; 256B.5011, subdivision 3; 256B.74,
subdivisions 2 and 5; 256D.051, subdivisions 6 and 19;
256D.053, subdivision 4; 256J.03; 256J.30, subdivision
6; 256J.62, subdivisions 2, 3, and 5; 257.071,
subdivisions 8 and 10; 462A.208; 548.091, subdivisions
3, 5, and 6; Laws 1997, chapters 85, article 1,
section 63; 203, article 4, section 55; 225, article
6, section 8; and Laws 1998, chapter 407, article 2,
section 104; Minnesota Rules, parts 4690.0100,
subparts 4, 13, 15, 19, 20, 21, 22, 23, 24, 26, 27,
and 29; 4690.0300; 4690.0400; 4690.0500; 4690.0600;
4690.0700; 4690.0800, subparts 1 and 2; 4690.0900;
4690.1000; 4690.1100; 4690.1200; 4690.1300; 4690.1600;
4690.1700; 4690.2100; 4690.2200, subparts 1, 3, 4, and
5; 4690.2300; 4690.2400, subparts 1, 2, and 3;
4690.2500; 4690.2900; 4690.3000; 4690.3700; 4690.3900;
4690.4000; 4690.4100; 4690.4200; 4690.4300; 4690.4400;
4690.4500; 4690.4600; 4690.4700; 4690.4800; 4690.4900;
4690.5000; 4690.5100; 4690.5200; 4690.5300; 4690.5400;
4690.5500; 4690.5700; 4690.5800; 4690.5900; 4690.6000;
4690.6100; 4690.6200; 4690.6300; 4690.6400; 4690.6500;
4690.6600; 4690.6700; 4690.6800; 4690.7000; 4690.7100;
4690.7200; 4690.7300; 4690.7400; 4690.7500; 4690.7600;
4690.7700; 4690.7800; 4690.8300, subparts 1, 2, 3, 4,
and 5; and 4735.5000.
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 "2000" and "2001" where
used in this article, mean that the appropriation or
appropriations listed under them are available for the fiscal
year ending June 30, 2000, or June 30, 2001, respectively.
Where a dollar amount appears in parentheses, it means a
reduction of an appropriation.
SUMMARY BY FUND
APPROPRIATIONS BIENNIAL
2000 2001 TOTAL
General $2,650,812,000 $2,774,558,000 $5,425,370,000
State Government
Special Revenue 36,424,000 36,103,000 72,527,000
Health Care
Access 146,224,000 175,017,000 321,241,000
Trunk Highway 1,726,000 1,773,000 3,499,000
Lottery Prize 1,300,000 1,300,000 2,600,000
TOTAL $2,836,486,000 $2,988,751,000 $5,825,237,000
APPROPRIATIONS
Available for the Year
Ending June 30
2000 2001
Sec. 2. COMMISSIONER OF
HUMAN SERVICES
Subdivision 1. Total
Appropriation $2,694,991,000 $2,847,745,000
Summary by Fund
General 2,556,927,000 2,680,977,000
State Government
Special Revenue 485,000 507,000
Health Care
Access 136,279,000 164,961,000
Lottery Prize 1,300,000 1,300,000
[INDIRECT COSTS NOT TO FUND PROGRAMS.]
The commissioner shall not use indirect
cost allocations to pay for the
operational costs of any program for
which the commissioner is responsible.
[FUND AND ACCOUNT REPORTING REQUIRED.]
On December 1, 1999, and December 1,
2000, the commissioner shall provide
the chairs of the house health and
human services finance committee and
the senate health and family security
budget division with detailed fund
balance statements for: (1) each fund
or account used by the commissioner in
the ongoing operations of the agency;
(2) each state-operated computer system
under Minnesota Statutes, section
256.014, including but not limited to
MAXIS, the current Medicaid management
information system (MMIS II), the child
support enforcement system (PRISM), the
electronic benefit transfer system
(EBT), and the executive information
system (EIS); and (3) the social
services information system (SSIS).
Subd. 2. Agency Management
General 28,311,000 28,345,000
State Government
Special Revenue 371,000 392,000
Health Care
Access 3,268,000 3,321,000
The amounts that may be spent from the
appropriation for each purpose are as
follows:
(a) Financial Operations
General 7,471,000 7,647,000
Health Care
Access 691,000 702,000
[RECEIPTS FOR SYSTEMS PROJECTS.]
Appropriations and federal receipts for
information system projects for MAXIS,
electronic benefit system, social
services information system, child
support enforcement, and Minnesota
Medicaid information system (MMIS II)
must be deposited in the state system
account authorized in Minnesota
Statutes, section 256.014. Money
appropriated for computer projects
approved by the Minnesota office of
technology, funded by the legislature,
and approved by the commissioner of
finance may be transferred from one
project to another and from development
to operations as the commissioner of
human services considers necessary.
Any unexpended balance in the
appropriation for these projects does
not cancel but is available for ongoing
development and operations.
(b) Legal & Regulation Operations
General 6,541,000 6,593,000
State Government
Special Revenue 371,000 392,000
Health Care
Access 141,000 145,000
[REIMBURSEMENT OF COUNTY COSTS.] Of the
general fund appropriation, $10,000 is
for the commissioner for the biennium
beginning July 1, 1999, to reimburse
counties for the legal and related
costs of contesting through the
administrative and judicial systems
decisions that affect state spending
but not county spending on programs
administered or financed by the
commissioner. The commissioner may
reimburse expenses that occurred on or
after January 1, 1998.
(c) Management Operations
General 14,299,000 14,105,000
Health Care
Access 2,436,000 2,474,000
Subd. 3. Children's Grants
General 52,845,000 54,931,000
[ADOPTION ASSISTANCE.] Federal funds
available during the biennium ending
June 30, 2001, for adoption incentive
grants, adoption and foster care
recruitment, and other adoption
services, are appropriated to the
commissioner for these purposes.
Subd. 4. Children's Services Management
General 3,900,000 3,740,000
Subd. 5. Basic Health Care Grants
Summary by Fund
General 867,174,000 916,234,000
Health Care
Access 116,490,000 145,469,000
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) Minnesota Care Grants-
Health Care
Access 116,490,000 145,469,000
[HOSPITAL INPATIENT COPAYMENTS.] The
commissioner of human services may
require hospitals to refund hospital
inpatient copayments paid by enrollees
pursuant to Minnesota Statutes, section
256L.03, subdivision 5, between March
1, 1999, and December 31, 1999. If the
commissioner requires hospitals to
refund these copayments, the hospitals
shall collect the copayment directly
from the commissioner.
[MINNESOTACARE OUTREACH FEDERAL
MATCHING FUNDS.] Any federal matching
funds received as a result of the
MinnesotaCare outreach activities
authorized by Laws 1997, chapter 225,
article 7, section 2, subdivision 1,
shall be deposited in the health care
access fund and dedicated to the
commissioner to be used for those
outreach purposes.
[FEDERAL RECEIPTS FOR ADMINISTRATION.]
Receipts received as a result of
federal participation pertaining to
administrative costs of the Minnesota
health care reform waiver shall be
deposited as nondedicated revenue in
the health care access fund. Receipts
received as a result of federal
participation pertaining to grants
shall be deposited in the federal fund
and shall offset health care access
funds for payments to providers.
[HEALTH CARE ACCESS FUND.] The
commissioner may expend money
appropriated from the health care
access fund for MinnesotaCare in either
fiscal year of the biennium.
(b) MA Basic Health Care Grants-
Families and Children
General 307,053,000 320,112,000
[COMMUNITY DENTAL CLINICS.] Of this
appropriation, $600,000 in fiscal year
2000 is for the commissioner to provide
start-up grants to establish community
dental clinics under Minnesota
Statutes, section 256B.76, paragraph
(b), clause (5). The commissioner
shall award grants and shall require
grant recipients to match the state
grant with nonstate funding on a
one-to-one basis. This is a one-time
appropriation and shall not become part
of base level funding for this activity
for the 2002-2003 biennium.
(c) MA Basic Health Care Grants-
Elderly & Disabled
General 404,814,000 451,928,000
[SURCHARGE COMPLIANCE.] In the event
that federal financial participation in
the Minnesota medical assistance
program is reduced as a result of a
determination that the surcharge and
intergovernmental transfers governed by
Minnesota Statutes, sections 256.9657
and 256B.19 are out of compliance with
United States Code, title 42, section
1396b(w), or its implementing
regulations or with any other federal
law designed to restrict provider tax
programs or intergovernmental
transfers, the commissioner shall
appeal the determination to the fullest
extent permitted by law and may ratably
reduce all medical assistance and
general assistance medical care
payments to providers other than the
state of Minnesota in order to
eliminate any shortfall resulting from
the reduced federal funding. Any
amount later recovered through the
appeals process shall be used to
reimburse providers for any ratable
reductions taken.
[BLOOD PRODUCTS LITIGATION.] To the
extent permitted by federal law,
Minnesota Statutes, section 256.015,
256B.042, and 256B.15, are waived as
necessary for the limited purpose of
resolving the state's claims in
connection with In re Factor VIII or IX
Concentrate Blood Products Litigation,
MDL-986, No. 93-C7452 (N.D.III.).
(d) General Assistance Medical Care
General 141,805,000 128,012,000
(e) Basic Health Care - Nonentitlement
General 13,502,000 16,182,000
[DENTAL ACCESS GRANT.] Of this
appropriation, $75,000 is from the
general fund to the commissioner in
fiscal year 2000 for a grant to a
nonprofit dental provider group
operating a dental clinic in Clay
county. The grant must be used to
increase access to dental services for
recipients of medical assistance,
general assistance medical care, and
the MinnesotaCare program in the
northwest area of the state. This
appropriation is available the day
following final enactment.
Subd. 6. Basic Health Care Management
General 23,268,000 23,227,000
Health Care
Access 15,208,000 14,853,000
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) Health Care Policy Administration
General 3,109,000 3,008,000
Health Care
Access 570,000 582,000
[TELEMEDICINE REPORT.] The commissioner
shall report to the legislature by
January 15, 2001, with an analysis of
whether the expansion of medical
assistance and general assistance
medical care to cover certain
telemedicine services resulted in cost
savings or other benefits to the health
care system and with a recommendation
on whether coverage of telemedicine
services should be continued beyond
June 30, 2001.
(b) Health Care Operations
General 20,159,000 20,219,000
Health Care
Access 14,638,000 14,271,000
[MINNESOTACARE STAFF.] Of this
appropriation, $1,060,000 for fiscal
year 2000 and $733,000 for fiscal year
2001 is from the health care access
fund to the commissioner for staff and
other administrative services
associated with improving MinnesotaCare
processing and caseload management. Of
this appropriation, $483,000 shall
become part of the base.
[WORK INCENTIVES FOR DISABLED.] Of this
appropriation, $28,000 each year is for
the commissioner to provide the five
percent state match that is required in
order for the state to access federal
funding in the amount of $550,000
annually in fiscal years 2000 to 2003,
for the Social Security
Administration's work incentives
demonstration project. The
commissioner shall transfer these
matching funds to the commissioner of
economic security. The base level
funding for this activity must be
established at $28,000 for the
2002-2003 biennium.
[SYSTEMS CONTINUITY.] In the event of
disruption of technical systems or
computer operations, the commissioner
may use available grant appropriations
to ensure continuity of payments for
maintaining the health, safety, and
well-being of clients served by
programs administered by the department
of human services. Grant funds must be
used in a manner consistent with the
original intent of the appropriation.
[PREPAID MEDICAL PROGRAMS.] The
nonfederal share of the prepaid medical
assistance program fund, which has been
appropriated to fund county managed
care advocacy and enrollment operating
costs, shall be disbursed as grants
using either a reimbursement or block
grant mechanism and may also be
transferred between grants and nongrant
administration costs with approval of
the commissioner of finance.
Subd. 7. State-Operated Services
General 206,929,000 212,002,000
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) SOS-Campus Based Programs
General 185,696,000 190,143,000
[DAY TRAINING SERVICES.] In order to
ensure eligible individuals have access
to day training and habilitation
services, the regional treatment
centers, the Minnesota extended
treatment options program, and
state-operated community services
operating according to Minnesota
Statutes, section 252.50, are exempt
from the provisions of Minnesota
Statutes, section 252.41, subdivision
9, clause (2). Notwithstanding section
13, this provision shall not expire.
[MITIGATION RELATED TO DEVELOPMENTAL
DISABILITIES DOWNSIZING.] Money
appropriated to finance mitigation
expenses related to the downsizing of
regional treatment center developmental
disabilities programs may be
transferred between fiscal years within
the biennium.
[REGIONAL TREATMENT CENTER CHEMICAL
DEPENDENCY PROGRAMS.] When the
operations of the regional treatment
center chemical dependency fund created
in Minnesota Statutes, section 246.18,
subdivision 2, are impeded by projected
cash deficiencies resulting from delays
in the receipt of grants, dedicated
income, or other similar receivables,
and when the deficiencies would be
corrected within the budget period
involved, the commissioner of finance
may transfer general fund cash reserves
into this account as necessary to meet
cash demands. The cash flow transfers
must be returned to the general fund in
the fiscal year that the transfer was
made. Any interest earned on general
fund cash flow transfers accrues to the
general fund and not the regional
treatment center chemical dependency
fund.
[LEAVE LIABILITIES.] The accrued leave
liabilities of state employees
transferred to state-operated community
services programs may be paid from the
appropriation in this subdivision for
state-operated services. Funds set
aside for this purpose shall not exceed
the amount of the actual leave
liability calculated as of June 30,
2000, and shall be available until
expended.
[REGIONAL TREATMENT CENTER
RESTRUCTURING.] For purposes of
restructuring the regional treatment
centers and state nursing homes, any
regional treatment center or state
nursing home employee whose position is
to be eliminated shall be afforded the
options provided in applicable
collective bargaining agreements. All
salary and mitigation allocations from
fiscal year 2000 shall be carried
forward into fiscal year 2001.
Provided there is no conflict with any
collective bargaining agreement, any
regional treatment center or state
nursing home position reduction must
only be accomplished through
mitigation, attrition, transfer, and
other measures as provided in state or
applicable collective bargaining
agreements and in Minnesota Statutes,
section 252.50, subdivision 11, and not
through layoff.
[REGIONAL TREATMENT CENTER POPULATION.]
If the resident population at the
regional treatment centers is projected
to be higher than the estimates upon
which the medical assistance forecast
and budget recommendations for the
2000-2001 biennium is based, the amount
of the medical assistance appropriation
that is attributable to the cost of
services that would have been provided
as an alternative to regional treatment
center services, including resources
for community placements and waivered
services for persons with mental
retardation and related conditions, is
transferred to the residential
facilities appropriation.
[REPAIRS AND BETTERMENTS.] The
commissioner may transfer unencumbered
appropriation balances between fiscal
years for the state residential
facilities repairs and betterments
account and special equipment.
[PROJECT LABOR.] Wages for project
labor may be paid by the commissioner
out of repairs and betterments money if
the individual is to be engaged in a
construction project or a repair
project of short-term and nonrecurring
nature. Compensation for project labor
shall be based on the prevailing wage
rates, as defined in Minnesota
Statutes, section 177.42, subdivision
6. Project laborers are excluded from
the provisions of Minnesota Statutes,
sections 43A.22 to 43A.30, and shall
not be eligible for state-paid
insurance and benefits.
[YEAR 2000 COSTS AT RTCS.] Of this
appropriation, $44,000 is for the costs
associated with addressing potential
year 2000 problems. Of this amount,
$19,000 is available the day following
final enactment.
(b) State-Operated Community
Services - Northeast Minnesota
Mental Health Services
General 3,983,000 4,055,000
(c) State-Operated Community
Services - Statewide DD Supports
General 15,493,000 16,047,000
(d) State-Operated Services -
Enterprise Activities
General 1,757,000 1,757,000
Subd. 8. Continuing Care and
Community Support Grants
General 1,174,195,000 1,259,767,000
Lottery Prize 1,158,000 1,158,000
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) Community Social Services
Block Grants
42,597,000 43,498,000
[CSSA TRADITIONAL APPROPRIATION.]
Notwithstanding Minnesota Statutes,
section 256E.06, subdivisions 1 and 2,
the appropriations available under that
section in fiscal years 2000 and 2001
must be distributed to each county
proportionately to the aid received by
the county in calendar year 1998. The
commissioner, in consultation with
counties, shall study the formula
limitations in subdivision 2 of that
section, and report findings and any
recommendations for revision of the
CSSA formula and its formula limitation
provisions to the legislature by
January 15, 2000.
(b) Consumer Support Grants
1,123,000 1,123,000
(c) Aging Adult Service Grants
7,965,000 7,765,000
[LIVING-AT-HOME/BLOCK NURSE PROGRAM.]
Of the general fund appropriation,
$120,000 in fiscal year 2000 and
$120,000 in fiscal year 2001 is for the
commissioner to provide funding to six
additional living-at-home/block nurse
programs. This appropriation shall
become part of the base for the
2002-2003 biennium.
[MINNESOTA SENIOR SERVICE CORPS.] Of
this appropriation, $160,000 for the
biennium is from the general fund to
the commissioner for the following
purposes:
(a) $40,000 in fiscal year 2000 and
$40,000 in fiscal year 2001 is to
increase the hourly stipend by ten
cents per hour in the foster
grandparent program, the retired and
senior volunteer program, and the
senior companion program.
(b) $40,000 in fiscal year 2000 and
$40,000 in fiscal year 2001 is for a
grant to the tri-valley opportunity
council in Crookston to expand services
in the ten-county area of northwestern
Minnesota.
(c) This appropriation shall become
part of the base for the 2002-2003
biennium.
[HEALTH INSURANCE COUNSELING.] Of this
appropriation, $100,000 in fiscal year
2000 and $100,000 in fiscal year 2001
is from the general fund to the
commissioner to transfer to the board
on aging for the purpose of awarding
health insurance counseling and
assistance grants to the area agencies
on aging providing state-funded health
insurance counseling services. Access
to health insurance counseling programs
shall be provided by the senior linkage
line service of the board on aging and
the area agencies on aging. The board
on aging shall explore opportunities
for obtaining alternative funding from
nonstate sources, including
contributions from individuals seeking
health insurance counseling services.
This is a one-time appropriation and
shall not become part of base level
funding for this activity for the
2002-2003 biennium.
(d) Deaf and Hard-of-Hearing
Services Grants
1,859,000 1,760,000
[SERVICES TO DEAF PERSONS WITH MENTAL
ILLNESS.] Of this appropriation,
$100,000 each year is to the
commissioner for a grant to a nonprofit
agency that currently serves deaf and
hard-of-hearing adults with mental
illness through residential programs
and supported housing outreach. The
grant must be used to operate a
community support program for persons
with mental illness that is
communicatively accessible for persons
who are deaf or hard-of-hearing. This
is a one-time appropriation and shall
not become part of base level funding
for this activity for the 2002-2003
biennium.
[DEAF-BLIND ORIENTATION AND MOBILITY
SERVICES.] Of this appropriation,
$120,000 for the biennium is to the
commissioner for a grant to DeafBlind
Services Minnesota to hire an
orientation and mobility specialist to
work with deaf-blind people. The
specialist will provide services to
deaf-blind Minnesotans, and training to
teachers and rehabilitation counselors,
on a statewide basis. This is a
one-time appropriation and shall not
become part of base level funding for
this activity for the 2002-2003
biennium.
(e) Mental Health Grants
General 45,169,000 46,528,000
Lottery Prize 1,158,000 1,158,000
[CRISIS HOUSING.] Of the general fund
appropriation, $126,000 in fiscal year
2000 and $150,000 in fiscal year 2001
is to the commissioner for the adult
mental illness crisis housing
assistance program under Minnesota
Statutes, section 245.99. This
appropriation shall become part of the
base for the 2002-2003 biennium.
[ADOLESCENT COMPULSIVE GAMBLING GRANT.]
$150,000 in fiscal year 2000 and
$150,000 in fiscal year 2001 is
appropriated from the lottery prize
fund created under Minnesota Statutes,
section 349A.10, subdivision 2, to the
commissioner for the purposes of a
grant to a compulsive gambling council
located in St. Louis county for a
statewide compulsive gambling
prevention and education project for
adolescents.
(f) Developmental Disabilities
Community Support Grants
9,323,000 10,958,000
[CRISIS INTERVENTION PROJECT.] Of this
appropriation, $40,000 in fiscal year
2000 is to the commissioner for the
action, support, and prevention project
of southeastern Minnesota.
[SILS FUNDING.] Of this appropriation,
$1,000,000 each year is for
semi-independent living services under
Minnesota Statutes, section 252.275.
This appropriation must be added to the
base level funding for this activity
for the 2002-2003 biennium. Unexpended
funds for fiscal year 2000 do not
cancel but are available to the
commissioner for this purpose in fiscal
year 2001.
[FAMILY SUPPORT GRANTS.] Of this
appropriation, $1,000,000 in fiscal
year 2000 and $2,500,000 in fiscal year
2001 is to increase the availability of
family support grants under Minnesota
Statutes, section 252.32. This
appropriation must be added to the base
level funding for this activity for the
2002-2003 biennium. Unexpended funds
for fiscal year 2000 do not cancel but
are available to the commissioner for
this purpose in fiscal year 2001.
(g) Medical Assistance Long-Term
Care Waivers and Home Care
349,052,000 414,240,000
[PROVIDER RATE INCREASES.] (a) The
commissioner shall increase
reimbursement rates by four percent the
first year of the biennium and by three
percent the second year for the
providers listed in paragraph (b). The
increases shall be effective for
services rendered on or after July 1 of
each year.
(b) The rate increases described in
this section shall be provided to home
and community-based waivered services
for persons with mental retardation or
related conditions under Minnesota
Statutes, section 256B.501; home and
community-based waivered services for
the elderly under Minnesota Statutes,
section 256B.0915; waivered services
under community alternatives for
disabled individuals under Minnesota
Statutes, section 256B.49; community
alternative care waivered services
under Minnesota Statutes, section
256B.49; traumatic brain injury
waivered services under Minnesota
Statutes, section 256B.49; nursing
services and home health services under
Minnesota Statutes, section 256B.0625,
subdivision 6a; personal care services
and nursing supervision of personal
care services under Minnesota Statutes,
section 256B.0625, subdivision 19a;
private-duty nursing services under
Minnesota Statutes, section 256B.0625,
subdivision 7; day training and
habilitation services for adults with
mental retardation or related
conditions under Minnesota Statutes,
sections 252.40 to 252.46; alternative
care services under Minnesota Statutes,
section 256B.0913; adult residential
program grants under Minnesota Rules,
parts 9535.2000 to 9535.3000; adult and
family community support grants under
Minnesota Rules, parts 9535.1700 to
9535.1760; semi-independent living
services under Minnesota Statutes,
section 252.275, including SILS funding
under county social services grants
formerly funded under Minnesota
Statutes, chapter 256I; and community
support services for deaf and
hard-of-hearing adults with mental
illness who use or wish to use sign
language as their primary means of
communication.
(c) The commissioner shall increase
reimbursement rates by two percent for
the group residential housing
supplementary service rate under
Minnesota Statutes, section 256I.05,
subdivision 1a, for services rendered
on or after January 1, 2000.
(d) Providers that receive a rate
increase under this section shall use
at least 80 percent of the additional
revenue to increase the compensation
paid to employees other than the
administrator and central office staff.
(e) A copy of the provider's plan for
complying with paragraph (d) must be
made available to all employees. This
must be done by giving each employee a
copy or by posting it in an area of the
provider's operation to which all
employees have access. If an employee
does not receive the salary adjustment
described in the plan and is unable to
resolve the problem with the provider,
the employee may contact the employee's
union representative. If the employee
is not covered by a collective
bargaining agreement, the employee may
contact the commissioner at a phone
number provided by the commissioner and
included in the provider's plan.
(f) Section 13, sunset of uncodified
language, does not apply to this
provision.
[DEVELOPMENTAL DISABILITIES WAIVER
SLOTS.] Of this appropriation,
$1,746,000 in fiscal year 2000 and
$4,683,000 in fiscal year 2001 is to
increase the availability of home and
community-based waiver services for
persons with mental retardation or
related conditions.
(h) Medical Assistance Long-Term
Care Facilities
546,228,000 558,349,000
[MORATORIUM EXCEPTIONS.] Of this
appropriation, $250,000 in fiscal year
2000 and $250,000 in fiscal year 2001
is from the general fund to the
commissioner for the medical assistance
costs of moratorium exceptions approved
by the commissioner of health under
Minnesota Statutes, section 144A.073.
Unexpended money appropriated for
fiscal year 2000 shall not cancel but
shall be available for fiscal year 2001.
[NURSING FACILITY OPERATED BY THE RED
LAKE BAND OF CHIPPEWA INDIANS.] (1) The
medical assistance payment rates for
the 47-bed nursing facility operated by
the Red Lake Band of Chippewa Indians
must be calculated according to
allowable reimbursement costs under the
medical assistance program, as
specified in Minnesota Statutes,
section 246.50, and are subject to the
facility-specific Medicare upper limits.
(2) In addition, the commissioner shall
make available an operating payment
rate adjustment effective July 1, 1999,
and July 1, 2000, that is equal to the
adjustment provided under Minnesota
Statutes, section 256B.431, subdivision
28. The commissioner must use the
facility's final 1998 and 1999 Medicare
cost reports, respectively, to
calculate the adjustment. The
adjustment shall be available based on
a plan submitted and approved according
to Minnesota Statutes, section
256B.431, subdivision 28. Section 13,
sunset of uncodified language, does not
apply to this paragraph.
[ICF/MR DISALLOWANCES.] Of this
appropriation, $65,000 in fiscal 2000
is to reimburse a four-bed ICF/MR in
Ramsey county for disallowances
resulting from field audit findings.
This is a one-time appropriation and
shall not become part of base level
funding for this activity for the
2002-2003 biennium.* (The preceding
text beginning "ICF/MR DISALLOWANCES."
was vetoed by the governor.)
[COSTS RELATED TO FACILITY
CERTIFICATION.] Of this appropriation,
$168,000 is for the costs of providing
one-half the state share of medical
assistance reimbursement for
residential and day habilitation
services under article 3, section 39.
This amount is available the day
following final enactment.
(i) Alternative Care Grants
General 60,873,000 59,981,000
[ALTERNATIVE CARE TRANSFER.] Any money
allocated to the alternative care
program that is not spent for the
purposes indicated does not cancel but
shall be transferred to the medical
assistance account.
[PREADMISSION SCREENING AMOUNT.] The
preadmission screening payment to all
counties shall continue at the payment
amount in effect for fiscal year 1999.
[ALTERNATIVE CARE APPROPRIATION.] The
commissioner may expend the money
appropriated for the alternative care
program for that purpose in either year
of the biennium.
(j) Group Residential Housing
General 66,477,000 70,390,000
[GROUP RESIDENTIAL FACILITY FOR WOMEN
IN RAMSEY COUNTY.] (a) Notwithstanding
Minnesota Statutes 1998, section
256I.05, subdivision 1d, the new 23-bed
group residential facility for women in
Ramsey county, with approval by the
county agency, may negotiate a
supplementary service rate in addition
to the board and lodging rate for
facilities licensed and registered by
the Minnesota department of health
under Minnesota Statutes, section
15.17. The supplementary service rate
shall not exceed $564 per person per
month and the total rate may not exceed
$1,177 per person per month.
(b) Of the general fund appropriation,
$19,000 in fiscal year 2000 and $38,000
in fiscal year 2001 is to the
commissioner for the costs associated
with paragraph (a). This appropriation
shall become part of the base for the
2002-2003 biennium.
(k) Chemical Dependency
Entitlement Grants
General 36,751,000 38,847,000
(l) Chemical Dependency
Nonentitlement Grants
General 6,778,000 6,328,000
[CHEMICAL DEPENDENCY SERVICES.] Of this
appropriation, $450,000 in fiscal year
2000 is to the commissioner for
chemical dependency services to persons
who qualify under Minnesota Statutes,
section 254B.04, subdivision 1,
paragraph (b).
[REPEAT DWI OFFENDER PROGRAM.] Of this
appropriation, $100,000 in fiscal year
2000 and $100,000 in fiscal year 2001
is for the commissioner to pay for
chemical dependency treatment for
repeat DWI offenders at Brainerd
regional human services center.
Payment to the Brainerd regional human
services center may only be authorized
from this appropriation after all
potential public and private
third-party payers have been billed and
a determination made that the offender
is not eligible for reimbursement of
the treatment costs. This
appropriation shall not become part of
the base for the 2002-2003 biennium.*
(The preceding text beginning "REPEAT
DWI OFFENDER PROGRAM." was vetoed by
the governor.)
Subd. 9. Continuing Care and
Community Support Management
General 17,318,000 17,616,000
Lottery Prize 142,000 142,000
State Government
Special Revenue 114,000 115,000
[MINNESOTA SENIOR HEALTH OPTIONS
PROJECT.] Of the general fund
appropriation, up to $200,000 may be
transferred to the Minnesota senior
health options project special revenue
account during the biennium ending June
30, 2001, to serve as matching funds.
[PERSONS WITH BRAIN INJURIES.] (a) The
commissioner shall study and report to
the legislature by January 15, 2000, on
the status of persons with brain
injuries residing in public and private
institutions. The report shall include
information on lengths of stay, ages of
institutionalized persons, and on the
supports and services needed to allow
these persons to return to their
communities.
(b) The commissioner shall apply to the
Health Care Financing Administration
for a grant to carry out a
demonstration project to transition
disabled persons out of nursing homes.
The project must:
(1) identify persons with brain
injuries and other disabled persons
residing in nursing homes who could
live successfully in the community with
appropriate supports;
(2) develop community-based services
and supports for institutionalized
persons;
(3) eliminate incentives to keep these
persons in institutions;
(4) foster the independence of
institutionalized persons by involving
them in the selection and management of
community-based services, such as
personal care assistance;
(5) develop innovative funding
arrangements to enable funding to
follow the individual; and
(6) empower disabled persons, families,
and advocacy groups by including them
in the design and implementation of
service delivery models that maximize
consumer choice and direction.
(c) Paragraph (b) is effective the day
following final enactment.
[CAMP.] Of this appropriation, $15,000
each year is from the mental health
special projects account, for adults
and children with mental illness from
across the state, for a camping program
which utilizes the Boundary Waters
Canoe Area and is cooperatively
sponsored by client advocacy, mental
health treatment, and outdoor
recreation agencies.
[DEMO PROJECT EXTERNAL ADVOCACY FUNDING
CAP.] Of the appropriation for the
demonstration project for people with
disabilities under Minnesota Statutes,
section 256B.77, no more than $79,000
per year may be paid for external
advocacy under Minnesota Statutes,
section 256B.77, subdivision 14.
[REGION 10 QUALITY ASSURANCE
COMMISSION.] (1) Of this appropriation,
$210,000 each year is appropriated to
the commissioner for a grant to the
region 10 quality assurance commission
established under Minnesota Statutes,
section 256B.0951, for the purposes
specified in clauses (2) to (4).
Unexpended funds for fiscal year 2000
do not cancel, but are available to the
commission for fiscal year 2001.
(2) $180,000 each year is for the
operating costs of the alternative
quality assurance licensing system
pilot project, and for the commission
to provide grants to counties
participating in the alternative
quality assurance licensing system
under Minnesota Statutes, section
256B.0953.
(3) $20,000 each year is for the
commission to contract with an
independent entity to conduct a
financial review of the alternative
quality assurance licensing system,
including an evaluation of possible
budgetary savings within the affected
state agencies as the result of
implementing the system.
(4) $10,000 each year is for the
commission, in consultation with the
commissioner of human services, to
establish an ongoing review process for
the alternative quality assurance
licensing system.
(5) This appropriation shall not become
part of the base for the 2002-2003
biennium.
Subd. 10. Economic Support Grants
General 142,037,000 124,758,000
[GIFTS.] Notwithstanding Minnesota
Statutes, chapter 7, the commissioner
may accept on behalf of the state
additional funding from sources other
than state funds for the purpose of
financing the cost of assistance
program grants or nongrant
administration. All additional funding
is appropriated to the commissioner for
use as designated by the grantee of
funding.
[CHILD SUPPORT PAYMENT CENTER
RECOUPMENT ACCOUNT.] The child support
payment center is authorized to
establish an account to cover checks
issued in error or in cases where
insufficient funds are available to pay
the checks. All recoupments against
payments from the account must be
deposited in the child support payment
center recoupment account and are
appropriated to the commissioner for
the purposes of the account. Any
unexpended balance in the account does
not cancel, but is available until
expended.
[FEDERAL TANF FUNDS.] (1) Federal
Temporary Assistance for Needy Families
block grant funds authorized under
title I, Public Law Number 104-193, the
Personal Responsibility and Work
Opportunity Reconciliation Act of 1996,
and awarded in federal fiscal years
1997 to 2002 are appropriated to the
commissioner in amounts up to
$256,265,000 is fiscal year 2000 and
$249,682,000 in fiscal year 2001. In
addition to these funds, the
commissioner may draw or transfer any
other appropriations or transfers of
federal TANF block grant funds that are
enacted into state law.
(2) Of the amounts in clause (1),
$15,000,000 is transferred each year of
the biennium to the state's federal
Title XX block grant. Notwithstanding
the provisions of Minnesota Statutes,
section 256E.07, in each year of the
biennium the commissioner shall
allocate $15,000,000 of the state's
Title XX block grant funds based on the
community social services aids formula
in Minnesota Statutes, section
256E.06. The commissioner shall ensure
that money allocated to counties under
this provision is used according to the
requirements of United States Code,
title 42, section 604(d)(3)(B).
(3) Of the amounts in clause (1),
$10,990,000 is transferred each year
from the state's federal TANF block
grant to the state's federal Title XX
block grant. In each year $140,000 is
for grants according to Minnesota
Statutes, section 257.3571, subdivision
2a, to the Indian child welfare defense
corporation to promote statewide
compliance with the Indian Child
Welfare Act of 1978; $4,650,000 is for
grants to counties for concurrent
permanency planning; and $6,200,000 is
for the commissioner to distribute
according to the formula in Minnesota
Statutes, section 256E.07. The
commissioner shall ensure that money
allocated under this clause is used
according to the requirements of United
States Code, title 42, section
604(d)(3)(B). In fiscal years 2002 and
2003, $140,000 per year is for grants
according to Minnesota Statutes,
section 257.3571, subdivision 2a, to
the Indian child welfare defense
corporation to promote statewide
compliance with the Indian Child
Welfare Act of 1978. Section 13,
sunset of uncodified language, does not
apply to this provision.
(4) Of the amounts in clause (1),
$13,360,000 each year is for increased
employment and training efforts and
shall be expended as follows:
(a) $140,000 each year is for a grant
to the new chance program. The new
chance program shall provide
comprehensive services through a
private, nonprofit agency to young
parents in Hennepin county who have
dropped out of school and are receiving
public assistance. The program
administrator shall report annually to
the commissioner on skills development,
education, job training, and job
placement outcomes for program
participants. This appropriation is
available for either year of the
biennium.
(b) $260,000 each year is for grants to
counties to operate the parents fair
share program to assist unemployed,
noncustodial parents with job search
and parenting skills.
(c) $12,960,000 each year is to
increase employment and training
services grants for MFIP of which
$750,000 each year is to be transferred
to the job skills partnership board for
the health care and human services
worker training and retention program.
(d) $10,400,000 of these appropriations
shall become part of the base for the
2002-2003 biennium.
(5) Of the amounts in clause (1),
$1,094,000 in fiscal year 2000 and
$1,676,000 in fiscal year 2001 is
transferred from the state's federal
TANF block grant to the state's federal
child care and development fund block
grant, and is appropriated to the
commissioner of children, families, and
learning for the purposes of Minnesota
Statutes, section 119B.05.
(6) Of the amounts in clause (1),
$1,000,000 for the biennium is for the
purposes of creating and expanding
adult-supervised supportive living
arrangement services under Minnesota
Statutes, section 256J.14. The
commissioner shall request proposals
from interested parties that have
knowledge and experience in the area of
adult-supervised adolescent housing and
supportive services, and award grants
for the purpose of either expanding
existing or creating new living
arrangements and supportive services.
Minor parents who are MFIP participants
shall be given priority for housing,
and excess living arrangements may be
used by minor parents who are not MFIP
participants.
(7) In order to maximize transfers from
Minnesota's 1998 and 1999 federal TANF
block grant awards, the commissioner
may implement the transfers of TANF
funds in clauses (2), (3), and (5) in
the first year of the biennium. This
must only be done to the extent allowed
by federal law and to the extent that
program funding requirements can be met
in the second year of the biennium.
(8) The commissioner shall ensure that
sufficient qualified state expenditures
are made each year to meet the TANF
basic maintenance of effort
requirements. The commissioner may
apply any allowable source of state
expenditures toward these requirements,
as necessary to meet minimum basic
maintenance of effort requirements and
to prevent the loss of federal funds.
[WORKER TRAINING AND RETENTION
ELIGIBILITY PROCEDURES.] The
commissioner shall develop eligibility
procedures for TANF expenditures under
Minnesota Statutes, section 256J.02,
subdivision 2, clause (5).
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) Assistance to Families Grants
General 64,870,000 66,117,000
[EMPLOYMENT SERVICES CARRYOVER.]
General fund and federal TANF block
grant appropriations for employment
services that remain unexpended
subsequent to the reallocation process
required in Minnesota Statutes, section
256J.62, do not cancel but are
available for these purposes in fiscal
year 2001.
(b) Work Grants
General 10,731,000 10,731,000
(c) Aid to Families With
Dependent Children and Other
Assistance
General 1,053,000 374,000
(d) Child Support Enforcement
General 5,359,000 5,359,000
[CHILD SUPPORT PAYMENT CENTER.]
Payments to the commissioner from other
governmental units, private
enterprises, and individuals for
services performed by the child support
payment center must be deposited in the
state systems account authorized under
Minnesota Statutes, section 256.014.
These payments are appropriated to the
commissioner for the operation of the
child support payment center or system,
according to Minnesota Statutes,
section 256.014.
[CHILD SUPPORT EXPEDITED PROCESS.] Of
this appropriation for child support
enforcement, $2,340,000 for the
biennium shall be transferred to the
state court administrator to fund the
child support expedited process, in
accordance with a cooperative agreement
to be negotiated between the parties.
State funds transferred for this
purpose in fiscal year 2000 may exceed
the base funding amount of $1,170,000
to the extent that there is an increase
in the number of orders issued in the
expedited process, but may not exceed
$1,420,000 in any case. Unexpended
expedited process appropriations in
fiscal year 2000 may be transferred to
fiscal year 2001 for this purpose.
Base funding for this program is set at
$1,170,000 for each year of the
2002-2003 biennium. The commissioner
shall include cost reimbursement claims
from the state court administrator for
the child support expedited process in
the department of human services
federal cost reimbursement claim
process according to federal law.
Federal dollars earned under these
claims are appropriated to the
commissioner and shall be disbursed to
the state court administrator according
to department procedures and schedules.
(e) General Assistance
General 33,927,000 14,973,000
[TRANSFERS FROM STATE TANF RESERVE.]
$4,666,000 in fiscal year 2000 is
transferred from the state TANF reserve
account to the general fund.
[GENERAL ASSISTANCE STANDARD.] The
commissioner shall set the monthly
standard of assistance for general
assistance units consisting of an adult
recipient who is childless and
unmarried or living apart from his or
her parents or a legal guardian at
$203. The commissioner may reduce this
amount in accordance with Laws 1997,
chapter 85, article 3, section 54.
(f) Minnesota Supplemental Aid
General 25,767,000 26,874,000
(g) Refugee Services
General 330,000 330,000
Subd. 11. Economic Support
Management
General 40,950,000 40,357,000
Health Care
Access 1,313,000 1,318,000
The amounts that may be spent from this
appropriation for each purpose are as
follows:
(a) Economic Support Policy
Administration
General 7,100,000 6,951,000
[FOOD STAMP ADMINISTRATIVE
REIMBURSEMENT.] The commissioner shall
reduce quarterly food stamp
administrative reimbursement to
counties in fiscal years 1999, 2000,
and 2001 by the amount that the United
States Department of Health and Human
Services determines to be the county
random moment study share of the food
stamp adjustment under Public Law
Number 105-185. The reductions shall
be allocated to each county in
proportion to each county's
contribution, if any, to the amount of
the adjustment. Any adjustment to
medical assistance administrative
reimbursement that is based on the
United States Department of Health and
Human Services' determinations under
Public Law Number 105-185 shall be
distributed to counties in the same
manner. This provision is effective
the day following final enactment.
[SPENDING AUTHORITY FOR FOOD STAMP
ENHANCED FUNDING.] In the event that
Minnesota qualifies for United States
Department of Agriculture Food and
Nutrition Services Food Stamp Program
enhanced funding beginning in federal
fiscal year 1998, the money is
appropriated to the commissioner for
the purposes of the program. The
commissioner may retain 25 percent of
the enhanced funding, with the
remaining 75 percent divided among the
counties according to a formula that
takes into account each county's impact
on the statewide food stamp error rate.
[ELIGIBILITY DETERMINATION FUNDING.]
Increased federal funds for the costs
of eligibility determination and other
permitted activities that are available
to the state through section 114 of the
Personal Responsibility and Work
Opportunity Reconciliation Act, Public
Law Number 104-193, are appropriated to
the commissioner.
(b) Economic Support Operations
General 33,850,000 33,406,000
Health Care
Access 1,313,000 1,318,000
[MAXIS BASE REDUCTION.] The base level
appropriation for MAXIS shall be
reduced by $2,500,000 each year of the
biennium beginning July 1, 2001.
Section 13, sunset of uncodified
language, does not apply to this
provision.
[FRAUD PREVENTION AND CONTROL FUNDING.]
Unexpended funds appropriated for the
provision of program integrity
activities for fiscal year 2000 are
also available to the commissioner to
fund fraud prevention and control
initiatives, and do not cancel but are
available to the commissioner for these
purposes for fiscal year 2001.
Unexpended funds may be transferred
between the fraud prevention
investigation program and fraud control
programs to promote the provisions of
Minnesota Statutes, sections 256.983
and 256.9861.
[TRANSFERS TO TITLE XX FOR CSSA.] When
preparing the governor's budget for the
2002-2003 biennium, the commissioner of
finance shall ensure that the base
level funding for the community social
services aids includes $11,000,000 in
fiscal year 2002 and $11,000,000 in
fiscal year 2003 in funding that is
transferred from the state's federal
TANF block grant to the state's federal
Title XX block grant. Notwithstanding
the provisions of Minnesota Statutes,
section 256E.07, the commissioner shall
allocate the portion of the state's
community social services aids funding
that is comprised of these transferred
funds based on the community social
services aids formula in Minnesota
Statutes, section 256E.06. The
commissioner shall ensure that money
allocated under this provision is used
in accordance with the requirements of
United States Code, title 42, section
604(d)(3)(B). Any reductions to the
amount of the state community social
services (CSSA) block grant funding in
fiscal year 2002 or 2003 shall not
reduce the base for the CSSA block
grant for the 2004-2005 biennial
budget. Section 13, sunset of
uncodified language, does not apply to
this provision.
Sec. 3. COMMISSIONER OF HEALTH
Subdivision 1. Total
Appropriation 100,424,000 98,641,000
Summary by Fund
General 64,916,000 63,565,000
State Government
Special Revenue 25,563,000 25,020,000
Health Care
Access 9,945,000 10,056,000
[INDIRECT COSTS NOT TO FUND PROGRAMS.]
The commissioner shall not use indirect
cost allocations to pay for the
operational costs of any program for
which the commissioner is responsible.
[GENERAL FUND GRANT REDUCTIONS.] The
commissioner may not reduce general
fund appropriations for grants without
specific legislative authority.
Subd. 2. Health Systems
and Special Populations 66,999,000 66,269,000
Summary by Fund
General 46,593,000 46,299,000
State Government
Special Revenue 10,557,000 10,012,000
Health Care
Access 9,849,000 9,958,000
[WIC TRANSFERS.] The general fund
appropriation for the women, infants,
and children (WIC) food supplement
program is available for either year of
the biennium. Transfers of these funds
between fiscal years must either be to
maximize federal funds or to minimize
fluctuations in the number of program
participants.
[MINNESOTA CHILDREN WITH SPECIAL HEALTH
NEEDS CARRYOVER.] General fund
appropriations for treatment services
in the services for Minnesota children
with special health needs program are
available for either year of the
biennium.
[SUICIDE PREVENTION STUDY.] Of the
general fund appropriation, $100,000 in
fiscal year 2000 is for the
commissioner to study suicide issues
and develop a suicide prevention plan.
The study must be conducted in
consultation with local community
health boards, mental health
professionals, schools, and other
interested parties. The plan must be
reported to the legislature by January
15, 2000.
[FAMILY PRACTICE RESIDENCY PROGRAM.] Of
the general fund appropriation,
$300,000 in fiscal year 2000 is to the
commissioner to make a grant to the
city of Duluth for a family practice
residency program for northeastern
Minnesota.
[UNCOMPENSATED CARE.] The commissioner
shall study and report to the
legislature by January 15, 2000, with:
(1) statistical information on the
amount of uncompensated health care
provided in Minnesota, the types of
care provided, the settings in which
the care is provided, and, if known,
the most common reasons why the care is
uncompensated; and
(2) recommendations for reducing the
level of uncompensated care, including,
but not limited to, methods to enroll
eligible persons in public health care
programs through simplification of the
application process and other efforts.
[RURAL HOSPITAL CAPITAL IMPROVEMENT
GRANT PROGRAM.] (a) Of this
appropriation, $2,800,000 for each
fiscal year is from the health care
access fund to the commissioner for the
rural hospital capital improvement
grant program described in Minnesota
Statutes, section 144.148. This
appropriation shall not become part of
the base for the 2002-2003 biennium.
(b) The commissioner may provide up to
$300,000 for the Westbrook health
center for hospital and clinic
improvements, upon receipt of
information from the Westbrook health
center indicating how it has fulfilled
the requirements of Minnesota Statutes,
section 144.148, and evidence that it
has raised at least a dollar-for-dollar
match from nonstate sources.
[ACCESS TO SUMMARY MINIMUM DATA SET
(MDS).] The commissioner, in
cooperation with the commissioner of
administration, shall work to obtain
access to Minimum Data Set (MDS) data
that is electronically transmitted by
nursing facilities to the health
department. The MDS data shall be made
available on a quarterly basis to
industry trade associations for use in
quality improvement efforts and
comparative analysis. The MDS data
shall be provided to the industry trade
associations in the form of summary
aggregate data, without patient
identifiers, to ensure patient
privacy. The commissioner may charge
for the actual cost of production of
these documents.
[NURSING HOME MORATORIUM REPORT.] In
preparing the report required by
Minnesota Statutes, section 144A.071,
subdivision 5, the commissioner and the
commissioner of human services shall
analyze the adequacy of the supply of
nursing home beds by measuring the
ability of hospitals to promptly
discharge patients to a nursing home
within the hospital's primary service
area. If it is determined that a
shortage of beds exists, the report
shall present a plan to correct the
service deficits. The report shall
also analyze the impact of assisted
living services on the medical
assistance utilization of nursing homes.
[HEALTH CARE PURCHASING ALLIANCES.] Of
the health care access fund
appropriation, $100,000 each year is to
the commissioner for grants to two
local organizations to develop health
care purchasing alliances under
Minnesota Statutes, section 62T.02, to
negotiate the purchase of health care
services from licensed entities. Of
this amount, $50,000 each year is for a
grant to the Southwest Regional
Development Commissioner to coordinate
purchasing alliance development in the
southwest area of the state, and
$50,000 each year is for a grant to the
University of Minnesota extension
services in Crookston to coordinate
purchasing alliance development in the
northwest area of the state. This is a
one-time appropriation and shall not
become part of base level funding for
this activity for the 2002-2003
biennium.
[GENERAL FUND TOBACCO BASE REDUCTION.]
The general fund base level
appropriation for tobacco prevention
and control programs and activities
shall be reduced by $1,100,000 each
year of the biennium beginning July 1,
2001. Section 13, sunset of uncodified
language, does not apply to this
provision.
[STANDARDS FOR SPECIAL CASE AUTOPSIES.]
Of this general fund appropriation,
$20,000 for the biennium is for a grant
to a professional association
representing coroners and medical
examiners in Minnesota to conduct case
studies, and develop and disseminate
guidelines, for autopsy practice in
special cases. This is a one-time
appropriation and shall not become part
of base level funding for the 2002-2003
biennium.
Subd. 3. Health Protection 27,046,000 27,240,000
Summary by Fund
General 12,221,000 12,417,000
State Government
Special Revenue 14,825,000 14,823,000
[PORTABLE WADING POOLS.] (a) Portable
wading pools used in the following
settings are defined as private
residential pools, and not public
pools, for purposes of public swimming
pool regulation under Minnesota Rules,
chapter 4717, provided they have a
maximum depth of 24 inches and are
capable of being manually emptied and
moved:
(1) a portable wading pool operated at
a family day care or group family day
care home that is licensed under
Minnesota Rules, chapter 9502; and
(2) a portable wading pool operated at
a home at which child care services are
provided under Minnesota Statutes,
section 245A.03, subdivision 2, clause
(2), or under Laws 1997, chapter 248,
section 46, including subsequent
amendments.
(b) Portable wading pools may not be
used by a child at a setting specified
in paragraph (a), clause (1) or (2),
unless the parent or legal guardian for
the child in care has provided written
consent. The written consent shall
include a statement that the parent or
legal guardian has received and read
material provided by the department of
health to the department of human
services for distribution to all child
care facilities, related to the use of
portable wading pools concerning the
risk of disease transmission as well as
other health risks.
(c) This provision is effective the day
following final enactment.
Subd. 4. Management and
Support Services 6,379,000 5,132,000
Summary by Fund
General 6,102,000 4,849,000
State Government
Special Revenue 181,000 185,000
Health Care
Access 96,000 98,000
[HEALTH NEEDS OF SPECIAL POPULATIONS.]
Of the general fund appropriation,
$400,000 in fiscal year 2000 is for
grants to local health agencies to
conduct a health needs assessment that
is specific to populations of color.
Any portion of this appropriation that
is unspent does not cancel but shall be
available for these purposes in fiscal
year 2001. This appropriation shall
not become part of the base for the
2002-2003 biennium.
[YEAR 2000 SURVEY OF FACILITIES AND
WATER SYSTEMS.] Of this general fund
appropriation, $100,000 is for the
costs associated with surveying by July
1, 1999, all hospitals, nursing homes,
nontransient community water systems
operated by a public entity, and
community water supply systems for year
2000 problems and proposed solutions.
Of this amount, $50,000 is available
the day following final enactment.
[SINGLE POINT OF ENTRY.] The
commissioner, in consultation with the
commissioners of commerce and human
services, the ombudsman for mental
health and mental retardation, and the
board on aging, shall report to the
chairs of the senate health and family
security committee and the house health
and human services committee by January
15, 2000, with a plan to:
(1) create a single point of entry for
health care consumer assistance and
advocacy services;
(2) integrate state offices of health
care consumer assistance; and
(3) coordinate and collaborate with
other state agencies and
nongovernmental entities to provide
consumers with assistance and advocacy
services related to health insurance
and health services.
The report shall also discuss the
feasibility of obtaining grants and
other revenue to provide these services.
Sec. 4. VETERANS NURSING
HOMES BOARD 26,121,000 27,103,000
[ALLOWANCE FOR FOOD.] The allowance for
food may be adjusted annually to
reflect changes in the producer price
index, as prepared by the United States
Bureau of Labor Statistics, with the
approval of the commissioner of
finance. Adjustments for fiscal year
2000 and fiscal year 2001 must be based
on the June 1998 and June 1999 producer
price index respectively, but the
adjustment must be prorated if it would
require money in excess of the
appropriation.
[IMPROVEMENTS USING DONATED MONEY.]
Notwithstanding Minnesota Statutes,
section 16B.30, the board may make and
maintain the following improvements to
the veterans homes using money donated
for those purposes:
(1) a picnic pavilion at the
Minneapolis veterans home;
(2) walking trails at the Hastings
veterans home;
(3) walking trails and landscaping at
the Silver Bay veterans home;
(4) an entrance canopy at the Fergus
Falls veterans home; and
(5) a suspended wooden dining deck at
the Luverne veterans home.
[ASSET PRESERVATION; FACILITY REPAIR.]
Of the general fund appropriation,
$1,190,000 each year is for asset
preservation and facility repair. The
appropriations are available in either
year of the biennium and may be used
for abatement and repair at the Luverne
home. This appropriation shall become
part of the board's base level funding
for the 2002-2003 biennium.
[VETERANS HOMES SPECIAL REVENUE
ACCOUNT.] The general fund
appropriations made to the board shall
be transferred to a veterans homes
special revenue account in the special
revenue fund in the same manner as
other receipts are deposited according
to Minnesota Statutes, section 198.34,
and are appropriated to the board for
the operation of board facilities and
programs.
[SETTING COST OF CARE.] (a) The board
may set the cost of care at the Fergus
Falls facility for fiscal year 2000
based on the cost of average skilled
nursing care provided to residents of
the Minneapolis veterans home for
fiscal year 2000.
(b) The cost of care for the
domiciliary residents at the
Minneapolis veterans home and the
skilled nursing care residents at the
Luverne veterans home for fiscal year
2000 and fiscal year 2001 shall be
calculated based on 100 percent
occupancy at each facility.
[LICENSED BED CAPACITY FOR MINNEAPOLIS
VETERANS HOME.] The commissioner of
health shall not reduce the licensed
bed capacity for the Minneapolis
veterans home pending completion of the
project authorized by Laws 1990,
chapter 610, article 1, section 9,
subdivision 3.
[LUVERNE ENVIRONMENTAL QUALITY.] Of
this appropriation, $591,000 in fiscal
year 2000 is from the general fund to
the board to ensure an adequate
staffing complement during the repairs
at the Luverne home. Of that amount,
$229,000 is available the day following
final enactment.
Sec. 5. HEALTH-RELATED BOARDS
Subdivision 1. Total
Appropriation 10,376,000 10,576,000
[STATE GOVERNMENT SPECIAL REVENUE
FUND.] The appropriations in this
section are from the state government
special revenue fund.
[NO SPENDING IN EXCESS OF REVENUES.]
The commissioner of finance shall not
permit the allotment, encumbrance, or
expenditure of money appropriated in
this section in excess of the
anticipated biennial revenues or
accumulated surplus revenues from fees
collected by the boards. Neither this
provision nor Minnesota Statutes,
section 214.06, applies to transfers
from the general contingent account.
Subd. 2. Board of Chiropractic
Examiners 350,000 361,000
Subd. 3. Board of Dentistry 783,000 806,000
Subd. 4. Board of Dietetic
and Nutrition Practice 92,000 95,000
Subd. 5. Board of Marriage and
Family Therapy 107,000 111,000
Subd. 6. Board of Medical
Practice 3,469,000 3,593,000
Subd. 7. Board of Nursing 2,202,000 2,245,000
Subd. 8. Board of Nursing
Home Administrators 548,000 566,000
[HEALTH PROFESSIONAL SERVICES
ACTIVITY.] Of these appropriations,
$368,000 the first year and $380,000
the second year are for the Health
Professional Services Activity.
Subd. 9. Board of Optometry 87,000 90,000
Subd. 10. Board of Pharmacy 1,125,000 1,137,000
[ADMINISTRATIVE SERVICES UNIT.] Of this
appropriation, $259,000 the first year
and $270,000 the second year are for
the health boards administrative
services unit. The administrative
services unit may receive and expend
reimbursements for services performed
for other agencies.
Subd. 11. Board of Physical Therapy 227,000 185,000
Subd. 12. Board of Podiatry 41,000 42,000
Subd. 13. Board of Psychology 556,000 534,000
[PART-TIME POSITIONS FUNDING.] Of this
appropriation, $34,000 in fiscal year
2000 is from the state government
special revenue fund to the board to
fund two part-time positions previously
funded through the legislative advisory
commission and for a budget shortage
due to position reallocations. This
appropriation is available the day
following final enactment.
Subd. 14. Board of Social Work 641,000 658,000
Subd. 15. Board of Veterinary
Medicine 148,000 153,000
Sec. 6. EMERGENCY MEDICAL
SERVICES BOARD 2,420,000 2,467,000
Summary by Fund
General 694,000 694,000
Trunk Highway 1,726,000 1,773,000
[COMPREHENSIVE ADVANCED LIFE SUPPORT
(CALS).] Of the general fund
appropriation, $108,000 each year is
for the board to establish a
comprehensive advanced life support
educational program under Minnesota
Statutes, section 144E.37.
[EMERGENCY MEDICAL SERVICES GRANTS.] Of
the appropriation from the trunk
highway fund, $18,000 in fiscal year
2000 and $36,000 in fiscal year 2001 is
to the board for grants to regional
emergency medical services programs.
This appropriation shall become part of
the base for the 2002-2003 biennium.
Sec. 7. COUNCIL ON DISABILITY 650,000 670,000
Sec. 8. OMBUDSMAN FOR MENTAL
HEALTH AND MENTAL RETARDATION 1,338,000 1,378,000
Sec. 9. OMBUDSMAN
FOR FAMILIES 166,000 171,000
Sec. 10. TRANSFERS
Subdivision 1. Grant Programs
The commissioner of human services,
with the approval of the commissioner
of finance, and after notification of
the chair of the senate health and
family security budget division and the
chair of the house health and human
services finance committee, may
transfer unencumbered appropriation
balances for the biennium ending June
30, 2001, within fiscal years among the
MFIP, general assistance, general
assistance medical care, medical
assistance, Minnesota supplemental aid,
and group residential housing programs,
and the entitlement portion of the
chemical dependency consolidated
treatment fund, and between fiscal
years of the biennium.
Subd. 2. Approval Required
Positions, salary money, and nonsalary
administrative money may be transferred
within the departments of human
services and health and within the
programs operated by the veterans
nursing homes board as the
commissioners and the board consider
necessary, with the advance approval of
the commissioner of finance. The
commissioner or the board shall inform
the chairs of the house health and
human services finance committee and
the senate health and family security
budget division quarterly about
transfers made under this provision.
Sec. 11. PROVISIONS
(a) Money appropriated to the
commissioner of human services for the
purchase of provisions must be used
solely for that purpose. Money
provided and not used for the purchase
of provisions must be canceled into the
fund from which appropriated, except
that money provided and not used for
the purchase of provisions because of
population decreases may be transferred
and used for the purchase of drugs and
medical and hospital supplies and
equipment with the approval of the
commissioner of finance after
notification of the chairs of the house
health and human services finance
committee and the senate health and
family security budget division.
(b) For fiscal year 2000, the allowance
for food may be adjusted to the
equivalent of the 75th percentile of
the comparable raw food costs for
community nursing homes as reported to
the commissioner of human services.
For fiscal year 2001, an adjustment may
be made to reflect the annual change in
the United States Bureau of Labor
Statistics producer price index as of
June 2000 with the approval of the
commissioner of finance. The
adjustments for either year must be
prorated if they would require money in
excess of this appropriation.
Sec. 12. CARRYOVER LIMITATION
None of the appropriations in this act
which are allowed to be carried forward
from fiscal year 2000 to fiscal year
2001 shall become part of the base
level funding for the 2002-2003
biennial budget, unless specifically
directed by the legislature.
Sec. 13. SUNSET OF UNCODIFIED LANGUAGE
All uncodified language contained in
this article expires on June 30, 2001,
unless a different expiration date is
explicit.
Sec. 14. Minnesota Statutes 1998, section 144.05, is
amended by adding a subdivision to read:
Subd. 3. [APPROPRIATION TRANSFERS TO BE REPORTED.] When
the commissioner transfers operational money between programs
under section 16A.285, in addition to the requirements of that
section the commissioner must provide the chairs of the
legislative committees that have jurisdiction over the agency's
budget with sufficient detail to identify the account to which
the money was originally appropriated, and the account to which
the money is being transferred.
Sec. 15. Minnesota Statutes 1998, section 198.003, is
amended by adding a subdivision to read:
Subd. 5. [APPROPRIATION TRANSFERS TO BE REPORTED.] When
the board transfers operational money between programs under
section 16A.285, in addition to the requirements of that section
the board must provide the chairs of the legislative committees
that have jurisdiction over the board's budget with sufficient
detail to identify the account to which the money was originally
appropriated, and the account to which the money is being
transferred.
Sec. 16. Minnesota Statutes 1998, section 256.01,
subdivision 2, is amended to read:
Subd. 2. [SPECIFIC POWERS.] Subject to the provisions of
section 241.021, subdivision 2, the commissioner of human
services shall:
(1) Administer and supervise all forms of public assistance
provided for by state law and other welfare activities or
services as are vested in the commissioner. Administration and
supervision of human services activities or services includes,
but is not limited to, assuring timely and accurate distribution
of benefits, completeness of service, and quality program
management. In addition to administering and supervising human
services activities vested by law in the department, the
commissioner shall have the authority to:
(a) require county agency participation in training and
technical assistance programs to promote compliance with
statutes, rules, federal laws, regulations, and policies
governing human services;
(b) monitor, on an ongoing basis, the performance of county
agencies in the operation and administration of human services,
enforce compliance with statutes, rules, federal laws,
regulations, and policies governing welfare services and promote
excellence of administration and program operation;
(c) develop a quality control program or other monitoring
program to review county performance and accuracy of benefit
determinations;
(d) require county agencies to make an adjustment to the
public assistance benefits issued to any individual consistent
with federal law and regulation and state law and rule and to
issue or recover benefits as appropriate;
(e) delay or deny payment of all or part of the state and
federal share of benefits and administrative reimbursement
according to the procedures set forth in section 256.017;
(f) make contracts with and grants to public and private
agencies and organizations, both profit and nonprofit, and
individuals, using appropriated funds; and
(g) enter into contractual agreements with federally
recognized Indian tribes with a reservation in Minnesota to the
extent necessary for the tribe to operate a federally approved
family assistance program or any other program under the
supervision of the commissioner. The commissioner shall consult
with the affected county or counties in the contractual
agreement negotiations, if the county or counties wish to be
included, in order to avoid the duplication of county and tribal
assistance program services. The commissioner may establish
necessary accounts for the purposes of receiving and disbursing
funds as necessary for the operation of the programs.
(2) Inform county agencies, on a timely basis, of changes
in statute, rule, federal law, regulation, and policy necessary
to county agency administration of the programs.
(3) Administer and supervise all child welfare activities;
promote the enforcement of laws protecting handicapped,
dependent, neglected and delinquent children, and children born
to mothers who were not married to the children's fathers at the
times of the conception nor at the births of the children;
license and supervise child-caring and child-placing agencies
and institutions; supervise the care of children in boarding and
foster homes or in private institutions; and generally perform
all functions relating to the field of child welfare now vested
in the state board of control.
(4) Administer and supervise all noninstitutional service
to handicapped persons, including those who are visually
impaired, hearing impaired, or physically impaired or otherwise
handicapped. The commissioner may provide and contract for the
care and treatment of qualified indigent children in facilities
other than those located and available at state hospitals when
it is not feasible to provide the service in state hospitals.
(5) Assist and actively cooperate with other departments,
agencies and institutions, local, state, and federal, by
performing services in conformity with the purposes of Laws
1939, chapter 431.
(6) Act as the agent of and cooperate with the federal
government in matters of mutual concern relative to and in
conformity with the provisions of Laws 1939, chapter 431,
including the administration of any federal funds granted to the
state to aid in the performance of any functions of the
commissioner as specified in Laws 1939, chapter 431, and
including the promulgation of rules making uniformly available
medical care benefits to all recipients of public assistance, at
such times as the federal government increases its participation
in assistance expenditures for medical care to recipients of
public assistance, the cost thereof to be borne in the same
proportion as are grants of aid to said recipients.
(7) Establish and maintain any administrative units
reasonably necessary for the performance of administrative
functions common to all divisions of the department.
(8) Act as designated guardian of both the estate and the
person of all the wards of the state of Minnesota, whether by
operation of law or by an order of court, without any further
act or proceeding whatever, except as to persons committed as
mentally retarded. For children under the guardianship of the
commissioner whose interests would be best served by adoptive
placement, the commissioner may contract with a licensed
child-placing agency to provide adoption services. A contract
with a licensed child-placing agency must be designed to
supplement existing county efforts and may not replace existing
county programs, unless the replacement is agreed to by the
county board and the appropriate exclusive bargaining
representative or the commissioner has evidence that child
placements of the county continue to be substantially below that
of other counties. Funds encumbered and obligated under an
agreement for a specific child shall remain available until the
terms of the agreement are fulfilled or the agreement is
terminated.
(9) Act as coordinating referral and informational center
on requests for service for newly arrived immigrants coming to
Minnesota.
(10) The specific enumeration of powers and duties as
hereinabove set forth shall in no way be construed to be a
limitation upon the general transfer of powers herein contained.
(11) Establish county, regional, or statewide schedules of
maximum fees and charges which may be paid by county agencies
for medical, dental, surgical, hospital, nursing and nursing
home care and medicine and medical supplies under all programs
of medical care provided by the state and for congregate living
care under the income maintenance programs.
(12) Have the authority to conduct and administer
experimental projects to test methods and procedures of
administering assistance and services to recipients or potential
recipients of public welfare. To carry out such experimental
projects, it is further provided that the commissioner of human
services is authorized to waive the enforcement of existing
specific statutory program requirements, rules, and standards in
one or more counties. The order establishing the waiver shall
provide alternative methods and procedures of administration,
shall not be in conflict with the basic purposes, coverage, or
benefits provided by law, and in no event shall the duration of
a project exceed four years. It is further provided that no
order establishing an experimental project as authorized by the
provisions of this section shall become effective until the
following conditions have been met:
(a) The secretary of health, education, and welfare of the
United States has agreed, for the same project, to waive state
plan requirements relative to statewide uniformity.
(b) A comprehensive plan, including estimated project
costs, shall be approved by the legislative advisory commission
and filed with the commissioner of administration.
(13) According to federal requirements, establish
procedures to be followed by local welfare boards in creating
citizen advisory committees, including procedures for selection
of committee members.
(14) Allocate federal fiscal disallowances or sanctions
which are based on quality control error rates for the aid to
families with dependent children, Minnesota family investment
program-statewide, medical assistance, or food stamp program in
the following manner:
(a) One-half of the total amount of the disallowance shall
be borne by the county boards responsible for administering the
programs. For the medical assistance, MFIP-S, and AFDC
programs, disallowances shall be shared by each county board in
the same proportion as that county's expenditures for the
sanctioned program are to the total of all counties'
expenditures for the AFDC, MFIP-S, and medical assistance
programs. For the food stamp program, sanctions shall be shared
by each county board, with 50 percent of the sanction being
distributed to each county in the same proportion as that
county's administrative costs for food stamps are to the total
of all food stamp administrative costs for all counties, and 50
percent of the sanctions being distributed to each county in the
same proportion as that county's value of food stamp benefits
issued are to the total of all benefits issued for all
counties. Each county shall pay its share of the disallowance
to the state of Minnesota. When a county fails to pay the
amount due hereunder, the commissioner may deduct the amount
from reimbursement otherwise due the county, or the attorney
general, upon the request of the commissioner, may institute
civil action to recover the amount due.
(b) Notwithstanding the provisions of paragraph (a), if the
disallowance results from knowing noncompliance by one or more
counties with a specific program instruction, and that knowing
noncompliance is a matter of official county board record, the
commissioner may require payment or recover from the county or
counties, in the manner prescribed in paragraph (a), an amount
equal to the portion of the total disallowance which resulted
from the noncompliance, and may distribute the balance of the
disallowance according to paragraph (a).
(15) Develop and implement special projects that maximize
reimbursements and result in the recovery of money to the
state. For the purpose of recovering state money, the
commissioner may enter into contracts with third parties. Any
recoveries that result from projects or contracts entered into
under this paragraph shall be deposited in the state treasury
and credited to a special account until the balance in the
account reaches $1,000,000. When the balance in the account
exceeds $1,000,000, the excess shall be transferred and credited
to the general fund. All money in the account is appropriated
to the commissioner for the purposes of this paragraph.
(16) Have the authority to make direct payments to
facilities providing shelter to women and their children
according to section 256D.05, subdivision 3. Upon the written
request of a shelter facility that has been denied payments
under section 256D.05, subdivision 3, the commissioner shall
review all relevant evidence and make a determination within 30
days of the request for review regarding issuance of direct
payments to the shelter facility. Failure to act within 30 days
shall be considered a determination not to issue direct payments.
(17) Have the authority to establish and enforce the
following county reporting requirements:
(a) The commissioner shall establish fiscal and statistical
reporting requirements necessary to account for the expenditure
of funds allocated to counties for human services programs.
When establishing financial and statistical reporting
requirements, the commissioner shall evaluate all reports, in
consultation with the counties, to determine if the reports can
be simplified or the number of reports can be reduced.
(b) The county board shall submit monthly or quarterly
reports to the department as required by the commissioner.
Monthly reports are due no later than 15 working days after the
end of the month. Quarterly reports are due no later than 30
calendar days after the end of the quarter, unless the
commissioner determines that the deadline must be shortened to
20 calendar days to avoid jeopardizing compliance with federal
deadlines or risking a loss of federal funding. Only reports
that are complete, legible, and in the required format shall be
accepted by the commissioner.
(c) If the required reports are not received by the
deadlines established in clause (b), the commissioner may delay
payments and withhold funds from the county board until the next
reporting period. When the report is needed to account for the
use of federal funds and the late report results in a reduction
in federal funding, the commissioner shall withhold from the
county boards with late reports an amount equal to the reduction
in federal funding until full federal funding is received.
(d) A county board that submits reports that are late,
illegible, incomplete, or not in the required format for two out
of three consecutive reporting periods is considered
noncompliant. When a county board is found to be noncompliant,
the commissioner shall notify the county board of the reason the
county board is considered noncompliant and request that the
county board develop a corrective action plan stating how the
county board plans to correct the problem. The corrective
action plan must be submitted to the commissioner within 45 days
after the date the county board received notice of noncompliance.
(e) The final deadline for fiscal reports or amendments to
fiscal reports is one year after the date the report was
originally due. If the commissioner does not receive a report
by the final deadline, the county board forfeits the funding
associated with the report for that reporting period and the
county board must repay any funds associated with the report
received for that reporting period.
(f) The commissioner may not delay payments, withhold
funds, or require repayment under paragraph (c) or (e) if the
county demonstrates that the commissioner failed to provide
appropriate forms, guidelines, and technical assistance to
enable the county to comply with the requirements. If the
county board disagrees with an action taken by the commissioner
under paragraph (c) or (e), the county board may appeal the
action according to sections 14.57 to 14.69.
(g) Counties subject to withholding of funds under
paragraph (c) or forfeiture or repayment of funds under
paragraph (e) shall not reduce or withhold benefits or services
to clients to cover costs incurred due to actions taken by the
commissioner under paragraph (c) or (e).
(18) Allocate federal fiscal disallowances or sanctions for
audit exceptions when federal fiscal disallowances or sanctions
are based on a statewide random sample for the foster care
program under title IV-E of the Social Security Act, United
States Code, title 42, in direct proportion to each county's
title IV-E foster care maintenance claim for that period.
(19) Be responsible for ensuring the detection, prevention,
investigation, and resolution of fraudulent activities or
behavior by applicants, recipients, and other participants in
the human services programs administered by the department.
(20) Require county agencies to identify overpayments,
establish claims, and utilize all available and cost-beneficial
methodologies to collect and recover these overpayments in the
human services programs administered by the department.
(21) Have the authority to administer a drug rebate program
for drugs purchased pursuant to the senior citizen drug program
established under section 256.955 after the beneficiary's
satisfaction of any deductible established in the program. The
commissioner shall require a rebate agreement from all
manufacturers of covered drugs as defined in section 256B.0625,
subdivision 13. For each drug, the amount of the rebate shall
be equal to the basic rebate as defined for purposes of the
federal rebate program in United States Code, title 42, section
1396r-8(c)(1). This basic rebate shall be applied to
single-source and multiple-source drugs. The manufacturers must
provide full payment within 30 days of receipt of the state
invoice for the rebate within the terms and conditions used for
the federal rebate program established pursuant to section 1927
of title XIX of the Social Security Act. The manufacturers must
provide the commissioner with any information necessary to
verify the rebate determined per drug. The rebate program shall
utilize the terms and conditions used for the federal rebate
program established pursuant to section 1927 of title XIX of the
Social Security Act.
(22) Operate the department's communication systems account
established in Laws 1993, First Special Session chapter 1,
article 1, section 2, subdivision 2, to manage shared
communication costs necessary for the operation of the programs
the commissioner supervises. A communications account may also
be established for each regional treatment center which operates
communications systems. Each account must be used to manage
shared communication costs necessary for the operations of the
programs the commissioner supervises. The commissioner may
distribute the costs of operating and maintaining communication
systems to participants in a manner that reflects actual usage.
Costs may include acquisition, licensing, insurance,
maintenance, repair, staff time and other costs as determined by
the commissioner. Nonprofit organizations and state, county,
and local government agencies involved in the operation of
programs the commissioner supervises may participate in the use
of the department's communications technology and share in the
cost of operation. The commissioner may accept on behalf of the
state any gift, bequest, devise or personal property of any
kind, or money tendered to the state for any lawful purpose
pertaining to the communication activities of the department.
Any money received for this purpose must be deposited in the
department's communication systems accounts. Money collected by
the commissioner for the use of communication systems must be
deposited in the state communication systems account, and is
appropriated to the commissioner for purposes of this section.
(23) Receive any federal matching money that is made
available through the medical assistance program for the
consumer satisfaction survey. Any federal money received for
the survey is appropriated to the commissioner for this
purpose. The commissioner may expend the federal money received
for the consumer satisfaction survey in either year of the
biennium.
(24) Incorporate cost reimbursement claims from First Call
Minnesota into the federal cost reimbursement claiming processes
of the department according to federal law, rule, and
regulations. Any reimbursement received is appropriated to the
commissioner and shall be disbursed to First Call Minnesota
according to normal department payment schedules.
Sec. 17. Minnesota Statutes 1998, section 256.01, is
amended by adding a subdivision to read:
Subd. 17. [APPROPRIATION TRANSFERS TO BE REPORTED.] When
the commissioner transfers operational money between programs
under section 16A.285, in addition to the requirements of that
section the commissioner must provide the chairs of the
legislative committees that have jurisdiction over the agency's
budget with sufficient detail to identify the account to which
the money was originally appropriated, and the account to which
the money is being transferred.
Sec. 18. Minnesota Statutes 1998, section 256.014, is
amended by adding a subdivision to read:
Subd. 4. [ISSUANCE OPERATIONS CENTER.] Payments to the
commissioner from other governmental units and private
enterprises for: services performed by the issuance operations
center; or reports generated by the payment and eligibility
systems must be deposited in the account created under
subdivision 2. These payments are appropriated to the
commissioner for the operation of the issuance center or system,
according to the provisions of this section.
Sec. 19. Minnesota Statutes 1998, section 256J.39,
subdivision 1, is amended to read:
Subdivision 1. [PAYMENT POLICY.] The following policies
apply to monthly assistance payments and corrective payments:
(1) Grant payments may be issued in the form of warrants
immediately redeemable in cash, electronic benefits transfer, or
by direct deposit into the recipient's account in a financial
institution.
(2) The commissioner shall mail assistance payment checks
to the address where a caregiver lives unless the county agency
approves an alternate arrangement.
(3) The commissioner shall mail monthly assistance payment
checks within time to allow postal service delivery to occur no
later than the first day of each month. Monthly assistance
payment checks must be dated the first day of the month. The
commissioner shall issue electronic benefits transfer payments
so that caregivers have access to the payments no later than the
first of the month.
(4) The commissioner shall issue replacement checks
promptly, but no later than seven calendar days after the
provisions of sections 16A.46; 256.01, subdivision 11; and
471.415 have been met.
(5) The commissioner, with the advance approval of the
commissioner of finance, may issue cash assistance grant
payments up to three days before the first day of each month,
including three days before the start of each state fiscal
year. Of the money appropriated for cash assistance grant
payments for each fiscal year, up to three percent of the annual
state appropriation is available to the commissioner in the
previous fiscal year. If that amount is insufficient for the
costs incurred, an additional amount of the appropriation as
needed may be transferred with the advance approval of the
commissioner of finance.
Sec. 20. [REPEALER.]
Minnesota Statutes 1998, section 256J.03, is repealed
effective July 2, 1999. Section 13, sunset of uncodified
language, does not apply to this section.
Sec. 21. [EFFECTIVE DATE.]
Section 19 is effective the day following final enactment.
ARTICLE 2
HEALTH DEPARTMENT
Section 1. Minnesota Statutes 1998, section 15.059,
subdivision 5a, is amended to read:
Subd. 5a. [LATER EXPIRATION.] Notwithstanding subdivision
5, the advisory councils and committees listed in this
subdivision do not expire June 30, 1997. These groups expire
June 30, 2001, unless the law creating the group or this
subdivision specifies an earlier expiration date.
Investment advisory council, created in section 11A.08;
Intergovernmental information systems advisory council,
created in section 16B.42, expires June 30, 1999;
Feedlot and manure management advisory committee, created
in section 17.136;
Aquaculture advisory committee, created in section 17.49;
Dairy producers board, created in section 17.76;
Pesticide applicator education and examination review
board, created in section 18B.305;
Advisory seed potato certification task force, created in
section 21.112;
Food safety advisory committee, created in section 28A.20;
Minnesota organic advisory task force, created in section
31.95;
Public programs risk adjustment work group, created in
section 62Q.03, expires June 30, 1999;
Workers' compensation self-insurers' advisory committee,
created in section 79A.02;
Youth corps advisory committee, created in section 84.0887;
Iron range off-highway vehicle advisory committee, created
in section 85.013;
Mineral coordinating committee, created in section 93.002;
Game and fish fund citizen advisory committees, created in
section 97A.055;
Wetland heritage advisory committee, created in section
103G.2242;
Wastewater treatment technical advisory committee, created
in section 115.54;
Solid waste management advisory council, created in section
115A.12;
Nuclear waste council, created in section 116C.711;
Genetically engineered organism advisory committee, created
in section 116C.93;
Environment and natural resources trust fund advisory
committee, created in section 116P.06;
Child abuse prevention advisory council, created in section
119A.13;
Chemical abuse and violence prevention council, created in
section 119A.27;
Youth neighborhood services advisory board, created in
section 119A.29;
Interagency coordinating council, created in section
125A.28, expires June 30, 1999;
Desegregation/integration advisory board, created in
section 124D.892;
Nonpublic education council, created in section 123B.445;
Permanent school fund advisory committee, created in
section 127A.30;
Indian scholarship committee, created in section 124D.84,
subdivision 2;
American Indian education committees, created in section
124D.80;
Summer scholarship advisory committee, created in section
124D.95;
Multicultural education advisory committee, created in
section 124D.894;
Male responsibility and fathering grants review committee,
created in section 124D.33;
Library for the blind and physically handicapped advisory
committee, created in section 134.31;
Higher education advisory council, created in section
136A.031;
Student advisory council, created in section 136A.031;
Cancer surveillance advisory committee, created in section
144.672;
Maternal and child health task force, created in section
145.881;
State community health advisory committee, created in
section 145A.10;
Mississippi River Parkway commission, created in section
161.1419;
School bus safety advisory committee, created in section
169.435;
Advisory council on workers' compensation, created in
section 175.007;
Code enforcement advisory council, created in section
175.008;
Medical services review board, created in section 176.103;
Apprenticeship advisory council, created in section 178.02;
OSHA advisory council, created in section 182.656;
Health professionals services program advisory committee,
created in section 214.32;
Rehabilitation advisory council for the blind, created in
section 248.10;
American Indian advisory council, created in section
254A.035;
Alcohol and other drug abuse advisory council, created in
section 254A.04;
Medical assistance drug formulary committee, created in
section 256B.0625;
Home care advisory committee, created in section 256B.071;
Preadmission screening, alternative care, and home and
community-based services advisory committee, created in section
256B.0911;
Traumatic brain injury advisory committee, created in
section 256B.093;
Minnesota commission serving deaf and hard-of-hearing
people, created in section 256C.28;
American Indian child welfare advisory council, created in
section 257.3579;
Juvenile justice advisory committee, created in section
268.29;
Northeast Minnesota economic development fund technical
advisory committees, created in section 298.2213;
Iron range higher education committee, created in section
298.2214;
Northeast Minnesota economic protection trust fund
technical advisory committee, created in section 298.297;
Pipeline safety advisory committee, created in section
299J.06, expires June 30, 1998;
Battered women's advisory council, created in section
611A.34.
Sec. 2. Minnesota Statutes 1998, section 62J.04,
subdivision 3, is amended to read:
Subd. 3. [COST CONTAINMENT DUTIES.] After obtaining the
advice and recommendations of the Minnesota health care
commission, The commissioner shall:
(1) establish statewide and regional cost containment goals
for total health care spending under this section and collect
data as described in sections 62J.38 to 62J.41 to monitor
statewide achievement of the cost containment goals;
(2) divide the state into no fewer than four regions, with
one of those regions being the Minneapolis/St. Paul metropolitan
statistical area but excluding Chisago, Isanti, Wright, and
Sherburne counties, for purposes of fostering the development of
regional health planning and coordination of health care
delivery among regional health care systems and working to
achieve the cost containment goals;
(3) provide technical assistance to regional coordinating
boards;
(4) monitor the quality of health care throughout the state
and take action as necessary to ensure an appropriate level of
quality;
(5) (4) issue recommendations regarding uniform billing
forms, uniform electronic billing procedures and data
interchanges, patient identification cards, and other uniform
claims and administrative procedures for health care providers
and private and public sector payers. In developing the
recommendations, the commissioner shall review the work of the
work group on electronic data interchange (WEDI) and the
American National Standards Institute (ANSI) at the national
level, and the work being done at the state and local level.
The commissioner may adopt rules requiring the use of the
Uniform Bill 82/92 form, the National Council of Prescription
Drug Providers (NCPDP) 3.2 electronic version, the Health Care
Financing Administration 1500 form, or other standardized forms
or procedures;
(6) (5) undertake health planning responsibilities as
provided in section 62J.15;
(7) (6) authorize, fund, or promote research and
experimentation on new technologies and health care procedures;
(8) (7) within the limits of appropriations for these
purposes, administer or contract for statewide consumer
education and wellness programs that will improve the health of
Minnesotans and increase individual responsibility relating to
personal health and the delivery of health care services,
undertake prevention programs including initiatives to improve
birth outcomes, expand childhood immunization efforts, and
provide start-up grants for worksite wellness programs;
(9) (8) undertake other activities to monitor and oversee
the delivery of health care services in Minnesota with the goal
of improving affordability, quality, and accessibility of health
care for all Minnesotans; and
(10) (9) make the cost containment goal data available to
the public in a consumer-oriented manner.
Sec. 3. Minnesota Statutes 1998, section 62J.06, is
amended to read:
62J.06 [IMMUNITY FROM LIABILITY.]
No member of the regional coordinating boards established
under section 62J.09, or the health technology advisory
committee established under section 62J.15, shall be held
civilly or criminally liable for an act or omission by that
person if the act or omission was in good faith and within the
scope of the member's responsibilities under this chapter.
Sec. 4. Minnesota Statutes 1998, section 62J.07,
subdivision 1, is amended to read:
Subdivision 1. [LEGISLATIVE OVERSIGHT.] The legislative
commission on health care access reviews the activities of the
commissioner of health, the regional coordinating boards, the
health technology advisory committee, and all other state
agencies involved in the implementation and administration of
this chapter, including efforts to obtain federal approval
through waivers and other means.
Sec. 5. Minnesota Statutes 1998, section 62J.07,
subdivision 3, is amended to read:
Subd. 3. [REPORTS TO THE COMMISSION.] The commissioner of
health, the regional coordinating boards, and the health
technology advisory committee shall report on their activities
annually and at other times at the request of the legislative
commission on health care access. The commissioners of health,
commerce, and human services shall provide periodic reports to
the legislative commission on the progress of rulemaking that is
authorized or required under this chapter and shall notify
members of the commission when a draft of a proposed rule has
been completed and scheduled for publication in the State
Register. At the request of a member of the commission, a
commissioner shall provide a description and a copy of a
proposed rule.
Sec. 6. Minnesota Statutes 1998, section 62J.09,
subdivision 8, is amended to read:
Subd. 8. [REPEALER.] This section is repealed effective
July 1, 2000 1999.
Sec. 7. Minnesota Statutes 1998, section 62J.2930,
subdivision 3, is amended to read:
Subd. 3. [CONSUMER INFORMATION.] The information
clearinghouse or another entity designated by the commissioner
shall provide consumer information to health plan company
enrollees to:
(1) assist enrollees in understanding their rights;
(2) explain and assist in the use of all available
complaint systems, including internal complaint systems within
health carriers, community integrated service networks, and the
departments of health and commerce;
(3) provide information on coverage options in each
regional coordinating board region of the state;
(4) provide information on the availability of purchasing
pools and enrollee subsidies; and
(5) help consumers use the health care system to obtain
coverage.
The information clearinghouse or other entity designated by
the commissioner for the purposes of this subdivision shall not:
(1) provide legal services to consumers;
(2) represent a consumer or enrollee; or
(3) serve as an advocate for consumers in disputes with
health plan companies.
Nothing in this subdivision shall interfere with the ombudsman
program established under section 256B.031, subdivision 6, or
other existing ombudsman programs.
Sec. 8. [62J.535] [UNIFORM BILLING REQUIREMENTS.]
Subdivision 1. [DEVELOPMENT OF UNIFORM BILLING
TRANSACTIONS.] The commissioner of health, after consultation
with the commissioner of commerce, shall adopt uniform billing
standards that comply with United States Code, title 42,
sections 1320d to 1320d-8, as amended from time to time. The
uniform billing standards shall apply to all paper and
electronic claim transactions and shall apply to all Minnesota
payers, including government programs.
Subd. 2. [COMPLIANCE.] (a) Concurrent with the effective
dates established under United States Code, title 42, sections
1320d to 1320d-8, as amended from time to time, for uniform
electronic billing standards, all health care providers must
conform to the uniform billing standards developed under
subdivision 1.
(b) Notwithstanding paragraph (a), the requirements for the
uniform remittance advice report shall be effective 12 months
after the date of the required compliance of the standards for
the electronic remittance advice transaction are effective under
United States Code, title 42, sections 1320d to 1320d-8, as
amended from time to time.
Sec. 9. [62J.691] [PURPOSE.]
The legislature finds that medical education and research
are important to the health and economic well being of
Minnesotans. The legislature further finds that, as a result of
competition in the health care marketplace, these teaching and
research institutions are facing increased difficulty funding
medical education and research. The purpose of sections 62J.692
and 62J.693 is to help offset lost patient care revenue for
those teaching institutions affected by increased competition in
the health care marketplace and to help ensure the continued
excellence of health care research in Minnesota.
Sec. 10. [62J.692] [MEDICAL EDUCATION.]
Subdivision 1. [DEFINITIONS.] For purposes of this
section, the following definitions apply:
(a) "Accredited clinical training" means the clinical
training provided by a medical education program that is
accredited through an organization recognized by the department
of education or the health care financing administration as the
official accrediting body for that program.
(b) "Commissioner" means the commissioner of health.
(c) "Clinical medical education program" means the
accredited clinical training of physicians (medical students and
residents), doctor of pharmacy practitioners, doctors of
chiropractic, dentists, advanced practice nurses (clinical nurse
specialists, certified registered nurse anesthetists, nurse
practitioners, and certified nurse midwives), and physician
assistants.
(d) "Sponsoring institution" means a hospital, school, or
consortium located in Minnesota that sponsors and maintains
primary organizational and financial responsibility for a
clinical medical education program in Minnesota and which is
accountable to the accrediting body.
(e) "Teaching institution" means a hospital, medical
center, clinic, or other organization that conducts a clinical
medical education program in Minnesota.
(f) "Trainee" means a student or resident involved in a
clinical medical education program.
(g) "Eligible trainee FTEs" means the number of trainees,
as measured by full-time equivalent counts, that are at training
sites located in Minnesota with a medical assistance provider
number where training occurs in either an inpatient or
ambulatory patient care setting and where the training is
funded, in part, by patient care revenues.
Subd. 2. [MEDICAL EDUCATION AND RESEARCH ADVISORY
COMMITTEE.] The commissioner shall appoint an advisory committee
to provide advice and oversight on the distribution of funds
appropriated for distribution under this section. In appointing
the members, the commissioner shall:
(1) consider the interest of all stakeholders;
(2) appoint members that represent both urban and rural
interests; and
(3) appoint members that represent ambulatory care as well
as inpatient perspectives.
The commissioner shall appoint to the advisory committee
representatives of the following groups to ensure appropriate
representation of all eligible provider groups and other
stakeholders: public and private medical researchers; public
and private academic medical centers, including representatives
from academic centers offering accredited training programs for
physicians, pharmacists, chiropractors, dentists, nurses, and
physician assistants; managed care organizations; employers;
consumers and other relevant stakeholders. The advisory
committee is governed by section 15.059 for membership terms and
removal of members and expires on June 30, 2001.
Subd. 3. [APPLICATION PROCESS.] (a) A clinical medical
education program conducted in Minnesota by a teaching
institution is eligible for funds under subdivision 4 if the
program:
(1) is funded, in part, by patient care revenues;
(2) occurs in patient care settings that face increased
financial pressure as a result of competition with nonteaching
patient care entities; and
(3) emphasizes primary care or specialties that are in
undersupply in Minnesota.
(b) Applications must be submitted to the commissioner by a
sponsoring institution on behalf of an eligible clinical medical
education program and must be received by September 30 of each
year for distribution in the following year. An application for
funds must contain the following information:
(1) the official name and address of the sponsoring
institution and the official name and site address of the
clinical medical education programs on whose behalf the
sponsoring institution is applying;
(2) the name, title, and business address of those persons
responsible for administering the funds;
(3) for each clinical medical education program for which
funds are being sought; the type and specialty orientation of
trainees in the program; the name, site address, and medical
assistance provider number of each training site used in the
program; the total number of trainees at each training site; and
the total number of eligible trainee FTEs at each site;
(4) audited clinical training costs per trainee for each
clinical medical education program where available or estimates
of clinical training costs based on audited financial data;
(5) a description of current sources of funding for
clinical medical education costs, including a description and
dollar amount of all state and federal financial support,
including Medicare direct and indirect payments;
(6) other revenue received for the purposes of clinical
training; and
(7) other supporting information the commissioner deems
necessary to determine program eligibility based on the criteria
in paragraph (a) and to ensure the equitable distribution of
funds.
(c) An applicant that does not provide information
requested by the commissioner shall not be eligible for funds
for the current funding cycle.
Subd. 4. [DISTRIBUTION OF FUNDS.] (a) The commissioner
shall annually distribute medical education funds to all
qualifying applicants based on the following criteria:
(1) total medical education funds available for
distribution;
(2) total number of eligible trainee FTEs in each clinical
medical education program; and
(3) the statewide average cost per trainee, by type of
trainee, in each clinical medical education program.
(b) Funds distributed shall not be used to displace current
funding appropriations from federal or state sources.
(c) Funds shall be distributed to the sponsoring
institutions indicating the amount to be distributed to each of
the sponsor's clinical medical education programs based on the
criteria in this subdivision and in accordance with the
commissioner's approval letter. Each clinical medical education
program must distribute funds to the training sites as specified
in the commissioner's approval letter. Sponsoring institutions,
which are accredited through an organization recognized by the
department of education or the health care financing
administration, may contract directly with training sites to
provide clinical training. To ensure the quality of clinical
training, those accredited sponsoring institutions must:
(1) develop contracts specifying the terms, expectations,
and outcomes of the clinical training conducted at sites; and
(2) take necessary action if the contract requirements are
not met. Action may include the withholding of payments under
this section or the removal of students from the site.
(d) Any funds not distributed in accordance with the
commissioner's approval letter must be returned to the medical
education and research fund within 30 days of receiving notice
from the commissioner. The commissioner shall distribute
returned funds to the appropriate training sites in accordance
with the commissioner's approval letter.
Subd. 5. [REPORT.] (a) Sponsoring institutions receiving
funds under this section must sign and submit a medical
education grant verification report (GVR) to verify that the
correct grant amount was forwarded to each eligible training
site. If the sponsoring institution fails to submit the GVR by
the stated deadline, or to request and meet the deadline for an
extension, the sponsoring institution is required to return the
full amount of funds received to the commissioner within 30 days
of receiving notice from the commissioner. The commissioner
shall distribute returned funds to the appropriate training
sites in accordance with the commissioner's approval letter.
(b) The reports must provide verification of the
distribution of the funds and must include:
(1) the total number of eligible trainee FTEs in each
clinical medical education program;
(2) the name of each funded program and, for each program,
the dollar amount distributed to each training site;
(3) documentation of any discrepancies between the initial
grant distribution notice included in the commissioner's
approval letter and the actual distribution;
(4) a statement by the sponsoring institution stating that
the completed grant verification report is valid and accurate;
and
(5) other information the commissioner, with advice from
the advisory committee, deems appropriate to evaluate the
effectiveness of the use of funds for medical education.
(c) By February 15 of each year, the commissioner, with
advice from the advisory committee, shall provide an annual
summary report to the legislature on the implementation of this
section.
Subd. 6. [OTHER AVAILABLE FUNDS.] The commissioner is
authorized to distribute, in accordance with subdivision 4,
funds made available through:
(1) voluntary contributions by employers or other entities;
(2) allocations for the commissioner 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 fund.
Subd. 7. [TRANSFERS FROM THE COMMISSIONER OF HUMAN
SERVICES.] (a) The amount transferred according to section
256B.69, subdivision 5c, shall be distributed by the
commissioner to clinical medical education programs that meet
the qualifications of subdivision 3 based on a distribution
formula that reflects a summation of two factors:
(1) an education factor, which is determined by the total
number of eligible trainee FTEs and the total statewide average
costs per trainee, by type of trainee, in each clinical medical
education program; and
(2) a public program volume factor, which is determined by
the total volume of public program revenue received by each
training site as a percentage of all public program revenue
received by all training sites in the fund pool created under
this subdivision.
In this formula, the education factor shall be weighted at
50 percent and the public program volume factor shall be
weighted at 50 percent.
(b) Public program revenue for the formula in paragraph (a)
shall include revenue from medical assistance, prepaid medical
assistance, general assistance medical care, and prepaid general
assistance medical care.
(c) Training sites that receive no public program revenue
shall be ineligible for funds available under this subdivision.
Subd. 8. [FEDERAL FINANCIAL PARTICIPATION.] The
commissioner of human services shall seek to maximize federal
financial participation in payments for medical education and
research costs. If the commissioner of human services
determines that federal financial participation is available for
the medical education and research, the commissioner of health
shall transfer to the commissioner of human services the amount
of state funds necessary to maximize the federal funds
available. The amount transferred to the commissioner of human
services, plus the amount of federal financial participation,
shall be distributed to medical assistance providers in
accordance with the distribution methodology described in
subdivision 4.
Subd. 9. [REVIEW OF ELIGIBLE PROVIDERS.] The commissioner
and the medical education and research costs advisory committee
may review provider groups included in the definition of a
clinical medical education program to assure that the
distribution of the funds continue to be consistent with the
purpose of this section. The results of any such reviews must
be reported to the legislative commission on health care access.
Sec. 11. [62J.693] [MEDICAL RESEARCH.]
Subdivision 1. [DEFINITIONS.] For purposes of this
section, health care research means approved clinical, outcomes,
and health services investigations.
Subd. 2. [GRANT APPLICATION PROCESS.] (a) The commissioner
of health shall make recommendations for a process for the
submission, review, and approval of research grant
applications. The process shall give priority for grants to
applications that are intended to gather preliminary data for
submission for a subsequent proposal for funding from a federal
agency or foundation, which awards research money on a
competitive, peer-reviewed basis. Grant recipients must be able
to demonstrate the ability to comply with federal regulations on
human subjects research in accordance with Code of Federal
Regulations, title 45, section 46, and shall conduct the
proposed research. Grants may be awarded to the University of
Minnesota, the Mayo clinic, or any other public or private
organization in the state involved in medical research. The
commissioner shall report to the legislature by January 15,
2000, with recommendations.
(b) The commissioner may consult with the medical education
and research advisory committee established in section 62J.692
in developing these recommendations or may appoint a research
advisory committee to provide advice and oversight on the grant
application process. If the commissioner appoints a research
advisory committee, the committee shall be governed by section
15.059 for membership terms and removal of members.
Sec. 12. Minnesota Statutes 1998, section 62Q.03,
subdivision 5a, is amended to read:
Subd. 5a. [PUBLIC PROGRAMS.] (a) A separate risk
adjustment system must be developed for state-run public
programs, including medical assistance, general assistance
medical care, and MinnesotaCare. The system must be developed
in accordance with the general risk adjustment methodologies
described in this section, must include factors in addition to
age and sex adjustment, and may include additional demographic
factors, different targeted conditions, and/or different payment
amounts for conditions. The risk adjustment system for public
programs must attempt to reflect the special needs related to
poverty, cultural, or language barriers and other needs of the
public program population.
(b) The commissioners of health and human services shall
jointly convene a public programs risk adjustment work group
responsible for advising the commissioners in the design of the
public programs risk adjustment system. The public programs
risk adjustment work group is governed by section 15.059 for
purposes of membership terms, expiration, and removal of members
and shall terminate on June 30, 1999. The work group shall meet
at the discretion of the commissioners of health and human
services. The commissioner of health shall work with the risk
adjustment association to ensure coordination between the risk
adjustment systems for the public and private sectors. The
commissioner of human services shall seek any needed federal
approvals necessary for the inclusion of the medical assistance
program in the public programs risk adjustment system.
(c) The public programs risk adjustment work group must be
representative of the persons served by publicly paid health
programs and providers and health plans that meet their needs.
To the greatest extent possible, the appointing authorities
shall attempt to select representatives that have historically
served a significant number of persons in publicly paid health
programs or the uninsured. Membership of the work group shall
be as follows:
(1) one provider member appointed by the Minnesota Medical
Association;
(2) two provider members appointed by the Minnesota
Hospital Association, at least one of whom must represent a
major disproportionate share hospital;
(3) five members appointed by the Minnesota Council of
HMOs, one of whom must represent an HMO with fewer than 50,000
enrollees located outside the metropolitan area and one of whom
must represent an HMO with at least 50 percent of total
membership enrolled through a public program;
(4) two representatives of counties appointed by the
Association of Minnesota Counties;
(5) three representatives of organizations representing the
interests of families, children, childless adults, and elderly
persons served by the various publicly paid health programs
appointed by the governor;
(6) two representatives of persons with mental health,
developmental or physical disabilities, chemical dependency, or
chronic illness appointed by the governor; and
(7) three public members appointed by the governor, at
least one of whom must represent a community health board. The
risk adjustment association may appoint a representative, if a
representative is not otherwise appointed by an appointing
authority.
(d) The commissioners of health and human services, with
the advice of the public programs risk adjustment work group,
shall develop a work plan and time frame and shall coordinate
their efforts with the private sector risk adjustment
association's activities and other state initiatives related to
public program managed care reimbursement.
(e) Before including risk adjustment in a contract for the
prepaid medical assistance program, the prepaid general
assistance medical care program, or the MinnesotaCare program,
the commissioner of human services shall provide to the
contractor an analysis of the expected impact on the contractor
of the implementation of risk adjustment. This analysis may be
limited by the available data and resources, as determined by
the commissioner, and shall not be binding on future contract
periods. This paragraph shall not apply if the contractor has
not supplied information to the commissioner related to the risk
adjustment analysis.
(f) The commissioner of human services shall report to the
public program risk adjustment work group on the methodology the
department will use for risk adjustment prior to implementation
of the risk adjustment payment methodology. Upon completion of
the report to the work group, the commissioner shall phase in
risk adjustment according to the following schedule:
(1) for the first contract year, no more than ten percent
of reimbursements shall be risk adjusted; and
(2) for the second contract year, no more than 30 percent
of reimbursements shall be risk adjusted.
Sec. 13. Minnesota Statutes 1998, section 62Q.075, is
amended to read:
62Q.075 [LOCAL PUBLIC ACCOUNTABILITY AND COLLABORATION
PLAN.]
Subdivision 1. [DEFINITION.] For purposes of this section,
"managed care organization" means a health maintenance
organization or community integrated service network.
Subd. 2. [REQUIREMENT.] Beginning October 31, 1997, all
managed care organizations shall 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.
Subd. 3. [CONTENTS.] The plan must address the following:
(a) specific measurement strategies and a description of
any activities which contribute to public health goals and needs
of high risk and special needs populations as defined and
developed under chapters 145A and 256E;
(b) description of the process by which the managed care
organization will coordinate its activities with the community
health boards, regional coordinating boards, and other relevant
community organizations servicing the same area;
(c) documentation indicating that local public health units
and local government unit designees were involved in the
development of the plan;
(d) documentation of compliance with the plan filed the
previous year, including data on the previously identified
progress measures.
Subd. 4. [REVIEW.] Upon receipt of the plan, the
appropriate commissioner shall provide a copy to the regional
coordinating boards, local community health boards, and other
relevant community organizations within the managed care
organization's service area. After reviewing the plan, these
community groups may submit written comments on the plan to
either the commissioner of health or commerce, as applicable,
and may advise the commissioner of the managed care
organization's effectiveness in assisting to achieve regional
public health goals. The plan may be reviewed by the county
boards, or city councils acting as a local board of health in
accordance with chapter 145A, within the managed care
organization's service area to determine whether the plan is
consistent with the goals and objectives of the plans required
under chapters 145A and 256E and whether the plan meets the
needs of the community. The county board, or applicable city
council, may also review and make recommendations on the
availability and accessibility of services provided by the
managed care organization. The county board, or applicable city
council, may submit written comments to the appropriate
commissioner, and may advise the commissioner of the managed
care organization's effectiveness in assisting to meet the needs
and goals as defined under the responsibilities of chapters 145A
and 256E. The commissioner of health shall develop
recommendations to utilize the written comments submitted as
part of the licensure process to ensure local public
accountability. These recommendations shall be reported to the
legislative commission on health care access by January 15,
1996. Copies of these written comments must be provided to the
managed care organization. The plan and any comments submitted
must be filed with the information clearinghouse to be
distributed to the public.
Sec. 14. Minnesota Statutes 1998, section 62R.06,
subdivision 1, is amended to read:
Subdivision 1. [PROVIDER CONTRACTS.] A health provider
cooperative and its licensed members may execute marketing and
service contracts requiring the provider members to provide some
or all of their health care services through the provider
cooperative to the enrollees, members, subscribers, or insureds,
of a health care network cooperative, community integrated
service network, nonprofit health service plan, health
maintenance organization, accident and health insurance company,
or any other purchaser, including the state of Minnesota and its
agencies, instruments, or units of local government. Each
purchasing entity is authorized to execute contracts for the
purchase of health care services from a health provider
cooperative in accordance with this section. Any A contract
between a provider cooperative and a purchaser must may provide
for payment by the purchaser to the health provider cooperative
on a substantially capitated or similar risk-sharing basis, by
fee-for-service arrangements, or by other financial arrangements
authorized under state law. Each contract between a provider
cooperative and a purchaser shall be filed by the provider
network cooperative with the commissioner of health and is
subject to the provisions of section 62D.19.
Sec. 15. Minnesota Statutes 1998, section 144.065, is
amended to read:
144.065 [VENEREAL DISEASE TREATMENT CENTERS PREVENTION AND
TREATMENT OF SEXUALLY TRANSMITTED INFECTIONS.]
The state commissioner of health shall assist local health
agencies and organizations throughout the state with the
development and maintenance of services for the detection and
treatment of venereal diseases sexually transmitted infections.
These services shall provide for research, screening and
diagnosis, treatment, case finding, investigation, and the
dissemination of appropriate educational information. The state
commissioner of health shall promulgate rules relative to
determine the composition of such services and shall establish a
method of providing funds to local health agencies boards of
health as defined in section 145A.02, subdivision 2, state
agencies, state councils, and organizations nonprofit
corporations, which offer such services. The state commissioner
of health shall provide technical assistance to such agencies
and organizations in accordance with the needs of the local
area. Planning and implementation of services, and technical
assistance may be conducted in collaboration with boards of
health; state agencies, including the University of Minnesota
and the department of children, families, and learning; state
councils; nonprofit organizations; and representatives of
affected populations.
Sec. 16. [144.1201] [DEFINITIONS.]
Subdivision 1. [APPLICABILITY.] For purposes of sections
144.1201 to 144.1204, the terms defined in this section have the
meanings given to them.
Subd. 2. [BY-PRODUCT NUCLEAR MATERIAL.] "By-product
nuclear material" means a radioactive material, other than
special nuclear material, yielded in or made radioactive by
exposure to radiation created incident to the process of
producing or utilizing special nuclear material.
Subd. 3. [RADIATION.] "Radiation" means ionizing radiation
and includes alpha rays; beta rays; gamma rays; x-rays; high
energy neutrons, protons, or electrons; and other atomic
particles.
Subd. 4. [RADIOACTIVE MATERIAL.] "Radioactive material"
means a matter that emits radiation. Radioactive material
includes special nuclear material, source nuclear material, and
by-product nuclear material.
Subd. 5. [SOURCE NUCLEAR MATERIAL.] "Source nuclear
material" means uranium or thorium, or a combination thereof, in
any physical or chemical form; or ores that contain by weight
1/20 of one percent (0.05 percent) or more of uranium, thorium,
or a combination thereof. Source nuclear material does not
include special nuclear material.
Subd. 6. [SPECIAL NUCLEAR MATERIAL.] "Special nuclear
material" means:
(1) plutonium, uranium enriched in the isotope 233 or in
the isotope 235, and any other material that the Nuclear
Regulatory Commission determines to be special nuclear material
according to United States Code, title 42, section 2071, except
that source nuclear material is not included; and
(2) a material artificially enriched by any of the
materials listed in clause (1), except that source nuclear
material is not included.
Sec. 17. [144.1202] [UNITED STATES NUCLEAR REGULATORY
COMMISSION AGREEMENT.]
Subdivision 1. [AGREEMENT AUTHORIZED.] In order to have a
comprehensive program to protect the public from radiation
hazards, the governor, on behalf of the state, is authorized to
enter into agreements with the United States Nuclear Regulatory
Commission under the Atomic Energy Act of 1954, section 274b, as
amended. The agreement shall provide for the discontinuance of
portions of the Nuclear Regulatory Commission's licensing and
related regulatory authority over by-product, source, and
special nuclear materials, and the assumption of regulatory
authority over these materials by the state.
Subd. 2. [HEALTH DEPARTMENT DESIGNATED LEAD.] The
department of health is designated as the lead agency to pursue
an agreement on behalf of the governor and for any assumption of
specified licensing and regulatory authority from the Nuclear
Regulatory Commission under an agreement with the commission.
The commissioner of health shall establish an advisory group to
assist in preparing the state to meet the requirements for
reaching an agreement. The commissioner may adopt rules to
allow the state to assume regulatory authority under an
agreement under this section, including the licensing and
regulation of radioactive materials. Any regulatory authority
assumed by the state includes the ability to set and collect
fees.
Subd. 3. [TRANSITION.] A person who, on the effective date
of an agreement under this section, possesses a Nuclear
Regulatory Commission license that is subject to the agreement
is deemed to possess a similar license issued by the department
of health. A department of health license obtained under this
subdivision expires on the expiration date specified in the
federal license.
Subd. 4. [AGREEMENT; CONDITIONS OF IMPLEMENTATION.] (a) An
agreement entered into before August 2, 2002, must remain in
effect until terminated under the Atomic Energy Act of 1954,
United States Code, title 42, section 2021, paragraph (j). The
governor may not enter into an initial agreement with the
Nuclear Regulatory Commission after August 1, 2002. If an
agreement is not entered into by August 1, 2002, any rules
adopted under this section are repealed effective August 1, 2002.
(b) An agreement authorized under subdivision 1 must be
approved by law before it may be implemented.
Sec. 18. [144.1203] [TRAINING; RULEMAKING.]
The commissioner shall adopt rules to ensure that
individuals handling or utilizing radioactive materials under
the terms of a license issued by the commissioner under section
144.1202 have proper training and qualifications to do so. The
rules adopted must be at least as stringent as federal
regulations on proper training and qualifications adopted by the
Nuclear Regulatory Commission. Rules adopted under this section
may incorporate federal regulations by reference.
Sec. 19. [144.1204] [SURETY REQUIREMENTS.]
Subdivision 1. [FINANCIAL ASSURANCE REQUIRED.] The
commissioner may require an applicant for a license under
section 144.1202, or a person who was formerly licensed by the
Nuclear Regulatory Commission and is now subject to sections
144.1201 to 144.1204, to post financial assurances to ensure the
completion of all requirements established by the commissioner
for the decontamination, closure, decommissioning, and
reclamation of sites, structures, and equipment used in
conjunction with activities related to licensure. The financial
assurances posted must be sufficient to restore the site to
unrestricted future use and must be sufficient to provide for
surveillance and care when radioactive materials remain at the
site after the licensed activities cease. The commissioner may
establish financial assurance criteria by rule. In establishing
such criteria, the commissioner may consider:
(1) the chemical and physical form of the licensed
radioactive material;
(2) the quantity of radioactive material authorized;
(3) the particular radioisotopes authorized and their
subsequent radiotoxicity;
(4) the method in which the radioactive material is held,
used, stored, processed, transferred, or disposed of; and
(5) the potential costs of decontamination, treatment, or
disposal of a licensee's equipment and facilities.
Subd. 2. [ACCEPTABLE FINANCIAL ASSURANCES.] The
commissioner may, by rule, establish types of financial
assurances that meet the requirements of this section. Such
financial assurances may include bank letters of credit,
deposits of cash, or deposits of government securities.
Subd. 3. [TRUST AGREEMENTS.] Financial assurances must be
established together with trust agreements. Both the financial
assurances and the trust agreements must be in a form and
substance that meet requirements established by the commissioner.
Subd. 4. [EXEMPTIONS.] The commissioner is authorized to
exempt from the requirements of this section, by rule, any
category of licensee upon a determination by the commissioner
that an exemption does not result in a significant risk to the
public health or safety or to the environment and does not pose
a financial risk to the state.
Subd. 5. [OTHER REMEDIES UNAFFECTED.] Nothing in this
section relieves a licensee of a civil liability incurred, nor
may this section be construed to relieve the licensee of
obligations to prevent or mitigate the consequences of improper
handling or abandonment of radioactive materials.
Sec. 20. Minnesota Statutes 1998, section 144.121, is
amended by adding a subdivision to read:
Subd. 8. [EXEMPTION FROM EXAMINATION REQUIREMENTS;
OPERATORS OF CERTAIN BONE DENSITOMETERS.] (a) This subdivision
applies to a bone densitometer that is used on humans to
estimate bone mineral content and bone mineral density in a
region of a finger on a person's nondominant hand, gives an
x-ray dose equivalent of less than 0.001 microsieverts per scan,
and has an x-ray leakage exposure rate of less than two
milliroentgens per hour at a distance of one meter, provided
that the bone densitometer is operating in accordance with
manufacturer specifications.
(b) An individual who operates a bone densitometer that
satisfies the definition in paragraph (a) and the facility in
which an individual operates such a bone densitometer are exempt
from the requirements of subdivisions 5 and 6.
Sec. 21. Minnesota Statutes 1998, section 144.148, is
amended to read:
144.148 [RURAL HOSPITAL CAPITAL IMPROVEMENT GRANT AND LOAN
PROGRAM.]
Subdivision 1. [DEFINITION.] (a) For purposes of this
section, the following definitions apply.
(b) "Eligible rural hospital" means a any nonfederal,
general acute care hospital that:
(1) is either located in a rural area, as defined in the
federal Medicare regulations, Code of Federal Regulations, title
42, section 405.1041, or located in a community with a
population of less than 5,000, according to United States Census
Bureau Statistics, outside the seven-county metropolitan area;
(2) has 50 or fewer licensed hospital beds with a net
hospital operating margin not greater than two percent in the
two fiscal years prior to application; and
(3) is 25 miles or more from another hospital not for
profit.
(c) "Eligible project" means a modernization project to
update, remodel, or replace aging hospital facilities and
equipment necessary to maintain the operations of a hospital.
Subd. 2. [PROGRAM.] The commissioner of health shall award
rural hospital capital improvement grants or loans to eligible
rural hospitals. A grant or loan shall not exceed
$1,500,000 $300,000 per hospital. Grants or loans shall be
interest free. An eligible rural hospital may apply the funds
retroactively to capital improvements made during the two fiscal
years preceding the fiscal year in which the grant or loan was
received, provided the hospital met the eligibility criteria
during that time period Prior to the receipt of any grant, the
hospital must certify to the commissioner that at least
one-quarter of the grant amount, which may include in-kind
services, is available for the same purposes from nonstate
resources.
Subd. 3. [APPLICATIONS.] Eligible hospitals seeking a
grant or loan shall apply to the commissioner. Applications
must include a description of the problem that the proposed
project will address, a description of the project including
construction and remodeling drawings or specifications, sources
of funds for the project, uses of funds for the project, the
results expected, and a plan to maintain or operate any facility
or equipment included in the project. The applicant must
describe achievable objectives, a timetable, and roles and
capabilities of responsible individuals and organization.
Applicants must submit to the commissioner evidence that
competitive bidding was used to select contractors for the
project.
Subd. 4. [CONSIDERATION OF APPLICATIONS.] The commissioner
shall review each application to determine whether or not the
hospital's application is complete and whether the hospital and
the project are eligible for a grant or loan. In evaluating
applications, the commissioner shall score each application on a
100 point scale, assigning: a maximum of 40 points for an
applicant's clarity and thoroughness in describing the problem
and the project; a maximum of 40 points for the extent to which
the applicant has demonstrated that it has made adequate
provisions to assure proper and efficient operation of the
facility once the project is completed; and a maximum of 20
points for the extent to which the proposed project is
consistent with the hospital's capital improvement plan or
strategic plan. The commissioner may also take into account
other relevant factors. During application review, the
commissioner may request additional information about a proposed
project, including information on project cost. Failure to
provide the information requested disqualifies a loan an
applicant.
Subd. 5. [PROGRAM OVERSIGHT.] The commissioner of health
shall review audited financial information of the hospital to
assess eligibility. The commissioner shall determine the amount
of a grant or loan to be given to an eligible rural hospital
based on the relative score of each eligible hospital's
application and the funds available to the commissioner. The
grant or loan shall be used to update, remodel, or replace aging
facilities and equipment necessary to maintain the operations of
the hospital. The commissioner may collect, from the hospitals
receiving grants, any information necessary to evaluate the
program.
Subd. 6. [LOAN PAYMENT.] Loans shall be repaid as provided
in this subdivision over a period of 15 years. In those years
when an eligible rural hospital experiences a positive net
operating margin in excess of two percent, the eligible rural
hospital shall pay to the state one-half of the excess above two
percent, up to the yearly payment amount based upon a loan
period of 15 years. If the amount paid back in any year is less
than the yearly payment amount, or if no payment is required
because the eligible rural hospital does not experience a
positive net operating margin in excess of two percent, the
amount unpaid for that year shall be forgiven by the state
without any financial penalty. As a condition of receiving an
award through this program, eligible hospitals must agree to any
and all collection activities the commissioner finds necessary
to collect loan payments in those years a payment is due.
Subd. 7. [ACCOUNTING TREATMENT.] The commissioner of
finance shall record as grants in the state accounting system
funds obligated by this section. Loan payments received under
this section shall be deposited in the health care access fund.
Subd. 8. [EXPIRATION.] This section expires June 30,
1999 2001.
Sec. 22. Minnesota Statutes 1998, section 144.1483, is
amended to read:
144.1483 [RURAL HEALTH INITIATIVES.]
The commissioner of health, through the office of rural
health, and consulting as necessary with the commissioner of
human services, the commissioner of commerce, the higher
education services office, and other state agencies, shall:
(1) develop a detailed plan regarding the feasibility of
coordinating rural health care services by organizing individual
medical providers and smaller hospitals and clinics into
referral networks with larger rural hospitals and clinics that
provide a broader array of services;
(2) develop and implement a program to assist rural
communities in establishing community health centers, as
required by section 144.1486;
(3) administer the program of financial assistance
established under section 144.1484 for rural hospitals in
isolated areas of the state that are in danger of closing
without financial assistance, and that have exhausted local
sources of support;
(4) develop recommendations regarding health education and
training programs in rural areas, including but not limited to a
physician assistants' training program, continuing education
programs for rural health care providers, and rural outreach
programs for nurse practitioners within existing training
programs;
(5) develop a statewide, coordinated recruitment strategy
for health care personnel and maintain a database on health care
personnel as required under section 144.1485;
(6) develop and administer technical assistance programs to
assist rural communities in: (i) planning and coordinating the
delivery of local health care services; and (ii) hiring
physicians, nurse practitioners, public health nurses, physician
assistants, and other health personnel;
(7) study and recommend changes in the regulation of health
care personnel, such as nurse practitioners and physician
assistants, related to scope of practice, the amount of on-site
physician supervision, and dispensing of medication, to address
rural health personnel shortages;
(8) support efforts to ensure continued funding for medical
and nursing education programs that will increase the number of
health professionals serving in rural areas;
(9) support efforts to secure higher reimbursement for
rural health care providers from the Medicare and medical
assistance programs;
(10) coordinate the development of a statewide plan for
emergency medical services, in cooperation with the emergency
medical services advisory council;
(11) establish a Medicare rural hospital flexibility
program pursuant to section 1820 of the federal Social Security
Act, United States Code, title 42, section 1395i-4, by
developing a state rural health plan and designating, consistent
with the rural health plan, rural nonprofit or public hospitals
in the state as critical access hospitals. Critical access
hospitals shall include facilities that are certified by the
state as necessary providers of health care services to
residents in the area. Necessary providers of health care
services are designated as critical access hospitals on the
basis of being more than 20 miles, defined as official mileage
as reported by the Minnesota department of transportation, from
the next nearest hospital or being the sole hospital in the
county or being a hospital located in a designated medical
underserved area or health professional shortage area. A
critical access hospital located in a designated medical
underserved area or a health professional shortage area shall
continue to be recognized as a critical access hospital in the
event the medical underserved area or health professional
shortage area designation is subsequently withdrawn; and
(12) carry out other activities necessary to address rural
health problems.
Sec. 23. Minnesota Statutes 1998, section 144.1492,
subdivision 3, is amended to read:
Subd. 3. [ELIGIBLE APPLICANTS AND CRITERIA FOR AWARDING OF
GRANTS TO RURAL COMMUNITIES.] (a) Funding which the department
receives to award grants to rural communities to establish
health care networks shall be awarded through a request for
proposals process. Planning grant funds may be used for
community facilitation and initial network development
activities including incorporation as a nonprofit organization
or cooperative, assessment of network models, and determination
of the best fit for the community. Implementation grant funds
can be used to enable incorporated nonprofit organizations and
cooperatives to purchase technical services needed for further
network development such as legal, actuarial, financial,
marketing, and administrative services.
(b) In order to be eligible to apply for a planning or
implementation grant under the federally funded health care
network reform program, an organization must be located in a
rural area of Minnesota excluding the seven-county Twin Cities
metropolitan area and the census-defined urbanized areas of
Duluth, Rochester, St. Cloud, and Moorhead. The proposed
network organization must also meet or plan to meet the criteria
for a community integrated service network.
(c) In determining which organizations will receive grants,
the commissioner may consider the following factors:
(1) the applicant's description of their plans for health
care network development, their need for technical assistance,
and other technical assistance resources available to the
applicant. The applicant must clearly describe the service area
to be served by the network, how the grant funds will be used,
what will be accomplished, and the expected results. The
applicant should describe achievable objectives, a timetable,
and roles and capabilities of responsible individuals and
organizations;
(2) the extent of community support for the applicant and
the health care network. The applicant should demonstrate
support from private and public health care providers in the
service area, and local community and government leaders, and
the regional coordinating board for the area. Evidence of such
support may include a commitment of financial support, in-kind
services, or cash, for development of the network;
(3) the size and demographic characteristics of the
population in the service area for the proposed network and the
distance of the service area from the nearest metropolitan area;
and
(4) the technical assistance resources available to the
applicant from nonstate sources and the financial ability of the
applicant to purchase technical assistance services with
nonstate funds.
Sec. 24. Minnesota Statutes 1998, section 144.413,
subdivision 2, is amended to read:
Subd. 2. [PUBLIC PLACE.] "Public place" means any
enclosed, indoor area used by the general public or serving as a
place of work, including, but not limited to, restaurants,
retail stores, offices and other commercial establishments,
public conveyances, educational facilities other than public
schools, as defined in section 120A.05, subdivision subdivisions
9, 11, and 13, hospitals, nursing homes, auditoriums, arenas,
meeting rooms, and common areas of rental apartment buildings,
but excluding private, enclosed offices occupied exclusively by
smokers even though such offices may be visited by nonsmokers.
Sec. 25. Minnesota Statutes 1998, section 144.414,
subdivision 1, is amended to read:
Subdivision 1. [PUBLIC PLACES.] No person shall smoke in a
public place or at a public meeting except in designated smoking
areas. This prohibition does not apply in cases in which an
entire room or hall is used for a private social function and
seating arrangements are under the control of the sponsor of the
function and not of the proprietor or person in charge of the
place. Furthermore, this prohibition shall not apply to
factories, warehouses, and similar places of work not usually
frequented by the general public, except that the state
commissioner of health shall establish rules to restrict or
prohibit smoking in factories, warehouses, and those places of
work where the close proximity of workers or the inadequacy of
ventilation causes smoke pollution detrimental to the health and
comfort of nonsmoking employees.
Sec. 26. Minnesota Statutes 1998, section 144.4165, is
amended to read:
144.4165 [TOBACCO PRODUCTS PROHIBITED IN PUBLIC SCHOOLS.]
No person shall at any time smoke, chew, or otherwise
ingest tobacco or a tobacco product in a public school, as
defined in section 120A.05, subdivision subdivisions 9, 11, and
13. This prohibition extends to all facilities, whether owned,
rented, or leased, and all vehicles that a school district owns,
leases, rents, contracts for, or controls. Nothing in this
section shall prohibit the lighting of tobacco by an adult as a
part of a traditional Indian spiritual or cultural ceremony.
For purposes of this section, an Indian is a person who is a
member of an Indian tribe as defined in section 257.351,
subdivision 9.
Sec. 27. Minnesota Statutes 1998, section 144.56,
subdivision 2b, is amended to read:
Subd. 2b. [BOARDING CARE HOMES.] The commissioner shall
not adopt or enforce any rule that limits:
(1) a certified boarding care home from providing nursing
services in accordance with the home's Medicaid certification;
or
(2) a noncertified boarding care home registered under
chapter 144D from providing home care services in accordance
with the home's registration.
Sec. 28. Minnesota Statutes 1998, section 144.99,
subdivision 1, is amended to read:
Subdivision 1. [REMEDIES AVAILABLE.] The provisions of
chapters 103I and 157 and sections 115.71 to 115.77; 144.12,
subdivision 1, paragraphs (1), (2), (5), (6), (10), (12), (13),
(14), and (15); 144.1201 to 144.1204; 144.121; 144.1222; 144.35;
144.381 to 144.385; 144.411 to 144.417; 144.495; 144.71 to
144.74; 144.9501 to 144.9509; 144.992; 326.37 to 326.45; 326.57
to 326.785; 327.10 to 327.131; and 327.14 to 327.28 and all
rules, orders, stipulation agreements, settlements, compliance
agreements, licenses, registrations, certificates, and permits
adopted or issued by the department or under any other law now
in force or later enacted for the preservation of public health
may, in addition to provisions in other statutes, be enforced
under this section.
Sec. 29. Minnesota Statutes 1998, section 144.99, is
amended by adding a subdivision to read:
Subd. 12. [SECURING RADIOACTIVE MATERIALS.] (a) In the
event of an emergency that poses a danger to the public health,
the commissioner shall have the authority to impound radioactive
materials and the associated shielding in the possession of a
person who fails to abide by the provisions of the statutes,
rules, and any other item listed in subdivision 1. If
impounding the source of these materials is impractical, the
commissioner shall have the authority to lock or otherwise
secure a facility that contains the source of such materials,
but only the portions of the facility as is necessary to protect
the public health. An action taken under this paragraph is
effective for up to 72 hours. The commissioner must seek an
injunction or take other administrative action to secure
radioactive materials beyond the initial 72-hour period.
(b) The commissioner may release impounded radioactive
materials and the associated shielding to the owner of the
radioactive materials and associated shielding, upon terms and
conditions that are in accordance with the provisions of
statutes, rules, and other items listed in subdivision 1. In
the alternative, the commissioner may bring an action in a court
of competent jurisdiction for an order directing the disposal of
impounded radioactive materials and associated shielding or
directing other disposition as necessary to protect the public
health and safety and the environment. The costs of
decontamination, transportation, burial, disposal, or other
disposition shall be borne by the owner or licensee of the
radioactive materials and shielding or by any other person who
has used the radioactive materials and shielding for business
purposes.
Sec. 30. Minnesota Statutes 1998, section 144A.4605,
subdivision 2, is amended to read:
Subd. 2. [ASSISTED LIVING HOME CARE LICENSE ESTABLISHED.]
A home care provider license category entitled assisted living
home care provider is hereby established. A home care provider
may obtain an assisted living license if the program meets the
following requirements:
(a) nursing services, delegated nursing services, other
services performed by unlicensed personnel, or central storage
of medications under the assisted living license are provided
solely for residents of one or more housing with services
establishments registered under chapter 144D;
(b) unlicensed personnel perform home health aide and home
care aide tasks identified in Minnesota Rules, parts 4668.0100,
subparts 1 and 2, and 4668.0110, subpart 1. Qualifications to
perform these tasks shall be established in accordance with
subdivision 3;
(c) periodic supervision of unlicensed personnel is
provided as required by rule;
(d) notwithstanding Minnesota Rules, part 4668.0160,
subpart 6, item D, client records shall include:
(1) daily records or a weekly summary of the client's
status and home care services provided;
(2) documentation each time medications are administered to
a client; and
(3) documentation on the day of occurrence of any
significant change in the client's status or any significant
incident, such as a fall or refusal to take medications.
All entries must be signed by the staff providing the
services and entered into the record no later than two weeks
after the end of the service day, except as specified in clauses
(2) and (3);
(e) medication and treatment orders, if any, are included
in the client record and are renewed at least every 12 months,
or more frequently when indicated by a clinical assessment;
(f) the central storage of medications in a housing with
services establishment registered under chapter 144D is managed
under a system that is established by a registered nurse and
addresses the control of medications, handling of medications,
medication containers, medication records, and disposition of
medications; and
(g) in other respects meets the requirements established by
rules adopted under sections 144A.45 to 144A.48.
Sec. 31. Minnesota Statutes 1998, section 145.924, is
amended to read:
145.924 [AIDS PREVENTION GRANTS.]
(a) The commissioner may award grants to boards of health
as defined in section 145A.02, subdivision 2, state agencies,
state councils, or nonprofit corporations to provide evaluation
and counseling services to populations at risk for acquiring
human immunodeficiency virus infection, including, but not
limited to, minorities, adolescents, intravenous drug users, and
homosexual men.
(b) The commissioner may award grants to agencies
experienced in providing services to communities of color, for
the design of innovative outreach and education programs for
targeted groups within the community who may be at risk of
acquiring the human immunodeficiency virus infection, including
intravenous drug users and their partners, adolescents, gay and
bisexual individuals and women. Grants shall be awarded on a
request for proposal basis and shall include funds for
administrative costs. Priority for grants shall be given to
agencies or organizations that have experience in providing
service to the particular community which the grantee proposes
to serve; that have policymakers representative of the targeted
population; that have experience in dealing with issues relating
to HIV/AIDS; and that have the capacity to deal effectively with
persons of differing sexual orientations. For purposes of this
paragraph, the "communities of color" are: the American-Indian
community; the Hispanic community; the African-American
community; and the Asian-Pacific community.
(c) All state grants awarded under this section for
programs targeted to adolescents shall include the promotion of
abstinence from sexual activity and drug use.
Sec. 32. Minnesota Statutes 1998, section 145.9255,
subdivision 1, is amended to read:
Subdivision 1. [ESTABLISHMENT.] The commissioner of
health, in consultation with a representative from Minnesota
planning, the commissioner of human services, and the
commissioner of children, families, and learning, shall develop
and implement the Minnesota education now and babies later (MN
ENABL) program, targeted to adolescents ages 12 to 14, with the
goal of reducing the incidence of adolescent pregnancy in the
state and promoting abstinence until marriage. The program must
provide a multifaceted, primary prevention, community health
promotion approach to educating and supporting adolescents in
the decision to postpone sexual involvement modeled after the
ENABL program in California. The commissioner of health shall
consult with the chief of the health education section of the
California department of health services for general guidance in
developing and implementing the program.
Sec. 33. Minnesota Statutes 1998, section 145.9255,
subdivision 4, is amended to read:
Subd. 4. [PROGRAM COMPONENTS.] The program must include
the following four major components:
(a) A community organization component in which the
community-based local contractors shall include:
(1) use of a postponing sexual involvement education
curriculum targeted to boys and girls ages 12 to 14 in schools
and/or community settings;
(2) planning and implementing community organization
strategies to convey and reinforce the MN ENABL message of
postponing sexual involvement, including activities promoting
awareness and involvement of parents and other primary
caregivers/significant adults, schools, and community; and
(3) development of local media linkages.
(b) A statewide, comprehensive media and public relations
campaign to promote changes in sexual attitudes and behaviors,
and reinforce the message of postponing adolescent sexual
involvement and promoting abstinence from sexual activity until
marriage. Nothing in this paragraph shall be construed to
prevent the commissioner from targeting populations that
historically have had a high incidence of adolescent pregnancy
with culturally appropriate messages on abstinence from sexual
activity.
The commissioner of health, in consultation with the
commissioner of children, families, and learning, shall contract
with the attorney general's office to develop and implement the
media and public relations campaign. In developing the
campaign, the attorney general's office commissioner of health
shall coordinate and consult with representatives from ethnic
and local communities to maximize effectiveness of the social
marketing approach to health promotion among the culturally
diverse population of the state. The development and
implementation of the campaign is subject to input and approval
by the commissioner of health. The commissioner may continue to
use any campaign materials or media messages developed or
produced prior to July 1, 1999.
The local community-based contractors shall collaborate and
coordinate efforts with other community organizations and
interested persons to provide school and community-wide
promotional activities that support and reinforce the message of
the MN ENABL curriculum.
(c) An evaluation component which evaluates the process and
the impact of the program.
The "process evaluation" must provide information to the
state on the breadth and scope of the program. The evaluation
must identify program areas that might need modification and
identify local MN ENABL contractor strategies and procedures
which are particularly effective. Contractors must keep
complete records on the demographics of clients served, number
of direct education sessions delivered and other appropriate
statistics, and must document exactly how the program was
implemented. The commissioner may select contractor sites for
more in-depth case studies.
The "impact evaluation" must provide information to the
state on the impact of the different components of the MN ENABL
program and an assessment of the impact of the program on
adolescents' related sexual knowledge, attitudes, and
risk-taking behavior.
The commissioner shall compare the MN ENABL evaluation
information and data with similar evaluation data from other
states pursuing a similar adolescent pregnancy prevention
program modeled after ENABL and use the information to improve
MN ENABL and build on aspects of the program that have
demonstrated a delay in adolescent sexual involvement.
(d) A training component requiring the commissioner of
health, in consultation with the commissioner of children,
families, and learning, to provide comprehensive uniform
training to the local MN ENABL community-based local contractors
and the direct education program staff.
The local community-based contractors may use adolescent
leaders slightly older than the adolescents in the program to
impart the message to postpone sexual involvement provided:
(1) the contractor follows a protocol for adult
mentors/leaders and older adolescent leaders established by the
commissioner of health;
(2) the older adolescent leader is accompanied by an adult
leader; and
(3) the contractor uses the curriculum as directed and
required by the commissioner of the department of health to
implement this part of the program. The commissioner of health
shall provide technical assistance to community-based local
contractors.
Sec. 34. Minnesota Statutes 1998, section 148.5194,
subdivision 2, is amended to read:
Subd. 2. [BIENNIAL REGISTRATION FEE.] The fee for initial
registration and biennial registration, temporary registration,
or renewal is $160 $200.
Sec. 35. Minnesota Statutes 1998, section 148.5194,
subdivision 3, is amended to read:
Subd. 3. [BIENNIAL REGISTRATION FEE FOR DUAL REGISTRATION
AS A SPEECH-LANGUAGE PATHOLOGIST AND AUDIOLOGIST.] The fee for
initial registration and biennial registration, temporary
registration, or renewal is $160 $200.
Sec. 36. Minnesota Statutes 1998, section 148.5194, is
amended by adding a subdivision to read:
Subd. 3a. [SURCHARGE FEE.] Notwithstanding section
16A.1285, subdivision 2, for a period of four years following
the effective date of this subdivision, an applicant for
registration or registration renewal must pay a surcharge fee of
$25 in addition to any other fees due upon registration or
registration renewal. This subdivision expires June 30, 2003.
Sec. 37. Minnesota Statutes 1998, section 148.5194,
subdivision 4, is amended to read:
Subd. 4. [PENALTY FEE FOR LATE RENEWALS.] The penalty fee
for late submission of a renewal application is $15 $45.
Sec. 38. Minnesota Statutes 1998, section 256B.69,
subdivision 5c, is amended to read:
Subd. 5c. [MEDICAL EDUCATION AND RESEARCH TRUST FUND.] (a)
Beginning in January 1999 and each year thereafter:
(1) the commissioner of human services shall transfer an
amount equal to the reduction in the prepaid medical assistance
and prepaid general assistance medical care payments resulting
from clause (2), excluding nursing facility and elderly waiver
payments, to the medical education and research trust fund
established under section 62J.69 62J.692;
(2) the county medical assistance and general assistance
medical care capitation base rate prior to plan specific
adjustments shall be reduced 6.3 percent for Hennepin county,
two percent for the remaining metropolitan counties, and 1.6
percent for nonmetropolitan Minnesota counties; and
(3) the amount calculated under clause (1) shall not be
adjusted for subsequent changes to the capitation payments for
periods already paid.
(b) This subdivision shall be effective upon approval of a
federal waiver which allows federal financial participation in
the medical education and research trust fund.
Sec. 39. Minnesota Statutes 1998, section 326.40,
subdivision 2, is amended to read:
Subd. 2. [MASTER PLUMBER'S LICENSE; BOND AND; INSURANCE
REQUIREMENTS.] The applicant for a master plumber license may
give bond to the state in the total penal sum of $2,000
conditioned upon the faithful and lawful performance of all work
entered upon within the state. Any person contracting to do
plumbing work must give bond to the state in the amount of
$25,000 for all work entered into within the state. The bond
shall be for the benefit of persons injured or suffering
financial loss by reason of failure of performance to comply
with the requirements of the plumbing code. The term of the
bond shall be concurrent with the term of the license. The A
bond given to the state shall be filed with the secretary of
state and shall be in lieu of all other license bonds to any
political subdivision required for plumbing work. The bond
shall be written by a corporate surety licensed to do business
in the state.
In addition, each applicant for a master plumber license or
renewal thereof, may provide evidence of public liability
insurance, including products liability insurance with limits of
at least $50,000 per person and $100,000 per occurrence and
property damage insurance with limits of at least $10,000. The
insurance shall be written by an insurer licensed to do business
in the state of Minnesota and each licensed master plumber shall
maintain on file with the state commissioner of health a
certificate evidencing the insurance providing that the
insurance shall not be canceled without the insurer first giving
15 days written notice to the commissioner. The term of the
insurance shall be concurrent with the term of the license. The
certificate shall be in lieu of all other certificates required
by any political subdivision for licensing purposes.
Sec. 40. Minnesota Statutes 1998, section 326.40,
subdivision 4, is amended to read:
Subd. 4. [ALTERNATIVE COMPLIANCE.] Compliance with the
local bond requirements of a locale within which work is to be
performed shall be deemed to satisfy the bond and insurance
requirements of subdivision 2, provided the local ordinance
requires at least a $25,000 bond.
Sec. 41. Minnesota Statutes 1998, section 326.40,
subdivision 5, is amended to read:
Subd. 5. [FEE.] The state commissioner of health may
charge each applicant for a master plumber license or for a
renewal of a master plumber license and an additional fee person
giving bond an annual bond filing fee commensurate with the cost
of administering the bond and insurance requirements of
subdivision 2.
Sec. 42. [STUDY REGARDING THE EXPANSION OF PLUMBER
LICENSURE AND PLUMBING INSPECTION REQUIREMENTS.]
(a) The commissioner of health, in consultation with
representatives of the plumbing industry and other interested
individuals, shall study and make recommendations to the
legislature on the following issues:
(1) whether licensure requirements for plumbers should be
expanded to require all persons and firms working as master
plumbers or journeyman plumbers in any home rule city or
statutory city to be licensed by the commissioner;
(2) whether any modifications are necessary to the
education requirements for licensure for master plumbers and
journeyman plumbers;
(3) whether the commissioner may charge fees to fund the
hiring of inspectors and plan reviewers to inspect and review
all new plumbing installations, and the amounts of such fees;
and
(4) whether the commissioner's authority to inspect new
plumbing installations should be expanded to require inspections
of all new plumbing installations for new construction and
additions, regardless of location or the population of the city
or town in which the installation is located.
(b) These recommendations, and draft legislation if
appropriate, must be presented to the legislature by January 15,
2000.
Sec. 43. [CASE STUDIES TO DEVELOP STANDARDS FOR AUTOPSY
PRACTICE IN SPECIAL CASES.]
Subdivision 1. [CASE STUDIES.] (a) If a professional
association representing coroners and medical examiners in
Minnesota accepts a grant from the commissioner of health for
purposes of this section, it must comply with the terms of this
section. A professional association representing coroners and
medical examiners in Minnesota may conduct a series of case
studies to examine cases in which performing autopsies are
controversial or in which autopsies are opposed by a decedent's
relative or friend based on the decedent's religious beliefs.
The cases to be examined may be cases in which it is not
immediately apparent that an autopsy is needed to determine the
person's cause of death but that, upon further investigation,
the coroner or medical examiner determines that an autopsy is
necessary to determine the cause of death and that the cause of
death must be determined. Using these case studies, the
professional association may develop:
(1) guidelines for coroners and medical examiners regarding
when to perform autopsies in controversial situations or in
situations in which autopsies are opposed based on a decedent's
religious beliefs; and
(2) special autopsy methods and procedures, if appropriate,
for autopsies in controversial situations or situations in which
autopsies are opposed based on a decedent's religious beliefs.
(b) The professional association may conduct 12 case
studies or more for the purposes in paragraph (a). Upon
completion of the case studies, the professional association may
disseminate the guidelines and procedures developed to all
coroners and medical examiners conducting autopsies in Minnesota.
Subd. 2. [REPORT TO LEGISLATURE.] The professional
association may report to the legislature by January 15, 2000,
on the results of the case studies, the guidelines developed for
autopsy practice, the special autopsy methods and procedures
developed, and efforts or plans to disseminate the guidelines
and procedures developed to coroners and medical examiners
conducting autopsies in Minnesota.
Subd. 3. [DATA PRIVACY.] All records held by the
professional association for purposes of completing the case
studies must be held in confidence. The guidelines for
autopsies and special autopsy methods and procedures that are
disseminated to coroners and medical examiners shall contain no
individually identifiable information.
Sec. 44. [AMENDMENT TO RULES.]
The commissioner of health shall amend Minnesota Rules,
chapter 4730 to conform with Minnesota Statutes, section
144.121, subdivision 8. The amendments required by this section
may be done in the manner specified in Minnesota Statutes,
section 14.388, under the authority of clause (3) of that
section. Minnesota Statutes, section 14.386, paragraph (b),
does not apply to amendments to rules made under this section.
Sec. 45. [REPEALER.]
(a) Minnesota Statutes 1998, sections 13.99, subdivision
19m; 62J.77; 62J.78; and 62J.79, are repealed.
(b) Minnesota Statutes 1998, sections 62J.69; 144.9507,
subdivision 4; 144.9511; and 145.46, are repealed.
(c) Laws 1998, chapter 407, article 2, section 104, is
repealed.
Sec. 46. [EFFECTIVE DATE.]
(a) Sections 33 to 35 are effective January 1, 2000.
(b) Sections 16, 20 to 22, and 37 are effective the day
following final enactment.
ARTICLE 3
LONG-TERM CARE
Section 1. Minnesota Statutes 1998, section 144A.073,
subdivision 5, is amended to read:
Subd. 5. [REPLACEMENT RESTRICTIONS.] (a) Proposals
submitted or approved under this section involving replacement
must provide for replacement of the facility on the existing
site except as allowed in this subdivision.
(b) Facilities located in a metropolitan statistical area
other than the Minneapolis-St. Paul seven-county metropolitan
area may relocate to a site within the same census tract or a
contiguous census tract.
(c) Facilities located in the Minneapolis-St. Paul
seven-county metropolitan area may relocate to a site within the
same or contiguous health planning area as adopted in March 1982
by the metropolitan council.
(d) Facilities located outside a metropolitan statistical
area may relocate to a site within the same city or township, or
within a contiguous township.
(e) A facility relocated to a different site under
paragraph (b), (c), or (d) must not be relocated to a site more
than six miles from the existing site.
(f) The relocation of part of an existing first facility to
a second location, under paragraphs (d) and (e), may include the
relocation to the second location of up to four beds from part
of an existing third facility located in a township contiguous
to the location of the first facility. The six-mile limit in
paragraph (e) does not apply to this relocation from the third
facility.
(g) For proposals approved on January 13, 1994, under this
section involving the replacement of 102 licensed and certified
beds, the relocation of the existing first facility to the
second and third locations new location under paragraphs (d) and
(e) may include the relocation of up to 50 percent of the 75
beds of the existing first facility to each of the locations.
The six-mile limit in paragraph (e) does not apply to this
relocation to the third location. Notwithstanding subdivision
3, construction of this project may be commenced any time prior
to January 1, 1996.
Sec. 2. Minnesota Statutes 1998, section 144A.10, is
amended by adding a subdivision to read:
Subd. 1a. [TRAINING AND EDUCATION FOR NURSING FACILITY
PROVIDERS.] The commissioner of health must establish and
implement a prescribed process and program for providing
training and education to providers licensed by the department
of health, either by itself or in conjunction with the industry
trade associations, before using any new regulatory guideline,
regulation, interpretation, program letter or memorandum, or any
other materials used in surveyor training to survey licensed
providers. The process should include, but is not limited to,
the following key components:
(1) facilitate the implementation of immediate revisions to
any course curriculum for nursing assistants which reflect any
new standard of care practice that has been adopted or
referenced by the health department concerning the issue in
question;
(2) conduct training of long-term care providers and health
department survey inspectors either jointly or during the same
time frame on the department's new expectations; and
(3) within available resources the commissioner shall
cooperate in the development of clinical standards, work with
vendors of supplies and services regarding hazards, and identify
research of interest to the long-term care community.
Sec. 3. Minnesota Statutes 1998, section 144A.10, is
amended by adding a subdivision to read:
Subd. 12. [DATA ON FOLLOW-UP SURVEYS.] (a) If requested,
and not prohibited by federal law, the commissioner shall make
available to the nursing home associations and the public
photocopies of statements of deficiencies and related letters
from the department pertaining to federal certification
surveys. The commissioner may charge for the actual cost of
reproduction of these documents.
(b) The commissioner shall also make available on a
quarterly basis aggregate data for all statements of
deficiencies issued after federal certification follow-up
surveys related to surveys that were conducted in the quarter
prior to the immediately preceding quarter. The data shall
include the number of facilities with deficiencies, the total
number of deficiencies, the number of facilities that did not
have any deficiencies, the number of facilities for which a
resurvey or follow-up survey was not performed, and the average
number of days between the follow-up or resurvey and the exit
date of the preceding survey.
Sec. 4. Minnesota Statutes 1998, section 144A.10, is
amended by adding a subdivision to read:
Subd. 13. [NURSE AIDE TRAINING WAIVERS.] Because any
disruption or delay in the training and registration of nurse
aides may reduce access to care in certified facilities, the
commissioner shall grant all possible waivers for the
continuation of an approved nurse aide training and competency
evaluation program or nurse aide training program or competency
evaluation program conducted by or on the site of any certified
nursing facility or skilled nursing facility that would
otherwise lose approval for the program or programs. The
commissioner shall take into consideration the distance to other
training programs, the frequency of other training programs, and
the impact that the loss of the onsite training will have on the
nursing facility's ability to recruit and train nurse aides.
Sec. 5. Minnesota Statutes 1998, section 144A.10, is
amended by adding a subdivision to read:
Subd. 14. [IMMEDIATE JEOPARDY.] When conducting survey
certification and enforcement activities related to regular,
expanded, or extended surveys under Code of Federal Regulations,
title 42, part 488, the commissioner may not issue a finding of
immediate jeopardy unless the specific event or omission that
constitutes the violation of the requirements of participation
poses an imminent risk of life-threatening or serious injury to
a resident. The commissioner may not issue any findings of
immediate jeopardy after the conclusion of a regular, expanded,
or extended survey unless the survey team identified the
deficient practice or practices that constitute immediate
jeopardy and the residents at risk prior to the close of the
exit conference.
Sec. 6. Minnesota Statutes 1998, section 144A.10, is
amended by adding a subdivision to read:
Subd. 15. [INFORMAL DISPUTE RESOLUTION.] The commissioner
shall respond in writing to a request from a nursing facility
certified under the federal Medicare and Medicaid programs for
an informal dispute resolution within 30 days of the exit date
of the facility's survey. The commissioner's response shall
identify the commissioner's decision regarding the continuation
of each deficiency citation challenged by the nursing facility,
as well as a statement of any changes in findings, level of
severity or scope, and proposed remedies or sanctions for each
deficiency citation.
Sec. 7. [144A.102] [USE OF CIVIL MONEY PENALTIES; WAIVER
FROM STATE AND FEDERAL RULES AND REGULATIONS.]
By January 2000, the commissioner of health shall work with
providers to examine state and federal rules and regulations
governing the provision of care in licensed nursing facilities
and apply for federal waivers and identify necessary changes in
state law to:
(1) allow the use of civil money penalties imposed upon
nursing facilities to abate any deficiencies identified in a
nursing facility's plan of correction; and
(2) stop the accrual of any fine imposed by the health
department when a follow-up inspection survey is not conducted
by the department within the regulatory deadline.
Sec. 8. Minnesota Statutes 1998, section 144D.01,
subdivision 4, is amended to read:
Subd. 4. [HOUSING WITH SERVICES ESTABLISHMENT OR
ESTABLISHMENT.] "Housing with services establishment" or
"establishment" means an establishment providing sleeping
accommodations to one or more adult residents, at least 80
percent of which are 55 years of age or older, and offering or
providing, for a fee, one or more regularly scheduled
health-related services or two or more regularly scheduled
supportive services, whether offered or provided directly by the
establishment or by another entity arranged for by the
establishment.
Housing with services establishment does not include:
(1) a nursing home licensed under chapter 144A;
(2) a hospital, certified boarding care home, or supervised
living facility licensed under sections 144.50 to 144.56;
(3) a board and lodging establishment licensed under
chapter 157 and Minnesota Rules, parts 9520.0500 to 9520.0670,
9525.0215 to 9525.0355, 9525.0500 to 9525.0660, or 9530.4100 to
9530.4450, or under chapter 245B;
(4) a board and lodging establishment which serves as a
shelter for battered women or other similar purpose;
(5) a family adult foster care home licensed by the
department of human services;
(6) private homes in which the residents are related by
kinship, law, or affinity with the providers of services;
(7) residential settings for persons with mental
retardation or related conditions in which the services are
licensed under Minnesota Rules, parts 9525.2100 to 9525.2140, or
applicable successor rules or laws;
(8) a home-sharing arrangement such as when an elderly or
disabled person or single-parent family makes lodging in a
private residence available to another person in exchange for
services or rent, or both;
(9) a duly organized condominium, cooperative, common
interest community, or owners' association of the foregoing
where at least 80 percent of the units that comprise the
condominium, cooperative, or common interest community are
occupied by individuals who are the owners, members, or
shareholders of the units; or
(10) services for persons with developmental disabilities
that are provided under a license according to Minnesota Rules,
parts 9525.2000 to 9525.2140 in effect until January 1, 1998, or
under chapter 245B.
Sec. 9. Minnesota Statutes 1998, section 252.28,
subdivision 1, is amended to read:
Subdivision 1. [DETERMINATIONS; REDETERMINATIONS.] In
conjunction with the appropriate county boards, the commissioner
of human services shall determine, and shall redetermine at
least every four years, the need, location, size, and program of
public and private residential services and day training and
habilitation services for persons with mental retardation or
related conditions. This subdivision does not apply to
semi-independent living services and residential-based
habilitation services provided to four or fewer persons at a
single site funded as home and community-based services. A
determination of need shall not be required for a change in
ownership.
Sec. 10. [252.282] [ICF/MR LOCAL SYSTEM NEEDS PLANNING.]
Subdivision 1. [HOST COUNTY RESPONSIBILITY.] (a) For
purposes of this section, "local system needs planning" means
the determination of need for ICF/MR services by program type,
location, demographics, and size of licensed services for
persons with developmental disabilities or related conditions.
(b) This section does not apply to semi-independent living
services and residential-based habilitation services funded as
home and community-based services.
(c) In collaboration with the commissioner and ICF/MR
providers, counties shall complete a local system needs planning
process for each ICF/MR facility. Counties shall evaluate the
preferences and needs of persons with developmental disabilities
to determine resource demands through a systematic assessment
and planning process by May 15, 2000, and by July 1 every two
years thereafter beginning in 2001.
(d) A local system needs planning process shall be
undertaken more frequently when the needs or preferences of
consumers change significantly to require reformation of the
resources available to persons with developmental disabilities.
(e) A local system needs plan shall be amended anytime
recommendations for modifications to existing ICF/MR services
are made to the host county, including recommendations for:
(1) closure;
(2) relocation of services;
(3) downsizing;
(4) rate adjustments exceeding 90 days duration to address
access; or
(5) modification of existing services for which a change in
the framework of service delivery is advocated.
Subd. 2. [CONSUMER NEEDS AND PREFERENCES.] In conducting
the local system needs planning process, the host county must
use information from the individual service plans of persons for
whom the county is financially responsible and of persons from
other counties for whom the county has agreed to be the host
county. The determination of services and supports offered
within the county shall be based on the preferences and needs of
consumers. The host county shall also consider the community
social services plan, waiting lists, and other sources that
identify unmet needs for services. A review of ICF/MR facility
licensing and certification surveys, substantiated maltreatment
reports, and established service standards shall be employed to
assess the performance of providers and shall be considered in
the county's recommendations. Consumer satisfaction surveys may
also be considered in this process.
Subd. 3. [RECOMMENDATIONS.] (a) Upon completion of the
local system needs planning assessment, the host county shall
make recommendations by May 15, 2000, and by July 1 every two
years thereafter beginning in 2001. If no change is
recommended, a copy of the assessment along with corresponding
documentation shall be provided to the commissioner by July 1
prior to the contract year.
(b) Except as provided in section 252.292, subdivision 4,
recommendations regarding closures, relocations, or downsizings
that include a rate increase and recommendations regarding rate
adjustments exceeding 90 days shall be submitted to the
statewide advisory committee for review and determination, along
with the assessment, plan, and corresponding budget.
(c) Recommendations for closures, relocations, and
downsizings that do not include a rate increase and for
modification of existing services for which a change in the
framework of service delivery is necessary shall be provided to
the commissioner by July 1 prior to the contract year or at
least 90 days prior to the anticipated change, along with the
assessment and corresponding documentation.
Subd. 4. [THE STATEWIDE ADVISORY COMMITTEE.] (a) The
commissioner shall appoint a five-member statewide advisory
committee. The advisory committee shall include representatives
of providers and counties and the commissioner or the
commissioner's designee.
(b) The criteria for ranking proposals, already developed
in 1997 by a task force authorized by the legislature, shall be
adopted and incorporated into the decision-making process.
Specific guidelines, including time frame for submission of
requests, shall be established and announced through the State
Register, and all requests shall be considered in comparison to
each other and the ranking criteria. The advisory committee
shall review and recommend requests for facility rate
adjustments to address closures, downsizing, relocation, or
access needs within the county and shall forward recommendations
and documentation to the commissioner. The committee shall
ensure that:
(1) applications are in compliance with applicable state
and federal law and with the state plan; and
(2) cost projections for the proposed service are within
fiscal limitations.
(c) The advisory committee shall review proposals and
submit recommendations to the commissioner within 60 days
following the published deadline for submission under
subdivision 5.
Subd. 5. [RESPONSIBILITIES OF THE COMMISSIONER.] (a) In
collaboration with counties, providers, and the statewide
advisory committee, the commissioner shall ensure that services
recognize the preferences and needs of persons with
developmental disabilities and related conditions through a
recurring systemic review and assessment of ICF/MR facilities
within the state.
(b) The commissioner shall publish a notice in the State
Register twice each calendar year to announce the opportunity
for counties or providers to submit requests for rate
adjustments associated with plans for downsizing, relocation,
and closure of ICF/MR facilities.
(c) The commissioner shall designate funding parameters to
counties and to the statewide advisory committee for the overall
implementation of system needs within the fiscal resources
allocated by the legislature.
(d) The commissioner shall contract with ICF/MR providers.
The initial contracts shall cover the period from October 1,
2000, to December 31, 2001. Subsequent contracts shall be for
two-year periods beginning January 1, 2002.
Sec. 11. Minnesota Statutes 1998, section 252.291, is
amended by adding a subdivision to read:
Subd. 2a. [EXCEPTION FOR LAKE OWASSO PROJECT.] (a) The
commissioner shall authorize and grant a license under chapter
245A to a new intermediate care facility for persons with mental
retardation effective January 1, 2000, under the following
circumstances:
(1) the new facility replaces an existing 64-bed
intermediate care facility for the mentally retarded located in
Ramsey county;
(2) the new facility is located upon a parcel of land
contiguous to the parcel upon which the existing 64-bed facility
is located;
(3) the new facility is comprised of no more than eight
twin home style buildings and an administration building;
(4) the total licensed bed capacity of the facility does
not exceed 64 beds; and
(5) the existing 64-bed facility is demolished.
(b) The medical assistance payment rate for the new
facility shall be the higher of the rate specified in paragraph
(c) or as otherwise provided by law.
(c) The new facility shall be considered a newly
established facility for rate setting purposes, and shall be
eligible for the investment per bed limit specified in section
256B.501, subdivision 11, paragraph (c), and the interest
expense limitation specified in section 256B.501, subdivision
11, paragraph (d). Notwithstanding section 256B.5011, the newly
established facility's initial payment rate shall be set
according to Minnesota Rules, part 9553.0075, and shall not be
subject to the provisions of section 256B.501, subdivision 5b.
(d) During the construction of the new facility, Ramsey
county shall work with residents, families, and service
providers to explore all service options open to current
residents of the facility.
Sec. 12. Minnesota Statutes 1998, section 256B.0911,
subdivision 6, is amended to read:
Subd. 6. [PAYMENT FOR PREADMISSION SCREENING.] (a) The
total screening payment for each county must be paid monthly by
certified nursing facilities in the county. The monthly amount
to be paid by each nursing facility for each fiscal year must be
determined by dividing the county's annual allocation for
screenings by 12 to determine the monthly payment and allocating
the monthly payment to each nursing facility based on the number
of licensed beds in the nursing facility.
(b) The commissioner shall include the total annual payment
for screening for each nursing facility according to section
256B.431, subdivision 2b, paragraph (g), or 256B.435.
(c) Payments for screening activities are available to the
county or counties to cover staff salaries and expenses to
provide the screening function. The lead agency shall employ,
or contract with other agencies to employ, within the limits of
available funding, sufficient personnel to conduct the
preadmission screening activity while meeting the state's
long-term care outcomes and objectives as defined in section
256B.0917, subdivision 1. The local agency shall be accountable
for meeting local objectives as approved by the commissioner in
the CSSA biennial plan.
(c) (d) Notwithstanding section 256B.0641, overpayments
attributable to payment of the screening costs under the medical
assistance program may not be recovered from a facility.
(d) (e) The commissioner of human services shall amend the
Minnesota medical assistance plan to include reimbursement for
the local screening teams.
Sec. 13. Minnesota Statutes 1998, 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;
(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.; and
(19) other services including direct cash payments to
clients, approved by the county agency, subject to the
provisions of paragraph (m). Total annual payments for other
services for all clients within a county may not exceed either
ten percent of that county's annual alternative care program
base allocation or $5,000, whichever is greater. In no case
shall this amount exceed the county's total annual alternative
care program base allocation.
(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. Except for the county
agencies' approval of direct cash payments to clients, 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) 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 which are not subject to registration under chapter
144D. 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 157.011 and 157.15 to 157.22.
(i) For establishments registered under chapter 144D,
assisted living services under this section means the services
described and licensed under section 144A.4605.
(j) 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
based on an individualized service plan for each resident. 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, unless the services are provided by a home care
provider licensed by the department of health and are provided
in a building that is registered as a housing with services
establishment under chapter 144D and that provides 24-hour
supervision.
(k) 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.
(l) 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.
(m) A county agency may make payment from their alternative
care program allocation for other services provided to an
alternative care program recipient if those services prevent,
shorten, or delay institutionalization. These services may
include direct cash payments to the recipient for the purpose of
purchasing the recipient's services. The following provisions
apply to payments under this paragraph:
(1) a cash payment to a client under this provision cannot
exceed 80 percent of the monthly payment limit for that client
as specified in subdivision 4, paragraph (a), clause (7);
(2) a county may not approve any cash payment for a client
who has been assessed as having a dependency in orientation,
unless the client has an authorized representative under section
256.476, subdivision 2, paragraph (g), or for a client who is
concurrently receiving adult foster care, residential care, or
assisted living services;
(3) any service approved under this section must be a
service which meets the purpose and goals of the program as
listed in subdivision 1;
(4) cash payments must also meet the criteria in section
256.476, subdivision 4, paragraph (b), and recipients of cash
grants must meet the requirements in section 256.476,
subdivision 10; and
(5) the county shall report client outcomes, services, and
costs under this paragraph in a manner prescribed by the
commissioner.
Upon implementation of direct cash payments to clients under
this section, any person determined eligible for the alternative
care program who chooses a cash payment approved by the county
agency shall receive the cash payment under this section and not
under section 256.476 unless the person was receiving a consumer
support grant under section 256.476 before implementation of
direct cash payments under this section.
Sec. 14. Minnesota Statutes 1998, section 256B.0913,
subdivision 10, is amended to read:
Subd. 10. [ALLOCATION FORMULA.] (a) The alternative care
appropriation for fiscal years 1992 and beyond shall cover only
180-day eligible clients.
(b) Prior to July 1 of each year, the commissioner shall
allocate to county agencies the state funds available for
alternative care for persons eligible under subdivision 2. The
allocation for fiscal year 1992 shall be calculated using a base
that is adjusted to exclude the medical assistance share of
alternative care expenditures. The adjusted base is calculated
by multiplying each county's allocation for fiscal year 1991 by
the percentage of county alternative care expenditures for
180-day eligible clients. The percentage is determined based on
expenditures for services rendered in fiscal year 1989 or
calendar year 1989, whichever is greater.
(c) If the county expenditures for 180-day eligible clients
are 95 percent or more of its adjusted base allocation, the
allocation for the next fiscal year is 100 percent of the
adjusted base, plus inflation to the extent that inflation is
included in the state budget.
(d) If the county expenditures for 180-day eligible clients
are less than 95 percent of its adjusted base allocation, the
allocation for the next fiscal year is the adjusted base
allocation less the amount of unspent funds below the 95 percent
level.
(e) For fiscal year 1992 only, a county may receive an
increased allocation if annualized service costs for the month
of May 1991 for 180-day eligible clients are greater than the
allocation otherwise determined. A county may apply for this
increase by reporting projected expenditures for May to the
commissioner by June 1, 1991. The amount of the allocation may
exceed the amount calculated in paragraph (b). The projected
expenditures for May must be based on actual 180-day eligible
client caseload and the individual cost of clients' care plans.
If a county does not report its expenditures for May, the amount
in paragraph (c) or (d) shall be used.
(f) Calculations for paragraphs (c) and (d) are to be made
as follows: for each county, the determination of expenditures
shall be based on payments for services rendered from April 1
through March 31 in the base year, to the extent that claims
have been submitted by June 1 of that year. Calculations for
paragraphs (c) and (d) must also include the funds transferred
to the consumer support grant program for clients who have
transferred to that program from April 1 through March 31 in the
base year.
(g) For the biennium ending June 30, 2001, the allocation
of state funds to county agencies shall be calculated as
described in paragraphs (c) and (d). If the annual legislative
appropriation for the alternative care program is inadequate to
fund the combined county allocations for fiscal year 2000 or
2001, the commissioner shall distribute to each county the
entire annual appropriation as that county's percentage of the
computed base as calculated in paragraph (f).
Sec. 15. Minnesota Statutes 1998, section 256B.0913,
subdivision 12, is amended to read:
Subd. 12. [CLIENT PREMIUMS.] (a) A premium is required for
all 180-day eligible clients to help pay for the cost of
participating in the program. The amount of the premium for the
alternative care client shall be determined as follows:
(1) when the alternative care client's income less
recurring and predictable medical expenses is greater than the
medical assistance income standard but less than 150 percent of
the federal poverty guideline, and total assets are less than
$6,000 $10,000, the fee is zero;
(2) when the alternative care client's income less
recurring and predictable medical expenses is greater than 150
percent of the federal poverty guideline, and total assets are
less than $6,000 $10,000, the fee is 25 percent of the cost of
alternative care services or the difference between 150 percent
of the federal poverty guideline and the client's income less
recurring and predictable medical expenses, whichever is less;
and
(3) when the alternative care client's total assets are
greater than $6,000 $10,000, the fee is 25 percent of the cost
of alternative care services.
For married persons, total assets are defined as the total
marital assets less the estimated community spouse asset
allowance, under section 256B.059, if applicable. For married
persons, total income is defined as the client's income less the
monthly spousal allotment, under section 256B.058.
All alternative care services except case management shall
be included in the estimated costs for the purpose of
determining 25 percent of the costs.
The monthly premium shall be calculated based on the cost
of the first full month of alternative care services and shall
continue unaltered until the next reassessment is completed or
at the end of 12 months, whichever comes first. Premiums are
due and payable each month alternative care services are
received unless the actual cost of the services is less than the
premium.
(b) The fee shall be waived by the commissioner when:
(1) a person who is residing in a nursing facility is
receiving case management only;
(2) a person is applying for medical assistance;
(3) a married couple is requesting an asset assessment
under the spousal impoverishment provisions;
(4) a person is a medical assistance recipient, but has
been approved for alternative care-funded assisted living
services;
(5) a person is found eligible for alternative care, but is
not yet receiving alternative care services; or
(6) a person's fee under paragraph (a) is less than $25.
(c) The county agency must collect the premium from the
client and forward the amounts collected to the commissioner in
the manner and at the times prescribed by the commissioner.
Money collected must be deposited in the general fund and is
appropriated to the commissioner for the alternative care
program. The client must supply the county with the client's
social security number at the time of application. If a client
fails or refuses to pay the premium due, the county shall supply
the commissioner with the client's social security number and
other information the commissioner requires to collect the
premium from the client. The commissioner shall collect unpaid
premiums using the Revenue Recapture Act in chapter 270A and
other methods available to the commissioner. The commissioner
may require counties to inform clients of the collection
procedures that may be used by the state if a premium is not
paid.
(d) The commissioner shall begin to adopt emergency or
permanent rules governing client premiums within 30 days after
July 1, 1991, including criteria for determining when services
to a client must be terminated due to failure to pay a premium.
Sec. 16. Minnesota Statutes 1998, section 256B.0913,
subdivision 16, is amended to read:
Subd. 16. [CONVERSION OF ENROLLMENT.] Upon approval of the
elderly waiver amendments described in section 256B.0915,
subdivision 1d, persons currently receiving services shall have
their eligibility for the elderly waiver program determined
under section 256B.0915. Persons currently receiving
alternative care services whose income is under the special
income standard according to Code of Federal Regulations, title
42, section 435.236, who are eligible for the elderly waiver
program shall be transferred to that program and shall receive
priority access to elderly waiver slots for six months after
implementation of this subdivision, except that persons whose
income is above the maintenance needs amount described in
section 256B.0915, subdivision 1d, paragraph (a), shall have the
option of remaining in the alternative care program. Persons
currently enrolled in the alternative care program who are not
eligible for the elderly waiver program shall continue to be
eligible for the alternative care program as long as continuous
eligibility is maintained. Continued eligibility for the
alternative care program shall be reviewed every six months.
Persons who apply for the alternative care program after
approval of the elderly waiver amendments in section 256B.0915,
subdivision 1d, are not eligible for alternative care if they
would qualify for the elderly waiver, with or without a
spenddown. Persons who apply for the alternative care program
after approval of the elderly waiver amendments in section
256B.0915, subdivision 1d, whose income is under the special
income standard according to Code of Federal Regulations, title
42, section 435.236, are not eligible for alternative care if
they would qualify for the elderly waiver, except that persons
whose income is above the maintenance needs amount described in
section 256B.0915, subdivision 1d, paragraph (a), shall have the
option of remaining in the alternative care program.
Sec. 17. Minnesota Statutes 1998, section 256B.431,
subdivision 2i, is amended to read:
Subd. 2i. [OPERATING COSTS AFTER JULY 1, 1988.] (a)
[OTHER OPERATING COST LIMITS.] For the rate year beginning July
1, 1988, the commissioner shall increase the other operating
cost limits established in Minnesota Rules, part 9549.0055,
subpart 2, item E, to 110 percent of the median of the array of
allowable historical other operating cost per diems and index
these limits as in Minnesota Rules, part 9549.0056, subparts 3
and 4. The limits must be established in accordance with
subdivision 2b, paragraph (d). For rate years beginning on or
after July 1, 1989, the adjusted other operating cost limits
must be indexed as in Minnesota Rules, part 9549.0056, subparts
3 and 4. For the rate period beginning October 1, 1992, and for
rate years beginning after June 30, 1993, the amount of the
surcharge under section 256.9657, subdivision 1, shall be
included in the plant operations and maintenance operating cost
category. The surcharge shall be an allowable cost for the
purpose of establishing the payment rate.
(b) [CARE-RELATED OPERATING COST LIMITS.] For the rate year
beginning July 1, 1988, the commissioner shall increase the
care-related operating cost limits established in Minnesota
Rules, part 9549.0055, subpart 2, items A and B, to 125 percent
of the median of the array of the allowable historical case mix
operating cost standardized per diems and the allowable
historical other care-related operating cost per diems and index
those limits as in Minnesota Rules, part 9549.0056, subparts 1
and 2. The limits must be established in accordance with
subdivision 2b, paragraph (d). For rate years beginning on or
after July 1, 1989, the adjusted care-related limits must be
indexed as in Minnesota Rules, part 9549.0056, subparts 1 and 2.
(c) [SALARY ADJUSTMENT PER DIEM.] Effective July 1, 1998,
to June 30, 2000, the commissioner shall make available the
salary adjustment per diem calculated in clause (1) or (2) to
the total operating cost payment rate of each nursing facility
reimbursed under this section or section 256B.434. The salary
adjustment per diem for each nursing facility must be determined
as follows:
(1) For each nursing facility that reports salaries for
registered nurses, licensed practical nurses, and aides,
orderlies and attendants separately, the commissioner shall
determine the salary adjustment per diem by multiplying the
total salaries, payroll taxes, and fringe benefits allowed in
each operating cost category, except management fees and
administrator and central office salaries and the related
payroll taxes and fringe benefits, by 3.0 percent and then
dividing the resulting amount by the nursing facility's actual
resident days.
(2) For each nursing facility that does not report salaries
for registered nurses, licensed practical nurses, aides,
orderlies, and attendants separately, the salary adjustment per
diem is the weighted average salary adjustment per diem increase
determined under clause (1).
(3) A nursing facility may apply for the salary adjustment
per diem calculated under clauses (1) and (2). The application
must be made to the commissioner and contain a plan by which the
nursing facility will distribute the salary adjustment to
employees of the nursing facility. In order to apply for a
salary adjustment, a nursing facility reimbursed under section
256B.434, must report the information required by clause (1) or
(2) in the application, in the manner specified by the
commissioner. For nursing facilities in which the employees are
represented by an exclusive bargaining representative, an
agreement negotiated and agreed to by the employer and the
exclusive bargaining representative, after July 1, 1998, may
constitute the plan for the salary distribution. The
commissioner shall review the plan to ensure that the salary
adjustment per diem is used solely to increase the compensation
of nursing home facility employees. To be eligible, a facility
must submit its plan for the salary distribution by December 31,
1998. If a facility's plan for salary distribution is effective
for its employees after July 1, 1998, the salary adjustment cost
per diem shall be effective the same date as its plan.
(4) Additional costs incurred by nursing facilities as a
result of this salary adjustment are not allowable costs for
purposes of the September 30, 1998, cost report.
(d) [NEW BASE YEAR.] The commissioner shall establish new
base years for both the reporting year ending September 30,
1989, and the reporting year ending September 30, 1990. In
establishing new base years, the commissioner must take into
account:
(1) statutory changes made in geographic groups;
(2) redefinitions of cost categories; and
(3) reclassification, pass-through, or exemption of certain
costs such as Public Employee Retirement Act contributions.
(e) (d) [NEW BASE YEAR.] The commissioner shall establish a
new base year for the reporting years ending September 30, 1991,
and September 30, 1992. In establishing a new base year, the
commissioner must take into account:
(1) statutory changes made in geographic groups;
(2) redefinitions of cost categories; and
(3) reclassification, pass-through, or exemption of certain
costs.
Sec. 18. Minnesota Statutes 1998, section 256B.431,
subdivision 17, is amended to read:
Subd. 17. [SPECIAL PROVISIONS FOR MORATORIUM EXCEPTIONS.]
(a) Notwithstanding Minnesota Rules, part 9549.0060, subpart 3,
for rate periods beginning on October 1, 1992, and for rate
years beginning after June 30, 1993, a nursing facility that (1)
has completed a construction project approved under section
144A.071, subdivision 4a, clause (m); (2) has completed a
construction project approved under section 144A.071,
subdivision 4a, and effective after June 30, 1995; or (3) has
completed a renovation, replacement, or upgrading project
approved under the moratorium exception process in section
144A.073 shall be reimbursed for costs directly identified to
that project as provided in subdivision 16 and this subdivision.
(b) Notwithstanding Minnesota Rules, part 9549.0060,
subparts 5, item A, subitems (1) and (3), and 7, item D,
allowable interest expense on debt shall include:
(1) interest expense on debt related to the cost of
purchasing or replacing depreciable equipment, excluding
vehicles, not to exceed six percent of the total historical cost
of the project; and
(2) interest expense on debt related to financing or
refinancing costs, including costs related to points, loan
origination fees, financing charges, legal fees, and title
searches; and issuance costs including bond discounts, bond
counsel, underwriter's counsel, corporate counsel, printing, and
financial forecasts. Allowable debt related to items in this
clause shall not exceed seven percent of the total historical
cost of the project. To the extent these costs are financed,
the straight-line amortization of the costs in this clause is
not an allowable cost; and
(3) interest on debt incurred for the establishment of a
debt reserve fund, net of the interest earned on the debt
reserve fund.
(c) Debt incurred for costs under paragraph (b) is not
subject to Minnesota Rules, part 9549.0060, subpart 5, item A,
subitem (5) or (6).
(d) The incremental increase in a nursing facility's rental
rate, determined under Minnesota Rules, parts 9549.0010 to
9549.0080, and this section, resulting from the acquisition of
allowable capital assets, and allowable debt and interest
expense under this subdivision shall be added to its
property-related payment rate and shall be effective on the
first day of the month following the month in which the
moratorium project was completed.
(e) Notwithstanding subdivision 3f, paragraph (a), for rate
periods beginning on October 1, 1992, and for rate years
beginning after June 30, 1993, the replacement-costs-new per bed
limit to be used in Minnesota Rules, part 9549.0060, subpart 4,
item B, for a nursing facility that has completed a renovation,
replacement, or upgrading project that has been approved under
the moratorium exception process in section 144A.073, or that
has completed an addition to or replacement of buildings,
attached fixtures, or land improvements for which the total
historical cost exceeds the lesser of $150,000 or ten percent of
the most recent appraised value, must be $47,500 per licensed
bed in multiple-bed rooms and $71,250 per licensed bed in a
single-bed room. These amounts must be adjusted annually as
specified in subdivision 3f, paragraph (a), beginning January 1,
1993.
(f) A nursing facility that completes a project identified
in this subdivision and, as of April 17, 1992, has not been
mailed a rate notice with a special appraisal for a completed
project, or completes a project after April 17, 1992, but before
September 1, 1992, may elect either to request a special
reappraisal with the corresponding adjustment to the
property-related payment rate under the laws in effect on June
30, 1992, or to submit their capital asset and debt information
after that date and obtain the property-related payment rate
adjustment under this section, but not both.
(g) For purposes of this paragraph, a total replacement
means the complete replacement of the nursing facility's
physical plant through the construction of a new physical plant
or the transfer of the nursing facility's license from one
physical plant location to another. For total replacement
projects completed on or after July 1, 1992, the commissioner
shall compute the incremental change in the nursing facility's
rental per diem, for rate years beginning on or after July 1,
1995, by replacing its appraised value, including the historical
capital asset costs, and the capital debt and interest costs
with the new nursing facility's allowable capital asset costs
and the related allowable capital debt and interest costs. If
the new nursing facility has decreased its licensed capacity,
the aggregate investment per bed limit in subdivision 3a,
paragraph (d), shall apply. If the new nursing facility has
retained a portion of the original physical plant for nursing
facility usage, then a portion of the appraised value prior to
the replacement must be retained and included in the calculation
of the incremental change in the nursing facility's rental per
diem. For purposes of this part, the original nursing facility
means the nursing facility prior to the total replacement
project. The portion of the appraised value to be retained
shall be calculated according to clauses (1) to (3):
(1) The numerator of the allocation ratio shall be the
square footage of the area in the original physical plant which
is being retained for nursing facility usage.
(2) The denominator of the allocation ratio shall be the
total square footage of the original nursing facility physical
plant.
(3) Each component of the nursing facility's allowable
appraised value prior to the total replacement project shall be
multiplied by the allocation ratio developed by dividing clause
(1) by clause (2).
In the case of either type of total replacement as
authorized under section 144A.071 or 144A.073, the provisions of
this subdivision shall also apply. For purposes of the
moratorium exception authorized under section 144A.071,
subdivision 4a, paragraph (s), if the total replacement involves
the renovation and use of an existing health care facility
physical plant, the new allowable capital asset costs and
related debt and interest costs shall include first the
allowable capital asset costs and related debt and interest
costs of the renovation, to which shall be added the allowable
capital asset costs of the existing physical plant prior to the
renovation, and if reported by the facility, the related
allowable capital debt and interest costs.
(h) Notwithstanding Minnesota Rules, part 9549.0060,
subpart 11, item C, subitem (2), for a total replacement, as
defined in paragraph (g), authorized under section 144A.071 or
144A.073 after July 1, 1999, the replacement-costs-new per bed
limit shall be $74,280 per licensed bed in multiple-bed rooms,
$92,850 per licensed bed in semiprivate rooms with a fixed
partition separating the resident beds, and $111,420 per
licensed bed in single rooms. Minnesota Rules, part 9549.0060,
subpart 11, item C, subitem (2), does not apply. These amounts
must be adjusted annually as specified in subdivision 3f,
paragraph (a), beginning January 1, 2000.
(i) For a total replacement, as defined in paragraph (g),
authorized under section 144A.073 for a 96-bed nursing home in
Carlton county, the replacement costs new per bed limit shall be
$74,280 per licensed bed in multiple-bed rooms, $92,850 per
licensed bed in semiprivate rooms with a fixed partition
separating the resident's beds, and $111,420 per licensed bed in
a single room. Minnesota Rules, part 9549.0060, subpart 11,
item C, subitem (2), does not apply. The resulting maximum
allowable replacement costs new multiplied by 1.25 shall
constitute the project's dollar threshold for purposes of
application of the limit set forth in section 144A.071,
subdivision 2. The commissioner of health may waive the
requirements of section 144A.073, subdivision 3b, paragraph (b),
clause (2), on the condition that the other requirements of that
paragraph are met.
Sec. 19. Minnesota Statutes 1998, section 256B.431,
subdivision 26, is amended to read:
Subd. 26. [CHANGES TO NURSING FACILITY REIMBURSEMENT
BEGINNING JULY 1, 1997.] The nursing facility reimbursement
changes in paragraphs (a) to (f) shall apply in the sequence
specified in Minnesota Rules, parts 9549.0010 to 9549.0080, and
this section, beginning July 1, 1997.
(a) For rate years beginning on or after July 1, 1997, the
commissioner shall limit a nursing facility's allowable
operating per diem for each case mix category for each rate year.
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:
(1) is at or 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 diem
as specified in Laws 1996, chapter 451, article 3, section 11,
paragraph (h), plus the inflation factor as established in
paragraph (d), clause (2), increased by two percentage points,
or the current reporting year's corresponding allowable
operating cost per diem; or
(2) is 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 diem as specified
in Laws 1996, chapter 451, article 3, section 11, paragraph (h),
plus the inflation factor as established in paragraph (d),
clause (2), increased by one percentage point, or the current
reporting year's corresponding allowable operating cost per diem.
For purposes of paragraph (a), if a nursing facility
reports on its cost report a reduction in cost due to a refund
or credit for a rate year beginning on or after July 1, 1998,
the commissioner shall increase that facility's spend-up limit
for the rate year following the current rate year by the amount
of the cost reduction divided by its resident days for the
reporting year preceding the rate year in which the adjustment
is to be made.
(b) For rate years beginning on or after July 1, 1997, the
commissioner shall limit the allowable operating cost per diem
for high cost nursing facilities. After application of the
limits in paragraph (a) to each nursing facility's operating
cost per diem, 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 diem 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 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 exceeds 1.0 standard deviation above the median, the
commissioner shall reduce their allowable operating cost per
diem 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 diem by two percent.
However, in no case shall a nursing facility's operating cost
per diem be reduced below its grouping's limit established at
0.5 standard deviations above the median.
(c) For rate years beginning on or after July 1, 1997, 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).
(d) For rate years beginning on or after July 1, 1997, the
forecasted price index for a nursing facility's allowable
operating cost per diem shall be determined under clauses (1)
and (2) using the change in the Consumer Price Index-All Items
(United States city average) (CPI-U) as forecasted by Data
Resources, Inc. 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).
(1) The CPI-U forecasted index for allowable operating cost
per diem 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) For rate years beginning on or after July 1, 1997, 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.
(e) After applying these provisions for the respective rate
years, the commissioner shall index these allowable operating
cost per diem by the inflation factor provided for in paragraph
(d), clause (1), and add the nursing facility's efficiency
incentive as computed in paragraph (c).
(f) For rate years beginning on or after July 1, 1997, the
total operating cost payment rates for a nursing facility shall
be the greater of the total operating cost payment rates
determined under this section or the total operating cost
payment rates in effect on June 30, 1997, subject to rate
adjustments due to field audit or rate appeal resolution. This
provision shall not apply to subsequent field audit adjustments
of the nursing facility's operating cost rates for rate years
beginning on or after July 1, 1997.
(g) For the rate years beginning on July 1, 1997, July 1,
1998, and July 1, 1999, 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 (a) and (b).
(h) For a nursing facility whose construction project was
authorized according to section 144A.073, subdivision 5,
paragraph (g), the operating cost payment rates for the third
new location shall be determined based on Minnesota Rules, part
9549.0057. The relocation allowed under section 144A.073,
subdivision 5, paragraph (g), and the rate determination allowed
under this paragraph must meet the cost neutrality requirements
of section 144A.073, subdivision 3c. Paragraphs (a) and (b)
shall not apply until the second rate year after the settle-up
cost report is filed. Notwithstanding subdivision 2b, paragraph
(g), real estate taxes and special assessments payable by
the third new location, a 501(c)(3) nonprofit corporation, shall
be included in the payment rates determined under this
subdivision for all subsequent rate years.
(i) For the rate year beginning July 1, 1997, the
commissioner shall compute the payment rate for a nursing
facility licensed for 94 beds on September 30, 1996, that
applied in October 1993 for approval of a total replacement
under the moratorium exception process in section 144A.073, and
completed the approved replacement in June 1995, with other
operating cost spend-up limit under paragraph (a), increased by
$3.98, and after computing the facility's payment rate according
to this section, the commissioner shall make a one-year positive
rate adjustment of $3.19 for operating costs related to the
newly constructed total replacement, without application of
paragraphs (a) and (b). The facility's per diem, before the
$3.19 adjustment, shall be used as the prior reporting year's
allowable operating cost per diem for payment rate calculation
for the rate year beginning July 1, 1998. A facility described
in this paragraph is exempt from paragraph (b) for the rate
years beginning July 1, 1997, and July 1, 1998.
(j) For the purpose of applying the limit stated in
paragraph (a), a nursing facility in Kandiyohi county licensed
for 86 beds that was granted hospital-attached status on
December 1, 1994, shall have the prior year's allowable
care-related per diem increased by $3.207 and the prior year's
other operating cost per diem increased by $4.777 before adding
the inflation in paragraph (d), clause (2), for the rate year
beginning on July 1, 1997.
(k) For the purpose of applying the limit stated in
paragraph (a), a 117 bed nursing facility located in Pine county
shall have the prior year's allowable other operating cost per
diem increased by $1.50 before adding the inflation in paragraph
(d), clause (2), for the rate year beginning on July 1, 1997.
(l) For the purpose of applying the limit under paragraph
(a), a nursing facility in Hibbing licensed for 192 beds shall
have the prior year's allowable other operating cost per diem
increased by $2.67 before adding the inflation in paragraph (d),
clause (2), for the rate year beginning July 1, 1997.
Sec. 20. Minnesota Statutes 1998, section 256B.431, is
amended by adding a subdivision to read:
Subd. 28. [NURSING FACILITY RATE INCREASES BEGINNING JULY
1, 1999, AND JULY 1, 2000.] (a) For the rate years beginning
July 1, 1999, and July 1, 2000, the commissioner shall make
available to each nursing facility reimbursed under this section
or section 256B.434 an adjustment to the total operating payment
rate. For each facility, total operating costs shall be
separated into costs that are compensation related and all other
costs. Compensation related costs include salaries, payroll
taxes, and fringe benefits for all employees except management
fees, the administrator, and central office staff.
(b) For the rate year beginning July 1, 1999, the
commissioner shall make available a rate increase for
compensation related costs of 4.843 percent and a rate increase
for all other operating costs of 3.446 percent.
(c) For the rate year beginning July 1, 2000, the
commissioner shall make available a rate increase for
compensation related costs of 3.632 percent and a rate increase
for all other operating costs of 2.585 percent.
(d) The payment rate adjustment for each nursing facility
must be determined under clause (1) or (2):
(1) for each nursing facility that reports salaries for
registered nurses, licensed practical nurses, aides, orderlies,
and attendants separately, the commissioner shall determine the
payment rate adjustment using the categories specified in
paragraph (a) multiplied by the rate increases specified in
paragraph (b) or (c), and then dividing the resulting amount by
the nursing facility's actual resident days. In determining the
amount of a payment rate adjustment for a nursing facility
reimbursed under section 256B.434, the commissioner shall
determine the proportions of the facility's rates that are
compensation related costs and all other operating costs based
on the facility's most recent cost report; and
(2) for each nursing facility that does not report salaries
for registered nurses, licensed practical nurses, aides,
orderlies, and attendants separately, the payment rate
adjustment shall be computed using the facility's total
operating costs, separated into the categories specified in
paragraph (a) in proportion to the weighted average of all
facilities determined under clause (1), multiplied by the rate
increases specified in paragraph (b) or (c), and then dividing
the resulting amount by the nursing facility's actual resident
days.
(e) A nursing facility may apply for the
compensation-related payment rate adjustment calculated under
this subdivision. The application must be made to the
commissioner and contain a plan by which the nursing facility
will distribute the compensation-related portion of the payment
rate adjustment to employees of the nursing facility. For
nursing facilities in which the employees are represented by an
exclusive bargaining representative, an agreement negotiated and
agreed to by the employer and the exclusive bargaining
representative constitutes the plan. The commissioner shall
review the plan to ensure that the payment rate adjustment per
diem is used as provided in paragraphs (a) to (c). To be
eligible, a facility must submit its plan for the compensation
distribution by December 31 each year. A facility may amend its
plan for the second rate year by submitting a revised plan by
December 31, 2000. If a facility's plan for compensation
distribution is effective for its employees after July 1 of the
year that the funds are available, the payment rate adjustment
per diem shall be effective the same date as its plan.
(f) A copy of the approved distribution plan must be made
available to all employees. This must be done by giving each
employee a copy or by posting it in an area of the nursing
facility to which all employees have access. If an employee
does not receive the compensation adjustment described in their
facility's approved plan and is unable to resolve the problem
with the facility's management or through the employee's union
representative, the employee may contact the commissioner at an
address or phone number provided by the commissioner and
included in the approved plan.
(g) If the reimbursement system under section 256B.435 is
not implemented until July 1, 2001, the salary adjustment per
diem authorized in subdivision 2i, paragraph (c), shall continue
until June 30, 2001.
(h) For the rate year beginning July 1, 1999, the following
nursing facilities shall be allowed a rate increase equal to 67
percent of the rate increase that would be allowed if
subdivision 26, paragraph (a), was not applied:
(1) a nursing facility in Carver county licensed for 33
nursing home beds and four boarding care beds;
(2) a nursing facility in Faribault county licensed for 159
nursing home beds on September 30, 1998; and
(3) a nursing facility in Houston county licensed for 68
nursing home beds on September 30, 1998.
(i) For the rate year beginning July 1, 1999, the following
nursing facilities shall be allowed a rate increase equal to 67
percent of the rate increase that would be allowed if
subdivision 26, paragraphs (a) and (b), were not applied:
(1) a nursing facility in Chisago county licensed for 135
nursing home beds on September 30, 1998; and
(2) a nursing facility in Murray county licensed for 62
nursing home beds on September 30, 1998.
(j) For the rate year beginning July 1, 1999, a nursing
facility in Hennepin county licensed for 134 beds on September
30, 1998, shall:
(1) have the prior year's allowable care-related per diem
increased by $3.93 and the prior year's other operating cost per
diem increased by $1.69 before adding the inflation in
subdivision 26, paragraph (d), clause (2); and
(2) be allowed a rate increase equal to 67 percent of the
rate increase that would be allowed if subdivision 26,
paragraphs (a) and (b), were not applied.
Sec. 21. Minnesota Statutes 1998, section 256B.434,
subdivision 3, is amended to read:
Subd. 3. [DURATION AND TERMINATION OF CONTRACTS.] (a)
Subject to available resources, the commissioner may begin to
execute contracts with nursing facilities November 1, 1995.
(b) All contracts entered into under this section are for a
term of one year. Either party may terminate a contract at any
time without cause by providing 30 90 calendar days advance
written notice to the other party. The decision to terminate a
contract is not appealable. If neither party provides written
notice of termination the contract shall be renegotiated for
additional one-year terms, for up to a total of four consecutive
one-year terms Notwithstanding section 16C.05, subdivision 2,
paragraph (a), clause (5), the contract shall be renegotiated
for additional one-year terms, unless either party provides
written notice of termination. The provisions of the contract
shall be renegotiated annually by the parties prior to the
expiration date of the contract. The parties may voluntarily
renegotiate the terms of the contract at any time by mutual
agreement.
(c) If a nursing facility fails to comply with the terms of
a contract, the commissioner shall provide reasonable notice
regarding the breach of contract and a reasonable opportunity
for the facility to come into compliance. If the facility fails
to come into compliance or to remain in compliance, the
commissioner may terminate the contract. If a contract is
terminated, the contract payment remains in effect for the
remainder of the rate year in which the contract was terminated,
but in all other respects the provisions of this section do not
apply to that facility effective the date the contract is
terminated. The contract shall contain a provision governing
the transition back to the cost-based reimbursement system
established under section 256B.431, subdivision 25, and
Minnesota Rules, parts 9549.0010 to 9549.0080. A contract
entered into under this section may be amended by mutual
agreement of the parties.
Sec. 22. Minnesota Statutes 1998, section 256B.434,
subdivision 4, is amended to read:
Subd. 4. [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For
nursing facilities which have their payment rates determined
under this section rather than section 256B.431, subdivision 25,
the commissioner shall establish a rate under this subdivision.
The nursing facility must enter into a written contract with the
commissioner.
(b) A nursing facility's case mix payment rate for the
first rate year of a facility's contract under this section is
the payment rate the facility would have received under section
256B.431, subdivision 25.
(c) A nursing facility's case mix payment rates for the
second and subsequent years of a facility's contract under this
section are the previous rate year's contract payment rates plus
an inflation adjustment. The index for the inflation adjustment
must be based on the change in the Consumer Price Index-All
Items (United States City average) (CPI-U) forecasted by Data
Resources, Inc., as forecasted in the fourth quarter of the
calendar year preceding the rate year. The inflation adjustment
must be based on the 12-month period from the midpoint of the
previous rate year to the midpoint of the rate year for which
the rate is being determined. For the rate years beginning on
July 1, 1999, and July 1, 2000, this paragraph shall apply only
to the property related payment rate. In determining the amount
of the property related payment rate adjustment under this
paragraph, the commissioner shall determine the proportion of
the facility's rates that are property related based on the
facility's most recent cost report.
(d) The commissioner shall develop additional
incentive-based payments of up to five percent above the
standard contract rate for achieving outcomes specified in each
contract. The specified facility-specific outcomes must be
measurable and approved by the commissioner. The commissioner
may establish, for each contract, various levels of achievement
within an outcome. After the outcomes have been specified the
commissioner shall assign various levels of payment associated
with achieving the outcome. Any incentive-based payment cancels
if there is a termination of the contract. In establishing the
specified outcomes and related criteria the commissioner shall
consider the following state policy objectives:
(1) improved cost effectiveness and quality of life as
measured by improved clinical outcomes;
(2) successful diversion or discharge to community
alternatives;
(3) decreased acute care costs;
(4) improved consumer satisfaction;
(5) the achievement of quality; or
(6) any additional outcomes proposed by a nursing facility
that the commissioner finds desirable.
Sec. 23. Minnesota Statutes 1998, section 256B.434, is
amended by adding a subdivision to read:
Subd. 4a. [FACILITY RATE INCREASES.] For the rate year
beginning July 1, 1999, the nursing facilities described in
clauses (1) to (5) shall receive the rate increases indicated.
The increases provided under this subdivision shall be included
in the facility's total payment rates for the purpose of
determining future rates under this section or any other section:
(1) a nursing facility in Becker county licensed for 102
nursing home beds on September 30, 1998, shall receive an
increase of $1.30 in its case mix class A payment rate; an
increase of $1.33 in its case mix class B payment rate; an
increase of $1.36 in its case mix class C payment rate; an
increase of $1.39 in its case mix class D payment rate; an
increase of $1.42 in its case mix class E payment rate; an
increase of $1.42 in its case mix class F payment rate; an
increase of $1.45 in its case mix class G payment rate; an
increase of $1.49 in its case mix class H payment rate; an
increase of $1.51 in its case mix class I payment rate; an
increase of $1.54 in its case mix class J payment rate; and an
increase of $1.59 in its case mix class K payment rate;
(2) a nursing facility in Chisago county licensed for 101
nursing home beds on September 30, 1998, shall receive an
increase of $3.67 in each case mix payment rate;
(3) a nursing facility in Canby, licensed for 75 beds shall
have its property-related per diem rate increased by $1.21.
This increase shall be recognized in the facility's contract
payment rate under this section;
(4) a nursing facility in Golden Valley with all its beds
licensed to provide residential rehabilitative services to young
adults under Minnesota Rules, parts 9570.2000 to 9570.3400,
shall have the payment rate computed according to this section
increased by $14.83; and
(5) a county-owned 130-bed nursing facility in Park Rapids
shall have its per diem contract payment rate increased by $1.02
for costs related to compliance with comparable worth
requirements.
Sec. 24. Minnesota Statutes 1998, section 256B.434,
subdivision 13, is amended to read:
Subd. 13. [PAYMENT SYSTEM REFORM ADVISORY COMMITTEE.] (a)
The commissioner, in consultation with an advisory committee,
shall study options for reforming the regulatory and
reimbursement system for nursing facilities to reduce the level
of regulation, reporting, and procedural requirements, and to
provide greater flexibility and incentives to stimulate
competition and innovation. The advisory committee shall
include, at a minimum, representatives from the long-term care
provider community, the department of health, and consumers of
long-term care services. The advisory committee sunsets on June
30, 1997. Among other things, the commissioner shall consider
the feasibility and desirability of changing from a
certification requirement to an accreditation requirement for
participation in the medical assistance program, options to
encourage early discharge of short-term residents through the
provision of intensive therapy, and further modifications needed
in rate equalization. The commissioner shall also include
detailed recommendations for a permanent managed care payment
system to replace the contractual alternative payment
demonstration project authorized under this section. The
commissioner shall submit a report with findings and
recommendations to the legislature by January 15, 1997.
(b) If a permanent managed care payment system has not been
enacted into law by July 1, 1997, the commissioner shall develop
and implement a transition plan to enable nursing facilities
under contract with the commissioner under this section to
revert to the cost-based payment system at the expiration of the
alternative payment demonstration project. The commissioner
shall include in the alternative payment demonstration project
contracts entered into under this section a provision to permit
an amendment to the contract to be made after July 1, 1997,
governing the transition back to the cost-based payment system.
The transition plan and contract amendments are not subject to
rulemaking requirements.
Sec. 25. Minnesota Statutes 1998, section 256B.435, is
amended to read:
256B.435 [NURSING FACILITY REIMBURSEMENT SYSTEM EFFECTIVE
JULY 1, 2000 2001.]
Subdivision 1. [IN GENERAL.] Effective July 1, 2000 2001,
the commissioner shall implement a performance-based contracting
system to replace the current method of setting operating cost
payment rates under sections 256B.431 and 256B.434 and Minnesota
Rules, parts 9549.0010 to 9549.0080. Operating cost payment
rates for newly established facilities under Minnesota Rules,
part 9549.0057, shall be established using section 256B.431 and
Minnesota Rules, parts 9549.0010 to 9549.0070. A nursing
facility in operation on May 1, 1998, with payment rates not
established under section 256B.431 or 256B.434 on that date, is
ineligible for this performance-based contracting system. In
determining prospective payment rates of nursing facility
services, the commissioner shall distinguish between operating
costs and property-related costs. The commissioner of finance
shall include an annual inflationary adjustment in operating
costs for nursing facilities using the inflation factor
specified in subdivision 3 and funding for incentive-based
payments as a budget change request in each biennial detailed
expenditure budget submitted to the legislature under section
16A.11. Property related payment rates, including real estate
taxes and special assessments, shall be determined under section
256B.431 or 256B.434 or under a new property-related
reimbursement system, if one is implemented by the commissioner
under subdivision 3. The commissioner shall present additional
recommendations for performance-based contracting for nursing
facilities to the legislature by February 15, 2000, in the
following specific areas:
(1) development of an interim default payment mechanism for
nursing facilities that do not respond to the state's request
for proposal but wish to continue participation in the medical
assistance program, and nursing facilities the state does not
select in the request for proposal process, and nursing
facilities whose contract has been canceled;
(2) development of criteria for facilities to earn
performance-based incentive payments based on relevant outcomes
negotiated by nursing facilities and the commissioner and that
recognize both continuous quality efforts and quality
improvement;
(3) development of criteria and a process under which
nursing facilities can request rate adjustments for low base
rates, geographic disparities, or other reasons;
(4) development of a dispute resolution mechanism for
nursing facilities that are denied a contract, denied incentive
payments, or denied a rate adjustment;
(5) development of a property payment system to address the
capital needs of nursing facilities that will be funded with
additional appropriations;
(6) establishment of a transitional plan to move from dual
assessment instruments to the federally mandated resident
assessment system, whereby the financial impact for each
facility would be budget neutral;
(7) identification of net cost implications for facilities
and to the department of preparing for and implementing
performance-based contracting or any proposed alternative
system;
(8) identification of facility financial and statistical
reporting requirements; and
(9) identification of exemptions from current regulations
and statutes applicable under performance-based contracting.
Subd. 1a. [REQUESTS FOR PROPOSALS.] (a) For nursing
facilities with rates established under section 256B.434 on
January 1, 2001, the commissioner shall renegotiate contracts
without requiring a response to a request for proposal,
notwithstanding the solicitation process described in chapter
16C.
(b) Prior to July 1, 2001, the commissioner shall publish
in the State Register a request for proposals to provide nursing
facility services according to this section. The commissioner
will consider proposals from all nursing facilities that have
payment rates established under section 256B.431. The
commissioner must respond to all proposals in a timely manner.
(c) In issuing a request for proposals, the commissioner
may develop reasonable requirements which, in the judgment of
the commissioner, are necessary to protect residents or ensure
that the performance-based contracting system furthers the
interests of the state of Minnesota. The request for proposals
may include, but need not be limited to:
(1) a requirement that a nursing facility make reasonable
efforts to maximize Medicare payments on behalf of eligible
residents;
(2) requirements designed to prevent inappropriate or
illegal discrimination against residents enrolled in the medical
assistance program as compared to private paying residents;
(3) requirements designed to ensure that admissions to a
nursing facility are appropriate and that reasonable efforts are
made to place residents in home and community-based settings
when appropriate;
(4) a requirement to agree to participate in the
development of data collection systems and outcome-based
standards. Among other requirements specified by the
commissioner, each facility entering into a contract may be
required to pay an annual fee not to exceed $1,000. The
commissioner must use revenue generated from the fees to
contract with a qualified consultant or contractor to develop
data collection systems and outcome-based contracting standards;
(5) a requirement that Medicare-certified contractors agree
to maintain Medicare cost reports and to submit them to the
commissioner upon request, or at times specified by the
commissioner; and that contractors that are not
Medicare-certified agree to maintain a uniform cost report in a
format established by the commissioner and to submit the report
to the commissioner upon request, or at times specified by the
commissioner;
(6) a requirement that demonstrates willingness and ability
to develop and maintain data collection and retrieval systems to
measure outcomes; and
(7) a requirement to provide all information and assurances
required by the terms and conditions of the federal waiver or
federal approval.
(d) In addition to the information and assurances contained
in the submitted proposals, the commissioner may consider the
following criteria in developing the terms of the contract:
(1) the facility's history of compliance with federal and
state laws and rules. A facility deemed to be in substantial
compliance with federal and state laws and rules is eligible to
respond to a request for proposals. A facility's compliance
history shall not be the sole determining factor in situations
where the facility has been sold and the new owners have
submitted a proposal;
(2) whether the facility has a record of excessive
licensure fines or sanctions or fraudulent cost reports;
(3) the facility's financial history and solvency; and
(4) other factors identified by the commissioner deemed
relevant to developing the terms of the contract, including a
determination that a contract with a particular facility is not
in the best interests of the residents of the facility or the
state of Minnesota.
(e) Notwithstanding the requirements of the solicitation
process described in chapter 16C, the commissioner may contract
with nursing facilities established according to section
144A.073 without issuing a request for proposals.
(f) Notwithstanding subdivision 1, after July 1, 2001, the
commissioner may contract with additional nursing facilities,
according to requests for proposals.
Subd. 2. [CONTRACT PROVISIONS.] (a) The performance-based
contract with each nursing facility must include provisions that:
(1) apply the resident case mix assessment provisions of
Minnesota Rules, parts 9549.0051, 9549.0058, and 9549.0059, or
another assessment system, with the goal of moving to a single
assessment system;
(2) monitor resident outcomes through various methods, such
as quality indicators based on the minimum data set and other
utilization and performance measures;
(3) require the establishment and use of a continuous
quality improvement process that integrates information from
quality indicators and regular resident and family satisfaction
interviews;
(4) require annual reporting of facility statistical
information, including resident days by case mix category,
productive nursing hours, wages and benefits, and raw food costs
for use by the commissioner in the development of facility
profiles that include trends in payment and service utilization;
(5) require from each nursing facility an annual certified
audited financial statement consisting of a balance sheet,
income and expense statements, and an opinion from either a
licensed or certified public accountant, if a certified audit
was prepared, or unaudited financial statements if no certified
audit was prepared; and
(6) specify the method for resolving disputes; and
(7) establish additional requirements and penalties for
nursing facilities not meeting the standards set forth in the
performance-based contract.
(b) The commissioner may develop additional incentive-based
payments for achieving specified outcomes specified in each
contract. The specified facility-specific outcomes must be
measurable and approved by the commissioner.
(c) The commissioner may also contract with nursing
facilities in other ways through requests for proposals,
including contracts on a risk or nonrisk basis, with nursing
facilities or consortia of nursing facilities, to provide
comprehensive long-term care coverage on a premium or capitated
basis.
(d) The commissioner may negotiate different contract terms
for different nursing facilities.
Subd. 2a. [DURATION AND TERMINATION OF CONTRACTS.] (a) All
contracts entered into under this section are for a term of one
year. Either party may terminate this contract at any time
without cause by providing 90 calendar days' advance written
notice to the other party. Notwithstanding section 16C.05,
subdivisions 2, paragraph (a), and 5, if neither party provides
written notice of termination, the contract shall be
renegotiated for additional one-year terms or the terms of the
existing contract will be extended for one year. The provisions
of the contract shall be renegotiated annually by the parties
prior to the expiration date of the contract. The parties may
voluntarily renegotiate the terms of the contract at any time by
mutual agreement.
(b) If a nursing facility fails to comply with the terms of
a contract, the commissioner shall provide reasonable notice
regarding the breach of contract and a reasonable opportunity
for the facility to come into compliance. If the facility fails
to come into compliance or to remain in compliance, the
commissioner may terminate the contract. If a contract is
terminated, provisions of section 256B.48, subdivision 1a, shall
apply.
Subd. 3. [PAYMENT RATE PROVISIONS.] (a) For rate years
beginning on or after July 1, 2000 2001, within the limits of
appropriations specifically for this purpose, the commissioner
shall determine operating cost payment rates for each licensed
and certified nursing facility by indexing its operating cost
payment rates in effect on June 30, 2000 2001, for inflation.
The inflation factor to be used must be based on the change in
the Consumer Price Index-All Items, United States city average
(CPI-U) as forecasted by Data Resources, Inc. in the fourth
quarter preceding the rate year. For rate years beginning on or
after July 1, 2001, the inflation factor must be based on the
change in the Employment Cost Index for Private Industry Workers
- Total Compensation as forecasted by the commissioner of
finance's national economic consultant, in the fourth quarter
preceding the rate year. The CPI-U forecasted index for
operating cost payment rates shall be based on the 12-month
period from the midpoint of the nursing facility's prior rate
year to the midpoint of the rate year for which the operating
payment rate is being determined. The operating cost payment
rate to be inflated shall be the total payment rate in effect on
June 30, 2001, minus the portion determined to be the
property-related payment rate, minus the per diem amount of the
preadmission screening cost included in the nursing facility's
last payment rate established under section 256B.431.
(b) Beginning July 1, 2000, each nursing facility subject
to a performance-based contract under this section shall choose
one of two methods of payment for property-related costs:
(1) the method established in section 256B.434; or
(2) the method established in section 256B.431.
Once the nursing facility has made the election in this
paragraph, that election shall remain in effect for at least
four years or until an alternative property payment system is
developed. A per diem amount for preadmission screening will be
added onto the contract payment rates according to the method of
distribution of county allocation described in section
256B.0911, subdivision 6, paragraph (a).
(c) For rate years beginning on or after July 1, 2000 2001,
the commissioner may implement a new method of payment for
property-related costs that addresses the capital needs of
facilities. Notwithstanding paragraph (b), The new property
payment system or systems, if implemented, shall replace the
current method methods of setting property payment rates under
sections 256B.431 and 256B.434.
Subd. 4. [CONTRACT PAYMENT RATES; APPEALS.] If an appeal
is pending concerning the cost-based payment rates that are the
basis for the calculation of the payment rate under this
section, the commissioner and the nursing facility may agree on
an interim contract rate to be used until the appeal is
resolved. When the appeal is resolved, the contract rate must
be adjusted retroactively according to the appeal decision.
Subd. 5. [CONSUMER PROTECTION.] In addition to complying
with all applicable laws regarding consumer protection, as a
condition of entering into a contract under this section, a
nursing facility must agree to:
(1) establish resident grievance procedures;
(2) establish expedited grievance procedures to resolve
complaints made by short-stay residents; and
(3) make available to residents and families a copy of the
performance-based contract and outcomes to be achieved.
Subd. 6. [CONTRACTS ARE VOLUNTARY.] Participation of
nursing facilities in the medical assistance program is
voluntary. The terms and procedures governing the
performance-based contract are determined under this section and
through negotiations between the commissioner and nursing
facilities.
Subd. 7. [FEDERAL REQUIREMENTS.] The commissioner shall
implement the performance-based contracting system subject to
any required federal waivers or approval and in a manner that is
consistent with federal requirements. If a provision of this
section is inconsistent with a federal requirement, the federal
requirement supersedes the inconsistent provision. The
commissioner shall seek federal approval and request waivers as
necessary to implement this section.
Sec. 26. Minnesota Statutes 1998, section 256B.48,
subdivision 1, is amended to read:
Subdivision 1. [PROHIBITED PRACTICES.] A nursing facility
is not eligible to receive medical assistance payments unless it
refrains from all of the following:
(a) Charging private paying residents rates for similar
services which exceed those which are approved by the state
agency for medical assistance recipients as determined by the
prospective desk audit rate, except under the following
circumstances: the nursing facility may (1) charge private
paying residents a higher rate for a private room, and (2)
charge for special services which are not included in the daily
rate if medical assistance residents are charged separately at
the same rate for the same services in addition to the daily
rate paid by the commissioner. Services covered by the payment
rate must be the same regardless of payment source. Special
services, if offered, must be available to all residents in all
areas of the nursing facility and charged separately at the same
rate. Residents are free to select or decline special
services. Special services must not include services which must
be provided by the nursing facility in order to comply with
licensure or certification standards and that if not provided
would result in a deficiency or violation by the nursing
facility. Services beyond those required to comply with
licensure or certification standards must not be charged
separately as a special service if they were included in the
payment rate for the previous reporting year. A nursing
facility that charges a private paying resident a rate in
violation of this clause is subject to an action by the state of
Minnesota or any of its subdivisions or agencies for civil
damages. A private paying resident or the resident's legal
representative has a cause of action for civil damages against a
nursing facility that charges the resident rates in violation of
this clause. The damages awarded shall include three times the
payments that result from the violation, together with costs and
disbursements, including reasonable attorneys' fees or their
equivalent. A private paying resident or the resident's legal
representative, the state, subdivision or agency, or a nursing
facility may request a hearing to determine the allowed rate or
rates at issue in the cause of action. Within 15 calendar days
after receiving a request for such a hearing, the commissioner
shall request assignment of an administrative law judge under
sections 14.48 to 14.56 to conduct the hearing as soon as
possible or according to agreement by the parties. The
administrative law judge shall issue a report within 15 calendar
days following the close of the hearing. The prohibition set
forth in this clause shall not apply to facilities licensed as
boarding care facilities which are not certified as skilled or
intermediate care facilities level I or II for reimbursement
through medical assistance.
(b) Requiring (1) Charging, soliciting, accepting, or
receiving from an applicant for admission to the facility, or
the guardian or conservator from anyone acting in behalf of the
applicant, as a condition of admission, to pay expediting the
admission, or as a requirement for the individual's continued
stay, any fee or, deposit in excess of $100, gift, money,
donation, or other consideration not otherwise required as
payment under the state plan;
(2) requiring an individual, or anyone acting in behalf of
the individual, to loan any money to the nursing facility, or;
(3) requiring an individual, or anyone acting in behalf of
the individual, to promise to leave all or part of the
applicant's individual's estate to the facility; or
(4) requiring a third-party guarantee of payment to the
facility as a condition of admission, expedited admission, or
continued stay in the facility.
Nothing in this paragraph would prohibit discharge for
nonpayment of services in accordance with state and federal
regulations.
(c) Requiring any resident of the nursing facility to
utilize a vendor of health care services chosen by the nursing
facility.
(d) Providing differential treatment on the basis of status
with regard to public assistance.
(e) Discriminating in admissions, services offered, or room
assignment on the basis of status with regard to public
assistance or refusal to purchase special services. Admissions
discrimination shall include, but is not limited to:
(1) basing admissions decisions upon assurance by the
applicant to the nursing facility, or the applicant's guardian
or conservator, that the applicant is neither eligible for nor
will seek public assistance for payment of nursing facility care
costs; and
(2) engaging in preferential selection from waiting lists
based on an applicant's ability to pay privately or an
applicant's refusal to pay for a special service.
The collection and use by a nursing facility of financial
information of any applicant pursuant to a preadmission
screening program established by law shall not raise an
inference that the nursing facility is utilizing that
information for any purpose prohibited by this paragraph.
(f) Requiring any vendor of medical care as defined by
section 256B.02, subdivision 7, who is reimbursed by medical
assistance under a separate fee schedule, to pay any amount
based on utilization or service levels or any portion of the
vendor's fee to the nursing facility except as payment for
renting or leasing space or equipment or purchasing support
services from the nursing facility as limited by section
256B.433. All agreements must be disclosed to the commissioner
upon request of the commissioner. Nursing facilities and
vendors of ancillary services that are found to be in violation
of this provision shall each be subject to an action by the
state of Minnesota or any of its subdivisions or agencies for
treble civil damages on the portion of the fee in excess of that
allowed by this provision and section 256B.433. Damages awarded
must include three times the excess payments together with costs
and disbursements including reasonable attorney's fees or their
equivalent.
(g) Refusing, for more than 24 hours, to accept a resident
returning to the same bed or a bed certified for the same level
of care, in accordance with a physician's order authorizing
transfer, after receiving inpatient hospital services.
The prohibitions set forth in clause (b) shall not apply to
a retirement facility with more than 325 beds including at least
150 licensed nursing facility beds and which:
(1) is owned and operated by an organization tax-exempt
under section 290.05, subdivision 1, clause (i); and
(2) accounts for all of the applicant's assets which are
required to be assigned to the facility so that only expenses
for the cost of care of the applicant may be charged against the
account; and
(3) agrees in writing at the time of admission to the
facility to permit the applicant, or the applicant's guardian,
or conservator, to examine the records relating to the
applicant's account upon request, and to receive an audited
statement of the expenditures charged against the applicant's
individual account upon request; and
(4) agrees in writing at the time of admission to the
facility to permit the applicant to withdraw from the facility
at any time and to receive, upon withdrawal, the balance of the
applicant's individual account.
For a period not to exceed 180 days, the commissioner may
continue to make medical assistance payments to a nursing
facility or boarding care home which is in violation of this
section if extreme hardship to the residents would result. In
these cases the commissioner shall issue an order requiring the
nursing facility to correct the violation. The nursing facility
shall have 20 days from its receipt of the order to correct the
violation. If the violation is not corrected within the 20-day
period the commissioner may reduce the payment rate to the
nursing facility by up to 20 percent. The amount of the payment
rate reduction shall be related to the severity of the violation
and shall remain in effect until the violation is corrected.
The nursing facility or boarding care home may appeal the
commissioner's action pursuant to the provisions of chapter 14
pertaining to contested cases. An appeal shall be considered
timely if written notice of appeal is received by the
commissioner within 20 days of notice of the commissioner's
proposed action.
In the event that the commissioner determines that a
nursing facility is not eligible for reimbursement for a
resident who is eligible for medical assistance, the
commissioner may authorize the nursing facility to receive
reimbursement on a temporary basis until the resident can be
relocated to a participating nursing facility.
Certified beds in facilities which do not allow medical
assistance intake on July 1, 1984, or after shall be deemed to
be decertified for purposes of section 144A.071 only.
Sec. 27. Minnesota Statutes 1998, section 256B.48,
subdivision 1a, is amended to read:
Subd. 1a. [TERMINATION.] If a nursing facility terminates
its participation in the medical assistance program, whether
voluntarily or involuntarily, the commissioner may authorize the
nursing facility to receive continued medical assistance
reimbursement only on a temporary basis until medical assistance
residents can be relocated to nursing facilities participating
in the medical assistance program.
Sec. 28. Minnesota Statutes 1998, section 256B.48,
subdivision 1b, is amended to read:
Subd. 1b. [EXCEPTION.] Notwithstanding any agreement
between a nursing facility and the department of human services
or the provisions of this section or section 256B.411, other
than subdivision 1a, the commissioner may authorize continued
medical assistance payments to a nursing facility which ceased
intake of medical assistance recipients prior to July 1, 1983,
and which charges private paying residents rates that exceed
those permitted by subdivision 1, paragraph (a), for (i)
residents who resided in the nursing facility before July 1,
1983, or (ii) residents for whom the commissioner or any
predecessors of the commissioner granted a permanent individual
waiver prior to October 1, 1983. Nursing facilities seeking
continued medical assistance payments under this subdivision
shall make the reports required under subdivision 2, except that
on or after December 31, 1985, the financial statements required
need not be audited by or contain the opinion of a certified
public accountant or licensed public accountant, but need only
be reviewed by a certified public accountant or licensed public
accountant. In the event that the state is determined by the
federal government to be no longer eligible for the federal
share of medical assistance payments made to a nursing facility
under this subdivision, the commissioner may cease medical
assistance payments, under this subdivision, to that nursing
facility. Between October 1, 1992, and July 1, 1993, a facility
governed by this subdivision may elect to resume full
participation in the medical assistance program by agreeing to
comply with all of the requirements of the medical assistance
program, including the rate equalization law in subdivision 1,
paragraph (a), and all other requirements established in law or
rule, and to resume intake of new medical assistance recipients.
Sec. 29. Minnesota Statutes 1998, section 256B.48,
subdivision 6, is amended to read:
Subd. 6. [MEDICARE CERTIFICATION.] (a) [DEFINITION.] For
purposes of this subdivision, "nursing facility" means a nursing
facility that is certified as a skilled nursing facility or,
after September 30, 1990, a nursing facility licensed under
chapter 144A that is certified as a nursing facility.
(b) [MEDICARE PARTICIPATION REQUIRED.] All nursing
facilities shall participate in Medicare part A and part B
unless, after submitting an application, Medicare certification
is denied by the federal health care financing administration.
Medicare review shall be conducted at the time of the annual
medical assistance review. Charges for Medicare-covered
services provided to residents who are simultaneously eligible
for medical assistance and Medicare must be billed to Medicare
part A or part B before billing medical assistance. Medical
assistance may be billed only for charges not reimbursed by
Medicare.
(c) [UNTIL SEPTEMBER 30, 1990.] Until September 30, 1990, a
nursing facility satisfies the requirements of paragraph (b)
if: (1) at least 50 percent of the facility's beds that are
licensed under section 144A and certified as skilled nursing
beds under the medical assistance program are Medicare
certified; or (2) if a nursing facility's beds are licensed
under section 144A, and some are medical assistance certified as
skilled nursing beds and others are medical assistance certified
as intermediate care facility I beds, at least 50 percent of the
facility's total skilled nursing beds and intermediate care
facility I beds or 100 percent of its skilled nursing beds,
whichever is less, are Medicare certified.
(d) [AFTER SEPTEMBER 30, 1990.] After September 30, 1990, a
nursing facility satisfies the requirements of paragraph (b) if
at least 50 percent of the facility's beds certified as nursing
facility beds under the medical assistance program are Medicare
certified.
(e) (d) [CONFLICT WITH MEDICARE DISTINCT PART
REQUIREMENTS.] At the request of a facility, the commissioner of
human services may reduce the 50 percent Medicare participation
requirement in paragraphs paragraph (c) and (d) to no less than
20 percent if the commissioner of health determines that, due to
the facility's physical plant configuration, the facility cannot
satisfy Medicare distinct part requirements at the 50 percent
certification level. To receive a reduction in the
participation requirement, a facility must demonstrate that the
reduction will not adversely affect access of Medicare-eligible
residents to Medicare-certified beds.
(f) (e) [INSTITUTIONS FOR MENTAL DISEASE.] The commissioner
may grant exceptions to the requirements of paragraph (b) for
nursing facilities that are designated as institutions for
mental disease.
(g) (f) [NOTICE OF RIGHTS.] The commissioner shall inform
recipients of their rights under this subdivision and section
144.651, subdivision 29.
Sec. 30. Minnesota Statutes 1998, section 256B.50,
subdivision 1e, is amended to read:
Subd. 1e. [ATTORNEY'S FEES AND COSTS.] (a) Notwithstanding
section 15.472, paragraph (a), for an issue appealed under
subdivision 1, the prevailing party in a contested case
proceeding or, if appealed, in subsequent judicial review, must
be awarded reasonable attorney's fees and costs incurred in
litigating the appeal, if the prevailing party shows that the
position of the opposing party was not substantially justified.
The procedures for awarding fees and costs set forth in section
15.474 must be followed in determining the prevailing party's
fees and costs except as otherwise provided in this
subdivision. For purposes of this subdivision, "costs" means
subpoena fees and mileage, transcript costs, court reporter
fees, witness fees, postage and delivery costs, photocopying and
printing costs, amounts charged the commissioner by the office
of administrative hearings, and direct administrative costs of
the department; and "substantially justified" means that a
position had a reasonable basis in law and fact, based on the
totality of the circumstances prior to and during the contested
case proceeding and subsequent review.
(b) When an award is made to the department under this
subdivision, attorney fees must be calculated at the cost to the
department. When an award is made to a provider under this
subdivision, attorney fees must be calculated at the rate
charged to the provider except that attorney fees awarded must
be the lesser of the attorney's normal hourly fee or $100 per
hour.
(c) In contested case proceedings involving more than one
issue, the administrative law judge shall determine what portion
of each party's attorney fees and costs is related to the issue
or issues on which it prevailed and for which it is entitled to
an award. In making that determination, the administrative law
judge shall consider the amount of time spent on each issue, the
precedential value of the issue, the complexity of the issue,
and other factors deemed appropriate by the administrative law
judge.
(d) When the department prevails on an issue involving more
than one provider, the administrative law judge shall allocate
the total amount of any award for attorney fees and costs among
the providers. In determining the allocation, the
administrative law judge shall consider each provider's monetary
interest in the issue and other factors deemed appropriate by
the administrative law judge.
(e) Attorney fees and costs awarded to the department for
proceedings under this subdivision must not be reported or
treated as allowable costs on the provider's cost report.
(f) Fees and costs awarded to a provider for proceedings
under this subdivision must be reimbursed to them by reporting
the amount of fees and costs awarded as allowable costs on the
provider's cost report for the reporting year in which they were
awarded. Fees and costs reported pursuant to this subdivision
must be included in the general and administrative cost category
but are not subject to categorical or overall cost limitations
established in rule or statute within 120 days of the final
decision on the award of attorney fees and costs.
(g) If the provider fails to pay the awarded attorney fees
and costs within 120 days of the final decision on the award of
attorney fees and costs, the department may collect the amount
due through any method available to it for the collection of
medical assistance overpayments to providers. Interest charges
must be assessed on balances outstanding after 120 days of the
final decision on the award of attorney fees and costs. The
annual interest rate charged must be the rate charged by the
commissioner of revenue for late payment of taxes that is in
effect on the 121st day after the final decision on the award of
attorney fees and costs.
(h) Amounts collected by the commissioner pursuant to this
subdivision must be deemed to be recoveries pursuant to section
256.01, subdivision 2, clause (15).
(i) This subdivision applies to all contested case
proceedings set on for hearing by the commissioner on or after
April 29, 1988, regardless of the date the appeal was filed.
Sec. 31. Minnesota Statutes 1998, section 256B.5011,
subdivision 1, is amended to read:
Subdivision 1. [IN GENERAL.] Effective October 1, 2000,
the commissioner shall implement a performance-based contracting
system to replace the current method of setting total cost
payment rates under section 256B.501 and Minnesota Rules, parts
9553.0010 to 9553.0080. In determining prospective payment
rates of intermediate care facilities for persons with mental
retardation or related conditions, the commissioner shall index
each facility's total operating payment rate by an inflation
factor as described in subdivision 3 section 256B.5012. The
commissioner of finance shall include annual inflation
adjustments in operating costs for intermediate care facilities
for persons with mental retardation and related conditions as a
budget change request in each biennial detailed expenditure
budget submitted to the legislature under section 16A.11.
Sec. 32. Minnesota Statutes 1998, section 256B.5011,
subdivision 2, is amended to read:
Subd. 2. [CONTRACT PROVISIONS.] (a) The
performance-based service contract with each intermediate care
facility must include provisions for:
(1) modifying payments when significant changes occur in
the needs of the consumers;
(2) monitoring service quality using performance indicators
that measure consumer outcomes;
(3) the establishment and use of continuous quality
improvement processes using the results attained through service
quality monitoring;
(4) the annual reporting of facility statistical
information on all supervisory personnel, direct care personnel,
specialized support personnel, hours, wages and benefits,
staff-to-consumer ratios, and staffing patterns
(3) appropriate and necessary statistical information
required by the commissioner;
(5) (4) annual aggregate facility financial information or
an annual certified audited financial statement, including a
balance sheet and income and expense statements for each
facility, if a certified audit was prepared; and
(6) (5) additional requirements and penalties for
intermediate care facilities not meeting the standards set forth
in the performance-based service contract.
(b) The commissioner shall recommend to the legislature by
January 15, 2000, whether the contract should include service
quality monitoring that may utilize performance indicators that
measure consumer and program outcomes. Performance measurement
shall not increase or duplicate regulatory requirements.
Sec. 33. [256B.5012] [ICF/MR PAYMENT SYSTEM
IMPLEMENTATION.]
Subdivision 1. [TOTAL PAYMENT RATE.] The total payment
rate effective October 1, 2000, for existing ICF/MR facilities
is the total of the operating payment rate and the property
payment rate plus inflation factors as defined in this section.
The initial rate year shall run from October 1, 2000, through
December 31, 2001. Subsequent rate years shall run from January
1 through December 31 beginning in the year 2002.
Subd. 2. [OPERATING PAYMENT RATE.] (a) The operating
payment rate equals the facility's total payment rate in effect
on September 30, 2000, minus the property rate. The operating
payment rate includes the special operating rate and the
efficiency incentive in effect as of September 30, 2000. Within
the limits of appropriations specifically for this purpose, the
operating payment shall be increased for each rate year by the
annual percentage change in the Employment Cost Index for
Private Industry Workers - Total Compensation, as forecasted by
the commissioner of finance's economic consultant, in the second
quarter of the calendar year preceding the start of each rate
year. In the case of the initial rate year beginning October 1,
2000, and continuing through December 31, 2001, the percentage
change shall be based on the percentage change in the Employment
Cost Index for Private Industry Workers - Total Compensation for
the 15-month period beginning October 1, 2000, as forecast by
Data Resources, Inc., in the first quarter of 2000.
(b) Effective October 1, 2000, the operating payment rate
shall be adjusted to reflect an occupancy rate equal to 100
percent of the facility's capacity days as of September 30, 2000.
Subd. 3. [PROPERTY PAYMENT RATE.] (a) The property payment
rate effective October 1, 2000, is based on the facility's
modified property payment rate in effect on September 30, 2000.
The modified property payment rate is the actual property
payment rate exclusive of the effect of gains or losses on
disposal of capital assets or adjustments for excess
depreciation claims. Effective October 1, 2000, a facility
minimum property rate of $8.13 shall be applied to all existing
ICF/MR facilities. Facilities with a modified property payment
rate effective September 30, 2000, which is below the minimum
property rate shall receive an increase effective October 1,
2000, equal to the difference between the minimum property
payment rate and the modified property payment rate in effect as
of September 30, 2000. Facilities with a modified property
payment rate at or above the minimum property payment rate
effective September 30, 2000, shall receive the modified
property payment rate effective October 1, 2000.
(b) Within the limits of appropriations specifically for
this purpose, facility property payment rates shall be increased
annually for inflation, effective January 1, 2002. The increase
shall be based on each facility's property payment rate in
effect on September 30, 2000. Modified property payment rates
effective September 30, 2000, shall be arrayed from highest to
lowest before applying the minimum property payment rate in
paragraph (a). For modified property payment rates at the 90th
percentile or above, the annual inflation increase shall be
zero. For modified property payment rates below the 90th
percentile but equal to or above the 75th percentile, the annual
inflation increase shall be one percent. For modified property
payment rates below the 75th percentile, the annual inflation
increase shall be two percent.
Sec. 34. [256B.5013] [PAYMENT RATE ADJUSTMENTS.]
Subdivision 1. [VARIABLE RATE ADJUSTMENTS.] When there is
a documented increase in the resource needs of a current ICF/MR
recipient or recipients, or a person is admitted to a facility
who requires additional resources, the county of financial
responsibility may approve an enhanced rate for one or more
persons in the facility. Resource needs directly attributable
to an individual that may be considered under the variable rate
adjustment include increased direct staff hours and other
specialized services, equipment, and human resources. The
guidelines in paragraphs (a) to (d) apply for the payment rate
adjustments under this section.
(a) All persons must be screened according to section
256B.092, subdivisions 7 and 8, prior to implementation of the
new payment system and annually thereafter. Screening data
shall be analyzed to develop broad profiles of the functional
characteristics of recipients. Three components shall be used
to distinguish recipients based on the following broad profiles:
(1) functional ability to care for and maintain one's own
basic needs;
(2) the intensity of any aggressive or destructive
behavior; and
(3) any history of obstructive behavior in combination with
a diagnosis of psychosis or neurosis.
The profile groups shall be used to link resource needs to
funding. The resource profile shall determine the level of
funding that may be authorized by the county. The county of
financial responsibility may approve a rate adjustment for an
individual. The commissioner shall recommend to the legislature
by January 15, 2000, a methodology using the profile groups to
determine variable rates. The variable rate must be applied to
expenses related to increased direct staff hours and other
specialized services, equipment, and human resources. This
variable rate component plus the facility's current operating
payment rate equals the individual's total operating payment
rate.
(b) A recipient must be screened by the county of financial
responsibility using the developmental disabilities screening
document completed immediately prior to approval of a variable
rate by the county. A comparison of the updated screening and
the previous screening must demonstrate an increase in resource
needs.
(c) Rate adjustments projected to exceed the authorized
funding level associated with the person's profile must be
submitted to the commissioner.
(d) The new rate approved through this process shall not be
averaged across all persons living at a facility but shall be an
individual rate. The county of financial responsibility must
indicate the projected length of time that the additional
funding may be needed by the individual. The need to continue
an individual variable rate must be reviewed at the end of the
anticipated duration of need but at least annually through the
completion of the developmental disabilities screening document.
Subd. 2. [OTHER PAYMENT RATE ADJUSTMENTS.] Facility total
payment rates may be adjusted by the host county, with
authorization from a statewide advisory committee, if, through
the local system needs planning process, it is determined that a
need exists to amend the package of purchased services with a
resulting increase or decrease in costs. Except as provided in
section 252.292, subdivision 4, if a provider demonstrates that
the loss of revenues caused by the downsizing or closure of a
facility cannot be absorbed by the facility based on current
operations, the host county or the provider may submit a request
to the statewide advisory committee for a facility base rate
adjustment.
Subd. 3. [RELOCATION.] (a) Property rates for all
facilities relocated after December 31, 1997, and up to and
including October 1, 2000, shall have the full annual costs of
relocation included in their October 1, 2000, property rate.
The property rate for the relocated home is subject to the costs
that were allowable under Minnesota Rules, chapter 9553, and the
investment per bed limitation for newly constructed or newly
established class B facilities.
(b) In ensuing years, all relocated homes shall be subject
to the investment per bed limit for newly constructed or newly
established class B facilities under section 256B.501,
subdivision 11. The limits shall be adjusted on January 1 of
each year by the percentage increase in the construction index
published by the Bureau of Economic Analysis of the United
States Department of Commerce in the Survey of Current Business
Statistics in October of the previous two years. Facilities
that are relocated within the investment per bed limit may be
approved by the statewide advisory committee. Costs for
relocation of a facility that exceed the investment per bed
limit must be absorbed by the facility.
(c) The payment rate shall take effect when the new
facility is licensed and certified by the commissioner of
health. Rates for facilities that are relocated after December
31, 1997, through October 1, 2000, shall be adjusted to reflect
the full inclusion of the relocation costs, subject to the
investment per bed limit in paragraph (b). The investment per
bed limit calculated rate for the year in which the facility was
relocated shall be the investment per bed limit used.
Subd. 4. [TEMPORARY RATE ADJUSTMENTS TO ADDRESS OCCUPANCY
AND ACCESS.] If a facility is operating at less than 100 percent
occupancy on September 30, 2000, or if a recipient is discharged
from a facility, the commissioner shall adjust the total payment
rate for up to 90 days for the remaining recipients. This
mechanism shall not be used to pay for hospital or therapeutic
leave days beyond the maximums allowed. Facility payment
adjustments exceeding 90 days to address a demonstrated need for
access must be submitted to the statewide advisory committee
with a local system needs assessment, plan, and budget for
review and recommendation.
Sec. 35. [256B.5014] [FINANCIAL REPORTING.]
All facilities shall maintain financial records and shall
provide annual income and expense reports to the commissioner of
human services on a form prescribed by the commissioner no later
than April 30 of each year in order to receive medical
assistance payments. The reports for the reporting year ending
December 31 must include:
(1) salaries and related expenses, including program
salaries, administrative salaries, other salaries, payroll
taxes, and fringe benefits;
(2) general operating expenses, including supplies,
training, repairs, purchased services and consultants,
utilities, food, licenses and fees, real estate taxes,
insurance, and working capital interest;
(3) property related costs, including depreciation, capital
debt interest, rent, and leases; and
(4) total annual resident days.
Sec. 36. [256B.5015] [PASS-THROUGH OF TRAINING AND
HABILITATION SERVICES COSTS.]
Training and habilitation services costs shall be paid as a
pass-through payment at the lowest rate paid for the comparable
services at that site under sections 252.40 to 252.46. The
pass-through payments for training and habilitation services
shall be paid separately by the commissioner and shall not be
included in the computation of the total payment rate.
Sec. 37. Minnesota Statutes 1998, section 256B.69,
subdivision 6a, is amended to read:
Subd. 6a. [NURSING HOME SERVICES.] (a) Notwithstanding
Minnesota Rules, part 9500.1457, subpart 1, item B, up to 90
days of nursing facility services as defined in section
256B.0625, subdivision 2, which are provided in a nursing
facility certified by the Minnesota department of health for
services provided and eligible for payment under Medicaid, shall
be covered under the prepaid medical assistance program for
individuals who are not residing in a nursing facility at the
time of enrollment in the prepaid medical assistance program.
Liability for coverage of nursing facility services by a
participating health plan is limited to 365 days for any person
enrolled under the prepaid medical assistance program.
(b) For individuals enrolled in the Minnesota senior health
options project authorized under subdivision 23, nursing
facility services shall be covered according to the terms and
conditions of the federal waiver agreement governing that
demonstration project.
Sec. 38. Minnesota Statutes 1998, section 256B.69,
subdivision 6b, is amended to read:
Subd. 6b. [ELDERLY HOME AND COMMUNITY-BASED WAIVER
SERVICES.] Notwithstanding Minnesota Rules, part 9500.1457,
subpart 1, item C, elderly waiver services shall be covered
under the prepaid medical assistance program for all individuals
who are eligible according to section 256B.0915. (a) For
individuals enrolled in the Minnesota senior health options
project authorized under subdivision 23, elderly waiver services
shall be covered according to the terms and conditions of the
federal waiver agreement governing that demonstration project.
(b) For individuals under age 65 with physical disabilities
but without a primary diagnosis of mental illness or
developmental disabilities, except for related conditions,
enrolled in the Minnesota senior health options project
authorized under subdivision 23, home and community-based waiver
services shall be covered according to the terms and conditions
of the federal agreement governing that demonstration project.
Sec. 39. Minnesota Statutes 1998, 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, and 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 190 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 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 or state 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, 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.; or (6) for group
residential housing beds in settings meeting the requirements of
subdivision 2a, clauses (1) and (3), which are used exclusively
for recipients receiving home and community-based waiver
services under sections 256B.0915, 256B.092, subdivision 5,
256B.093, and 256B.49, and who resided in a nursing facility for
the six months immediately prior to the month of entry into the
group residential housing setting. The group residential
housing rate for these beds must be set so that the monthly
group residential housing payment for an individual occupying
the bed when combined with the nonfederal share of services
delivered under the waiver for that person does not exceed the
nonfederal share of the monthly medical assistance payment made
for the person to the nursing facility in which the person
resided prior to entry into the group residential housing
establishment. The rate may not exceed the MSA equivalent rate
plus $426.37 for any case.
(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. 40. Minnesota Statutes 1998, section 256I.05,
subdivision 1, is amended to read:
Subdivision 1. [MAXIMUM RATES.] Monthly room and board
rates negotiated by a county agency for a recipient living in
group residential housing must not exceed the MSA equivalent
rate specified under section 256I.03, subdivision 5, with the
exception that a county agency may negotiate a supplementary
room and board rate that exceeds the MSA equivalent rate by up
to $426.37 for recipients of waiver services under title XIX of
the Social Security Act. This exception is subject to the
following conditions:
(1) that the Secretary of Health and Human Services has not
approved a state request to include room and board costs which
exceed the MSA equivalent rate in an individual's set of waiver
services under title XIX of the Social Security Act; or
(2) that the Secretary of Health and Human Services has
approved the inclusion of room and board costs which exceed the
MSA equivalent rate, but in an amount that is insufficient to
cover costs which are included in a group residential housing
agreement in effect on June 30, 1994; and
(3) the amount of the rate that is above the MSA equivalent
rate has been approved by the commissioner the setting is
licensed by the commissioner of human services under Minnesota
Rules, parts 9555.5050 to 9555.6265;
(2) the setting is not the primary residence of the license
holder and in which the license holder is not the primary
caregiver; and
(3) the average supplementary room and board rate in a
county for a calendar year may not exceed the average
supplementary room and board rate for that county in effect on
January 1, 2000. For calendar years beginning on or after
January 1, 2002, within the limits of appropriations
specifically for this purpose, the commissioner shall increase
each county's supplemental room and board rate average on an
annual basis by a factor consisting of the percentage change in
the Consumer Price Index-All items, United States city average
(CPI-U) for that calendar year compared to the preceding
calendar year as forecasted by Data Resources, Inc., in the
third quarter of the preceding calendar year. If a county has
not negotiated supplementary room and board rates for any
facilities located in the county as of January 1, 2000, or has
an average supplemental room and board rate under $100 per
person as of January 1, 2000, it may submit a supplementary room
and board rate request with budget information for a facility to
the commissioner for approval.
The county agency may at any time negotiate a higher or lower
room and board rate than the average supplementary room and
board rate that would otherwise be paid under this subdivision.
Sec. 41. Minnesota Statutes 1998, section 256I.05,
subdivision 1a, is amended to read:
Subd. 1a. [SUPPLEMENTARY SERVICE RATES.] (a) Subject to
the provisions of section 256I.04, subdivision 3, in addition to
the room and board rate specified in subdivision 1, the county
agency may negotiate a payment not to exceed $426.37 for other
services necessary to provide room and board provided by the
group residence if the residence is licensed by or registered by
the department of health, or licensed by the department of human
services to provide services in addition to room and board, and
if the provider of services is not also concurrently receiving
funding for services for a recipient under a home and
community-based waiver under title XIX of the Social Security
Act; or funding from the medical assistance program under
section 256B.0627, subdivision 4, for personal care services for
residents in the setting; or residing in a setting which
receives funding under Minnesota Rules, parts 9535.2000 to
9535.3000. If funding is available for other necessary services
through a home and community-based waiver, or personal care
services under section 256B.0627, subdivision 4, then the GRH
rate is limited to the rate set in subdivision 1. Unless
otherwise provided in law, in no case may the supplementary
service rate plus the supplementary room and board rate exceed
$426.37. The registration and licensure requirement does not
apply to establishments which are exempt from state licensure
because they are located on Indian reservations and for which
the tribe has prescribed health and safety requirements.
Service payments under this section may be prohibited under
rules to prevent the supplanting of federal funds with state
funds. The commissioner shall pursue the feasibility of
obtaining the approval of the Secretary of Health and Human
Services to provide home and community-based waiver services
under title XIX of the Social Security Act for residents who are
not eligible for an existing home and community-based waiver due
to a primary diagnosis of mental illness or chemical dependency
and shall apply for a waiver if it is determined to be
cost-effective.
(b) The commissioner is authorized to make cost-neutral
transfers from the GRH fund for beds under this section to other
funding programs administered by the department after
consultation with the county or counties in which the affected
beds are located. The commissioner may also make cost-neutral
transfers from the GRH fund to county human service agencies for
beds permanently removed from the GRH census under a plan
submitted by the county agency and approved by the
commissioner. The commissioner shall report the amount of any
transfers under this provision annually to the legislature.
(c) The provisions of paragraph (b) do not apply to a
facility that has its reimbursement rate established under
section 256B.431, subdivision 4, paragraph (c).
Sec. 42. Minnesota Statutes 1998, section 256I.05, is
amended by adding a subdivision to read:
Subd. 1e. [SUPPLEMENTARY RATE FOR CERTAIN FACILITIES.]
Notwithstanding the provisions of subdivisions 1a and 1c,
beginning July 1, 1999, a county agency shall negotiate a
supplementary rate in addition to the rate specified in
subdivision 1, equal to 25 percent of the amount specified in
subdivision 1a, for a group residential housing provider that:
(1) is located in Hennepin county and has had a group
residential housing contract with the county since June 1996;
(2) operates in three separate locations a 56-bed facility,
a 40-bed facility, and a 30-bed facility; and
(3) serves a chemically dependent clientele, providing 24
hours per day supervision and limiting a resident's maximum
length of stay to 13 months out of a consecutive 24-month period.
Sec. 43. Laws 1995, chapter 207, article 3, section 21, is
amended to read:
Sec. 21. [FACILITY CERTIFICATION.]
Notwithstanding Minnesota Statutes, section 252.291,
subdivisions 1 and 2, the commissioner of health shall inspect
to certify a large community-based facility currently licensed
under Minnesota Rules, parts 9525.0215 to 9525.0355, for more
than 16 beds and located in Northfield. The facility may be
certified for up to 44 beds. The commissioner of health must
inspect to certify the facility as soon as possible after the
effective date of this section. The commissioner of human
services shall work with the facility and affected counties to
relocate any current residents of the facility who do not meet
the admission criteria for an ICF/MR. Until January 1, 1999, in
order to fund the ICF/MR services and relocations of current
residents authorized, the commissioner of human services may
transfer on a quarterly basis to the medical assistance account
from each affected county's community social service allocation,
an amount equal to the state share of medical assistance
reimbursement for the residential and day habilitation services
funded by medical assistance and provided to clients for whom
the county is financially responsible. After January 1, 1999,
the commissioner of human services shall fund the services under
the state medical assistance program and may transfer on a
quarterly basis to the medical assistance account from each
affected county's community social service allocation, an amount
equal to one-half of the state share of medical assistance
reimbursement for the residential and day habilitation services
funded by medical assistance and provided to clients for whom
the county is financially responsible. For nonresidents of
Minnesota seeking admission to the facility, Rice county shall
be notified in order to assure that appropriate funding is
guaranteed from their state or country of residence.
Sec. 44. [DEADLINE EXTENSION.]
Notwithstanding Minnesota Statutes, section 144A.073,
subdivision 3, the commissioner of health shall extend approval
to May 31, 2000, for a total replacement of a 96-bed nursing
home located in Carlton county previously approved under
Minnesota Statutes, section 144A.073.
Sec. 45. [STATE LICENSURE CONFLICTS WITH FEDERAL
REGULATIONS.]
(a) Notwithstanding the provisions of Minnesota Rules, part
4658.0520, an incontinent resident must be checked according to
a specific time interval written in the resident's care plan.
The resident's attending physician must authorize in writing any
interval longer than two hours.
(b) This section expires July 1, 2001.
Sec. 46. [GROUP RESIDENTIAL HOUSING STUDY.]
The commissioner of human services shall submit to the
legislature by February 15, 2000, a study of the cost of
providing housing for individuals eligible for group residential
housing payments and an analysis of the relationship of the
costs to market rate housing costs in a representative number of
regions in the state. In preparing the study, the commissioner
shall consult with representatives of affected industries,
counties, and consumers.
Sec. 47. [ICF/MR SERVICE RECONFIGURATION PROJECT.]
(a) The commissioner of human services may authorize a
project to reconfigure two existing intermediate care facilities
for persons with mental retardation or related conditions
(ICFs/MR) located on the same campus in Carver county and
totaling 60 licensed beds in one 46-bed facility and one 14-bed
facility. The reconfiguration project will involve the
relocation of up to six beds to a six-bed ICF/MR. The remaining
two ICFs/MR shall consist of one 34-bed ICF/MR and one ten-bed
ICF/MR.
(b) The project shall include the development of
alternative home and community-based services for individuals
relocated from the existing facilities. In conjunction with
this project, two beds in the 34-bed facility shall be reserved
for temporary care services for individuals receiving
alternative home and community-based services. The ICF/MR may
seek county approval to modify its need determinations in order
to serve fewer clients, or to provide additional beds for
temporary care services.
(c) 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 vendors for the alternative services. The
commissioner is authorized to develop the two additional beds
required, and set aside waivered service slots as needed for
individuals choosing alternative home and community-based
services.
(d) Upon approval of the project, the following additional
conditions shall apply to rate setting:
(1) the two existing facilities' aggregate
investment-per-bed limits in effect before the downsizing shall
be the investment-per-bed limit after the downsizing;
(2) the ten-bed and the 34-bed facilities shall be eligible
for a one-time rate adjustment to be negotiated with the
commissioner taking into consideration estimated excess revenues
available from the six-bed facility;
(3) the relocated six-bed facility shall receive the
payment rates established for the former 46-bed facility until
each facility files a cost report for a period of five months or
longer ending on December 31 following their opening and those
reports are desk audited by the commissioner. The two remaining
facilities shall file their regularly scheduled annual cost
reports;
(4) all facilities are exempt from the spend-up and high
cost limits in Minnesota Statutes, section 256B.501, subdivision
5b, for the rate year following the first cost report submitted
under clause (3); and
(5) the maintenance limit for the 34-bed facility shall be
established using the methodology in Minnesota Statutes, section
256B.501, subdivision 5d. The maintenance limit for the ten-bed
facility shall be adjusted by the same ratio used to adjust the
34-bed facility's maintenance limit.
Sec. 48. [ICF/MR REIMBURSEMENT EFFECTIVE OCTOBER 1, 1999.]
(a) For the rate year beginning October 1, 1999, the
commissioner of human services shall exempt an intermediate care
facility for persons with mental retardation 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 that has been converted under
Minnesota Statutes, section 252.292, since rate year 1990;
(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.
(b) Notwithstanding any contrary provision in Minnesota
Statutes, section 256B.501, for the rate year beginning October
1, 1999, the commissioner of human services shall, for purposes
of the spend-up limit, array facilities within each grouping
established under 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 the 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 report year's cost per resident day plus the
inflation factor established under Minnesota Statutes, section
256B.501, subdivision 3c, clause (2), increased by three
percentage points. In no case shall the amount of this
reduction exceed: (i) three percent for a facility with a
licensed capacity greater than 16 beds; (ii) two percent for a
facility with a licensed capacity of nine to 16 beds; and (iii)
one percent for a facility with a licensed capacity of eight or
fewer beds.
(c) The commissioner shall not apply the limits established
under Minnesota Statutes, section 256B.501, subdivision 5b,
paragraph (d), clause (8), for the rate year beginning October
1, 1999.
(d) Notwithstanding paragraphs (b) and (c), the
commissioner must utilize facility payment rates based on the
laws in effect for October 1, 1998, payment rates and use the
resulting allowable operating cost per diems as the basis for
the spend-up limits for the rate year beginning October 1, 1999.
Sec. 49. [DEADLINE EXTENSION.]
Notwithstanding Minnesota Statutes, section 144A.073,
subdivision 3, the commissioner of health shall extend approval
to May 31, 2000, for a total replacement of a 96-bed nursing
home located in Carlton county previously approved under
Minnesota Statutes, section 144A.073.
Sec. 50. [GROUP RESIDENTIAL HOUSING STUDY.]
The commissioner of human services shall submit to the
legislature by February 15, 2000, a study of the cost of
providing housing for individuals eligible for group residential
housing payments and an analysis of the relationship of the
costs to market rate housing costs in a representative number of
regions in the state. In preparing the study, the commissioner
shall consult with representatives of affected industries,
counties, and consumers.
Sec. 51. [REPEALER.]
(a) Minnesota Statutes 1998, sections 144.0723; and
256B.5011, subdivision 3, are repealed.
(b) Minnesota Statutes 1998, section 256B.434, subdivision
17, is repealed effective July 1, 1999.
(c) Minnesota Statutes 1998, section 256B.501, subdivision
3g, is repealed effective October 1, 2000.
(d) Laws 1997, chapter 203, article 4, section 55, is
repealed.
(e) Section 45 is repealed effective July 1, 2001.
Sec. 52. [EFFECTIVE DATE.]
Sections 3 to 7 and 45 are effective the day following
final enactment.
ARTICLE 4
HEALTH CARE PROGRAMS
Section 1. Minnesota Statutes 1998, section 62A.045, is
amended to read:
62A.045 [PAYMENTS ON BEHALF OF ENROLLEES IN GOVERNMENT
HEALTH PROGRAMS.]
(a) No health plan issued or renewed to provide coverage to
a Minnesota resident shall contain any provision denying or
reducing benefits because services are rendered to a person who
is eligible for or receiving medical benefits pursuant to title
XIX of the Social Security Act (Medicaid) in this or any other
state; chapter 256; 256B; or 256D or services pursuant to
section 252.27; 256L.01 to 256L.10; 260.251, subdivision 1a; or
393.07, subdivision 1 or 2. No health carrier providing
benefits under plans covered by this section shall use
eligibility for medical programs named in this section as an
underwriting guideline or reason for nonacceptance of the risk.
(b) If payment for covered expenses has been made under
state medical programs for health care items or services
provided to an individual, and a third party has a legal
liability to make payments, the rights of payment and appeal of
an adverse coverage decision for the individual, or in the case
of a child their responsible relative or caretaker, will be
subrogated to the state and/or its authorized agent agency. The
state agency may assert its rights under this section within
three years of the date the service was rendered. For purposes
of this section, "state agency" includes prepaid health plans
under contract with the commissioner according to sections
256B.69, 256D.03, subdivision 4, paragraph (d), and 256L.12;
children's mental health collaboratives under section 245.493;
demonstration projects for persons with disabilities under
section 256B.77; nursing homes under the alternative payment
demonstration project under section 256B.434; and county-based
purchasing entities under section 256B.692.
(c) Notwithstanding any law to the contrary, when a person
covered by a health plan receives medical benefits according to
any statute listed in this section, payment for covered services
or notice of denial for services billed by the provider must be
issued directly to the provider. If a person was receiving
medical benefits through the department of human services at the
time a service was provided, the provider must indicate this
benefit coverage on any claim forms submitted by the provider to
the health carrier for those services. If the commissioner of
human services notifies the health carrier that the commissioner
has made payments to the provider, payment for benefits or
notices of denials issued by the health carrier must be issued
directly to the commissioner. Submission by the department to
the health carrier of the claim on a department of human
services claim form is proper notice and shall be considered
proof of payment of the claim to the provider and supersedes any
contract requirements of the health carrier relating to the form
of submission. Liability to the insured for coverage is
satisfied to the extent that payments for those benefits are
made by the health carrier to the provider or the commissioner
as required by this section.
(d) When a state agency has acquired the rights of an
individual eligible for medical programs named in this section
and has health benefits coverage through a health carrier, the
health carrier shall not impose requirements that are different
from requirements applicable to an agent or assignee of any
other individual covered.
(e) For the purpose of this section, health plan includes
coverage offered by community integrated service networks, any
plan governed under the federal Employee Retirement Income
Security Act of 1974 (ERISA), United States Code, title 29,
sections 1001 to 1461, and coverage offered under the exclusions
listed in section 62A.011, subdivision 3, clauses (2), (6), (9),
(10), and (12).
Sec. 2. Minnesota Statutes 1998, section 122A.09,
subdivision 4, is amended to read:
Subd. 4. [LICENSE AND RULES.] (a) The board must adopt
rules to license public school teachers and interns subject to
chapter 14.
(b) The board must adopt rules requiring a person to
successfully complete a skills examination in reading, writing,
and mathematics as a requirement for initial teacher licensure.
Such rules must require college and universities offering a
board approved teacher preparation program to provide remedial
assistance to persons who did not achieve a qualifying score on
the skills examination, including those for whom English is a
second language.
(c) The board must adopt rules to approve teacher
preparation programs.
(d) The board must provide the leadership and shall adopt
rules for the redesign of teacher education programs to
implement a research based, results-oriented curriculum that
focuses on the skills teachers need in order to be effective.
The board shall implement new systems of teacher preparation
program evaluation to assure program effectiveness based on
proficiency of graduates in demonstrating attainment of program
outcomes.
(e) The board must adopt rules requiring successful
completion of an examination of general pedagogical knowledge
and examinations of licensure-specific teaching skills. The
rules shall be effective on the dates determined by the board,
but not later than July 1, 1999.
(f) The board must adopt rules requiring teacher educators
to work directly with elementary or secondary school teachers in
elementary or secondary schools to obtain periodic exposure to
the elementary or secondary teaching environment.
(g) The board must grant licenses to interns and to
candidates for initial licenses.
(h) The board must design and implement an assessment
system which requires a candidate for an initial license and
first continuing license to demonstrate the abilities necessary
to perform selected, representative teaching tasks at
appropriate levels.
(i) The board must receive recommendations from local
committees as established by the board for the renewal of
teaching licenses.
(j) The board must grant life licenses to those who qualify
according to requirements established by the board, and suspend
or revoke licenses pursuant to sections 122A.20 and 214.10. The
board must not establish any expiration date for application for
life licenses.
(k) In adopting rules to license public school teachers who
provide health-related services for disabled children, the board
shall adopt rules consistent with license or registration
requirements of the commissioner of health and the
health-related boards who license personnel who perform similar
services outside of the school.
Sec. 3. Minnesota Statutes 1998, section 125A.08, is
amended to read:
125A.08 [SCHOOL DISTRICT OBLIGATIONS.]
(a) As defined in this section, to the extent required by
federal law as of July 1, 1999 2000, every district must ensure
the following:
(1) all students with disabilities are provided the special
instruction and services which are appropriate to their needs.
Where the individual education plan team has determined
appropriate goals and objectives based on the student's needs,
including the extent to which the student can be included in the
least restrictive environment, and where there are essentially
equivalent and effective instruction, related services, or
assistive technology devices available to meet the student's
needs, cost to the district may be among the factors considered
by the team in choosing how to provide the appropriate services,
instruction, or devices that are to be made part of the
student's individual education plan. The individual education
plan team shall consider and may authorize services covered by
medical assistance according to section 256B.0625, subdivision
26. The student's needs and the special education instruction
and services to be provided must be agreed upon through the
development of an individual education plan. The plan must
address the student's need to develop skills to live and work as
independently as possible within the community. By grade 9 or
age 14, the plan must address the student's needs for transition
from secondary services to post-secondary education and
training, employment, community participation, recreation, and
leisure and home living. In developing the plan, districts must
inform parents of the full range of transitional goals and
related services that should be considered. The plan must
include a statement of the needed transition services, including
a statement of the interagency responsibilities or linkages or
both before secondary services are concluded;
(2) children with a disability under age five and their
families are provided special instruction and services
appropriate to the child's level of functioning and needs;
(3) children with a disability and their parents or
guardians are guaranteed procedural safeguards and the right to
participate in decisions involving identification, assessment
including assistive technology assessment, and educational
placement of children with a disability;
(4) eligibility and needs of children with a disability are
determined by an initial assessment or reassessment, which may
be completed using existing data under United States Code, title
20, section 33, et seq.;
(5) to the maximum extent appropriate, children with a
disability, including those in public or private institutions or
other care facilities, are educated with children who are not
disabled, and that special classes, separate schooling, or other
removal of children with a disability from the regular
educational environment occurs only when and to the extent that
the nature or severity of the disability is such that education
in regular classes with the use of supplementary services cannot
be achieved satisfactorily;
(6) in accordance with recognized professional standards,
testing and evaluation materials, and procedures used for the
purposes of classification and placement of children with a
disability are selected and administered so as not to be
racially or culturally discriminatory; and
(7) the rights of the child are protected when the parents
or guardians are not known or not available, or the child is a
ward of the state.
(b) For paraprofessionals employed to work in programs for
students with disabilities, the school board in each district
shall ensure that:
(1) before or immediately upon employment, each
paraprofessional develops sufficient knowledge and skills in
emergency procedures, building orientation, roles and
responsibilities, confidentiality, vulnerability, and
reportability, among other things, to begin meeting the needs of
the students with whom the paraprofessional works;
(2) annual training opportunities are available to enable
the paraprofessional to continue to further develop the
knowledge and skills that are specific to the students with whom
the paraprofessional works, including understanding
disabilities, following lesson plans, and implementing follow-up
instructional procedures and activities; and
(3) a districtwide process obligates each paraprofessional
to work under the ongoing direction of a licensed teacher and,
where appropriate and possible, the supervision of a school
nurse.
Sec. 4. Minnesota Statutes 1998, section 125A.744,
subdivision 3, is amended to read:
Subd. 3. [IMPLEMENTATION.] Consistent with section
256B.0625, subdivision 26, school districts may enroll as
medical assistance providers or subcontractors and bill the
department of human services under the medical assistance fee
for service claims processing system for special education
services which are covered services under chapter 256B, which
are provided in the school setting for a medical assistance
recipient, and for whom the district has secured informed
consent consistent with section 13.05, subdivision 4, paragraph
(d), and section 256B.77, subdivision 2, paragraph (p), to bill
for each type of covered service. School districts shall be
reimbursed by the commissioner of human services for the federal
share of individual education plan health-related services that
qualify for reimbursement by medical assistance, minus up to
five percent retained by the commissioner of human services for
administrative costs, not to exceed $350,000 per fiscal year.
The commissioner may withhold up to five percent of each payment
to a school district. Following the end of each fiscal year,
the commissioner shall settle up with each school district in
order to ensure that collections from each district for
departmental administrative costs are made on a pro rata basis
according to federal earnings for these services in each
district. A school district is not eligible to enroll as a home
care provider or a personal care provider organization for
purposes of billing home care services under section 256B.0627
until the commissioner of human services issues a bulletin
instructing county public health nurses on how to assess for the
needs of eligible recipients during school hours. To use
private duty nursing services or personal care services at
school, the recipient or responsible party must provide written
authorization in the care plan identifying the chosen provider
and the daily amount of services to be used at school. Medical
assistance services for those enrolled in a prepaid health plan
shall remain the responsibility of the contracted health plan
subject to their network, credentialing, prior authorization,
and determination of medical necessity criteria. The
commissioner of human services shall adjust payments to health
plans to reflect increased costs incurred by health plans due to
increased payments made to school districts or new payment or
delivery arrangements developed by health plans in cooperation
with school districts.
Sec. 5. Minnesota Statutes 1998, section 125A.76,
subdivision 2, is amended to read:
Subd. 2. [SPECIAL EDUCATION BASE REVENUE.] (a) The special
education base revenue equals the sum of the following amounts
computed using base year data:
(1) 68 percent of the salary of each essential person
employed in the district's program for children with a
disability during the fiscal year, not including the share of
salaries for personnel providing health-related services counted
in clause (8), whether the person is employed by one or more
districts or a Minnesota correctional facility operating on a
fee-for-service basis;
(2) for the Minnesota state academy for the deaf or the
Minnesota state academy for the blind, 68 percent of the salary
of each instructional aide assigned to a child attending the
academy, if that aide is required by the child's individual
education plan;
(3) for special instruction and services provided to any
pupil by contracting with public, private, or voluntary agencies
other than school districts, in place of special instruction and
services provided by the district, 52 percent of the difference
between the amount of the contract and the basic revenue of the
district for that pupil for the fraction of the school day the
pupil receives services under the contract;
(4) for special instruction and services provided to any
pupil by contracting for services with public, private, or
voluntary agencies other than school districts, that are
supplementary to a full educational program provided by the
school district, 52 percent of the amount of the contract for
that pupil;
(5) for supplies and equipment purchased or rented for use
in the instruction of children with a disability, not including
the portion of the expenses for supplies and equipment used to
provide health-related services counted in clause (8), an amount
equal to 47 percent of the sum actually expended by the
district, or a Minnesota correctional facility operating on a
fee-for-service basis, but not to exceed an average of $47 in
any one school year for each child with a disability receiving
instruction;
(6) for fiscal years 1997 and later, special education base
revenue shall include amounts under clauses (1) to (5) for
special education summer programs provided during the base year
for that fiscal year; and
(7) for fiscal years 1999 and later, the cost of providing
transportation services for children with disabilities under
section 123B.92, subdivision 1, paragraph (b), clause (4); and
(8) for fiscal years 2001 and later, the cost of salaries,
supplies and equipment, and other related costs actually
expended by the district for the nonfederal share of medical
assistance services according to section 256B.0625, subdivision
26.
(b) If requested by a school district operating a special
education program during the base year for less than the full
fiscal year, or a school district in which is located a
Minnesota correctional facility operating on a fee-for-service
basis for less than the full fiscal year, the commissioner may
adjust the base revenue to reflect the expenditures that would
have occurred during the base year had the program been operated
for the full fiscal year.
(c) Notwithstanding paragraphs (a) and (b), the portion of
a school district's base revenue attributable to a Minnesota
correctional facility operating on a fee-for-service basis
during the facility's first year of operating on a
fee-for-service basis shall be computed using current year data.
Sec. 6. [127A.11] [MONITOR MEDICAL ASSISTANCE SERVICES FOR
DISABLED STUDENTS.]
The commissioner of children, families, and learning, in
cooperation with the commissioner of human services, shall
monitor the costs of health-related, special education services
provided by public schools.
Sec. 7. [214.045] [COORDINATION WITH BOARD OF TEACHING.]
The commissioner of health and the health-related licensing
boards must coordinate with the board of teaching when modifying
licensure requirements for regulated persons in order to have
consistent regulatory requirements for personnel who perform
services in schools.
Sec. 8. [245.99] [ADULT MENTAL ILLNESS CRISIS HOUSING
ASSISTANCE PROGRAM.]
Subdivision 1. [CREATION.] The adult mental illness crisis
housing assistance program is established in the department of
human services.
Subd. 2. [RENTAL ASSISTANCE.] The program shall pay up to
90 days of housing assistance for persons with a serious and
persistent mental illness who require inpatient or residential
care for stabilization. The commissioner of human services may
extend the length of assistance on a case-by-case basis.
Subd. 3. [ELIGIBILITY.] Housing assistance under this
section is available only to persons of low or moderate income
as determined by the commissioner.
Subd. 4. [ADMINISTRATION.] The commissioner may contract
with organizations or government units experienced in housing
assistance to operate the program under this section.
Sec. 9. Minnesota Statutes 1998, section 245A.04,
subdivision 3a, is amended to read:
Subd. 3a. [NOTIFICATION TO SUBJECT AND LICENSE HOLDER OF
STUDY RESULTS; DETERMINATION OF RISK OF HARM.] (a) The
commissioner shall notify the applicant or license holder and
the individual who is the subject of the study, in writing or by
electronic transmission, of the results of the study. When the
study is completed, a notice that the study was undertaken and
completed shall be maintained in the personnel files of the
program. For studies on individuals pertaining to a license to
provide family day care or group family day care, foster care
for children in the provider's own home, or foster care or day
care services for adults in the provider's own home, the
commissioner is not required to provide a separate notice of the
background study results to the individual who is the subject of
the study unless the study results in a disqualification of the
individual.
The commissioner shall notify the individual studied if the
information in the study indicates the individual is
disqualified from direct contact with persons served by the
program. The commissioner shall disclose the information
causing disqualification and instructions on how to request a
reconsideration of the disqualification to the individual
studied. An applicant or license holder who is not the subject
of the study shall be informed that the commissioner has found
information that disqualifies the subject from direct contact
with persons served by the program. However, only the
individual studied must be informed of the information contained
in the subject's background study unless the only basis for the
disqualification is failure to cooperate, the Data Practices Act
provides for release of the information, or the individual
studied authorizes the release of the information.
(b) If the commissioner determines that the individual
studied has a disqualifying characteristic, the commissioner
shall review the information immediately available and make a
determination as to the subject's immediate risk of harm to
persons served by the program where the individual studied will
have direct contact. The commissioner shall consider all
relevant information available, including the following factors
in determining the immediate risk of harm: the recency of the
disqualifying characteristic; the recency of discharge from
probation for the crimes; the number of disqualifying
characteristics; the intrusiveness or violence of the
disqualifying characteristic; the vulnerability of the victim
involved in the disqualifying characteristic; and the similarity
of the victim to the persons served by the program where the
individual studied will have direct contact. The commissioner
may determine that the evaluation of the information immediately
available gives the commissioner reason to believe one of the
following:
(1) The individual poses an imminent risk of harm to
persons served by the program where the individual studied will
have direct contact. If the commissioner determines that an
individual studied poses an imminent risk of harm to persons
served by the program where the individual studied will have
direct contact, the individual and the license holder must be
sent a notice of disqualification. The commissioner shall order
the license holder to immediately remove the individual studied
from direct contact. The notice to the individual studied must
include an explanation of the basis of this determination.
(2) The individual poses a risk of harm requiring
continuous supervision while providing direct contact services
during the period in which the subject may request a
reconsideration. If the commissioner determines that an
individual studied poses a risk of harm that requires continuous
supervision, the individual and the license holder must be sent
a notice of disqualification. The commissioner shall order the
license holder to immediately remove the individual studied from
direct contact services or assure that the individual studied is
within sight or hearing of another staff person when providing
direct contact services during the period in which the
individual may request a reconsideration of the
disqualification. If the individual studied does not submit a
timely request for reconsideration, or the individual submits a
timely request for reconsideration, but the disqualification is
not set aside for that license holder, the license holder will
be notified of the disqualification and ordered to immediately
remove the individual from any position allowing direct contact
with persons receiving services from the license holder.
(3) The individual does not pose an imminent risk of harm
or a risk of harm requiring continuous supervision while
providing direct contact services during the period in which the
subject may request a reconsideration. If the commissioner
determines that an individual studied does not pose a risk of
harm that requires continuous supervision, only the individual
must be sent a notice of disqualification. The license holder
must be sent a notice that more time is needed to complete the
individual's background study. If the individual studied
submits a timely request for reconsideration, and if the
disqualification is set aside for that license holder, the
license holder will receive the same notification received by
license holders in cases where the individual studied has no
disqualifying characteristic. If the individual studied does
not submit a timely request for reconsideration, or the
individual submits a timely request for reconsideration, but the
disqualification is not set aside for that license holder, the
license holder will be notified of the disqualification and
ordered to immediately remove the individual from any position
allowing direct contact with persons receiving services from the
license holder.
(c) County licensing agencies performing duties under this
subdivision may develop an alternative system for determining
the subject's immediate risk of harm to persons served by the
program, providing the notices under paragraph (b), and
documenting the action taken by the county licensing agency.
Each county licensing agency's implementation of the alternative
system is subject to approval by the commissioner.
Notwithstanding this alternative system, county licensing
agencies shall complete the requirements of paragraph (a).
Sec. 10. Minnesota Statutes 1998, section 245A.08,
subdivision 5, is amended to read:
Subd. 5. [NOTICE OF THE COMMISSIONER'S FINAL ORDER.] After
considering the findings of fact, conclusions, and
recommendations of the administrative law judge, the
commissioner shall issue a final order. The commissioner shall
consider, but shall not be bound by, the recommendations of the
administrative law judge. The appellant must be notified of the
commissioner's final order as required by chapter 14. The
notice must also contain information about the appellant's
rights under chapter 14. The institution of proceedings for
judicial review of the commissioner's final order shall not stay
the enforcement of the final order except as provided in section
14.65. A license holder and each controlling individual of a
license holder whose license has been revoked because of
noncompliance with applicable law or rule must not be granted a
license for five years following the revocation. An applicant
whose application was denied must not be granted a license for
two years following a denial, unless the applicant's subsequent
application contains new information which constitutes a
substantial change in the conditions that caused the previous
denial.
Sec. 11. Minnesota Statutes 1998, section 245B.05,
subdivision 7, is amended to read:
Subd. 7. [REPORTING INCIDENTS AND EMERGENCIES.] The
license holder must report the following incidents to the
consumer's legal representative, caregiver, and case manager
within 24 hours of the occurrence, or within 24 hours of receipt
of the information:
(1) the death of a consumer;
(2) any medical emergencies, unexpected serious illnesses,
or accidents that require physician treatment or
hospitalization;
(3) a consumer's unauthorized absence; or
(4) any fires and incidents involving a law enforcement
agency.
Death or serious injury of the consumer must also be
reported to the commissioner department of human services
licensing division and the ombudsman, as required under sections
245.91 and 245.94, subdivision 2a.
Sec. 12. Minnesota Statutes 1998, section 245B.07,
subdivision 5, is amended to read:
Subd. 5. [STAFF ORIENTATION.] (a) Within 60 days of hiring
staff who provide direct service, the license holder must
provide 30 hours of staff orientation. Direct care staff must
complete 15 of the 30 hours orientation before providing any
unsupervised direct service to a consumer. If the staff person
has received orientation training from a license holder licensed
under 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 under this chapter.
(b) The 30 hours of orientation must combine supervised
on-the-job training with coverage of the following material:
(1) review of the consumer's service plans and risk
management plan to achieve an understanding of the consumer as a
unique individual;
(2) review and instruction on 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 section
245A.65; sections 626.556 and 626.557, governing maltreatment
reporting and service planning for children and vulnerable
adults; and section 245.825, governing use of aversive and
deprivation procedures;
(6) medication administration as it applies to the
individual consumer, from a training curriculum developed by a
health services professional described in section 245B.05,
subdivision 5, and when the consumer meets the criteria of
having overriding health care needs, then medication
administration taught by a health services professional. Staff
may administer medications only after they demonstrate the
ability, as defined in the license holder's medication
administration policy and procedures. Once a consumer with
overriding health care needs is admitted, staff will be provided
with remedial training as deemed necessary by the license holder
and the health professional to meet the needs of that consumer.
For purposes of this section, overriding health care needs
means a health care condition that affects the service options
available to the consumer because the condition requires:
(i) specialized or intensive medical or nursing
supervision; and
(ii) nonmedical service providers to adapt their services
to accommodate the health and safety needs of the 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.
Sec. 13. Minnesota Statutes 1998, section 245B.07,
subdivision 8, is amended to read:
Subd. 8. [POLICIES AND PROCEDURES.] The license holder
must develop and implement the policies and procedures in
paragraphs (1) to (3).
(1) policies and procedures that promote consumer health
and safety by ensuring:
(i) consumer safety in emergency situations as identified
in section 245B.05, subdivision 7;
(ii) consumer health through sanitary practices;
(iii) safe transportation, when the license holder is
responsible for transportation of consumers, with provisions for
handling emergency situations;
(iv) a system of recordkeeping for both individuals and the
organization, for review of incidents and emergencies, and
corrective action if needed;
(v) a plan for responding to and reporting all emergencies,
including deaths, medical emergencies, illnesses, accidents,
missing consumers, fires, severe weather and natural disasters,
bomb threats, and other threats;
(vi) safe medication administration as identified in
section 245B.05, subdivision 5, incorporating an observed skill
assessment to ensure that staff demonstrate the ability to
administer medications consistent with the license holder's
policy and procedures;
(vii) psychotropic medication monitoring when the consumer
is prescribed a psychotropic medication, including the use of
the psychotropic medication use checklist. If the
responsibility for implementing the psychotropic medication use
checklist has not been assigned in the individual service plan
and the consumer lives in a licensed site, the residential
license holder shall be designated; and
(viii) criteria for admission or service initiation
developed by the license holder;
(2) policies and procedures that protect consumer rights
and privacy by ensuring:
(i) consumer data privacy, in compliance with the Minnesota
Data Practices Act, chapter 13; and
(ii) that complaint procedures provide consumers with a
simple process to bring grievances and consumers receive a
response to the grievance within a reasonable time period. The
license holder must provide a copy of the program's grievance
procedure and time lines for addressing grievances. The
program's grievance procedure must permit consumers served by
the program and the authorized representatives to bring a
grievance to the highest level of authority in the program; and
(3) policies and procedures that promote continuity and
quality of consumer supports by ensuring:
(i) continuity of care and service coordination, including
provisions for service termination, temporary service
suspension, and efforts made by the license holder to coordinate
services with other vendors who also provide support to the
consumer. The policy must include the following requirements:
(A) the license holder must notify the consumer or
consumer's legal representative and the consumer's case manager
in writing of the intended termination or temporary service
suspension and the consumer's right to seek a temporary order
staying the termination or suspension of service according to
the procedures in section 256.045, subdivision 4a or subdivision
6, paragraph (c);
(B) notice of the proposed termination of services,
including those situations that began with a temporary service
suspension, must be given at least 60 days before the proposed
termination is to become effective, unless services are
temporarily suspended according to the license holder's written
temporary service suspension procedures, in which case notice
must be given as soon as possible;
(C) the license holder must provide information requested
by the consumer or consumer's legal representative or case
manager when services are temporarily suspended or upon notice
of termination;
(D) use of temporary service suspension procedures are
restricted to situations in which the consumer's behavior causes
immediate and serious danger to the health and safety of the
individual or others;
(E) prior to giving notice of service termination or
temporary service suspension, the license holder must document
actions taken to minimize or eliminate the need for service
termination or temporary service suspension; and
(F) during the period of temporary service suspension, the
license holder will work with the appropriate county agency to
develop reasonable alternatives to protect the individual and
others; and
(ii) quality services measured through a program evaluation
process including regular evaluations of consumer satisfaction
and sharing the results of the evaluations with the consumers
and legal representatives.
Sec. 14. Minnesota Statutes 1998, section 245B.07,
subdivision 10, is amended to read:
Subd. 10. [CONSUMER FUNDS.] (a) The license holder must
ensure that consumers retain the use and availability of
personal funds or property unless restrictions are justified in
the consumer's individual service plan.
(b) The license holder must ensure separation of resident
consumer funds from funds of the license holder, the residential
program, or program staff.
(c) Whenever the license holder assists a consumer with the
safekeeping of funds or other property, the license holder
must have written authorization to do so by the consumer or the
consumer's legal representative, and the case manager. In
addition, the license holder must:
(1) document receipt and disbursement of the consumer's
funds or the property, and include the signature of the
consumer, conservator, or payee;
(2) provide a statement at least quarterly itemizing
annually survey, document, and implement the preferences of the
consumer, consumer's legal representative, and the case manager
for frequency of receiving a statement that itemizes receipts
and disbursements of resident consumer funds or other property;
and
(3) return to the consumer upon the consumer's request,
funds and property in the license holder's possession subject to
restrictions in the consumer's individual service plan, as soon
as possible, but no later than three working days after the date
of the request.
(d) License holders and program staff must not:
(1) borrow money from a consumer;
(2) purchase personal items from a consumer;
(3) sell merchandise or personal services to a consumer;
(4) require a resident consumer to purchase items for which
the license holder is eligible for reimbursement; or
(5) use resident consumer funds in a manner that would
violate section 256B.04, or any rules promulgated under that
section.
Sec. 15. Minnesota Statutes 1998, section 252.32,
subdivision 3a, is amended to read:
Subd. 3a. [REPORTS AND ALLOCATIONS.] (a) The commissioner
shall specify requirements for quarterly fiscal and annual
program reports according to section 256.01, subdivision 2,
paragraph (17). Program reports shall include data which will
enable the commissioner to evaluate program effectiveness and to
audit compliance. The commissioner shall reimburse county costs
on a quarterly basis.
(b) Beginning January 1, 1998, The commissioner shall
allocate state funds made available under this section to county
social service agencies on a calendar year basis. The
commissioner shall allocate to each county first in amounts
equal to each county's guaranteed floor as described in clause
(1), and second, any remaining funds, after the allocation of
funds to the newly participating counties as provided for in
clause (3), shall be allocated in proportion to each county's
total number of families receiving a grant on July 1 of the most
recent calendar year will be allocated to county agencies to
support children in their family homes.
(1) Each county's guaranteed floor shall be calculated as
follows:
(i) 95 percent of the county's allocation received in the
preceding calendar year. For the calendar year 1998 allocation,
the preceding calendar year shall be considered to be double the
six-month allocation as provided in clause (2);
(ii) when the amount of funds available for allocation is
less than the amount available in the preceding year, each
county's previous year allocation shall be reduced in proportion
to the reduction in statewide funding, for the purpose of
establishing the guaranteed floor.
(2) For the period July 1, 1997, to December 31, 1997, the
commissioner shall allocate to each county an amount equal to
the actual, state approved grants issued to the families for the
month of January 1997, multiplied by six. This six-month
allocation shall be combined with the calendar year 1998
allocation and be administered as an 18-month allocation.
(3) At the commissioner's discretion, funds may be
allocated to any nonparticipating county that requests an
allocation under this section. Allocations to newly
participating counties are dependent upon the availability of
funds, as determined by the actual expenditure amount of the
participating counties for the most recently completed calendar
year.
(4) The commissioner shall regularly review the use of
family support fund allocations by county. The commissioner may
reallocate unexpended or unencumbered money at any time to those
counties that have a demonstrated need for additional funding.
(c) County allocations under this section will be adjusted
for transfers that occur according to section 256.476 or when
the county of financial responsibility changes according to
chapter 256G for eligible recipients.
Sec. 16. Minnesota Statutes 1998, section 256.015,
subdivision 1, is amended to read:
Subdivision 1. [STATE AGENCY HAS LIEN.] When the state
agency provides, pays for, or becomes liable for medical care or
furnishes subsistence or other payments to a person, the agency
shall have a lien for the cost of the care and payments on any
and all causes of action or recovery rights under any policy,
plan, or contract providing benefits for health care or injury
which accrue to the person to whom the care or payments were
furnished, or to the person's legal representatives, as a result
of the occurrence that necessitated the medical care,
subsistence, or other payments. For purposes of this section,
"state agency" includes authorized agents of the state agency
prepaid health plans under contract with the commissioner
according to sections 256B.69, 256D.03, subdivision 4, paragraph
(d), and 256L.12; children's mental health collaboratives under
section 245.493; demonstration projects for persons with
disabilities under section 256B.77; nursing homes under the
alternative payment demonstration project under section
256B.434; and county-based purchasing entities under section
256B.692.
Sec. 17. Minnesota Statutes 1998, section 256.015,
subdivision 3, is amended to read:
Subd. 3. [PROSECUTOR.] The attorney general, or the
appropriate county attorney acting at the direction of the
attorney general, shall represent the state agency commissioner
to enforce the lien created under this section or, if no action
has been brought, may initiate and prosecute an independent
action on behalf of the state agency commissioner against a
person, firm, or corporation that may be liable to the person to
whom the care or payment was furnished.
Any prepaid health plan providing services under sections
256B.69, 256D.03, subdivision 4, paragraph (d), and 256L.12;
children's mental health collaboratives under section 245.493;
demonstration projects for persons with disabilities under
section 256B.77; nursing homes under the alternative payment
demonstration project under section 256B.434; or the
county-based purchasing entity providing services under section
256B.692 may retain legal representation to enforce their lien
created under this section or, if no action has been brought,
may initiate and prosecute an independent action on their behalf
against a person, firm, or corporation that may be liable to the
person to whom the care or payment was furnished.
Sec. 18. [256.028] [TAX REBATES.]
Any federal or state tax rebate received by a recipient of
a public assistance program shall not be counted as income or as
an asset for purposes of any of the public assistance programs
under this chapter or any other chapter, including, but not
limited to, chapter 256B, 256D, 256E, 256I, 256J, or 256L to the
extent permitted under federal law.
Sec. 19. Minnesota Statutes 1998, section 256.955,
subdivision 3, is amended to read:
Subd. 3. [PRESCRIPTION DRUG COVERAGE.] Coverage under the
program is limited to prescription drugs covered under the
medical assistance program as described in section 256B.0625,
subdivision 13, subject to a maximum deductible of $300
annually, except drugs cleared by the FDA shall be available to
qualified senior citizens enrolled in the program without
restriction when prescribed for medically accepted indication as
defined in the federal rebate program under section 1927 of
title XIX of the federal Social Security Act. Coverage under
the program shall be limited to those prescription drugs that:
(1) are covered under the medical assistance program as
described in section 256B.0625, subdivision 13; and
(2) are provided by manufacturers that have fully executed
senior drug rebate agreements with the commissioner and comply
with such agreements.
Sec. 20. Minnesota Statutes 1998, section 256.955,
subdivision 4, is amended to read:
Subd. 4. [APPLICATION PROCEDURES AND COORDINATION WITH
MEDICAL ASSISTANCE.] Applications and information on the program
must be made available at county social service agencies, health
care provider offices, and agencies and organizations serving
senior citizens. Senior citizens shall submit applications and
any information specified by the commissioner as being necessary
to verify eligibility directly to the county social service
agencies:
(1) beginning January 1, 1999, the county social service
agency shall determine medical assistance spenddown eligibility
of individuals who qualify for the senior citizen drug program
of individuals; and
(2) program payments will be used to reduce the spenddown
obligations of individuals who are determined to be eligible for
medical assistance with a spenddown as defined in section
256B.056, subdivision 5.
Seniors who are eligible for medical assistance with a spenddown
shall be financially responsible for the deductible amount up to
the satisfaction of the spenddown. No deductible applies once
the spenddown has been met. Payments to providers for
prescription drugs for persons eligible under this subdivision
shall be reduced by the deductible.
County social service agencies shall determine an
applicant's eligibility for the program within 30 days from the
date the application is received. Eligibility begins the month
after approval.
Sec. 21. Minnesota Statutes 1998, section 256.955,
subdivision 7, is amended to read:
Subd. 7. [COST SHARING.] (a) Enrollees shall pay an annual
premium of $120.
(b) Program enrollees must satisfy a $300 $420 annual
deductible, based upon expenditures for prescription drugs, to
be paid as follows:
(1) $25 monthly deductible for persons with a monthly
spenddown; or
(2) $150 biannual deductible for persons with a six-month
spenddown in $35 monthly increments.
Sec. 22. Minnesota Statutes 1998, section 256.955,
subdivision 8, is amended to read:
Subd. 8. [REPORT.] The commissioner shall annually report
to the legislature on the senior citizen drug program. The
report must include demographic information on enrollees,
per-prescription expenditures, total program expenditures,
hospital and nursing home costs avoided by enrollees, any
savings to medical assistance and Medicare resulting from the
provision of prescription drug coverage under Medicare by health
maintenance organizations, other public and private options for
drug assistance to the senior population, any hardships caused
by the annual premium and deductible, and any recommendations
for changes in the senior drug program.
Sec. 23. Minnesota Statutes 1998, section 256.955,
subdivision 9, is amended to read:
Subd. 9. [PROGRAM LIMITATION.] The commissioner shall
administer the senior drug program so that the costs total no
more than funds appropriated plus the drug rebate proceeds.
Senior drug program rebate revenues are appropriated to the
commissioner and shall be expended to augment funding of the
senior drug program. New enrollment shall cease if the
commissioner determines that, given current enrollment, costs of
the program will exceed appropriated funds and rebate proceeds.
This section shall be repealed upon federal approval of the
waiver to allow the commissioner to provide prescription drug
coverage for qualified Medicare beneficiaries whose income is
less than 150 percent of the federal poverty guidelines.
Sec. 24. Minnesota Statutes 1998, section 256.9685,
subdivision 1a, is amended to read:
Subd. 1a. [ADMINISTRATIVE RECONSIDERATION.]
Notwithstanding sections 256B.04, subdivision 15, and 256D.03,
subdivision 7, the commissioner shall establish an
administrative reconsideration process for appeals of inpatient
hospital services determined to be medically unnecessary. A
physician or hospital may request a reconsideration of the
decision that inpatient hospital services are not medically
necessary by submitting a written request for review to the
commissioner within 30 days after receiving notice of the
decision. The reconsideration process shall take place prior to
the procedures of subdivision 1b and shall be conducted by
physicians that are independent of the case under
reconsideration. A majority decision by the physicians is
necessary to make a determination that the services were not
medically necessary.
Sec. 25. Minnesota Statutes 1998, 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 through calendar year 1999 2001. The index for
calendar year 2000 shall be reduced 2.5 percentage points to
recover overprojections of the index from 1994 to 1996. 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. 26. Minnesota Statutes 1998, section 256B.04,
subdivision 16, is amended to read:
Subd. 16. [PERSONAL CARE SERVICES.] (a) Notwithstanding
any contrary language in this paragraph, the commissioner of
human services and the commissioner of health shall jointly
promulgate rules to be applied to the licensure of personal care
services provided under the medical assistance program. The
rules shall consider standards for personal care services that
are based on the World Institute on Disability's recommendations
regarding personal care services. These rules shall at a
minimum consider the standards and requirements adopted by the
commissioner of health under section 144A.45, which the
commissioner of human services determines are applicable to the
provision of personal care services, in addition to other
standards or modifications which the commissioner of human
services determines are appropriate.
The commissioner of human services shall establish an
advisory group including personal care consumers and providers
to provide advice regarding which standards or modifications
should be adopted. The advisory group membership must include
not less than 15 members, of which at least 60 percent must be
consumers of personal care services and representatives of
recipients with various disabilities and diagnoses and ages. At
least 51 percent of the members of the advisory group must be
recipients of personal care.
The commissioner of human services may contract with the
commissioner of health to enforce the jointly promulgated
licensure rules for personal care service providers.
Prior to final promulgation of the joint rule the
commissioner of human services shall report preliminary findings
along with any comments of the advisory group and a plan for
monitoring and enforcement by the department of health to the
legislature by February 15, 1992.
Limits on the extent of personal care services that may be
provided to an individual must be based on the
cost-effectiveness of the services in relation to the costs of
inpatient hospital care, nursing home care, and other available
types of care. The rules must provide, at a minimum:
(1) that agencies be selected to contract with or employ
and train staff to provide and supervise the provision of
personal care services;
(2) that agencies employ or contract with a qualified
applicant that a qualified recipient proposes to the agency as
the recipient's choice of assistant;
(3) that agencies bill the medical assistance program for a
personal care service by a personal care assistant and
supervision by the registered nurse a qualified professional
supervising the personal care assistant unless the recipient
selects the fiscal agent option under section 256B.0627,
subdivision 10;
(4) that agencies establish a grievance mechanism; and
(5) that agencies have a quality assurance program.
(b) The commissioner may waive the requirement for the
provision of personal care services through an agency in a
particular county, when there are less than two agencies
providing services in that county and shall waive the
requirement for personal care assistants required to join an
agency for the first time during 1993 when personal care
services are provided under a relative hardship waiver under
section 256B.0627, subdivision 4, paragraph (b), clause (7), and
at least two agencies providing personal care services have
refused to employ or contract with the independent personal care
assistant.
Sec. 27. Minnesota Statutes 1998, section 256B.04, is
amended by adding a subdivision to read:
Subd. 19. [PERFORMANCE DATA REPORTING UNIT.] The
commissioner of human services shall establish a performance
data reporting unit that serves counties and the state. The
department shall support this unit and provide technical
assistance and access to the data warehouse. The performance
data reporting unit, which will operate within the department's
central office and consist of both county and department staff,
shall provide performance data reports to individual counties,
share expertise from counties and the department perspective,
and participate in joint planning to link with county databases
and other county data sources in order to provide information on
services provided to public clients from state, federal, and
county funding sources. The performance data reporting unit
shall provide counties both individual and group summary level
standard or unique reports on health care eligibility and
services provided to clients for whom they have financial
responsibility.
Sec. 28. Minnesota Statutes 1998, section 256B.042,
subdivision 1, is amended to read:
Subdivision 1. [LIEN FOR COST OF CARE.] When the state
agency provides, pays for, or becomes liable for medical care,
it shall have a lien for the cost of the care upon any and all
causes of action or recovery rights under any policy, plan, or
contract providing benefits for health care or injury, which
accrue to the person to whom the care was furnished, or to the
person's legal representatives, as a result of the illness or
injuries which necessitated the medical care. For purposes of
this section, "state agency" includes prepaid health plans under
contract with the commissioner according to sections 256B.69,
256D.03, subdivision 4, paragraph (d), and 256L.12; children's
mental health collaboratives under section 245.493;
demonstration projects for persons with disabilities under
section 256B.77; nursing facilities under the alternative
payment demonstration project under section 256B.434; and
county-based purchasing entities under section 256B.692.
Sec. 29. Minnesota Statutes 1998, section 256B.042,
subdivision 2, is amended to read:
Subd. 2. [LIEN ENFORCEMENT.] (a) The state agency may
perfect and enforce its lien by following the procedures set
forth in sections 514.69, 514.70 and 514.71, and its verified
lien statement shall be filed with the appropriate court
administrator in the county of financial responsibility. The
verified lien statement shall contain the following: the name
and address of the person to whom medical care was furnished,
the date of injury, the name and address of the vendor or
vendors furnishing medical care, the dates of the service, the
amount claimed to be due for the care, and, to the best of the
state agency's knowledge, the names and addresses of all
persons, firms, or corporations claimed to be liable for damages
arising from the injuries. This section shall not affect the
priority of any attorney's lien.
(b) The state agency is not subject to any limitations
period referred to in section 514.69 or 514.71 and has one year
from the date notice is first received by it under subdivision
4, paragraph (c), even if the notice is untimely, or one year
from the date medical bills are first paid by the state agency,
whichever is later, to file its verified lien statement. The
state agency may commence an action to enforce the lien within
one year of (1) the date the notice required by subdivision 4,
paragraph (c), is received or (2) the date the recipient's cause
of action is concluded by judgment, award, settlement, or
otherwise, whichever is later. For purposes of this section,
"state agency" includes authorized agents of the state agency.
(c) If the notice required in subdivision 4 is not provided
by any of the parties to the claim at any stage of the claim,
the state agency will have one year from the date the state
agency learns of the lack of notice to commence an action. If
amounts on the claim or cause of action are paid and the amount
required to be paid to the state agency under subdivision 5, is
not paid to the state agency, the state agency may commence an
action to recover on the lien against any or all of the parties
or entities which have either paid or received the payments.
Sec. 30. Minnesota Statutes 1998, section 256B.042,
subdivision 3, is amended to read:
Subd. 3. The attorney general, or the appropriate county
attorney acting at the direction of the attorney general, shall
represent the state agency commissioner to enforce the lien
created under this section or, if no action has been brought,
may initiate and prosecute an independent action on behalf of
the state agency commissioner against a person, firm, or
corporation that may be liable to the person to whom the care
was furnished.
Any prepaid health plan providing services under sections
256B.69, 256D.03, subdivision 4, paragraph (d), and 256L.12;
children's mental health collaboratives under section 245.493;
demonstration projects for persons with disabilities under
section 256B.77; nursing homes under the alternative payment
demonstration project under section 256B.434; or the
county-based purchasing entity providing services under section
256B.692 may retain legal representation to enforce their lien
created under this section or, if no action has been brought,
may initiate and prosecute an independent action on their behalf
against a person, firm, or corporation that may be liable to the
person to whom the care or payment was furnished.
Sec. 31. Minnesota Statutes 1998, section 256B.055,
subdivision 3a, is amended to read:
Subd. 3a. [MFIP-S FAMILIES; FAMILIES ELIGIBLE UNDER PRIOR
AFDC RULES.] (a) Beginning January 1, 1998, or on the date that
MFIP-S is implemented in counties, medical assistance may be
paid for a person receiving public assistance under the MFIP-S
program.
(b) Beginning January 1, 1998, medical assistance may be
paid for a person who would have been eligible for public
assistance under the income and resource standards and
deprivation requirements, or who would have been eligible but
for excess income or assets, under the state's AFDC plan in
effect as of July 16, 1996, as required by the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996
(PRWORA), Public Law Number 104-193.
Sec. 32. Minnesota Statutes 1998, section 256B.056,
subdivision 4, is amended to read:
Subd. 4. [INCOME.] To be eligible for medical assistance,
a person eligible under section 256B.055, subdivision 7, not
receiving supplemental security income program payments, and
families and children may have an income up to 133-1/3 percent
of the AFDC income standard in effect under the July 16, 1996,
AFDC state plan. For rate years beginning on or after July 1,
1999, the commissioner shall consider increasing Effective July
1, 2000, the base AFDC standard in effect on July 16, 1996, by
an amount equal to the percent change in the Consumer Price
Index for all urban consumers for the previous October compared
to one year earlier shall be increased by three percent.
Effective January 1, 2000, and each successive January,
recipients of supplemental security income may have an income up
to the supplemental security income standard in effect on that
date. In computing income to determine eligibility of persons
who are not residents of long-term care facilities, the
commissioner shall disregard increases in income as required by
Public Law Numbers 94-566, section 503; 99-272; and 99-509.
Veterans aid and attendance benefits and Veterans Administration
unusual medical expense payments are considered income to the
recipient.
Sec. 33. Minnesota Statutes 1998, section 256B.057,
subdivision 3, is amended to read:
Subd. 3. [QUALIFIED MEDICARE BENEFICIARIES.] A person who
is entitled to Part A Medicare benefits, whose income is equal
to or less than 85 100 percent of the federal poverty
guidelines, and whose assets are no more than twice the asset
limit used to determine eligibility for the supplemental
security income program, is eligible for medical assistance
reimbursement of Part A and Part B premiums, Part A and Part B
coinsurance and deductibles, and cost-effective premiums for
enrollment with a health maintenance organization or a
competitive medical plan under section 1876 of the Social
Security Act. The income limit shall be increased to 90 percent
of the federal poverty guidelines on January 1, 1990; and to 100
percent on January 1, 1991. Reimbursement of the Medicare
coinsurance and deductibles, when added to the amount paid by
Medicare, must not exceed the total rate the provider would have
received for the same service or services if the person were a
medical assistance recipient with Medicare coverage. Increases
in benefits under Title II of the Social Security Act shall not
be counted as income for purposes of this subdivision until the
first day of the second full month following publication of the
change in the federal poverty guidelines.
Sec. 34. Minnesota Statutes 1998, section 256B.057, is
amended by adding a subdivision to read:
Subd. 9. [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical
assistance may be paid for a person who is employed and who:
(1) meets the definition of disabled under the supplemental
security income program;
(2) meets the asset limits in paragraph (b); and
(3) pays a premium, if required, under paragraph (c).
Any spousal income or assets shall be disregarded for purposes
of eligibility and premium determinations.
(b) For purposes of determining eligibility under this
subdivision, a person's assets must not exceed $20,000,
excluding:
(1) all assets excluded under section 256B.056;
(2) retirement accounts, including individual accounts,
401(k) plans, 403(b) plans, Keogh plans, and pension plans; and
(3) medical expense accounts set up through the person's
employer.
(c) A person whose earned and unearned income is greater
than 200 percent of federal poverty guidelines for the
applicable family size must pay a premium to be eligible for
medical assistance. The premium shall be equal to ten percent
of the person's gross earned and unearned income above 200
percent of federal poverty guidelines for the applicable family
size up to the cost of coverage.
(d) A person's eligibility and premium shall be determined
by the local county agency. Premiums must be paid to the
commissioner. All premiums are dedicated to the commissioner.
(e) Any required premium shall be determined at application
and redetermined annually at recertification or when a change in
income of family size occurs.
(f) Premium payment is due upon notification from the
commissioner of the premium amount required. Premiums may be
paid in installments at the discretion of the commissioner.
(g) Nonpayment of the premium shall result in denial or
termination of medical assistance unless the person demonstrates
good cause for nonpayment. Good cause exists if the
requirements specified in Minnesota Rules, part 9506.0040,
subpart 7, items B to D, are met. Nonpayment shall include
payment with a returned, refused, or dishonored instrument. The
commissioner may require a guaranteed form of payment as the
only means to replace a returned, refused, or dishonored
instrument.
Sec. 35. Minnesota Statutes 1998, 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) all other exclusions from income for institutionalized
persons as mandated by federal law; and
(9) 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. 36. Minnesota Statutes 1998, section 256B.061, is
amended to read:
256B.061 [ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONS.]
(a) If any individual has been determined to be eligible
for medical assistance, it will be made available for care and
services included under the plan and furnished in or after the
third month before the month in which the individual made
application for such assistance, if such individual was, or upon
application would have been, eligible for medical assistance at
the time the care and services were furnished. The commissioner
may limit, restrict, or suspend the eligibility of an individual
for up to one year upon that individual's conviction of a
criminal offense related to application for or receipt of
medical assistance benefits.
(b) On the basis of information provided on the completed
application, an applicant who meets the following criteria shall
be determined eligible beginning in the month of application:
(1) whose gross income is less than 90 percent of the
applicable income standard;
(2) whose total liquid assets are less than 90 percent of
the asset limit;
(3) does not reside in a long-term care facility; and
(4) meets all other eligibility requirements.
The applicant must provide all required verifications within 30
days' notice of the eligibility determination or eligibility
shall be terminated.
Sec. 37. Minnesota Statutes 1998, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 3b. [TELEMEDICINE CONSULTATIONS.] (a) Medical
assistance covers telemedicine consultations. Telemedicine
consultations must be made via two-way, interactive video or
store-and-forward technology. Store-and-forward technology
includes telemedicine consultations that do not occur in real
time via synchronous transmissions, and that do not require a
face-to-face encounter with the patient for all or any part of
any such telemedicine consultation. The patient record must
include a written opinion from the consulting physician
providing the telemedicine consultation. A communication
between two physicians that consists solely of a telephone
conversation is not a telemedicine consultation. Coverage is
limited to three telemedicine consultations per recipient per
calendar week. Telemedicine consultations shall be paid at the
full allowable rate.
(b) This subdivision expires July 1, 2001.
Sec. 38. Minnesota Statutes 1998, section 256B.0625,
subdivision 6a, is amended to read:
Subd. 6a. [HOME HEALTH SERVICES.] Home health services are
those services specified in Minnesota Rules, part 9505.0290.
Medical assistance covers home health services at a recipient's
home residence. Medical assistance does not cover home health
services for residents of a hospital, nursing facility, or
intermediate care facility, or a health care facility licensed
by the commissioner of health, unless the program is funded
under a home and community-based services waiver or unless the
commissioner of human services has prior authorized skilled
nurse visits for less than 90 days for a resident at an
intermediate care facility for persons with mental retardation,
to prevent an admission to a hospital or nursing facility or
unless a resident who is otherwise eligible is on leave from the
facility and the facility either pays for the home health
services or forgoes the facility per diem for the leave days
that home health services are used. Home health services must
be provided by a Medicare certified home health agency. All
nursing and home health aide services must be provided according
to section 256B.0627.
Sec. 39. Minnesota Statutes 1998, section 256B.0625,
subdivision 8, is amended to read:
Subd. 8. [PHYSICAL THERAPY.] Medical assistance covers
physical therapy and related services, including specialized
maintenance therapy. Services provided by a physical therapy
assistant shall be reimbursed at the same rate as services
performed by a physical therapist when the services of the
physical therapy assistant are provided under the direction of a
physical therapist who is on the premises. Services provided by
a physical therapy assistant that are provided under the
direction of a physical therapist who is not on the premises
shall be reimbursed at 65 percent of the physical therapist rate.
Sec. 40. Minnesota Statutes 1998, section 256B.0625,
subdivision 8a, is amended to read:
Subd. 8a. [OCCUPATIONAL THERAPY.] Medical assistance
covers occupational therapy and related services, including
specialized maintenance therapy. Services provided by an
occupational therapy assistant shall be reimbursed at the same
rate as services performed by an occupational therapist when the
services of the occupational therapy assistant are provided
under the direction of the occupational therapist who is on the
premises. Services provided by an occupational therapy
assistant that are provided under the direction of an
occupational therapist who is not on the premises shall be
reimbursed at 65 percent of the occupational therapist rate.
Sec. 41. Minnesota Statutes 1998, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 8b. [SPEECH LANGUAGE PATHOLOGY SERVICES.] Medical
assistance covers speech language pathology and related
services, including specialized maintenance therapy.
Sec. 42. Minnesota Statutes 1998, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 8c. [CARE MANAGEMENT; REHABILITATION SERVICES.] (a)
Effective July 1, 1999, one-time thresholds shall replace annual
thresholds for provision of rehabilitation services described in
subdivisions 8, 8a, and 8b. The one-time thresholds will be the
same in amount and description as the thresholds prescribed by
the department of human services health care programs provider
manual for calendar year 1997, except they will not be renewed
annually, and they will include sensory skills and cognitive
training skills.
(b) A care management approach for authorization of
services beyond the threshold shall be instituted in conjunction
with the one-time thresholds. The care management approach
shall require the provider and the department rehabilitation
reviewer to work together directly through written
communication, or telephone communication when appropriate, to
establish a medically necessary care management plan.
Authorization for rehabilitation services shall include approval
for up to 12 months of services at a time without additional
documentation from the provider during the extended period, when
the rehabilitation services are medically necessary due to an
ongoing health condition.
(c) The commissioner shall implement an expedited five-day
turnaround time to review authorization requests for recipients
who need emergency rehabilitation services and who have
exhausted their one-time threshold limit for those services.
Sec. 43. Minnesota Statutes 1998, section 256B.0625,
subdivision 13, is amended to read:
Subd. 13. [DRUGS.] (a) Medical assistance covers drugs,
except for fertility drugs when specifically used to enhance
fertility, if prescribed by a licensed practitioner and
dispensed by a licensed pharmacist, by a physician enrolled in
the medical assistance program as a dispensing physician, or by
a physician or a nurse practitioner employed by or under
contract with a community health board as defined in section
145A.02, subdivision 5, for the purposes of communicable disease
control. The commissioner, after receiving recommendations from
professional medical associations and professional pharmacist
associations, shall designate a formulary committee to advise
the commissioner on the names of drugs for which payment is
made, recommend a system for reimbursing providers on a set fee
or charge basis rather than the present system, and develop
methods encouraging use of generic drugs when they are less
expensive and equally effective as trademark drugs. The
formulary committee shall consist of nine members, four of whom
shall be physicians who are not employed by the department of
human services, and a majority of whose practice is for persons
paying privately or through health insurance, three of whom
shall be pharmacists who are not employed by the department of
human services, and a majority of whose practice is for persons
paying privately or through health insurance, a consumer
representative, and a nursing home representative. Committee
members shall serve three-year terms and shall serve without
compensation. Members may be reappointed once.
(b) The commissioner shall establish a drug formulary. Its
establishment and publication shall not be subject to the
requirements of the Administrative Procedure Act, but the
formulary committee shall review and comment on the formulary
contents. The formulary committee shall review and recommend
drugs which require prior authorization. The formulary
committee may recommend drugs for prior authorization directly
to the commissioner, as long as opportunity for public input is
provided. Prior authorization may be requested by the
commissioner based on medical and clinical criteria before
certain drugs are eligible for payment. Before a drug may be
considered for prior authorization at the request of the
commissioner:
(1) the drug formulary committee must develop criteria to
be used for identifying drugs; the development of these criteria
is not subject to the requirements of chapter 14, but the
formulary committee shall provide opportunity for public input
in developing criteria;
(2) the drug formulary committee must hold a public forum
and receive public comment for an additional 15 days; and
(3) the commissioner must provide information to the
formulary committee on the impact that placing the drug on prior
authorization will have on the quality of patient care and
information regarding whether the drug is subject to clinical
abuse or misuse. Prior authorization may be required by the
commissioner before certain formulary drugs are eligible for
payment. The formulary shall not include:
(i) drugs or products for which there is no federal
funding;
(ii) over-the-counter drugs, except for antacids,
acetaminophen, family planning products, aspirin, insulin,
products for the treatment of lice, vitamins for adults with
documented vitamin deficiencies, vitamins for children under the
age of seven and pregnant or nursing women, and any other
over-the-counter drug identified by the commissioner, in
consultation with the drug formulary committee, as necessary,
appropriate, and cost-effective for the treatment of certain
specified chronic diseases, conditions or disorders, and this
determination shall not be subject to the requirements of
chapter 14;
(iii) anorectics, except that medically necessary
anorectics shall be covered for a recipient previously diagnosed
as having pickwickian syndrome and currently diagnosed as having
diabetes and being morbidly obese;
(iv) drugs for which medical value has not been
established; and
(v) drugs from manufacturers who have not signed a rebate
agreement with the Department of Health and Human Services
pursuant to section 1927 of title XIX of the Social Security Act
and who have not signed an agreement with the state for drugs
purchased pursuant to the senior citizen drug program
established under section 256.955.
The commissioner shall publish conditions for prohibiting
payment for specific drugs after considering the formulary
committee's recommendations.
(c) The basis for determining the amount of payment shall
be the lower of the actual acquisition costs of the drugs plus a
fixed dispensing fee; the maximum allowable cost set by the
federal government or by the commissioner plus the fixed
dispensing fee; or the usual and customary price charged to the
public. The pharmacy dispensing fee shall be $3.65. Actual
acquisition cost includes quantity and other special discounts
except time and cash discounts. The actual acquisition cost of
a drug shall be estimated by the commissioner, at average
wholesale price minus nine percent. The maximum allowable cost
of a multisource drug may be set by the commissioner and it
shall be comparable to, but no higher than, the maximum amount
paid by other third-party payors in this state who have maximum
allowable cost programs. The commissioner shall set maximum
allowable costs for multisource drugs that are not on the
federal upper limit list as described in United States Code,
title 42, chapter 7, section 1396r-8(e), the Social Security
Act, and Code of Federal Regulations, title 42, part 447,
section 447.332. Establishment of the amount of payment for
drugs shall not be subject to the requirements of the
Administrative Procedure Act. An additional dispensing fee of
$.30 may be added to the dispensing fee paid to pharmacists for
legend drug prescriptions dispensed to residents of long-term
care facilities when a unit dose blister card system, approved
by the department, is used. Under this type of dispensing
system, the pharmacist must dispense a 30-day supply of drug.
The National Drug Code (NDC) from the drug container used to
fill the blister card must be identified on the claim to the
department. The unit dose blister card containing the drug must
meet the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the
pharmacy for reuse. The pharmacy provider will be required to
credit the department for the actual acquisition cost of all
unused drugs that are eligible for reuse. Over-the-counter
medications must be dispensed in the manufacturer's unopened
package. The commissioner may permit the drug clozapine to be
dispensed in a quantity that is less than a 30-day supply.
Whenever a generically equivalent product is available, payment
shall be on the basis of the actual acquisition cost of the
generic drug, unless the prescriber specifically indicates
"dispense as written - brand necessary" on the prescription as
required by section 151.21, subdivision 2.
(d) For purposes of this subdivision, "multisource drugs"
means covered outpatient drugs, excluding innovator multisource
drugs for which there are two or more drug products, which:
(1) are related as therapeutically equivalent under the
Food and Drug Administration's most recent publication of
"Approved Drug Products with Therapeutic Equivalence
Evaluations";
(2) are pharmaceutically equivalent and bioequivalent as
determined by the Food and Drug Administration; and
(3) are sold or marketed in Minnesota.
"Innovator multisource drug" means a multisource drug that was
originally marketed under an original new drug application
approved by the Food and Drug Administration.
Sec. 44. Minnesota Statutes 1998, section 256B.0625,
subdivision 19c, is amended to read:
Subd. 19c. [PERSONAL CARE.] Medical assistance covers
personal care services provided by an individual who is
qualified to provide the services according to subdivision 19a
and section 256B.0627, where the services are prescribed by a
physician in accordance with a plan of treatment and are
supervised by a registered nurse the recipient under the fiscal
agent option according to section 256B.0627, subdivision 10, or
a qualified professional. "Qualified professional" means a
mental health professional as defined in section 245.462,
subdivision 18, or 245.4871, subdivision 26; or a registered
nurse as defined in sections 148.171 to 148.285. As part of the
assessment, the county public health nurse will consult with the
recipient or responsible party and identify the most appropriate
person to provide supervision of the personal care assistant.
The qualified professional shall perform the duties described in
Minnesota Rules, part 9505.0335, subpart 4.
Sec. 45. Minnesota Statutes 1998, section 256B.0625,
subdivision 26, is amended to read:
Subd. 26. [SPECIAL EDUCATION SERVICES.] (a) Medical
assistance covers medical services identified in a recipient's
individualized education plan and covered under the medical
assistance state plan. Covered services include occupational
therapy, physical therapy, speech-language therapy, clinical
psychological services, nursing services, school psychological
services, school social work services, personal care assistants
serving as management aides, assistive technology devices,
transportation services, and other services covered under the
medical assistance state plan. Mental health services eligible
for medical assistance reimbursement must be provided or
coordinated through a children's mental health collaborative
where a collaborative exists if the child is included in the
collaborative operational target population. The provision or
coordination of services does not require that the individual
education plan be developed by the collaborative.
The services may be provided by a Minnesota school district
that is enrolled as a medical assistance provider or its
subcontractor, and only if the services meet all the
requirements otherwise applicable if the service had been
provided by a provider other than a school district, in the
following areas: medical necessity, physician's orders,
documentation, personnel qualifications, and prior authorization
requirements. The nonfederal share of costs for services
provided under this subdivision is the responsibility of the
local school district as provided in section 125A.74. Services
listed in a child's individual education plan are eligible for
medical assistance reimbursement only if those services meet
criteria for federal financial participation under the Medicaid
program.
(b) Approval of health-related services for inclusion in
the individual education plan does not require prior
authorization for purposes of reimbursement under this chapter.
The commissioner may require physician review and approval of
the plan not more than once annually or upon any modification of
the individual education plan that reflects a change in
health-related services.
(c) Services of a speech-language pathologist provided
under this section are covered notwithstanding Minnesota Rules,
part 9505.0390, subpart 1, item L, if the person:
(1) holds a masters degree in speech-language pathology;
(2) is licensed by the Minnesota board of teaching as an
educational speech-language pathologist; and
(3) either has a certificate of clinical competence from
the American Speech and Hearing Association, has completed the
equivalent educational requirements and work experience
necessary for the certificate or has completed the academic
program and is acquiring supervised work experience to qualify
for the certificate.
(d) Medical assistance coverage for medically necessary
services provided under other subdivisions in this section may
not be denied solely on the basis that the same or similar
services are covered under this subdivision.
(e) The commissioner shall develop and implement package
rates, bundled rates, or per diem rates for special education
services under which separately covered services are grouped
together and billed as a unit in order to reduce administrative
complexity.
(f) The commissioner shall develop a cost-based payment
structure for payment of these services.
(g) Effective July 1, 2000, medical assistance services
provided under an individual education plan or an individual
family service plan by local school districts shall not count
against medical assistance authorization thresholds for that
child.
Sec. 46. Minnesota Statutes 1998, section 256B.0625,
subdivision 28, is amended to read:
Subd. 28. [CERTIFIED NURSE PRACTITIONER SERVICES.] Medical
assistance covers services performed by a certified pediatric
nurse practitioner, a certified family nurse practitioner, a
certified adult nurse practitioner, a certified
obstetric/gynecological nurse practitioner, a certified neonatal
nurse practitioner, or a certified geriatric nurse practitioner
in independent practice, if:
(1) the service provided on an inpatient basis is not
included as part of the cost for inpatient services included in
the operating payment rate;
(2) the services are service is otherwise covered under
this chapter as a physician service,; and if
(3) the service is within the scope of practice of the
nurse practitioner's license as a registered nurse, as defined
in section 148.171.
Sec. 47. Minnesota Statutes 1998, 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 after application. For federally qualified
health centers and rural health clinics that either do not apply
within the time specified above 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.
(d) Effective July 1, 1999, the provisions of paragraph (c)
requiring a federally qualified health center or a rural health
clinic to make application for an essential community provider
designation in order to have cost-based payments made according
to paragraphs (a) and (b) no longer apply.
(e) Effective January 1, 2000, payments made according to
paragraphs (a) and (b) shall be limited to the cost phase-out
schedule of the Balanced Budget Act of 1997.
Sec. 48. Minnesota Statutes 1998, section 256B.0625,
subdivision 32, is amended to read:
Subd. 32. [NUTRITIONAL PRODUCTS.] (a) Medical assistance
covers nutritional products needed for nutritional
supplementation because solid food or nutrients thereof cannot
be properly absorbed by the body or needed for treatment of
phenylketonuria, hyperlysinemia, maple syrup urine disease, a
combined allergy to human milk, cow's milk, and soy formula, or
any other childhood or adult diseases, conditions, or disorders
identified by the commissioner as requiring a similarly
necessary nutritional product. Nutritional products needed for
the treatment of a combined allergy to human milk, cow's milk,
and soy formula require prior authorization. Separate payment
shall not be made for nutritional products for residents of
long-term care facilities. Payment for dietary requirements is
a component of the per diem rate paid to these facilities.
(b) The commissioner shall designate a nutritional
supplementation products advisory committee to advise the
commissioner on nutritional supplementation products for which
payment is made. The committee shall consist of nine members,
one of whom shall be a physician, one of whom shall be a
pharmacist, two of whom shall be registered dietitians, one of
whom shall be a public health nurse, one of whom shall be a
representative of a home health care agency, one of whom shall
be a provider of long-term care services, and two of whom shall
be consumers of nutritional supplementation products. Committee
members shall serve two-year terms and shall serve without
compensation.
(c) The advisory committee shall review and recommend
nutritional supplementation products which require prior
authorization. The commissioner shall develop procedures for
the operation of the advisory committee so that the advisory
committee operates in a manner parallel to the drug formulary
committee.
Sec. 49. Minnesota Statutes 1998, section 256B.0625,
subdivision 35, is amended to read:
Subd. 35. [FAMILY COMMUNITY SUPPORT SERVICES.] Medical
assistance covers family community support services as defined
in section 245.4871, subdivision 17. In addition to the
provisions of section 245.4871, and to the extent authorized by
rules promulgated by the state agency, medical assistance covers
the following services as family community support services:
(1) services identified in an individual treatment plan
when provided by a trained mental health behavioral aide under
the direction of a mental health practitioner or mental health
professional;
(2) mental health crisis intervention and crisis
stabilization services provided outside of hospital inpatient
settings; and
(3) the therapeutic components of preschool and therapeutic
camp programs.
Sec. 50. Minnesota Statutes 1998, section 256B.0627,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITION.] (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 registered private duty nurse.
Assessments for home health agency services shall be conducted
by a home health agency nurse. Assessments for personal
care assistant 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 A face-to-face assessment
must include: a face-to-face health status assessment and
determination of baseline need, evaluation of service outcomes,
collection of initial case data, identification of appropriate
services and service plan development or modification,
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 face-to-face assessment for
personal care services is conducted on those recipients who have
never had a county public health nurse assessment. A
face-to-face assessment must occur at least annually or when
there is a significant change in consumer the recipient's
condition and or when there is a change in the need for personal
care assistant services. The reassessment visit A service
update may substitute for the annual face-to-face assessment
when there is not a significant change in recipient condition or
a change in the need for personal care assistant service. A
service update or review for temporary increase 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 qualified
professional 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 service plan that is reviewed by
the physician at least once every 60 62 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 effectively 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
qualified professional; (5) is not a consumer of personal care
services; and (6) is subject to criminal background checks and
procedures specified in section 245A.04. An individual who has
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 background study as
provided in section 245A.04. 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 been convicted of a
crime specified in section 245A.04, or a comparable crime in
another jurisdiction, unless the owner or managerial official
meets the reconsideration criteria specified in section 245A.04;
(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. 51. Minnesota Statutes 1998, section 256B.0627,
subdivision 2, is amended to read:
Subd. 2. [SERVICES COVERED.] Home care services covered
under this section include:
(1) nursing services under section 256B.0625, subdivision
6a;
(2) private duty nursing services under section 256B.0625,
subdivision 7;
(3) home health aide services under section 256B.0625,
subdivision 6a;
(4) personal care services under section 256B.0625,
subdivision 19a;
(5) nursing supervision of personal care assistant services
provided by a qualified professional under section 256B.0625,
subdivision 19a; and
(6) consulting professional of personal care assistant
services under the fiscal agent option as specified in
subdivision 10;
(7) face-to-face assessments by county public health nurses
for services under section 256B.0625, subdivision 19a; and
(8) service updates and review of temporary increases for
personal care assistant services by the county public health
nurse for services under section 256B.0625, subdivision 19a.
Sec. 52. Minnesota Statutes 1998, section 256B.0627,
subdivision 4, is amended to read:
Subd. 4. [PERSONAL CARE SERVICES.] (a) The personal care
services that are eligible for payment are the following:
(1) bowel and bladder care;
(2) skin care to maintain the health of the skin;
(3) repetitive maintenance range of motion, 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;
(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 care services 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;
(18) tracheostomy suctioning using a clean procedure if the
procedure is properly delegated by a registered nurse. Before
this procedure can be delegated to a personal care assistant, a
registered nurse must determine that the tracheostomy suctioning
can be accomplished utilizing a clean rather than a sterile
procedure and must ensure that the personal care assistant has
been taught the proper procedure; and
(19) incidental household services that are an integral
part of a personal care service described in clauses (1) to (18).
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. For purposes of this
subdivision, a clean procedure refers to a procedure that
reduces the numbers of microorganisms or prevents or reduces the
transmission of microorganisms from one person or place to
another. A clean procedure may be used beginning 14 days after
insertion.
(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 the recipient's 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;
(7) services that are the responsibility of a residential
or program license holder under the terms of a service agreement
and administrative rules;
(8) sterile procedures;
(9) injections of fluids into veins, muscles, or skin;
(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, special language needs, 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;
(11) homemaker services that are not an integral part of a
personal care services;
(12) home maintenance, or chore services;
(13) services not specified under paragraph (a); and
(14) services not authorized by the commissioner or the
commissioner's designee.
Sec. 53. Minnesota Statutes 1998, section 256B.0627,
subdivision 5, is amended to read:
Subd. 5. [LIMITATION ON PAYMENTS.] Medical assistance
payments for home care services shall be limited according to
this subdivision.
(a) [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A
recipient may receive the following home care services during a
calendar year:
(1) any initial assessment up to two face-to-face
assessments to determine a recipient's need for personal care
assistant services;
(2) up to two reassessments per year one service update
done to determine a recipient's need for personal care services;
and
(3) up to five skilled nurse visits.
(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;
(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 after the
first year, the recipient or the responsible party, in
conjunction with the public health nurse, may complete a service
update on forms developed by the commissioner according to
criteria and procedures in subdivision 1. The service update
may substitute for the annual reassessment described in
subdivision 1.
(e) [PRIOR AUTHORIZATION.] The commissioner, or the
commissioner's designee, shall review the assessment, the
service update, request for temporary services, 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 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 by a qualified
professional 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 two times the average number of direct care hours
provided in nursing facilities for the recipient's comparable
case mix level; or
(B) up to three times the average number of direct care
hours provided in nursing facilities for recipients who have
complex medical needs or are dependent in at least seven
activities of daily living and need physical assistance with
eating or have a neurological diagnosis; or
(C) up to 60 percent of the average reimbursement rate, as
of July 1, 1991, 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
(E) up to the amount medical assistance would reimburse for
facility care for recipients referred to the commissioner by a
preadmission screening team established under section 256B.0911
or 256B.092; and
(F) a reasonable amount of time for the provision of
nursing supervision by a qualified professional of personal care
services.
(ii) The number of direct care hours shall be determined
according to the annual cost report submitted to the department
by nursing facilities. The average number of direct care hours,
as established by May 1, 1992, shall be calculated and
incorporated into the home care limits on July 1, 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 the recipient's 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 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
(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. 54. Minnesota Statutes 1998, section 256B.0627,
subdivision 8, is amended to read:
Subd. 8. [SHARED PERSONAL CARE ASSISTANT SERVICES; SHARED
CARE.] (a) Medical assistance payments for shared personal care
assistance shared care services shall be limited according to
this subdivision.
(b) Recipients of personal care assistant services may
share staff and the commissioner shall provide a rate system for
shared personal care assistant services. For two persons
sharing care services, the rate paid to a provider shall not
exceed 1-1/2 times the rate paid for serving a single
individual, and for three persons sharing care services, the
rate paid to a provider shall not exceed twice the rate paid for
serving a single individual. These rates apply only to
situations in which all recipients were present and received
shared care services on the date for which the service is
billed. No more than three persons may receive shared care
services from a personal care assistant in a single setting.
(c) Shared care service is the provision of personal care
services by a personal care assistant to two or three recipients
at the same time and in the same setting. For the purposes of
this subdivision, "setting" means:
(1) the home or foster care home of one of the individual
recipients; or
(2) a child care program in which all recipients served by
one personal care assistant are participating, which is licensed
under chapter 245A or operated by a local school district or
private school.
The provisions of this subdivision do not apply when a
personal care assistant is caring for multiple recipients in
more than one setting.
(d) The recipient or the recipient's responsible party, in
conjunction with the county public health nurse, shall determine:
(1) whether shared care personal care assistant services is
an appropriate option based on the individual needs and
preferences of the recipient; and
(2) the amount of shared care services allocated as part of
the overall authorization of personal care services.
The recipient or the responsible party, in conjunction with
the supervising registered nurse qualified professional, shall
approve arrange the setting, and grouping, and arrangement of
shared care services based on the individual needs and
preferences of the recipients. Decisions on the selection of
recipients to share care services must be based on the ages of
the recipients, compatibility, and coordination of their care
needs.
(e) The following items must be considered by the recipient
or the responsible party and the supervising nurse qualified
professional, and documented in the recipient's care plan health
service record:
(1) the additional qualifications needed by the personal
care assistant to provide care to several recipients in the same
setting;
(2) the additional training and supervision needed by the
personal care assistant to ensure that the needs of the
recipient are met appropriately and safely. The provider must
provide on-site supervision by a registered nurse qualified
professional within the first 14 days of shared care services,
and monthly thereafter;
(3) the setting in which the shared care services will be
provided;
(4) the ongoing monitoring and evaluation of the
effectiveness and appropriateness of the service and process
used to make changes in service or setting; and
(5) a contingency plan which accounts for absence of the
recipient in a shared care services setting due to illness or
other circumstances and staffing contingencies.
(f) The provider must offer the recipient or the
responsible party the option of shared or individual one-on-one
personal care assistant care services. The recipient or the
responsible party can withdraw from participating in a shared
care services arrangement at any time.
(g) In addition to documentation requirements under
Minnesota Rules, part 9505.2175, a personal care provider must
meet documentation requirements for shared personal
care assistant services and must document the following in the
health service record for each individual recipient sharing care
services:
(1) authorization permission by the recipient or the
recipient's responsible party, if any, for the maximum number of
shared care services hours per week chosen by the recipient;
(2) authorization permission by the recipient or the
recipient's responsible party, if any, for personal
care assistant services provided outside the recipient's
residence;
(3) authorization permission by the recipient or the
recipient's responsible party, if any, for others to receive
shared care services in the recipient's residence;
(4) revocation by the recipient or the recipient's
responsible party, if any, of the shared care service
authorization, or the shared care service to be provided to
others in the recipient's residence, or the shared care service
to be provided outside the recipient's residence;
(5) supervision of the shared care personal care assistant
services by the supervisory nurse qualified professional,
including the date, time of day, number of hours spent
supervising the provision of shared care services, whether the
supervision was face-to-face or another method of supervision,
changes in the recipient's condition, shared care services
scheduling issues and recommendations;
(6) documentation by the personal care assistant qualified
professional of telephone calls or other discussions with
the supervisory nurse personal care assistant regarding services
being provided to the recipient; and
(7) daily documentation of the shared care services
provided by each identified personal care assistant including:
(i) the names of each recipient receiving shared care
services together;
(ii) the setting for the day's care shared services,
including the starting and ending times that the recipient
received shared care services; and
(iii) notes by the personal care assistant regarding
changes in the recipient's condition, problems that may arise
from the sharing of care services, scheduling issues, care
issues, and other notes as required by the supervising nurse
qualified professional.
(h) Unless otherwise provided in this subdivision, all
other statutory and regulatory provisions relating to personal
care services apply to shared care services.
Nothing in this subdivision shall be construed to reduce
the total number of hours authorized for an individual recipient.
Sec. 55. Minnesota Statutes 1998, section 256B.0627, is
amended by adding a subdivision to read:
Subd. 9. [FLEXIBLE USE OF PERSONAL CARE ASSISTANT
HOURS.] (a) The commissioner may allow for the flexible use of
personal care assistant hours. "Flexible use" means the
scheduled use of authorized hours of personal care assistant
services, which vary within the length of the service
authorization in order to more effectively meet the needs and
schedule of the recipient. Recipients may use their approved
hours flexibly within the service authorization period for
medically necessary covered services specified in the assessment
required in subdivision 1. The flexible use of authorized hours
does not increase the total amount of authorized hours available
to a recipient as determined under subdivision 5. The
commissioner shall not authorize additional personal care
assistant services to supplement a service authorization that is
exhausted before the end date under a flexible service use plan,
unless the county public health nurse determines a change in
condition and a need for increased services is established.
(b) The recipient or responsible party, together with the
county public health nurse, shall determine whether flexible use
is an appropriate option based on the needs and preferences of
the recipient or responsible party, and, if appropriate, must
ensure that the allocation of hours covers the ongoing needs of
the recipient over the entire service authorization period. As
part of the assessment and service planning process, the
recipient or responsible party must work with the county public
health nurse to develop a written month-to-month plan of the
projected use of personal care assistant services that is part
of the service plan and ensures that the:
(1) health and safety needs of the recipient will be met;
(2) total annual authorization will not exceed before the
end date; and
(3) how actual use of hours will be monitored.
(c) If the actual use of personal care assistant service
varies significantly from the use projected in the plan, the
written plan must be promptly updated by the recipient or
responsible party and the county public health nurse.
(d) The recipient or responsible party, together with the
provider, must work to monitor and document the use of
authorized hours and ensure that a recipient is able to manage
services effectively throughout the authorized period. The
provider must ensure that the month-to-month plan is
incorporated into the care plan. Upon request of the recipient
or responsible party, the provider must furnish regular updates
to the recipient or responsible party on the amount of personal
care assistant services used.
(e) The recipient or responsible party may revoke the
authorization for flexible use of hours by notifying the
provider and county public health nurse in writing.
(f) If the requirements in paragraphs (a) to (e) have not
substantially been met, the commissioner shall deny, revoke, or
suspend the authorization to use authorized hours flexibly. The
recipient or responsible party may appeal the commissioner's
action according to section 256.045. The denial, revocation, or
suspension to use the flexible hours option shall not affect the
recipient's authorized level of personal care assistant services
as determined under subdivision 5.
Sec. 56. Minnesota Statutes 1998, section 256B.0627, is
amended by adding a subdivision to read:
Subd. 10. [FISCAL AGENT OPTION AVAILABLE FOR PERSONAL CARE
ASSISTANT SERVICES.] (a) "Fiscal agent option" is an option that
allows the recipient to:
(1) use a fiscal agent instead of a personal care provider
organization;
(2) supervise the personal care assistant; and
(3) use a consulting professional.
The commissioner may allow a recipient of personal care
assistant services to use a fiscal agent to assist the recipient
in paying and accounting for medically necessary covered
personal care assistant services authorized in subdivision 4 and
within the payment parameters of subdivision 5. Unless
otherwise provided in this subdivision, all other statutory and
regulatory provisions relating to personal care services apply
to a recipient using the fiscal agent option.
(b) The recipient or responsible party shall:
(1) hire, and terminate the personal care assistant and
consulting professional, with the fiscal agent;
(2) recruit the personal care assistant and consulting
professional and orient and train the personal care assistant in
areas that do not require professional delegation as determined
by the county public health nurse;
(3) supervise and evaluate the personal care assistant in
areas that do not require professional delegation as determined
in the assessment;
(4) cooperate with a consulting professional and implement
recommendations pertaining to the health and safety of the
recipient;
(5) hire a qualified professional to train and supervise
the performance of delegated tasks done by the personal care
assistant;
(6) monitor services and verify in writing the hours worked
by the personal care assistant and the consulting professional;
(7) develop and revise a care plan with assistance from a
consulting professional;
(8) verify and document the credentials of the consulting
professional; and
(9) enter into a written agreement, as specified in
paragraph (f).
(c) The duties of the fiscal agent shall be to:
(1) bill the medical assistance program for personal care
assistant and consulting professional services;
(2) request and secure background checks on personal care
assistants and consulting professionals according to section
245A.04;
(3) pay the personal care assistant and consulting
professional based on actual hours of services provided;
(4) withhold and pay all applicable federal and state
taxes;
(5) verify and document hours worked by the personal care
assistant and consulting professional;
(6) make the arrangements and pay unemployment insurance,
taxes, workers' compensation, liability insurance, and other
benefits, if any;
(7) enroll in the medical assistance program as a fiscal
agent; and
(8) enter into a written agreement as specified in
paragraph (f) before services are provided.
(d) The fiscal agent:
(1) may not be related to the recipient, consulting
professional, or the personal care assistant;
(2) must ensure arm's length transactions with the
recipient and personal care assistant; and
(3) shall be considered a joint employer of the personal
care assistant and consulting professional to the extent
specified in this section.
The fiscal agent or owners of the entity that provides
fiscal agent services under this subdivision must pass a
criminal background check as required in section 256B.0627,
subdivision 1, paragraph (e).
(e) The consulting professional providing assistance to the
recipient shall meet the qualifications specified in section
256B.0625, subdivision 19c. The consulting professional shall
assist the recipient in developing and revising a plan to meet
the recipient's assessed needs, and supervise the performance of
delegated tasks, as determined by the public health nurse. In
performing this function, the consulting professional must visit
the recipient in the recipient's home at least once annually.
The consulting professional must report to the local county
public health nurse concerns relating to the health and safety
of the recipient, and any suspected abuse, neglect, or financial
exploitation of the recipient to the appropriate authorities.
(f) The fiscal agent, recipient or responsible party,
personal care assistant, and consulting professional shall enter
into a written agreement before services are started. The
agreement shall include:
(1) the duties of the recipient, professional, personal
care assistant, and fiscal agent based on paragraphs (a) to (e);
(2) the salary and benefits for the personal care assistant
and those providing professional consultation;
(3) the administrative fee of the fiscal agent and services
paid for with that fee, including background check fees;
(4) procedures to respond to billing or payment complaints;
and
(5) procedures for hiring and terminating the personal care
assistant and those providing professional consultation.
(g) The rates paid for personal care services, professional
assistance, and fiscal agency services under this subdivision
shall be the same rates paid for personal care services and
qualified professional services under subdivision 2
respectively. Except for the administrative fee of the fiscal
agent specified in paragraph (f), the remainder of the rates
paid to the fiscal agent must be used to pay for the salary and
benefits for the personal care assistant or those providing
professional consultation.
(h) As part of the assessment defined in subdivision 1, the
following conditions must be met to use or continue use of a
fiscal agent:
(1) the recipient must be able to direct the recipient's
own care, or the responsible party for the recipient must be
readily available to direct the care of the personal care
assistant;
(2) the recipient or responsible party must be
knowledgeable of the health care needs of the recipient and be
able to effectively communicate those needs;
(3) a face-to-face assessment must be conducted by the
local county public health nurse at least annually, or when
there is a significant change in the recipient's condition or
change in the need for personal care assistant services. The
county public health nurse shall determine the services that
require professional delegation, if any, and the amount and
frequency of related supervision;
(4) the recipient cannot select the shared services option
as specified in subdivision 8; and
(5) parties must be in compliance with the written
agreement specified in paragraph (f).
(i) The commissioner shall deny, revoke, or suspend the
authorization to use the fiscal agent option if:
(1) it has been determined by the consulting professional
or local county public health nurse that the use of this option
jeopardizes the recipient's health and safety;
(2) the parties have failed to comply with the written
agreement specified in paragraph (f); or
(3) the use of the option has led to abusive or fraudulent
billing for personal care assistant services.
The recipient or responsible party may appeal the
commissioner's action according to section 256.045. The denial,
revocation, or suspension to use the fiscal agent option shall
not affect the recipient's authorized level of personal care
assistant services as determined in subdivision 5.
Sec. 57. Minnesota Statutes 1998, section 256B.0627, is
amended by adding a subdivision to read:
Subd. 11. [SHARED PRIVATE DUTY NURSING CARE OPTION.] (a)
Medical assistance payments for shared private duty nursing
services by a private duty nurse shall be limited according to
this subdivision. For the purposes of this section, "private
duty nursing agency" means an agency licensed under chapter 144A
to provide private duty nursing services.
(b) Recipients of private duty nursing services may share
nursing staff and the commissioner shall provide a rate
methodology for shared private duty nursing. For two persons
sharing nursing care, the rate paid to a provider shall not
exceed 1.5 times the nonwaivered private duty nursing rates paid
for serving a single individual who is not ventilator dependent,
by a registered nurse or licensed practical nurse. These rates
apply only to situations in which both recipients are present
and receive shared private duty nursing care on the date for
which the service is billed. No more than two persons may
receive shared private duty nursing services from a private duty
nurse in a single setting.
(c) Shared private duty nursing care is the provision of
nursing services by a private duty nurse to two recipients at
the same time and in the same setting. For the purposes of this
subdivision, "setting" means:
(1) the home or foster care home of one of the individual
recipients; or
(2) a child care program licensed under chapter 245A or
operated by a local school district or private school; or
(3) an adult day care service licensed under chapter 245A.
This subdivision does not apply when a private duty nurse
is caring for multiple recipients in more than one setting.
(d) The recipient or the recipient's legal representative,
and the recipient's physician, in conjunction with the home
health care agency, shall determine:
(1) whether shared private duty nursing care is an
appropriate option based on the individual needs and preferences
of the recipient; and
(2) the amount of shared private duty nursing services
authorized as part of the overall authorization of nursing
services.
(e) The recipient or the recipient's legal representative,
in conjunction with the private duty nursing agency, shall
approve the setting, grouping, and arrangement of shared private
duty nursing care based on the individual needs and preferences
of the recipients. Decisions on the selection of recipients to
share services must be based on the ages of the recipients,
compatibility, and coordination of their care needs.
(f) The following items must be considered by the recipient
or the recipient's legal representative and the private duty
nursing agency, and documented in the recipient's health service
record:
(1) the additional training needed by the private duty
nurse to provide care to several recipients in the same setting
and to ensure that the needs of the recipients are met
appropriately and safely;
(2) the setting in which the shared private duty nursing
care will be provided;
(3) the ongoing monitoring and evaluation of the
effectiveness and appropriateness of the service and process
used to make changes in service or setting;
(4) a contingency plan which accounts for absence of the
recipient in a shared private duty nursing setting due to
illness or other circumstances;
(5) staffing backup contingencies in the event of employee
illness or absence; and
(6) arrangements for additional assistance to respond to
urgent or emergency care needs of the recipients.
(g) The provider must offer the recipient or responsible
party the option of shared or one-on-one private duty nursing
services. The recipient or responsible party can withdraw from
participating in a shared service arrangement at any time.
(h) The private duty nursing agency must document the
following in the health service record for each individual
recipient sharing private duty nursing care:
(1) permission by the recipient or the recipient's legal
representative for the maximum number of shared nursing care
hours per week chosen by the recipient;
(2) permission by the recipient or the recipient's legal
representative for shared private duty nursing services provided
outside the recipient's residence;
(3) permission by the recipient or the recipient's legal
representative for others to receive shared private duty nursing
services in the recipient's residence;
(4) revocation by the recipient or the recipient's legal
representative of the shared private duty nursing care
authorization, or the shared care to be provided to others in
the recipient's residence, or the shared private duty nursing
services to be provided outside the recipient's residence; and
(5) daily documentation of the shared private duty nursing
services provided by each identified private duty nurse,
including:
(i) the names of each recipient receiving shared private
duty nursing services together;
(ii) the setting for the shared services, including the
starting and ending times that the recipient received shared
private duty nursing care; and
(iii) notes by the private duty nurse regarding changes in
the recipient's condition, problems that may arise from the
sharing of private duty nursing services, and scheduling and
care issues.
(i) Unless otherwise provided in this subdivision, all
other statutory and regulatory provisions relating to private
duty nursing services apply to shared private duty nursing
services.
Nothing in this subdivision shall be construed to reduce
the total number of private duty nursing hours authorized for an
individual recipient under subdivision 5.
Sec. 58. Minnesota Statutes 1998, section 256B.0627, is
amended by adding a subdivision to read:
Subd. 12. [PUBLIC HEALTH NURSE ASSESSMENT RATE.] (a) The
reimbursement rates for public health nurse visits that relate
to the provision of personal care services under this section
and section 256B.0625, subdivision 19a, are:
(i) $210.50 for a face-to-face assessment visit;
(ii) $105.25 for each service update; and
(iii) $105.25 for each request for a temporary service
increase.
(b) The rates specified in paragraph (a) must be adjusted
to reflect provider rate increases for personal care assistant
services that are approved by the legislature for the fiscal
year ending June 30, 2000, and subsequent fiscal years. Any
requirements applied by the legislature to provider rate
increases for personal care assistant services also apply to
adjustments under this paragraph.
Sec. 59. Minnesota Statutes 1998, section 256B.0635,
subdivision 3, is amended to read:
Subd. 3. [MEDICAL ASSISTANCE FOR MFIP-S PARTICIPANTS WHO
OPT TO DISCONTINUE MONTHLY CASH ASSISTANCE.] Upon federal
approval, Medical assistance is available to persons who
received MFIP-S in at least three of the six months preceding
the month in which the person opted opt to discontinue receiving
MFIP-S cash assistance under section 256J.31, subdivision 12. A
person who is eligible for medical assistance under this section
may receive medical assistance without reapplication as long as
the person meets MFIP-S eligibility requirements, unless the
assistance unit does not include a dependent child. Medical
assistance may be paid pursuant to subdivisions 1 and 2 for
persons who are no longer eligible for MFIP-S due to increased
employment or child support. A person may be eligible for
MinnesotaCare due to increased employment or child support, and
as such must be informed of the option to transition onto
MinnesotaCare.
Sec. 60. [256B.0914] [CONFLICTS OF INTEREST RELATED TO
MEDICAID EXPENDITURES.]
Subdivision 1. [DEFINITIONS.] (a) "Contract" means a
written, fully executed agreement for the purchase of goods and
services involving a substantial expenditure of Medicaid
funding. A contract under a renewal period shall be considered
a separate contract.
(b) "Contractor bid or proposal information" means cost or
pricing data, indirect costs, and proprietary information marked
as such by the bidder in accordance with applicable law.
(c) "Particular expenditure" means a substantial
expenditure as defined below, for a specified term, involving
specific parties. The renewal of an existing contract for the
substantial expenditure of Medicaid funds is considered a
separate, particular expenditure from the original contract.
(d) "Source selection information" means any of the
following information prepared for use by the state, county, or
independent contractor for the purpose of evaluating a bid or
proposal to enter into a Medicaid procurement contract, if that
information has not been previously made available to the public
or disclosed publicly:
(1) bid prices submitted in response to a solicitation for
sealed bids, or lists of the bid prices before bid opening;
(2) proposed costs or prices submitted in response to a
solicitation, or lists of those proposed costs or prices;
(3) source selection plans;
(4) technical evaluations plans;
(5) technical evaluations of proposals;
(6) cost or price evaluation of proposals;
(7) competitive range determinations that identify
proposals that have a reasonable chance of being selected for
award of a contract;
(8) rankings of bids, proposals, or competitors;
(9) the reports and evaluations of source selection panels,
boards, or advisory councils; and
(10) other information marked as "source selection
information" based on a case-by-case determination by the head
of the agency, contractor, designees, or the contracting officer
that disclosure of the information would jeopardize the
integrity or successful completion of the Medicaid procurement
to which the information relates.
(e) "Substantial expenditure" and "substantial amounts"
mean a purchase of goods or services in excess of $10,000,000 in
Medicaid funding under this chapter or chapter 256L.
Subd. 2. [APPLICABILITY.] (a) Unless provided otherwise,
this section applies to:
(1) any state or local officer, employee, or independent
contractor who is responsible for the substantial expenditures
of medical assistance or MinnesotaCare funding under this
chapter or chapter 256L for which federal Medicaid matching
funds are available;
(2) any individual who formerly was such an officer,
employee, or independent contractor; and
(3) any partner of such a state or local officer, employee,
or independent contractor.
(b) This section is intended to meet the requirements of
state participation in the Medicaid program at United States
Code, title 42, sections 1396a(a)(4) and 1396u-2(d)(3), which
require that states have in place restrictions against conflicts
of interest in the Medicaid procurement process, that are at
least as stringent as those in effect under United States Code,
title 41, section 423, and title 18, sections 207 and 208, as
they apply to federal employees.
Subd. 3. [DISCLOSURE OF PROCUREMENT INFORMATION.] A person
described in subdivision 2 may not knowingly disclose contractor
bid or proposal information, or source selection information
before the award by the state, county, or independent contractor
of a Medicaid procurement contract to which the information
relates unless the disclosure is otherwise authorized by law.
No person, other than as provided by law, shall knowingly obtain
contractor bid or proposal information or source selection
information before the award of a Medicaid procurement contract
to which the information relates.
Subd. 4. [OFFERS OF EMPLOYMENT.] When a person described
in subdivision 2, paragraph (a), is participating personally and
substantially in a Medicaid procurement for a contract contacts
or is contacted by a person who is a bidder or offeror in the
same procurement regarding possible employment outside of the
entity by which the person is currently employed, the person
must:
(1) report the contact in writing to the person's
supervisor and employer's ethics officer; and
(2) either:
(i) reject the possibility of employment with the bidder or
offeror; or
(ii) be disqualified from further participation in the
procurement until the bidder or offeror is no longer involved in
that procurement, or all discussions with the bidder or offeror
regarding possible employment have terminated without an
arrangement for employment. A bidder or offeror may not engage
in employment discussions with an official who is subject to
this subdivision, until the bidder or offeror is no longer
involved in that procurement.
Subd. 5. [ACCEPTANCE OF COMPENSATION BY A FORMER
OFFICIAL.] (a) A former official of the state or county, or a
former independent contractor, described in subdivision 2 may
not accept compensation from a Medicaid contractor of a
substantial expenditure as an employee, officer, director, or
consultant of the contractor within one year after the former
official or independent contractor:
(1) served as the procuring contracting officer, the source
selection authority, a member of the source selection evaluation
board, or the chief of a financial or technical evaluation team
in a procurement in which the contractor was selected for award;
(2) served as the program manager, deputy program manager,
or administrative contracting officer for a contract awarded to
the contractor; or
(3) personally made decisions for the state, county, or
independent contractor to:
(i) award a contract, subcontract, modification of a
contract or subcontract, or a task order or delivery order to
the contractor;
(ii) establish overhead or other rates applicable to a
contract or contracts with the contractor;
(iii) approve issuance of a contract payment or payments to
the contractor; or
(iv) pay or settle a claim with the contractor.
(b) Paragraph (a) does not prohibit a former official of
the state, county, or independent contractor from accepting
compensation from any division or affiliate of a contractor not
involved in the same or similar products or services as the
division or affiliate of the contractor that is responsible for
the contract referred to in paragraph (a), clause (1), (2), or
(3).
(c) A contractor shall not provide compensation to a former
official knowing that the former official is accepting that
compensation in violation of this subdivision.
Subd. 6. [PERMANENT RESTRICTIONS ON REPRESENTATION AND
COMMUNICATION.] (a) A person described in subdivision 2, after
termination of his or her service with state, county, or
independent contractor, is permanently restricted from knowingly
making, with the intent to influence, any communication to or
appearance before an officer or employee of a department,
agency, or court of the United States, the state of Minnesota
and its counties in connection with a particular expenditure:
(1) in which the United States, the state of Minnesota, or
a Minnesota county is a party or has a direct and substantial
interest;
(2) in which the person participated personally and
substantially as an officer, employee, or independent
contractor; and
(3) which involved a specific party or parties at the time
of participation.
(b) For purposes of this subdivision and subdivisions 7 and
9, "participated" means an action taken through decision,
approval, disapproval, recommendation, the rendering of advice,
investigation, or other such action.
Subd. 7. [TWO-YEAR RESTRICTIONS ON REPRESENTATION AND
COMMUNICATION.] No person described in subdivision 2, within two
years after termination of service with the state, county, or
independent contractor, shall knowingly make, with the intent to
influence, any communication to or appearance before any officer
or employee of any government department, agency, or court in
connection with a particular expenditure:
(1) in which the United States, the state of Minnesota, or
a Minnesota county is a party or has a direct and substantial
interest;
(2) which the person knows or reasonably should know was
actually pending under the official's responsibility as an
officer, employee, or independent contractor within one year
before the termination of the official's service with the state,
county, or independent contractor; and
(3) which involved a specific party or parties at the time
the expenditure was pending.
Subd. 8. [EXCEPTIONS TO PERMANENT AND TWO-YEAR
RESTRICTIONS ON REPRESENTATION AND COMMUNICATION.] Subdivisions
6 and 7 do not apply to:
(1) communications or representations made in carrying out
official duties on behalf of the United States, the state of
Minnesota or local government, or as an elected official of the
state or local government;
(2) communications made solely for the purpose of
furnishing scientific or technological information; or
(3) giving testimony under oath. A person subject to
subdivisions 6 and 7 may serve as an expert witness in that
matter, without restriction, for the state, county, or
independent contractor. Under court order, a person subject to
subdivisions 6 and 7 may serve as an expert witness for others.
Otherwise, the person may not serve as an expert witness in that
matter.
Subd. 9. [WAIVER.] The commissioner of human services, or
the governor in the case of the commissioner, may grant a waiver
of a restriction in subdivisions 6 and 7 if he or she determines
that a waiver is in the public interest and that the services of
the officer or employee are critically needed for the benefit of
the state or county government.
Subd. 10. [ACTS AFFECTING A PERSONAL FINANCIAL
INTEREST.] A person described in subdivision 2, paragraph (a),
clause (1), who participates in a particular expenditure in
which the person has knowledge or has a financial interest, is
subject to the penalties in subdivision 12. For purposes of
this subdivision, "financial interest" also includes the
financial interest of a spouse, minor child, general partner,
organization in which the officer or employee is serving as an
officer, director, trustee, general partner, or employee, or any
person or organization with whom the individual is negotiating
or has any arrangement concerning prospective employment.
Subd. 11. [EXCEPTIONS TO PROHIBITIONS REGARDING FINANCIAL
INTEREST.] Subdivision 10 does not apply if:
(1) the person first advises the person's supervisor and
the employer's ethics officer regarding the nature and
circumstances of the particular expenditure and makes full
disclosure of the financial interest and receives in advance a
written determination made by the commissioner of human
services, or the governor in the case of the commissioner, that
the interest is not so substantial as to likely affect the
integrity of the services which the government may expect from
the officer, employee, or independent contractor;
(2) the financial interest is listed as an exemption at
Code of Federal Regulations, title 5, sections 2640.201 to
2640.203, as too remote or inconsequential to affect the
integrity of the services of the office, employee, or
independent contractor to which the requirement applies.
Subd. 12. [CRIMINAL PENALTIES.] (a) A person who violates
subdivisions 3 to 5 for the purpose of either exchanging the
information covered by this section for anything of value, or
for obtaining or giving anyone a competitive advantage in the
award of a Medicaid contract, may be sentenced to imprisonment
for not more than five years or payment of a fine of not more
than $50,000 for each violation, or the amount of compensation
which the person received or offered for the prohibited conduct,
whichever is greater, or both.
(b) A person who violates a provision of subdivisions 6 to
11 may be sentenced to imprisonment for not more than one year
or payment of a fine of not more than $50,000 for each violation
or the amount of compensation which the person received or
offered for the prohibited conduct, whichever amount is greater,
or both. A person who willfully engages in conduct in violation
of subdivisions 6 to 11 may be sentenced to imprisonment for not
more than five years or to payment of fine of not more than
$50,000 for each violation or the amount of compensation which
the person received or offered for the prohibited conduct,
whichever amount is greater, or both.
(c) Nothing in this section precludes prosecution under
other laws such as section 609.43.
Subd. 13. [CIVIL PENALTIES AND INJUNCTIVE RELIEF.] (a) The
Minnesota attorney general may bring a civil action in Ramsey
county district court against a person who violates this section.
Upon proof of such conduct by a preponderance of evidence, the
person is subject to a civil penalty. An individual who
violates this section is subject to a civil penalty of not more
than $50,000 for each violation plus twice the amount of
compensation which the individual received or offered for the
prohibited conduct. An organization that violates this section
is subject to a civil penalty of not more than $500,000 for each
violation plus twice the amount of compensation which the
organization received or offered for the prohibited conduct.
(b) If the Minnesota attorney general has reason to believe
that a person is engaging in conduct in violation of this
section, the attorney general may petition the Ramsey county
district court for an order prohibiting that person from
engaging in such conduct. The court may issue an order
prohibiting that person from engaging in such conduct if the
court finds that the conduct constitutes such a violation. The
filing of a petition under this subdivision does not preclude
any other remedy which is available by law.
Subd. 14. [ADMINISTRATIVE ACTIONS.] (a) If a state agency,
local agency, or independent contractor receives information
that a contractor or a person has violated this section, the
state agency, local agency, or independent contractor may:
(1) cancel the procurement if a contract has not already
been awarded;
(2) rescind the contract; or
(3) initiate suspension or debarment proceedings according
to applicable state or federal law.
(b) If the contract is rescinded, the state agency, local
agency, or independent contractor is entitled to recover, in
addition to any penalty prescribed by law, the amount expended
under the contract.
(c) This section does not:
(1) restrict the disclosure of information to or from any
person or class of persons authorized to receive that
information;
(2) restrict a contractor from disclosing the contractor's
bid or proposal information or the recipient from receiving that
information;
(3) restrict the disclosure or receipt of information
relating to a Medicaid procurement after it has been canceled by
the state agency, county agency, or independent contractor
before the contract award unless the agency or independent
contractor plans to resume the procurement; or
(4) limit the applicability of any requirements, sanctions,
contract penalties, and remedies established under any other law
or regulation.
(d) No person may file a protest against the award or
proposed award of a Medicaid contract alleging a violation of
this section unless that person reported the information the
person believes constitutes evidence of the offense to the
applicable state agency, local agency, or independent contractor
responsible for the procurement. The report must be made no
later than 14 days after the person first discovered the
possible violation.
Sec. 61. Minnesota Statutes 1998, section 256B.0916, is
amended to read:
256B.0916 [EXPANSION OF HOME AND COMMUNITY-BASED SERVICES;
MANAGEMENT AND ALLOCATION RESPONSIBILITIES.]
(a) The commissioner shall expand availability of home and
community-based services for persons with mental retardation and
related conditions to the extent allowed by federal law and
regulation and shall assist counties in transferring persons
from semi-independent living services to home and
community-based services. The commissioner may transfer funds
from the state semi-independent living services account
available under section 252.275, subdivision 8, and state
community social services aids available under section 256E.15
to the medical assistance account to pay for the nonfederal
share of nonresidential and residential home and community-based
services authorized under section 256B.092 for persons
transferring from semi-independent living services.
(b) Upon federal approval, county boards are not
responsible for funding semi-independent living services as a
social service for those persons who have transferred to the
home and community-based waiver program as a result of the
expansion under this subdivision. The county responsibility for
those persons transferred shall be assumed under section
256B.092. Notwithstanding the provisions of section 252.275,
the commissioner shall continue to allocate funds under that
section for semi-independent living services and county boards
shall continue to fund services under sections 256E.06 and
256E.14 for those persons who cannot access home and
community-based services under section 256B.092.
(c) Eighty percent of the state funds made available to the
commissioner under section 252.275 as a result of persons
transferring from the semi-independent living services program
to the home and community-based services program shall be used
to fund additional persons in the semi-independent living
services program.
(d) Beginning August 1, 1998, the commissioner shall issue
an annual report on the home and community-based waiver for
persons with mental retardation or related conditions, that
includes a list of the counties in which less than 95 percent of
the allocation provided, excluding the county waivered services
reserve, has been committed for two or more quarters during the
previous state fiscal year. For each listed county, the report
shall include the amount of funds allocated but not used, the
number and ages of individuals screened and waiting for
services, the services needed, a description of the technical
assistance provided by the commissioner to assist the counties
in jointly planning with other counties in order to serve more
persons, and additional actions which will be taken to serve
those screened and waiting for services.
Subdivision 1. [REDUCTION OF WAITING LIST.] (a) The
legislature recognizes that as of January 1, 1999, 3,300 persons
with mental retardation or related conditions have been screened
and determined eligible for the home and community-based waiver
services program for persons with mental retardation or related
conditions. Many wait for several years before receiving
service.
(b) The waiting list for this program shall be reduced or
eliminated by June 30, 2003. In order to reduce the number of
eligible persons waiting for identified services provided
through the home and community-based waiver for persons with
mental retardation or related conditions, funding shall be
increased to add 100 additional eligible persons each year
beyond the February 1999 medical assistance forecast.
(c) The commissioner shall allocate resources in such a
manner as to use all resources budgeted for the home and
community-based waiver for persons with mental retardation or
related conditions according to the priorities listed in
subdivision 2, paragraph (b), and then to serve other persons on
the waiting list. Resources allocated for a fiscal year to
serve persons affected by public and private sector ICF/MR
closures, but not expected to be expended for that purpose, must
be reallocated within that fiscal year to serve other persons on
the waiting list, and the number of waiver diversion slots shall
be adjusted accordingly.
(d) For fiscal year 2001, at least one-half of the increase
in funding over the previous year provided in the February 1999
medical assistance forecast for the home and community-based
waiver for persons with mental retardation and related
conditions, including changes made by the 1999 legislature, must
be used to serve persons who are not affected by public and
private sector ICF/MR closures.
Subd. 2. [DISTRIBUTION OF FUNDS; PARTNERSHIPS.] (a)
Beginning with fiscal year 2000, the commissioner shall
distribute all funding available for home and community-based
waiver services for persons with mental retardation or related
conditions to individual counties or to groups of counties that
form partnerships to jointly plan, administer, and authorize
funding for eligible individuals. The commissioner shall
encourage counties to form partnerships that have a sufficient
number of recipients and funding to adequately manage the risk
and maximize use of available resources.
(b) Counties must submit a request for funds and a plan for
administering the program as required by the commissioner. The
plan must identify the number of clients to be served, their
ages, and their priority listing based on:
(1) requirements in Minnesota Rules, part 9525.1880;
(2) unstable living situations due to the age or incapacity
of the primary caregiver;
(3) the need for services to avoid out-of-home placement of
children; and
(4) the need to serve persons affected by private sector
ICF/MR closures.
The plan must also identify changes made to improve services to
eligible persons and to improve program management.
(c) In allocating resources to counties, priority must be
given to groups of counties that form partnerships to jointly
plan, administer, and authorize funding for eligible individuals
and to counties determined by the commissioner to have
sufficient waiver capacity to maximize resource use.
(d) Within 30 days after receiving the county request for
funds and plans, the commissioner shall provide a written
response to the plan that includes the level of resources
available to serve additional persons.
(e) Counties are eligible to receive medical assistance
administrative reimbursement for administrative costs under
criteria established by the commissioner.
Subd. 3. [FAILURE TO DEVELOP PARTNERSHIPS OR SUBMIT A
PLAN.] (a) By October 1 of each year the commissioner shall
notify the county board if any county determined by the
commissioner to have insufficient capacity to maximize use of
available resources fails to develop a partnership with other
counties or fails to submit a plan as required in subdivision
2. The commissioner shall provide needed technical assistance
to a county or group of counties that fails to form a
partnership or submit a plan. If a county has not joined a
county partnership or submitted a plan within 30 days following
the notice by the commissioner of its failure, the commissioner
shall require and assist that county to develop a plan or
contract with another county or group of counties to plan and
administer the waiver services program in that county.
(b) Counties may request technical assistance, management
information, and administrative support from the commissioner at
any time. The commissioner shall respond to county requests
within 30 days. Priority shall be given to activities that
support the administrative needs of newly formed county
partnerships.
Subd. 4. [ALLOWED RESERVE.] Counties or groups of counties
participating in partnerships that have submitted a plan under
this section may develop an allowed reserve amount to meet
crises and other unmet needs of current home and community-based
waiver recipients. The amount of the allowed reserve shall be a
county specific amount based upon documented past experience and
projected need for the coming year described in an allowed
reserve plan submitted for approval to the commissioner with the
allocation request for the fiscal year.
Subd. 5. [PRIORITIES FOR REASSIGNMENT OF RESOURCES AND
APPROVAL OF INCREASED CAPACITY.] In order to maximize the number
of persons served with waiver funds, the commissioner shall
monitor county utilization of allocated resources and, as
appropriate, reassign resources not utilized and approve
increased capacity within available county allocations.
Priority consideration for reassignment of resources and
approval of increased capacity shall be given to counties with
sufficient capacity and counties that form partnerships. In
addition to the priorities listed in Minnesota Rules, part
9525.1880, the commissioner shall also give priority
consideration to persons whose living situations are unstable
due to the age or incapacity of the primary caregiver and to
children to avoid out-of-home placement.
Subd. 6. [WAIVER REQUEST.] (a) The commissioner shall
submit to the federal Health Care Financing Administration by
September 1, 1999, a request for a waiver to include an option
that would allow waiver service recipients to directly receive
95 percent of the funds that would be allocated to individuals
based on written county criteria and procedures approved by the
commissioner for the purchase of services to meet their
long-term care needs. The waiver request must include a
provision requiring recipients who receive funds directly to
provide to the commissioner annually, a description of the type
of services used, the amount paid for the services purchased,
and the amount of unspent funds.
(b) The commissioner, in cooperation with county
representatives, waiver service providers, recipients,
recipients' families, legal guardians, and advocacy groups,
shall develop criteria for:
(1) eligibility to receive funding directly;
(2) determination of the amount of funds made available to
each eligible person based on need; and
(3) the accountability required of persons directly
receiving funds.
(c) If this waiver is approved and implemented, any unspent
money from the waiver services allocation, including the five
percent not directly allocated to recipients and any unspent
portion of the money that is directly allocated, shall be used
to meet the needs of other eligible persons waiting for services
funded through the waiver.
(d) The commissioner, in consultation with county social
services agencies, waiver services providers, recipients,
recipients' families, legal guardians, and advocacy groups shall
evaluate the effectiveness of this option within two years of
its implementation.
Subd. 7. [ANNUAL REPORT BY COMMISSIONER.] Beginning
October 1, 1999, and each October 1 thereafter, the commissioner
shall issue an annual report on county and state use of
available resources for the home and community-based waiver for
persons with mental retardation or related conditions. For each
county or county partnership, the report shall include:
(1) the amount of funds allocated but not used;
(2) the county specific allowed reserve amount approved and
used;
(3) the number, ages and living situations of individuals
screened and waiting for services;
(4) the urgency of need for services to begin within one,
two, or more than two years for each individual;
(5) the services needed;
(6) the number of additional persons served by approval of
increased capacity within existing allocations;
(7) results of action by the commissioner to streamline
administrative requirements and improve county resource
management; and
(8) additional action that would decrease the number of
those eligible and waiting for waivered services.
The commissioner shall specify intended outcomes for the program
and the degree to which these specified outcomes are attained.
(e) Subd. 8. [FINANCIAL INFORMATION BY COUNTY.] The
commissioner shall make available to interested parties, upon
request, financial information by county including the amount of
resources allocated for the home and community-based waiver for
persons with mental retardation and related conditions, the
resources committed, the number of persons screened and waiting
for services, the type of services requested by those waiting,
and the amount of allocated resources not committed.
Subd. 9. [LEGAL REPRESENTATIVE PARTICIPATION
EXCEPTION.] The commissioner, in cooperation with
representatives of counties, service providers, service
recipients, family members, legal representatives and advocates,
shall develop criteria to allow legal representatives to be
reimbursed for providing specific support services to meet the
person's needs when a plan which assures health and safety has
been agreed upon and carried out by the legal representative,
the person, and the county. Legal representatives providing
support under consumer-directed community support services
pursuant to section 256B.092, subdivision 4, or the consumer
support grant program pursuant to section 256B.092, subdivision
7, shall not be considered to have a direct or indirect service
provider interest under section 256B.092, subdivision 7, if a
health and safety plan which meets the criteria established has
been agreed upon and implemented. By October 1, 1999, the
commissioner shall submit, for federal approval, amendments to
allow legal representatives to provide supports and receive
reimbursement under the consumer-directed community support
services section of the home and community-based waiver plan.
Sec. 62. Minnesota Statutes 1998, section 256B.0917,
subdivision 8, is amended to read:
Subd. 8. [LIVING-AT-HOME/BLOCK NURSE PROGRAM GRANT.] (a)
The organization awarded the contract under subdivision 7, shall
develop and administer a grant program to establish or expand up
to 27 33 community-based organizations that will implement
living-at-home/block nurse programs that are designed to enable
senior citizens to live as independently as possible in their
homes and in their communities. At least one-half of the
programs must be in counties outside the seven-county
metropolitan area. Nonprofit organizations and units of local
government are eligible to apply for grants to establish the
community organizations that will implement living-at-home/block
nurse programs. In awarding grants, the organization awarded
the contract under subdivision 7 shall give preference to
nonprofit organizations and units of local government from
communities that:
(1) have high nursing home occupancy rates;
(2) have a shortage of health care professionals;
(3) are located in counties adjacent to, or are located in,
counties with existing living-at-home/block nurse programs; and
(4) meet other criteria established by LAH/BN, Inc., in
consultation with the commissioner.
(b) Grant applicants must also meet the following criteria:
(1) the local community demonstrates a readiness to
establish a community model of care, including the formation of
a board of directors, advisory committee, or similar group, of
which at least two-thirds is comprised of community citizens
interested in community-based care for older persons;
(2) the program has sponsorship by a credible,
representative organization within the community;
(3) the program has defined specific geographic boundaries
and defined its organization, staffing and coordination/delivery
of services;
(4) the program demonstrates a team approach to
coordination and care, ensuring that the older adult
participants, their families, the formal and informal providers
are all part of the effort to plan and provide services; and
(5) the program provides assurances that all community
resources and funding will be coordinated and that other funding
sources will be maximized, including a person's own resources.
(c) Grant applicants must provide a minimum of five percent
of total estimated development costs from local community
funding. Grants shall be awarded for four-year periods, and the
base amount shall not exceed $80,000 per applicant for the grant
period. The organization under contract may increase the grant
amount for applicants from communities that have socioeconomic
characteristics that indicate a higher level of need for
assistance. Subject to the availability of funding, grants and
grant renewals awarded or entered into on or after July 1, 1997,
shall be renewed by LAH/BN, Inc. every four years, unless
LAH/BN, Inc. determines that the grant recipient has not
satisfactorily operated the living-at-home/block nurse program
in compliance with the requirements of paragraphs (b) and (d).
Grants provided to living-at-home/block nurse programs under
this paragraph may be used for both program development and the
delivery of services.
(d) Each living-at-home/block nurse program shall be
designed by representatives of the communities being served to
ensure that the program addresses the specific needs of the
community residents. The programs must be designed to:
(1) incorporate the basic community, organizational, and
service delivery principles of the living-at-home/block nurse
program model;
(2) provide senior citizens with registered nurse directed
assessment, provision and coordination of health and personal
care services on a sliding fee basis as an alternative to
expensive nursing home care;
(3) provide information, support services, homemaking
services, counseling, and training for the client and family
caregivers;
(4) encourage the development and use of respite care,
caregiver support, and in-home support programs, such as adult
foster care and in-home adult day care;
(5) encourage neighborhood residents and local
organizations to collaborate in meeting the needs of senior
citizens in their communities;
(6) recruit, train, and direct the use of volunteers to
provide informal services and other appropriate support to
senior citizens and their caregivers; and
(7) provide coordination and management of formal and
informal services to senior citizens and their families using
less expensive alternatives.
Sec. 63. Minnesota Statutes 1998, section 256B.0951,
subdivision 1, is amended to read:
Subdivision 1. [MEMBERSHIP.] The region 10 quality
assurance commission is established. The commission consists of
at least 13 14 but not more than 20 21 members as follows: at
least three but not more than five members representing advocacy
organizations; at least three but not more than five members
representing consumers, families, and their legal
representatives; at least three but not more than five members
representing service providers; and at least three but not more
than five members representing counties; and the commissioner of
human services or the commissioner's designee. Initial
membership of the commission shall be recruited and approved by
the region 10 stakeholders group. Prior to approving the
commission's membership, the stakeholders group shall provide to
the commissioner a list of the membership in the stakeholders
group, as of February 1, 1997, a brief summary of meetings held
by the group since July 1, 1996, and copies of any materials
prepared by the group for public distribution. The first
commission shall establish membership guidelines for the
transition and recruitment of membership for the commission's
ongoing existence. Members of the commission who do not receive
a salary or wages from an employer for time spent on commission
duties may receive a per diem payment when performing commission
duties and functions. All members may be reimbursed for
expenses related to commission activities. Notwithstanding the
provisions of section 15.059, subdivision 5, the commission
expires on June 30, 2001.
Sec. 64. Minnesota Statutes 1998, section 256B.0951,
subdivision 3, is amended to read:
Subd. 3. [COMMISSION DUTIES.] (a) By October 1, 1997, the
commission, in cooperation with the commissioners of human
services and health, shall do the following: (1) approve an
alternative quality assurance licensing system based on the
evaluation of outcomes; (2) approve measurable outcomes in the
areas of health and safety, consumer evaluation, education and
training, providers, and systems that shall be evaluated during
the alternative licensing process; and (3) establish variable
licensure periods not to exceed three years based on outcomes
achieved. For purposes of this subdivision, "outcome" means the
behavior, action, or status of a person that can be observed or
measured and can be reliably and validly determined.
(b) By January 15, 1998, the commission shall approve, in
cooperation with the commissioner of human services, a training
program for members of the quality assurance teams established
under section 256B.0952, subdivision 4.
(c) The commission and the commissioner shall establish an
ongoing review process for the alternative quality assurance
licensing system. The review shall take into account the
comprehensive nature of the alternative system, which is
designed to evaluate the broad spectrum of licensed and
unlicensed entities that provide services to clients, as
compared to the current licensing system.
(d) The commission shall contract with an independent
entity to conduct a financial review of the alternative quality
assurance pilot project. The review shall take into account the
comprehensive nature of the alternative system, which is
designed to evaluate the broad spectrum of licensed and
unlicensed entities that provide services to clients, as
compared to the current licensing system. The review shall
include an evaluation of possible budgetary savings within the
department of human services as a result of implementation of
the alternative quality assurance pilot project. If a federal
waiver is approved under subdivision 7, the financial review
shall also evaluate possible savings within the department of
health. This review must be completed by December 15, 2000.
(e) The commission shall submit a report to the legislature
by January 15, 2001, on the results of the review process for
the alternative quality assurance pilot project, a summary of
the results of the independent financial review, and a
recommendation on whether the pilot project should be extended
beyond June 30, 2001.
Sec. 65. Minnesota Statutes 1998, section 256B.0955, is
amended to read:
256B.0955 [DUTIES OF THE COMMISSIONER OF HUMAN SERVICES.]
(a) Effective July 1, 1998, the commissioner of human
services shall delegate authority to perform licensing functions
and activities, in accordance with section 245A.16, to counties
participating in the alternative licensing system. The
commissioner shall not license or reimburse a facility, program,
or service for persons with developmental disabilities in a
county that participates in the alternative licensing system if
the commissioner has received from the appropriate county
notification that the facility, program, or service has been
reviewed by a quality assurance team and has failed to qualify
for licensure.
(b) The commissioner may conduct random licensing
inspections based on outcomes adopted under section 256B.0951 at
facilities, programs, and services governed by the alternative
licensing system. The role of such random inspections shall be
to verify that the alternative licensing system protects the
safety and well-being of consumers and maintains the
availability of high-quality services for persons with
developmental disabilities.
(c) The commissioner shall provide technical assistance and
support or training to the alternative licensing system pilot
project.
(d) The commissioner and the commission shall establish an
ongoing evaluation process for the alternative licensing system.
(e) The commissioner shall contract with an independent
entity to conduct a financial review of the alternative
licensing system, including an evaluation of possible budgetary
savings within the department of human services and the
department of health as a result of implementation of the
alternative quality assurance licensing system. This review
must be completed by December 15, 2000.
(f) The commissioner and the commission shall submit a
report to the legislature by January 15, 2001, on the results of
the evaluation process of the alternative licensing system, a
summary of the results of the independent financial review, and
a recommendation on whether the pilot project should be extended
beyond June 30, 2001.
Sec. 66. Minnesota Statutes 1998, section 256B.37,
subdivision 2, is amended to read:
Subd. 2. [CIVIL ACTION FOR RECOVERY.] To recover under
this section, the attorney general, or the appropriate county
attorney, acting upon direction from the attorney general, may
institute or join a civil action to enforce the subrogation
rights of the commissioner established under this section.
Any prepaid health plan providing services under sections
256B.69, 256D.03, subdivision 4, paragraph (d), and 256L.12;
children's mental health collaboratives under section 245.493;
demonstration projects for persons with disabilities under
section 256B.77; nursing homes under the alternative payment
demonstration project under section 256B.434; or the
county-based purchasing entity providing services under section
256B.692 may retain legal representation to enforce the
subrogation rights created under this section or, if no action
has been brought, may initiate and prosecute an independent
action on their behalf against a person, firm, or corporation
that may be liable to the person to whom the care or payment was
furnished.
Sec. 67. Minnesota Statutes 1998, section 256B.48,
subdivision 1, is amended to read:
Subdivision 1. [PROHIBITED PRACTICES.] A nursing facility
is not eligible to receive medical assistance payments unless it
refrains from all of the following:
(a) Charging private paying residents rates for similar
services which exceed those which are approved by the state
agency for medical assistance recipients as determined by the
prospective desk audit rate, except under the following
circumstances: the nursing facility may (1) charge private
paying residents a higher rate for a private room, and (2)
charge for special services which are not included in the daily
rate if medical assistance residents are charged separately at
the same rate for the same services in addition to the daily
rate paid by the commissioner. Services covered by the payment
rate must be the same regardless of payment source. Special
services, if offered, must be available to all residents in all
areas of the nursing facility and charged separately at the same
rate. Residents are free to select or decline special
services. Special services must not include services which must
be provided by the nursing facility in order to comply with
licensure or certification standards and that if not provided
would result in a deficiency or violation by the nursing
facility. Services beyond those required to comply with
licensure or certification standards must not be charged
separately as a special service if they were included in the
payment rate for the previous reporting year. A nursing
facility that charges a private paying resident a rate in
violation of this clause is subject to an action by the state of
Minnesota or any of its subdivisions or agencies for civil
damages. A private paying resident or the resident's legal
representative has a cause of action for civil damages against a
nursing facility that charges the resident rates in violation of
this clause. The damages awarded shall include three times the
payments that result from the violation, together with costs and
disbursements, including reasonable attorneys' fees or their
equivalent. A private paying resident or the resident's legal
representative, the state, subdivision or agency, or a nursing
facility may request a hearing to determine the allowed rate or
rates at issue in the cause of action. Within 15 calendar days
after receiving a request for such a hearing, the commissioner
shall request assignment of an administrative law judge under
sections 14.48 to 14.56 to conduct the hearing as soon as
possible or according to agreement by the parties. The
administrative law judge shall issue a report within 15 calendar
days following the close of the hearing. The prohibition set
forth in this clause shall not apply to facilities licensed as
boarding care facilities which are not certified as skilled or
intermediate care facilities level I or II for reimbursement
through medical assistance.
(b) Requiring an applicant for admission to the facility,
or the guardian or conservator of the applicant, as a condition
of admission, to pay any fee or deposit in excess of $100, loan
any money to the nursing facility, or promise to leave all or
part of the applicant's estate to the facility.
(c) Requiring any resident of the nursing facility to
utilize a vendor of health care services chosen by the nursing
facility. A nursing facility may require a resident to use
pharmacies that utilize unit dose packing systems approved by
the Minnesota board of pharmacy, and may require a resident to
use pharmacies that are able to meet the federal regulations for
safe and timely administration of medications such as systems
with specific number of doses, prompt delivery of medications,
or access to medications on a 24-hour basis. Notwithstanding
the provisions of this paragraph, nursing facilities shall not
restrict a resident's choice of pharmacy because the pharmacy
utilizes a specific system of unit dose drug packing.
(d) Providing differential treatment on the basis of status
with regard to public assistance.
(e) Discriminating in admissions, services offered, or room
assignment on the basis of status with regard to public
assistance or refusal to purchase special services. Admissions
discrimination shall include, but is not limited to:
(1) basing admissions decisions upon assurance by the
applicant to the nursing facility, or the applicant's guardian
or conservator, that the applicant is neither eligible for nor
will seek public assistance for payment of nursing facility care
costs; and
(2) engaging in preferential selection from waiting lists
based on an applicant's ability to pay privately or an
applicant's refusal to pay for a special service.
The collection and use by a nursing facility of financial
information of any applicant pursuant to a preadmission
screening program established by law shall not raise an
inference that the nursing facility is utilizing that
information for any purpose prohibited by this paragraph.
(f) Requiring any vendor of medical care as defined by
section 256B.02, subdivision 7, who is reimbursed by medical
assistance under a separate fee schedule, to pay any amount
based on utilization or service levels or any portion of the
vendor's fee to the nursing facility except as payment for
renting or leasing space or equipment or purchasing support
services from the nursing facility as limited by section
256B.433. All agreements must be disclosed to the commissioner
upon request of the commissioner. Nursing facilities and
vendors of ancillary services that are found to be in violation
of this provision shall each be subject to an action by the
state of Minnesota or any of its subdivisions or agencies for
treble civil damages on the portion of the fee in excess of that
allowed by this provision and section 256B.433. Damages awarded
must include three times the excess payments together with costs
and disbursements including reasonable attorney's fees or their
equivalent.
(g) Refusing, for more than 24 hours, to accept a resident
returning to the same bed or a bed certified for the same level
of care, in accordance with a physician's order authorizing
transfer, after receiving inpatient hospital services.
The prohibitions set forth in clause (b) shall not apply to
a retirement facility with more than 325 beds including at least
150 licensed nursing facility beds and which:
(1) is owned and operated by an organization tax-exempt
under section 290.05, subdivision 1, clause (i); and
(2) accounts for all of the applicant's assets which are
required to be assigned to the facility so that only expenses
for the cost of care of the applicant may be charged against the
account; and
(3) agrees in writing at the time of admission to the
facility to permit the applicant, or the applicant's guardian,
or conservator, to examine the records relating to the
applicant's account upon request, and to receive an audited
statement of the expenditures charged against the applicant's
individual account upon request; and
(4) agrees in writing at the time of admission to the
facility to permit the applicant to withdraw from the facility
at any time and to receive, upon withdrawal, the balance of the
applicant's individual account.
For a period not to exceed 180 days, the commissioner may
continue to make medical assistance payments to a nursing
facility or boarding care home which is in violation of this
section if extreme hardship to the residents would result. In
these cases the commissioner shall issue an order requiring the
nursing facility to correct the violation. The nursing facility
shall have 20 days from its receipt of the order to correct the
violation. If the violation is not corrected within the 20-day
period the commissioner may reduce the payment rate to the
nursing facility by up to 20 percent. The amount of the payment
rate reduction shall be related to the severity of the violation
and shall remain in effect until the violation is corrected.
The nursing facility or boarding care home may appeal the
commissioner's action pursuant to the provisions of chapter 14
pertaining to contested cases. An appeal shall be considered
timely if written notice of appeal is received by the
commissioner within 20 days of notice of the commissioner's
proposed action.
In the event that the commissioner determines that a
nursing facility is not eligible for reimbursement for a
resident who is eligible for medical assistance, the
commissioner may authorize the nursing facility to receive
reimbursement on a temporary basis until the resident can be
relocated to a participating nursing facility.
Certified beds in facilities which do not allow medical
assistance intake on July 1, 1984, or after shall be deemed to
be decertified for purposes of section 144A.071 only.
Sec. 68. Minnesota Statutes 1998, section 256B.37,
subdivision 2, is amended to read:
Subd. 2. [CIVIL ACTION FOR RECOVERY.] To recover under
this section, the attorney general, or the appropriate county
attorney, acting upon direction from the attorney general, may
institute or join a civil action to enforce the subrogation
rights of the commissioner established under this section.
Any prepaid health plan providing services under sections
256B.69, 256D.03, subdivision 4, paragraph (d), and 256L.12;
children's mental health collaboratives under section 245.493;
demonstration projects for persons with disabilities under
section 256B.77; nursing homes under the alternative payment
demonstration project under section 256B.434; or the
county-based purchasing entity providing services under section
256B.692 may retain legal representation to enforce the
subrogation rights created under this section or, if no action
has been brought, may initiate and prosecute an independent
action on their behalf against a person, firm, or corporation
that may be liable to the person to whom the care or payment was
furnished.
Sec. 69. Minnesota Statutes 1998, section 256B.501,
subdivision 8a, is amended to read:
Subd. 8a. [PAYMENT FOR PERSONS WITH SPECIAL NEEDS FOR
CRISIS INTERVENTION SERVICES.] State-operated, Community-based
crisis services provided in accordance with section 252.50,
subdivision 7, to authorized by the commissioner or the
commissioner's designee for a resident of an intermediate care
facility for persons with mental retardation (ICF/MR) reimbursed
under this section shall be paid by medical assistance in
accordance with the paragraphs (a) to (h) (g).
(a) "Crisis services" means the specialized services listed
in clauses (1) to (3) provided to prevent the recipient from
requiring placement in a more restrictive institutional setting
such as an inpatient hospital or regional treatment center and
to maintain the recipient in the present community setting.
(1) The crisis services provider shall assess the
recipient's behavior and environment to identify factors
contributing to the crisis.
(2) The crisis services provider shall develop a
recipient-specific intervention plan in coordination with the
service planning team and provide recommendations for revisions
to the individual service plan if necessary to prevent or
minimize the likelihood of future crisis situations. The
intervention plan shall include a transition plan to aid the
recipient in returning to the community-based ICF/MR if the
recipient is receiving residential crisis services.
(3) The crisis services provider shall consult with and
provide training and ongoing technical assistance to the
recipient's service providers to aid in the implementation of
the intervention plan and revisions to the individual service
plan.
(b) "Residential crisis services" means crisis services
that are provided to a recipient admitted to the crisis services
foster care setting an alternative, state-licensed site approved
by the commissioner, because the ICF/MR receiving reimbursement
under this section is not able, as determined by the
commissioner, to provide the intervention and protection of the
recipient and others living with the recipient that is necessary
to prevent the recipient from requiring placement in a more
restrictive institutional setting.
(c) Residential crisis services providers must be licensed
by maintain a license from the commissioner under section
245A.03 to provide foster care, must exclusively provide for the
residence when providing crisis services for short-term crisis
intervention, and must not be located in a private residence.
(d) Payment rates are determined annually for each crisis
services provider based on cost of care for each provider as
defined in section 246.50. Interim payment rates are calculated
on a per diem basis by dividing the projected cost of providing
care by the projected number of contact days for the fiscal
year, as estimated by the commissioner. Final payment rates are
calculated by dividing the actual cost of providing care by the
actual number of contact days in the applicable fiscal
year shall be established consistent with county negotiated
crisis intervention services.
(e) Payment shall be made for each contact day. "Contact
day" means any day in which the crisis services provider has
face-to-face contact with the recipient or any of the
recipient's medical assistance service providers for the purpose
of providing crisis services as defined in paragraph (c).
(f) Payment for residential crisis services is limited to
21 days, unless an additional period is authorized by the
commissioner or part of an approved regional plan. The
additional period may not exceed 21 days.
(g) (f) Payment for crisis services shall be made only for
services provided while the ICF/MR receiving reimbursement under
this section:
(1) has a shared services agreement with the crisis
services provider in effect in accordance with under section
246.57; and
(2) has reassigned payment for the provision of the crisis
services under this subdivision to the commissioner in
accordance with Code of Federal Regulations, title 42, section
447.10(e); and
(3) has executed a cooperative agreement with the crisis
services provider to implement the intervention plan and
revisions to the individual service plan as necessary to prevent
or minimize the likelihood of future crisis situations, to
maintain the recipient in the present community setting, and to
prevent the recipient from requiring a more restrictive
institutional setting.
(h) (g) Payment to the ICF/MR receiving reimbursement under
this section shall be made for up to 18 therapeutic leave days
during which the recipient is receiving residential crisis
services, if the ICF/MR is otherwise eligible to receive payment
for a therapeutic leave day under Minnesota Rules, part
9505.0415. Payment under this paragraph shall be terminated if
the commissioner determines that the ICF/MR is not meeting the
terms of the cooperative shared service agreement under
paragraph (g) (f) or that the recipient will not return to the
ICF/MR.
Sec. 70. Minnesota Statutes 1998, 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 county board or a single entity representing a group
of county boards and the commissioner shall mutually select
health plans for participation at the time of initial
implementation of the prepaid medical assistance program in that
county or group of counties and at the time of contract renewal.
The commissioner shall also seek input for contract requirements
from the county or single entity representing a group of county
boards at each contract renewal and incorporate those
recommendations into the contract negotiation process. 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, but counties must
agree to initial enrollment beginning on or before January 1,
1999, in either the prepaid medical assistance and general
assistance medical care programs or county-based purchasing
under section 256B.692. 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 256L.06 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.
(c) At the option of the county board, the board may
develop contract requirements related to the achievement of
local public health goals to meet the health needs of medical
assistance and general assistance medical care enrollees. These
requirements must be reasonably related to the performance of
health plan functions and within the scope of the medical
assistance and general assistance medical care benefit sets. If
the county board and the commissioner mutually agree to such
requirements, the department shall include such requirements in
all health plan contracts governing the prepaid medical
assistance and general assistance medical care programs in that
county at initial implementation of the program in that county
and at the time of contract renewal. The county board may
participate in the enforcement of the contract provisions
related to local public health goals.
(d) For counties in which prepaid medical assistance and
general assistance medical care programs have not been
established, the commissioner shall not implement those programs
if a county board submits acceptable and timely preliminary and
final proposals under section 256B.692, until county-based
purchasing is no longer operational in that county. For
counties in which prepaid medical assistance and general
assistance medical care programs are in existence on or after
September 1, 1997, the commissioner must terminate contracts
with health plans according to section 256B.692, subdivision 5,
if the county board submits and the commissioner accepts
preliminary and final proposals according to that subdivision.
The commissioner is not required to terminate contracts that
begin on or after September 1, 1997, according to section
256B.692 until two years have elapsed from the date of initial
enrollment.
(e) In the event that a county board or a single entity
representing a group of county boards and the commissioner
cannot reach agreement regarding: (i) the selection of
participating health plans in that county; (ii) contract
requirements; or (iii) implementation and enforcement of county
requirements including provisions regarding local public health
goals, the commissioner shall resolve all disputes after taking
into account the recommendations of a three-person mediation
panel. The panel shall be composed of one designee of the
president of the association of Minnesota counties, one designee
of the commissioner of human services, and one designee of the
commissioner of health.
(f) If a county which elects to implement county-based
purchasing ceases to implement county-based purchasing, it is
prohibited from assuming the responsibility of county-based
purchasing for a period of five years from the date it
discontinues purchasing.
(g) Notwithstanding the requirement in this subdivision
that a county must agree to initial enrollment on or before
January 1, 1999, the commissioner shall grant a delay of up to
nine months in the implementation of the county-based purchasing
authorized in section 256B.692 until federal waiver authority
and approval has been granted, if the county or group of
counties has submitted a preliminary proposal for county-based
purchasing by September 1, 1997, has not already implemented the
prepaid medical assistance program before January 1, 1998, and
has submitted a written request for the delay to the
commissioner by July 1, 1998. In order for the delay to be
continued, the county or group of counties must also submit to
the commissioner the following information by December 1, 1998.
The information must:
(1) identify the proposed date of implementation, not later
than October 1, 1999 as determined under section 256B.692,
subdivision 5;
(2) include copies of the county board resolutions which
demonstrate the continued commitment to the implementation of
county-based purchasing by the proposed date. County board
authorization may remain contingent on the submission of a final
proposal which meets the requirements of section 256B.692,
subdivision 5, paragraph (b);
(3) demonstrate actions taken for the establishment of a
governance structure between the participating counties and
describe how the fiduciary responsibilities of county-based
purchasing will be allocated between the counties, if more than
one county is involved in the proposal;
(4) describe how the risk of a deficit will be managed in
the event expenditures are greater than total capitation
payments. This description must identify how any of the
following strategies will be used:
(i) risk contracts with licensed health plans;
(ii) risk arrangements with providers who are not licensed
health plans;
(iii) risk arrangements with other licensed insurance
entities; and
(iv) funding from other county resources;
(5) include, if county-based purchasing will not contract
with licensed health plans or provider networks, letters of
interest from local providers in at least the categories of
hospital, physician, mental health, and pharmacy which express
interest in contracting for services. These letters must
recognize any risk transfer identified in clause (4), item (ii);
and
(6) describe the options being considered to obtain the
administrative services required in section 256B.692,
subdivision 3, clauses (3) and (5).
(h) For counties which receive a delay under this
subdivision, the final proposals required under section
256B.692, subdivision 5, paragraph (b), must be submitted at
least six months prior to the requested implementation date.
Authority to implement county-based purchasing remains
contingent on approval of the final proposal as required under
section 256B.692.
(i) If the commissioner is unable to provide
county-specific, individual-level fee-for-service claims to
counties by June 4, 1998, the commissioner shall grant a delay
under paragraph (g) of up to 12 months in the implementation of
county-based purchasing, and shall require implementation not
later than January 1, 2000. In order to receive an extension of
the proposed date of implementation under this paragraph, a
county or group of counties must submit a written request for
the extension to the commissioner by August 1, 1998, must submit
the information required under paragraph (g) by December 1,
1998, and must submit a final proposal as provided under
paragraph (h).
(j) Notwithstanding other requirements of this subdivision,
the commissioner shall not require the implementation of the
county-based purchasing authorized in section 256B.692 until six
months after federal waiver approval has been obtained for
county-based purchasing, if the county or counties have
submitted the final plan as required in section 256B.692,
subdivision 5. The commissioner shall allow the county or
counties which submitted information under section 256B.692,
subdivision 5, to submit supplemental or additional information
which was not possible to submit by April 1, 1999. A county or
counties shall continue to submit the required information and
substantive detail necessary to obtain a prompt response and
waiver approval. If amendments to the final plan are necessary
due to the terms and conditions of the waiver approval, the
commissioner shall allow the county or group of counties 60 days
to make the necessary amendments to the final plan and shall not
require implementation of the county-based purchasing until six
months after the revised final plan has been submitted.
Sec. 71. Minnesota Statutes 1998, section 256B.69, is
amended by adding a subdivision to read:
Subd. 3b. [PROVISION OF DATA TO COUNTY BOARDS.] The
commissioner, in consultation with representatives of county
boards of commissioners shall identify program information and
data necessary on an ongoing basis for county boards to: (1)
make recommendations to the commissioner related to state
purchasing under the prepaid medical assistance program; and (2)
effectively administer county-based purchasing. This
information and data must include, but is not limited to,
county-specific, individual-level fee-for-service and prepaid
health plan claims information.
Sec. 72. Minnesota Statutes 1998, section 256B.69, is
amended by adding a subdivision to read:
Subd. 4b. [INDIVIDUAL EDUCATION PLAN AND INDIVIDUALIZED
FAMILY SERVICE PLAN SERVICES.] The commissioner shall amend the
federal waiver allowing the state to separate out individual
education plan and individualized family service plan services
for children enrolled in the prepaid medical assistance program
and the MinnesotaCare program. Effective July 1, 1999, or upon
federal approval, medical assistance coverage of eligible
individual education plan and individualized family service plan
services shall not be included in the capitated services for
children enrolled in health plans through the prepaid medical
assistance program and the MinnesotaCare program. Upon federal
approval, local school districts shall bill the commissioner for
these services, and claims shall be paid on a fee-for-service
basis.
Sec. 73. Minnesota Statutes 1998, section 256B.69,
subdivision 5a, is amended to read:
Subd. 5a. [MANAGED CARE CONTRACTS.] Managed care contracts
under this section, sections 256.9363, and 256D.03, shall be
entered into or renewed on a calendar year basis beginning
January 1, 1996. Managed care contracts which were in effect on
June 30, 1995, and set to renew on July 1, 1995, shall be
renewed for the period July 1, 1995 through December 31, 1995 at
the same terms that were in effect on June 30, 1995.
A prepaid health plan providing covered health services for
eligible persons pursuant to chapters 256B, 256D, and 256L, is
responsible for complying with the terms of its contract with
the commissioner. Requirements applicable to managed care
programs under chapters 256B, 256D, and 256L, established after
the effective date of a contract with the commissioner take
effect when the contract is next issued or renewed.
Sec. 74. Minnesota Statutes 1998, section 256B.69,
subdivision 5b, is amended to read:
Subd. 5b. [PROSPECTIVE REIMBURSEMENT RATES.] (a) 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, 1998, capitation rates
for nonmetropolitan counties shall on a weighted average be no
less than 88 percent of the capitation rates for metropolitan
counties, excluding Hennepin county. The commissioner shall
make a pro rata adjustment in capitation rates paid to counties
other than nonmetropolitan counties in order to make this
provision budget neutral.
(b) For prepaid medical assistance program contract rates
set by the commissioner under subdivision 5 and effective on or
after January 1, 2001, capitation rates for nonmetropolitan
counties shall, on a weighted average, be no less than 89
percent of the capitation rates for metropolitan counties,
excluding Hennepin county.
Sec. 75. Minnesota Statutes 1998, section 256B.69, is
amended by adding a subdivision to read:
Subd. 5e. [MEDICAL EDUCATION AND RESEARCH PAYMENTS.] For
the calendar years 1999, 2000, and 2001, a hospital that
participates in funding the federal share of the medical
education and research trust fund payment under Laws 1998,
chapter 407, article 1, section 3, shall not be held liable for
any amounts attributable to this payment above the charge limit
of section 256.969, subdivision 3a. The commissioner of human
services shall assume liability for any corresponding federal
share of the payments above the charge limit.
Sec. 76. Minnesota Statutes 1998, section 256B.692,
subdivision 2, is amended to read:
Subd. 2. [DUTIES OF THE COMMISSIONER OF HEALTH.] (a)
Notwithstanding chapters 62D and 62N, a county that elects to
purchase medical assistance and general assistance medical care
in return for a fixed sum without regard to the frequency or
extent of services furnished to any particular enrollee is not
required to obtain a certificate of authority under chapter 62D
or 62N. The county board of commissioners is the governing body
of a county-based purchasing program. In a multicounty
arrangement, the governing body is a joint powers board
established under section 471.59.
(b) A county that elects to purchase medical assistance and
general assistance medical care services under this section must
satisfy the commissioner of health that the requirements for
assurance of consumer protection, provider protection, and
fiscal solvency of chapter 62D, applicable to health maintenance
organizations, or chapter 62N, applicable to community
integrated service networks, will be met.
(c) A county must also assure the commissioner of health
that the requirements of sections 62J.041; 62J.48; 62J.71 to
62J.73; 62M.01 to 62M.16; all applicable provisions of chapter
62Q, including sections 62Q.07; 62Q.075; 62Q.105; 62Q.1055;
62Q.106; 62Q.11; 62Q.12; 62Q.135; 62Q.14; 62Q.145; 62Q.19;
62Q.23, paragraph (c); 62Q.30; 62Q.43; 62Q.47; 62Q.50; 62Q.52 to
62Q.56; 62Q.58; 62Q.64; and 72A.201 will be met.
(d) All enforcement and rulemaking powers available under
chapters 62D, 62J, 62M, 62N, and 62Q are hereby granted to the
commissioner of health with respect to counties that purchase
medical assistance and general assistance medical care services
under this section.
(e) The commissioner, in consultation with county
government, shall develop administrative and financial reporting
requirements for county-based purchasing programs relating to
sections 62D.041, 62D.042, 62D.045, 62D.08, 62N.28, 62N.29, and
62N.31, and other sections as necessary, that are specific to
county administrative, accounting, and reporting systems and
consistent with other statutory requirements of counties.
Sec. 77. Minnesota Statutes 1998, section 256B.75, is
amended to read:
256B.75 [HOSPITAL OUTPATIENT REIMBURSEMENT.]
(a) For outpatient hospital facility fee payments for
services rendered on or after October 1, 1992, the commissioner
of human services shall pay the lower of (1) submitted charge,
or (2) 32 percent above the rate in effect on June 30, 1992,
except for those services for which there is a federal maximum
allowable payment. Effective for services rendered on or after
January 1, 2000, payment rates for nonsurgical outpatient
hospital facility fees and emergency room facility fees shall be
increased by eight percent over the rates in effect on December
31, 1999, except for those services for which there is a federal
maximum allowable payment. Services for which there is a
federal maximum allowable payment shall be paid at the lower of
(1) submitted charge, or (2) the federal maximum allowable
payment. Total aggregate payment for outpatient hospital
facility fee services shall not exceed the Medicare upper
limit. If it is determined that a provision of this section
conflicts with existing or future requirements of the United
States government with respect to federal financial
participation in medical assistance, the federal requirements
prevail. The commissioner may, in the aggregate, prospectively
reduce payment rates to avoid reduced federal financial
participation resulting from rates that are in excess of the
Medicare upper limitations.
(b) Notwithstanding paragraph (a), payment for outpatient,
emergency, and ambulatory surgery hospital facility fee services
for critical access hospitals designated under section 144.1483,
clause (11), shall be paid on a cost-based payment system that
is based on the cost-finding methods and allowable costs of the
Medicare program.
Sec. 78. Minnesota Statutes 1998, section 256B.76, is
amended to read:
256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.]
(a) The physician reimbursement increase provided in
section 256B.74, subdivision 2, shall not be implemented.
Effective for services rendered on or after October 1, 1992, the
commissioner shall make payments for physician services as
follows:
(1) payment for level one Health Care Finance
Administration's common procedural coding system (HCPCS) codes
titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum,
and postpartum care," "critical care," Caesarean delivery and
pharmacologic management provided to psychiatric patients, and
HCPCS level three codes for enhanced services for prenatal high
risk, shall be paid at the lower of (i) submitted charges, or
(ii) 25 percent above the rate in effect on June 30, 1992. If
the rate on any procedure code within these categories is
different than the rate that would have been paid under the
methodology in section 256B.74, subdivision 2, then the larger
rate shall be paid;
(2) payments for all other services shall be paid at the
lower of (i) submitted charges, or (ii) 15.4 percent above the
rate in effect on June 30, 1992; and
(3) all physician rates shall be converted from the 50th
percentile of 1982 to the 50th percentile of 1989, less the
percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall
be the rates in effect on September 30, 1992.;
(4) effective for services rendered on or after January 1,
2000, payment rates for physician and professional services
shall be increased by three percent over the rates in effect on
December 31, 1999, except for home health agency and family
planning agency services; and
(5) the increases in clause (4) shall be implemented
January 1, 2000, for managed care.
(b) The dental reimbursement increase provided in section
256B.74, subdivision 5, shall not be implemented. Effective for
services rendered on or after October 1, 1992, the commissioner
shall make payments for dental services as follows:
(1) dental services shall be paid at the lower of (i)
submitted charges, or (ii) 25 percent above the rate in effect
on June 30, 1992; and
(2) dental rates shall be converted from the 50th
percentile of 1982 to the 50th percentile of 1989, less the
percent in aggregate necessary to equal the above increases.;
(3) effective for services rendered on or after January 1,
2000, payment rates for dental services shall be increased by
three percent over the rates in effect on December 31, 1999;
(4) the commissioner shall award grants to community
clinics or other nonprofit community organizations, political
subdivisions, professional associations, or other organizations
that demonstrate the ability to provide dental services
effectively to public program recipients. Grants may be used to
fund the costs related to coordinating access for recipients,
developing and implementing patient care criteria, upgrading or
establishing new facilities, acquiring furnishings or equipment,
recruiting new providers, or other development costs that will
improve access to dental care in a region. In awarding grants,
the commissioner shall give priority to applicants that plan to
serve areas of the state in which the number of dental providers
is not currently sufficient to meet the needs of recipients of
public programs or uninsured individuals. The commissioner
shall consider the following in awarding the grants: (i)
potential to successfully increase access to an underserved
population; (ii) the ability to raise matching funds; (iii) the
long-term viability of the project to improve access beyond the
period of initial funding; (iv) the efficiency in the use of the
funding; and (v) the experience of the proposers in providing
services to the target population.
The commissioner shall monitor the grants and may terminate
a grant if the grantee does not increase dental access for
public program recipients. The commissioner shall consider
grants for the following:
(i) implementation of new programs or continued expansion
of current access programs that have demonstrated success in
providing dental services in underserved areas;
(ii) a pilot program for utilizing hygienists outside of a
traditional dental office to provide dental hygiene services;
and
(iii) a program that organizes a network of volunteer
dentists, establishes a system to refer eligible individuals to
volunteer dentists, and through that network provides donated
dental care services to public program recipients or uninsured
individuals.
(5) beginning October 1, 1999, the payment for tooth
sealants and fluoride treatments shall be the lower of (i)
submitted charge, or (ii) 80 percent of median 1997 charges; and
(6) the increases listed in clauses (3) and (5) shall be
implemented January 1, 2000, for managed care.
(c) An entity that operates both a Medicare certified
comprehensive outpatient rehabilitation facility and a facility
which was certified prior to January 1, 1993, that is licensed
under Minnesota Rules, parts 9570.2000 to 9570.3600, and for
whom at least 33 percent of the clients receiving rehabilitation
services in the most recent calendar year are medical assistance
recipients, shall be reimbursed by the commissioner for
rehabilitation services at rates that are 38 percent greater
than the maximum reimbursement rate allowed under paragraph (a),
clause (2), when those services are (1) provided within the
comprehensive outpatient rehabilitation facility and (2)
provided to residents of nursing facilities owned by the entity.
Sec. 79. [256B.765] [PROVIDER RATE INCREASES.]
(a) Effective July 1, 2001, within the limits of
appropriations specifically for this purpose, the commissioner
shall provide an annual inflation adjustment for the providers
listed in paragraph (c). The index for the inflation adjustment
must be based on the change in the Employment Cost Index for
Private Industry Workers - Total Compensation forecasted by Data
Resources, Inc., as forecasted in the fourth quarter of the
calendar year preceding the fiscal year. The commissioner shall
increase reimbursement or allocation rates by the percentage of
this adjustment, and county boards shall adjust provider
contracts as needed.
(b) The commissioner of finance shall include an annual
inflationary adjustment in reimbursement rates for the providers
listed in paragraph (c) using the inflation factor specified in
paragraph (a) as a budget change request in each biennial
detailed expenditure budget submitted to the legislature under
section 16A.11.
(c) The annual adjustment under paragraph (a) shall be
provided for home and community-based waiver services for
persons with mental retardation or related conditions under
section 256B.501; home and community-based waiver services for
the elderly under section 256B.0915; waivered services under
community alternatives for disabled individuals under section
256B.49; community alternative care waivered services under
section 256B.49; traumatic brain injury waivered services under
section 256B.49; nursing services and home health services under
section 256B.0625, subdivision 6a; personal care services and
nursing supervision of personal care services under section
256B.0625, subdivision 19a; private duty nursing services under
section 256B.0625, subdivision 7; day training and habilitation
services for adults with mental retardation or related
conditions under sections 252.40 to 252.46; physical therapy
services under sections 256B.0625, subdivision 8, and 256D.03,
subdivision 4; occupational therapy services under sections
256B.0625, subdivision 8a, and 256D.03, subdivision 4;
speech-language therapy services under section 256D.03,
subdivision 4, and Minnesota Rules, part 9505.0390; respiratory
therapy services under section 256D.03, subdivision 4, and
Minnesota Rules, part 9505.0295; alternative care services under
section 256B.0913; adult residential program grants under
Minnesota Rules, parts 9535.2000 to 9535.3000; adult and family
community support grants under Minnesota Rules, parts 9535.1700
to 9535.1760; semi-independent living services under section
252.275 including SILS funding under county social services
grants formerly funded under chapter 256I; and community support
services for deaf and hard-of-hearing adults with mental illness
who use or wish to use sign language as their primary means of
communication.
Sec. 80. Minnesota Statutes 1998, section 256B.77,
subdivision 7a, is amended to read:
Subd. 7a. [ELIGIBLE INDIVIDUALS.] (a) Persons are eligible
for the demonstration project as provided in this subdivision.
(b) "Eligible individuals" means those persons living in
the demonstration site who are eligible for medical assistance
and are disabled based on a disability determination under
section 256B.055, subdivisions 7 and 12, or who are eligible for
medical assistance and have been diagnosed as having:
(1) serious and persistent mental illness as defined in
section 245.462, subdivision 20;
(2) severe emotional disturbance as defined in section
245.487 245.4871, subdivision 6; or
(3) mental retardation, or being a mentally retarded person
as defined in section 252A.02, or a related condition as defined
in section 252.27, subdivision 1a.
Other individuals may be included at the option of the county
authority based on agreement with the commissioner.
(c) Eligible individuals residing on a federally recognized
Indian reservation may be excluded from participation in the
demonstration project at the discretion of the tribal government
based on agreement with the commissioner, in consultation with
the county authority.
(d) Eligible individuals include individuals in excluded
time status, as defined in chapter 256G. Enrollees in excluded
time at the time of enrollment shall remain in excluded time
status as long as they live in the demonstration site and shall
be eligible for 90 days after placement outside the
demonstration site if they move to excluded time status in a
county within Minnesota other than their county of financial
responsibility.
(e) (d) A person who is a sexual psychopathic personality
as defined in section 253B.02, subdivision 18a, or a sexually
dangerous person as defined in section 253B.02, subdivision 18b,
is excluded from enrollment in the demonstration project.
Sec. 81. Minnesota Statutes 1998, section 256B.77, is
amended by adding a subdivision to read:
Subd. 7b. [AMERICAN INDIAN RECIPIENTS.] (a) Beginning on
or after July 1, 1999, for American Indian recipients of medical
assistance who are required to enroll with a county
administrative entity or service delivery organization under
subdivision 7, medical assistance shall cover health care
services provided at American Indian health services facilities
and facilities operated by a tribe or tribal organization under
funding authorized by United States Code, title 25, sections
450f to 450n, or title III of the Indian Self-Determination and
Education Assistance Act, Public Law Number 93-638, if those
services would otherwise be covered under section 256B.0625.
Payments for services provided under this subdivision shall be
made on a fee-for-service basis, and may, at the option of the
tribe or tribal organization, be made according to rates
authorized under sections 256.969, subdivision 16, and
256B.0625, subdivision 34. Implementation of this purchasing
model is contingent on federal approval.
(b) The commissioner of human services, in consultation
with tribal governments, shall develop a plan for tribes to
assist in the enrollment process for American Indian recipients
enrolled in the demonstration project for people with
disabilities under this section. This plan also shall address
how tribes will be included in ensuring the coordination of care
for American Indian recipients between Indian health service or
tribal providers and other providers.
(c) For purposes of this subdivision, "American Indian" has
the meaning given to persons to whom services will be provided
for in Code of Federal Regulations, title 42, section 36.12.
Sec. 82. Minnesota Statutes 1998, section 256B.77,
subdivision 8, is amended to read:
Subd. 8. [RESPONSIBILITIES OF THE COUNTY ADMINISTRATIVE
ENTITY.] (a) The county administrative entity shall meet the
requirements of this subdivision, unless the county authority or
the commissioner, with written approval of the county authority,
enters into a service delivery contract with a service delivery
organization for any or all of the requirements contained in
this subdivision.
(b) The county administrative entity shall enroll eligible
individuals regardless of health or disability status.
(c) The county administrative entity shall provide all
enrollees timely access to the medical assistance benefit set.
Alternative services and additional services are available to
enrollees at the option of the county administrative entity and
may be provided if specified in the personal support plan.
County authorities are not required to seek prior authorization
from the department as required by the laws and rules governing
medical assistance.
(d) The county administrative entity shall cover necessary
services as a result of an emergency without prior
authorization, even if the services were rendered outside of the
provider network.
(e) The county administrative entity shall authorize
necessary and appropriate services when needed and requested by
the enrollee or the enrollee's legal representative in response
to an urgent situation. Enrollees shall have 24-hour access to
urgent care services coordinated by experienced disability
providers who have information about enrollees' needs and
conditions.
(f) The county administrative entity shall accept the
capitation payment from the commissioner in return for the
provision of services for enrollees.
(g) The county administrative entity shall maintain
internal grievance and complaint procedures, including an
expedited informal complaint process in which the county
administrative entity must respond to verbal complaints within
ten calendar days, and a formal grievance process, in which the
county administrative entity must respond to written complaints
within 30 calendar days.
(h) The county administrative entity shall provide a
certificate of coverage, upon enrollment, to each enrollee and
the enrollee's legal representative, if any, which describes the
benefits covered by the county administrative entity, any
limitations on those benefits, and information about providers
and the service delivery network. This information must also be
made available to prospective enrollees. This certificate must
be approved by the commissioner.
(i) The county administrative entity shall present evidence
of an expedited process to approve exceptions to benefits,
provider network restrictions, and other plan limitations under
appropriate circumstances.
(j) The county administrative entity shall provide
enrollees or their legal representatives with written notice of
their appeal rights under subdivision 16, and of ombudsman and
advocacy programs under subdivisions 13 and 14, at the following
times: upon enrollment, upon submission of a written complaint,
when a service is reduced, denied, or terminated, or when
renewal of authorization for ongoing service is refused.
(k) The county administrative entity shall determine
immediate needs, including services, support, and assessments,
within 30 calendar days of after enrollment, or within a shorter
time frame if specified in the intergovernmental contract.
(l) The county administrative entity shall assess the need
for services of new enrollees within 60 calendar days of after
enrollment, or within a shorter time frame if specified in the
intergovernmental contract, and periodically reassess the need
for services for all enrollees.
(m) The county administrative entity shall ensure the
development of a personal support plan for each person within 60
calendar days of enrollment, or within a shorter time frame if
specified in the intergovernmental contract, unless otherwise
agreed to by the enrollee and the enrollee's legal
representative, if any. Until a personal support plan is
developed and agreed to by the enrollee, enrollees must have
access to the same amount, type, setting, duration, and
frequency of covered services that they had at the time of
enrollment unless other covered services are needed. For an
enrollee who is not receiving covered services at the time of
enrollment and for enrollees whose personal support plan is
being revised, access to the medical assistance benefit set must
be assured until a personal support plan is developed or
revised. If an enrollee chooses not to develop a personal
support plan, the enrollee will be subject to the network and
prior authorization requirements of the county administrative
entity or service delivery organization 60 days after
enrollment. An enrollee can choose to have a personal support
plan developed at any time. The personal support plan must be
based on choices, preferences, and assessed needs and strengths
of the enrollee. The service coordinator shall develop the
personal support plan, in consultation with the enrollee or the
enrollee's legal representative and other individuals requested
by the enrollee. The personal support plan must be updated as
needed or as requested by the enrollee. Enrollees may choose
not to have a personal support plan.
(n) The county administrative entity shall ensure timely
authorization, arrangement, and continuity of needed and covered
supports and services.
(o) The county administrative entity shall offer service
coordination that fulfills the responsibilities under
subdivision 12 and is appropriate to the enrollee's needs,
choices, and preferences, including a choice of service
coordinator.
(p) The county administrative entity shall contract with
schools and other agencies as appropriate to provide otherwise
covered medically necessary medical assistance services as
described in an enrollee's individual family support plan, as
described in sections 125A.26 to 125A.48, or individual
education plan, as described in chapter 125A.
(q) The county administrative entity shall develop and
implement strategies, based on consultation with affected
groups, to respect diversity and ensure culturally competent
service delivery in a manner that promotes the physical, social,
psychological, and spiritual well-being of enrollees and
preserves the dignity of individuals, families, and their
communities.
(r) When an enrollee changes county authorities, county
administrative entities shall ensure coordination with the
entity that is assuming responsibility for administering the
medical assistance benefit set to ensure continuity of supports
and services for the enrollee.
(s) The county administrative entity shall comply with
additional requirements as specified in the intergovernmental
contract.
(t) To the extent that alternatives are approved under
subdivision 17, county administrative entities must provide for
the health and safety of enrollees and protect the rights to
privacy and to provide informed consent.
Sec. 83. Minnesota Statutes 1998, section 256B.77,
subdivision 10, is amended to read:
Subd. 10. [CAPITATION PAYMENT.] (a) The commissioner shall
pay a capitation payment to the county authority and, when
applicable under subdivision 6, paragraph (a), to the service
delivery organization for each medical assistance eligible
enrollee. The commissioner shall develop capitation payment
rates for the initial contract period for each demonstration
site in consultation with an independent actuary, to ensure that
the cost of services under the demonstration project does not
exceed the estimated cost for medical assistance services for
the covered population under the fee-for-service system for the
demonstration period. For each year of the demonstration
project, the capitation payment rate shall be based on 96
percent of the projected per person costs that would otherwise
have been paid under medical assistance fee-for-service during
each of those years. Rates shall be adjusted within the limits
of the available risk adjustment technology, as mandated by
section 62Q.03. In addition, the commissioner shall implement
appropriate risk and savings sharing provisions with county
administrative entities and, when applicable under subdivision
6, paragraph (a), service delivery organizations within the
projected budget limits. Capitation rates shall be adjusted, at
least annually, to include any rate increases and payments for
expanded or newly covered services for eligible individuals.
The initial demonstration project rate shall include an amount
in addition to the fee-for-service payments to adjust for
underutilization of dental services. Any savings beyond those
allowed for the county authority, county administrative entity,
or service delivery organization shall be first used to meet the
unmet needs of eligible individuals. Payments to providers
participating in the project are exempt from the requirements of
sections 256.966 and 256B.03, subdivision 2.
(b) The commissioner shall monitor and evaluate annually
the effect of the discount on consumers, the county authority,
and providers of disability services. Findings shall be
reported and recommendations made, as appropriate, to ensure
that the discount effect does not adversely affect the ability
of the county administrative entity or providers of services to
provide appropriate services to eligible individuals, and does
not result in cost shifting of eligible individuals to the
county authority.
(c) For risk-sharing to occur under this subdivision, the
aggregate fee-for-service cost of covered services provided by
the county administrative entity under this section must exceed
the aggregate sum of capitation payments made to the county
administrative entity under this section. The county authority
is required to maintain its current level of nonmedical
assistance spending on enrollees. If the county authority
spends less in nonmedical assistance dollars on enrollees than
it spent the year prior to the contract year, the amount of
underspending shall be deducted from the aggregate
fee-for-service cost of covered services. The commissioner
shall then compare the fee-for-service costs and capitation
payments related to the services provided for the term of this
contract. The commissioner shall base its calculation of the
fee-for-service costs on application of the medical assistance
fee schedule to services identified on the county administrative
entity's encounter claims submitted to the commissioner. The
aggregate fee-for-service cost shall not include any third-party
recoveries or cost-avoided amounts.
If the commissioner finds that the aggregate
fee-for-service cost is greater than the sum of the capitation
payments, the commissioner shall settle according to the
following schedule:
(1) For the first contract year for each project, the
commissioner shall pay the county administrative entity 50
percent of the difference between the sum of the capitation
payments and 100 percent of projected fee-for-service costs.
For aggregate fee-for-service costs in excess of 100 percent of
projected fee-for-service costs, the commissioner shall pay 250
percent of the difference between the aggregate fee-for-service
cost and the projected fee-for-service cost, up to 104 percent
of the projected fee-for-service costs. The county
administrative entity shall be responsible for all costs in
excess of 104 percent of projected fee-for-service costs.
(2) For the second contract year for each project, the
commissioner shall pay the county administrative entity 37.5
percent of the difference between the sum of the capitation
payments and 100 percent of projected fee-for-service costs.
The county administrative entity shall be responsible for all
costs in excess of 100 percent of projected fee-for-service
costs.
(3) For the third contract year for each project, the
commissioner shall pay the county administrative entity 25
percent of the difference between the sum of the capitation
payments and 100 percent of projected fee-for-service costs.
The county administrative entity shall be responsible for all
costs in excess of 100 percent of projected fee-for-service
costs.
(4) For the fourth and subsequent contract years for each
project, the county administrative entity shall be responsible
for all costs in excess of the capitation payments.
(d) In addition to other payments under this subdivision,
the commissioner may increase payments by up to 0.25 percent of
the projected per person costs that would otherwise have been
paid under medical assistance fee-for-service. The commissioner
may make the increased payments to:
(1) offset rate increases for regional treatment services
under subdivision 22 which are higher than was expected by the
commissioner when the capitation was set at 96 percent; and
(2) implement incentives to encourage appropriate, high
quality, efficient services.
Sec. 84. Minnesota Statutes 1998, section 256B.77,
subdivision 14, is amended to read:
Subd. 14. [EXTERNAL ADVOCACY.] In addition to ombudsman
services, enrollees shall have access to advocacy services on a
local or regional basis. The purpose of external advocacy
includes providing individual advocacy services for enrollees
who have complaints or grievances with the county administrative
entity, service delivery organization, or a service provider;
assisting enrollees to understand the service delivery system
and select providers and, if applicable, a service delivery
organization; and understand and exercise their rights as an
enrollee. External advocacy contractors must demonstrate that
they have the expertise to advocate on behalf of all categories
of eligible individuals and are independent of the commissioner,
county authority, county administrative entity, service delivery
organization, or any service provider within the demonstration
project.
These advocacy services shall be provided through the
ombudsman for mental health and mental retardation directly, or
under contract with private, nonprofit organizations, with
funding provided through the demonstration project. The funding
shall be provided annually to the ombudsman's office based on
0.1 percent of the projected per person costs that would
otherwise have been paid under medical assistance
fee-for-service during those years. Funding for external
advocacy shall be provided for each year of the demonstration
period through general fund appropriations. This funding is in
addition to the capitation payment available under subdivision
10.
Sec. 85. Minnesota Statutes 1998, section 256B.77, is
amended by adding a subdivision to read:
Subd. 27. [SERVICE COORDINATION TRANSITION.] Demonstration
sites designated under subdivision 5, with the permission of an
eligible individual, may implement the provisions of subdivision
12 beginning 60 calendar days prior to an individual's
enrollment. This implementation may occur prior to the
enrollment of eligible individuals, but is restricted to
eligible individuals.
Sec. 86. Minnesota Statutes 1998, section 256D.03,
subdivision 3, is amended to read:
Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.]
(a) General assistance medical care may be paid for any person
who is not eligible for medical assistance under chapter 256B,
including eligibility for medical assistance based on a
spenddown of excess income according to section 256B.056,
subdivision 5, or MinnesotaCare as defined in paragraph (b),
except as provided in paragraph (c); and:
(1) who is receiving assistance under section 256D.05,
except for families with children who are eligible under
Minnesota family investment program-statewide (MFIP-S), who is
having a payment made on the person's behalf under sections
256I.01 to 256I.06, or who resides in group residential housing
as defined in chapter 256I and can meet a spenddown using the
cost of remedial services received through group residential
housing; or
(2)(i) who is a resident of Minnesota; and whose equity in
assets is not in excess of $1,000 per assistance unit. Exempt
assets, the reduction of excess assets, and the waiver of excess
assets must conform to the medical assistance program in chapter
256B, with the following exception: the maximum amount of
undistributed funds in a trust that could be distributed to or
on behalf of the beneficiary by the trustee, assuming the full
exercise of the trustee's discretion under the terms of the
trust, must be applied toward the asset maximum; and
(ii) who has countable income not in excess of the
assistance standards established in section 256B.056,
subdivision 4, or whose excess income is spent down according to
section 256B.056, subdivision 5, using a six-month budget
period. The method for calculating earned income disregards and
deductions for a person who resides with a dependent child under
age 21 shall follow section 256B.056, subdivision 1a. However,
if a disregard of $30 and one-third of the remainder has been
applied to the wage earner's income, the disregard shall not be
applied again until the wage earner's income has not been
considered in an eligibility determination for general
assistance, general assistance medical care, medical assistance,
or MFIP-S for 12 consecutive months. The earned income and work
expense deductions for a person who does not reside with a
dependent child under age 21 shall be the same as the method
used to determine eligibility for a person under section
256D.06, subdivision 1, except the disregard of the first $50 of
earned income is not allowed;
(3) who would be eligible for medical assistance except
that the person resides in a facility that is determined by the
commissioner or the federal Health Care Financing Administration
to be an institution for mental diseases; or
(4) who is ineligible for medical assistance under chapter
256B or general assistance medical care under any other
provision of this section, and is receiving care and
rehabilitation services from a nonprofit center established to
serve victims of torture. These individuals are eligible for
general assistance medical care only for the period during which
they are receiving services from the center. During this period
of eligibility, individuals eligible under this clause shall not
be required to participate in prepaid general assistance medical
care.
(b) Beginning January 1, 2000, applicants or recipients who
meet all eligibility requirements of MinnesotaCare as defined in
sections 256L.01 to 256L.16, and are:
(i) adults with dependent children under 21 whose gross
family income is equal to or less than 275 percent of the
federal poverty guidelines; or
(ii) adults without children with earned income and whose
family gross income is between 75 percent of the federal poverty
guidelines and the amount set by section 256L.04, subdivision 7,
shall be terminated from general assistance medical care upon
enrollment in MinnesotaCare.
(c) For services rendered on or after July 1, 1997,
eligibility is limited to one month prior to application if the
person is determined eligible in the prior month. A
redetermination of eligibility must occur every 12 months.
Beginning January 1, 2000, Minnesota health care program
applications completed by recipients and applicants who are
persons described in paragraph (b), may be returned to the
county agency to be forwarded to the department of human
services or sent directly to the department of human services
for enrollment in MinnesotaCare. If all other eligibility
requirements of this subdivision are met, eligibility for
general assistance medical care shall be available in any month
during which a MinnesotaCare eligibility determination and
enrollment are pending. Upon notification of eligibility for
MinnesotaCare, notice of termination for eligibility for general
assistance medical care shall be sent to an applicant or
recipient. If all other eligibility requirements of this
subdivision are met, eligibility for general assistance medical
care shall be available until enrollment in MinnesotaCare
subject to the provisions of paragraph (e).
(d) The date of an initial Minnesota health care program
application necessary to begin a determination of eligibility
shall be the date the applicant has provided a name, address,
and social security number, signed and dated, to the county
agency or the department of human services. If the applicant is
unable to provide an initial application when health care is
delivered due to a medical condition or disability, a health
care provider may act on the person's behalf to complete the
initial application. The applicant must complete the remainder
of the application and provide necessary verification before
eligibility can be determined. The county agency must assist
the applicant in obtaining verification if necessary. On the
basis of information provided on the completed application, an
applicant who meets the following criteria shall be determined
eligible beginning in the month of application:
(1) has gross income less than 90 percent of the applicable
income standard;
(2) has liquid assets that total within $300 of the asset
standard;
(3) does not reside in a long-term care facility; and
(4) meets all other eligibility requirements.
The applicant must provide all required verifications within 30
days' notice of the eligibility determination or eligibility
shall be terminated.
(e) County agencies are authorized to use all automated
databases containing information regarding recipients' or
applicants' income in order to determine eligibility for general
assistance medical care or MinnesotaCare. Such use shall be
considered sufficient in order to determine eligibility and
premium payments by the county agency.
(f) General assistance medical care is not available for a
person in a correctional facility unless the person is detained
by law for less than one year in a county correctional or
detention facility as a person accused or convicted of a crime,
or admitted as an inpatient to a hospital on a criminal hold
order, and the person is a recipient of general assistance
medical care at the time the person is detained by law or
admitted on a criminal hold order and as long as the person
continues to meet other eligibility requirements of this
subdivision.
(g) General assistance medical care is not available for
applicants or recipients who do not cooperate with the county
agency to meet the requirements of medical assistance. General
assistance medical care is limited to payment of emergency
services only for applicants or recipients as described in
paragraph (b), whose MinnesotaCare coverage is denied or
terminated for nonpayment of premiums as required by sections
256L.06 and 256L.07.
(h) In determining the amount of assets of an individual,
there shall be included any asset or interest in an asset,
including an asset excluded under paragraph (a), that was given
away, sold, or disposed of for less than fair market value
within the 60 months preceding application for general
assistance medical care or during the period of eligibility.
Any transfer described in this paragraph shall be presumed to
have been for the purpose of establishing eligibility for
general assistance medical care, unless the individual furnishes
convincing evidence to establish that the transaction was
exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair
market value at the time it was given away, sold, or disposed
of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility,
including partial months, shall be calculated by dividing the
uncompensated transfer amount by the average monthly per person
payment made by the medical assistance program to skilled
nursing facilities for the previous calendar year. The
individual shall remain ineligible until this fixed period has
expired. The period of ineligibility may exceed 30 months, and
a reapplication for benefits after 30 months from the date of
the transfer shall not result in eligibility unless and until
the period of ineligibility has expired. The period of
ineligibility begins in the month the transfer was reported to
the county agency, or if the transfer was not reported, the
month in which the county agency discovered the transfer,
whichever comes first. For applicants, the period of
ineligibility begins on the date of the first approved
application.
(i) When determining eligibility for any state benefits
under this subdivision, the income and resources of all
noncitizens shall be deemed to include their sponsor's income
and resources as defined in the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996, title IV, Public Law
Number 104-193, sections 421 and 422, and subsequently set out
in federal rules.
(j)(1) An undocumented noncitizen or a nonimmigrant is
ineligible for general assistance medical care other than
emergency services. For purposes of this subdivision, a
nonimmigrant is an individual in one or more of the classes
listed in United States Code, title 8, section 1101(a)(15), and
an undocumented noncitizen is an individual who resides in the
United States without the approval or acquiescence of the
Immigration and Naturalization Service.
(2) This paragraph does not apply to a child under age 18,
to a Cuban or Haitian entrant as defined in Public Law Number
96-422, section 501(e)(1) or (2)(a), or to a noncitizen who is
aged, blind, or disabled as defined in Code of Federal
Regulations, title 42, sections 435.520, 435.530, 435.531,
435.540, and 435.541, or effective October 1, 1998, to an
individual eligible for general assistance medical care under
paragraph (a), clause (4), who cooperates with the Immigration
and Naturalization Service to pursue any applicable immigration
status, including citizenship, that would qualify the individual
for medical assistance with federal financial participation.
(3) For purposes of this paragraph, "emergency services"
has the meaning given in Code of Federal Regulations, title 42,
section 440.255(b)(1), except that it also means services
rendered because of suspected or actual pesticide poisoning.
(k) Notwithstanding any other provision of law, a
noncitizen who is ineligible for medical assistance due to the
deeming of a sponsor's income and resources, is ineligible for
general assistance medical care.
Sec. 87. Minnesota Statutes 1998, 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) psychological services, medical supplies and
equipment, and Medicare premiums, coinsurance and deductible
payments;
(19) 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;
(20) services performed by a certified pediatric nurse
practitioner, a certified family nurse practitioner, a certified
adult nurse practitioner, a certified obstetric/gynecological
nurse practitioner, a certified neonatal nurse practitioner, or
a certified geriatric nurse practitioner in independent
practice, if (1) the services are service is otherwise covered
under this chapter as a physician service, (2) a service
provided on an inpatient basis is not included as part of the
cost for inpatient services included in the operating payment
rate, and if (3) 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
(21) 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; and
(22) telemedicine consultations, to the extent they are
covered under section 256B.0625, subdivision 3b.
(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. 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:
(i) 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.
(ii) 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.
(iii) 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.
(iv) 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.
(v) 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.
(f) 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.
(g) Any county may, from its own resources, provide medical
payments for which state payments are not made.
(h) Chemical dependency services that are reimbursed under
chapter 254B must not be reimbursed under general assistance
medical care.
(i) 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.
(j) 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. 88. Minnesota Statutes 1998, section 256D.03,
subdivision 8, is amended to read:
Subd. 8. [PRIVATE INSURANCE POLICIES.] (a) Private
accident and health care coverage for medical services is
primary coverage and must be exhausted before general assistance
medical care is paid. When a person who is otherwise eligible
for general assistance medical care has private accident or
health care coverage, including a prepaid health plan, the
private health care benefits available to the person must be
used first and to the fullest extent. General assistance
medical care payment will not be made when either covered
charges are paid in full by a third party or the provider has an
agreement to accept payment for less than charges as payment in
full. Payment for patients that are simultaneously covered by
general assistance medical care and a liable third party other
than Medicare will be determined as the lesser of clauses (1) to
(3):
(1) the patient liability according to the provider/insurer
agreement;
(2) covered charges minus the third party payment amount;
or
(3) the general assistance medical care rate minus the
third party payment amount.
A negative difference will not be implemented.
(b) When a parent or a person with an obligation of support
has enrolled in a prepaid health care plan under section
518.171, subdivision 1, the commissioner of human services shall
limit the recipient of general assistance medical care to the
benefits payable under that prepaid health care plan to the
extent that services available under general assistance medical
care are also available under the prepaid health care plan.
(c) Upon furnishing general assistance medical care or
general assistance to any person having private accident or
health care coverage, or having a cause of action arising out of
an occurrence that necessitated the payment of assistance, the
state agency shall be subrogated, to the extent of the cost of
medical care, subsistence, or other payments furnished, to any
rights the person may have under the terms of the coverage or
under the cause of action. For purposes of this subdivision,
"state agency" includes prepaid health plans under contract with
the commissioner according to sections 256B.69, 256D.03,
subdivision 4, paragraph (d), and 256L.12; children's mental
health collaboratives under section 245.493; demonstration
projects for persons with disabilities under section 256B.77;
nursing homes under the alternative payment demonstration
project under section 256B.434; and county-based purchasing
entities under section 256B.692.
This right of subrogation includes all portions of the
cause of action, notwithstanding any settlement allocation or
apportionment that purports to dispose of portions of the cause
of action not subject to subrogation.
(d) To recover under this section, the attorney general or
the appropriate county attorney, acting upon direction from the
attorney general, may institute or join a civil action to
enforce the subrogation rights the commissioner established
under this section.
Any prepaid health plan providing services under sections
256B.69, 256D.03, subdivision 4, paragraph (d), and 256L.12;
children's mental health collaboratives under section 245.493;
demonstration projects for persons with disabilities under
section 256B.77; nursing homes under the alternative payment
demonstration project under section 256B.434; or the
county-based purchasing entity providing services under section
256B.692 may retain legal representation to enforce the
subrogation rights created under this section or, if no action
has been brought, may initiate and prosecute an independent
action on their behalf against a person, firm, or corporation
that may be liable to the person to whom the care or payment was
furnished.
(e) The state agency must be given notice of monetary
claims against a person, firm, or corporation that may be liable
in damages, or otherwise obligated to pay part or all of the
costs related to an injury when the state agency has paid or
become liable for the cost of care or payments related to the
injury. Notice must be given as follows:
(i) Applicants for general assistance or general assistance
medical care shall notify the state or county agency of any
possible claims when they submit the application. Recipients of
general assistance or general assistance medical care shall
notify the state or county agency of any possible claims when
those claims arise.
(ii) A person providing medical care services to a
recipient of general assistance medical care shall notify the
state agency when the person has reason to believe that a third
party may be liable for payment of the cost of medical care.
(iii) A person who is party to a claim upon which the state
agency may be entitled to subrogation under this section shall
notify the state agency of its potential subrogation claim
before filing a claim, commencing an action, or negotiating a
settlement. A person who is a party to a claim includes the
plaintiff, the defendants, and any other party to the cause of
action.
Notice given to the county agency is not sufficient to meet
the requirements of paragraphs (b) and (c).
(f) Upon any judgment, award, or settlement of a cause of
action, or any part of it, upon which the state agency has a
subrogation right, including compensation for liquidated,
unliquidated, or other damages, reasonable costs of collection,
including attorney fees, must be deducted first. The full
amount of general assistance or general assistance medical care
paid to or on behalf of the person as a result of the injury
must be deducted next and paid to the state agency. The rest
must be paid to the public assistance recipient or other
plaintiff. The plaintiff, however, must receive at least
one-third of the net recovery after attorney fees and collection
costs.
Sec. 89. Minnesota Statutes 1998, section 256L.03,
subdivision 5, is amended to read:
Subd. 5. [COPAYMENTS AND COINSURANCE.] (a) The
MinnesotaCare benefit plan shall include the following
copayments and coinsurance requirements for all enrollees except
parents and relative caretakers of children under the age of 21
in households with income at or below 175 percent of the federal
poverty guidelines and pregnant women and children under the age
of 21:
(1) ten percent of the paid charges for inpatient hospital
services for adult enrollees, subject to an annual inpatient
out-of-pocket maximum of $1,000 per individual and $3,000 per
family;
(2) $3 per prescription for adult enrollees;
(3) $25 for eyeglasses for adult enrollees; and
(4) effective July 1, 1998, 50 percent of the
fee-for-service rate for adult dental care services other than
preventive care services for persons eligible under section
256L.04, subdivisions 1 to 7, with income equal to or less than
175 percent of the federal poverty guidelines.
The exceptions described in this paragraph shall only be
implemented if required to obtain federal Medicaid funding for
these individuals and shall expire July 1, 2000.
(b) Effective July 1, 1997, adult enrollees with family
gross income that exceeds 175 percent of the federal poverty
guidelines and who are not pregnant shall be financially
responsible for the coinsurance amount and amounts which exceed
the $10,000 inpatient hospital benefit limit.
(c) When a MinnesotaCare enrollee becomes a member of a
prepaid health plan, or changes from one prepaid health plan to
another during a calendar year, any charges submitted towards
the $10,000 annual inpatient benefit limit, and any
out-of-pocket expenses incurred by the enrollee for inpatient
services, that were submitted or incurred prior to enrollment,
or prior to the change in health plans, shall be disregarded.
Sec. 90. Minnesota Statutes 1998, section 256L.03,
subdivision 6, is amended to read:
Subd. 6. [LIEN.] When the state agency provides, pays for,
or becomes liable for covered health services, the agency shall
have a lien for the cost of the covered health services upon any
and all causes of action accruing to the enrollee, or to the
enrollee's legal representatives, as a result of the occurrence
that necessitated the payment for the covered health services.
All liens under this section shall be subject to the provisions
of section 256.015. For purposes of this subdivision, "state
agency" includes authorized agents of the state agency prepaid
health plans under contract with the commissioner according to
sections 256B.69, 256D.03, subdivision 4, paragraph (d), and
256L.12; and county-based purchasing entities under section
256B.692.
Sec. 91. Minnesota Statutes 1998, section 256L.04,
subdivision 2, is amended to read:
Subd. 2. [COOPERATION IN ESTABLISHING THIRD-PARTY
LIABILITY, PATERNITY, AND OTHER MEDICAL SUPPORT.] (a) To be
eligible for MinnesotaCare, individuals and families must
cooperate with the state agency to identify potentially liable
third-party payers and assist the state in obtaining third-party
payments. "Cooperation" includes, but is not limited to,
identifying any third party who may be liable for care and
services provided under MinnesotaCare to the enrollee, providing
relevant information to assist the state in pursuing a
potentially liable third party, and completing forms necessary
to recover third-party payments.
(b) A parent, guardian, relative caretaker, or child
enrolled in the MinnesotaCare program must cooperate with the
department of human services and the local agency in
establishing the paternity of an enrolled child and in obtaining
medical care support and payments for the child and any other
person for whom the person can legally assign rights, in
accordance with applicable laws and rules governing the medical
assistance program. A child shall not be ineligible for or
disenrolled from the MinnesotaCare program solely because the
child's parent, relative caretaker, or guardian fails to
cooperate in establishing paternity or obtaining medical support.
Sec. 92. Minnesota Statutes 1998, section 256L.04,
subdivision 8, is amended to read:
Subd. 8. [APPLICANTS POTENTIALLY ELIGIBLE FOR MEDICAL
ASSISTANCE.] (a) Individuals who receive supplemental security
income or retirement, survivors, or disability benefits due to a
disability, or other disability-based pension, who qualify under
subdivision 7, but who are potentially eligible for medical
assistance without a spenddown shall be allowed to enroll in
MinnesotaCare for a period of 60 days, so long as the applicant
meets all other conditions of eligibility. The commissioner
shall identify and refer the applications of such individuals to
their county social service agency. The county and the
commissioner shall cooperate to ensure that the individuals
obtain medical assistance coverage for any months for which they
are eligible.
(b) The enrollee must cooperate with the county social
service agency in determining medical assistance eligibility
within the 60-day enrollment period. Enrollees who do not
cooperate with medical assistance within the 60-day enrollment
period shall be disenrolled from the plan within one calendar
month. Persons disenrolled for nonapplication for medical
assistance may not reenroll until they have obtained a medical
assistance eligibility determination. Persons disenrolled for
noncooperation with medical assistance may not reenroll until
they have cooperated with the county agency and have obtained a
medical assistance eligibility determination.
(c) Beginning January 1, 2000, counties that choose to
become MinnesotaCare enrollment sites shall consider
MinnesotaCare applications of individuals described in paragraph
(a) to also be applications for medical assistance and shall
first determine whether medical assistance eligibility exists.
Adults with children with family income under 175 percent of the
federal poverty guidelines for the applicable family size,
pregnant women, and children who qualify under subdivision 1
Applicants who are potentially eligible for medical assistance
without a spenddown, except for those described in paragraph
(a), may choose to enroll in either MinnesotaCare or medical
assistance.
(d) The commissioner shall redetermine provider payments
made under MinnesotaCare to the appropriate medical assistance
payments for those enrollees who subsequently become eligible
for medical assistance.
Sec. 93. Minnesota Statutes 1998, section 256L.04,
subdivision 11, is amended to read:
Subd. 11. [MINNESOTACARE OUTREACH.] (a) The commissioner
shall award grants to public or private organizations to provide
information on the importance of maintaining insurance coverage
and on how to obtain coverage through the MinnesotaCare program
in areas of the state with high uninsured populations.
(b) In awarding the grants, the commissioner shall consider
the following:
(1) geographic areas and populations with high uninsured
rates;
(2) the ability to raise matching funds; and
(3) the ability to contact or serve eligible populations.
The commissioner shall monitor the grants and may terminate
a grant if the outreach effort does not increase the
MinnesotaCare program enrollment in medical assistance, general
assistance medical care, or the MinnesotaCare program.
Sec. 94. Minnesota Statutes 1998, section 256L.04,
subdivision 13, is amended to read:
Subd. 13. [FAMILIES WITH GRANDPARENTS, RELATIVE
CARETAKERS, FOSTER PARENTS, OR LEGAL GUARDIANS.] Beginning
January 1, 1999, in families that include a grandparent,
relative caretaker as defined in the medical assistance program,
foster parent, or legal guardian, the grandparent, relative
caretaker, foster parent, or legal guardian may apply as a
family or may apply separately for the children. If the
caretaker applies separately for the children, only the
children's income is counted and the provisions of subdivision
1, paragraph (b), do not apply. If the grandparent, relative
caretaker, foster parent, or legal guardian applies with the
children, their income is included in the gross family income
for determining eligibility and premium amount.
Sec. 95. Minnesota Statutes 1998, section 256L.05, is
amended by adding a subdivision to read:
Subd. 3c. [RETROACTIVE COVERAGE.] Notwithstanding
subdivision 3, the effective date of coverage shall be the first
day of the month following termination from medical assistance
or general assistance medical care for families and individuals
who are eligible for MinnesotaCare and who submitted a written
request for retroactive MinnesotaCare coverage with a completed
application within 30 days of the mailing of notification of
termination from medical assistance or general assistance
medical care. The applicant must provide all required
verifications within 30 days of the written request for
verification. For retroactive coverage, premiums must be paid
in full for any retroactive month, current month, and next month
within 30 days of the premium billing.
Sec. 96. Minnesota Statutes 1998, section 256L.05,
subdivision 4, is amended to read:
Subd. 4. [APPLICATION PROCESSING.] The commissioner of
human services shall determine an applicant's eligibility for
MinnesotaCare no more than 30 days from the date that the
application is received by the department of human services.
Beginning January 1, 2000, this requirement also applies to
local county human services agencies that determine eligibility
for MinnesotaCare. Once annually at application or
reenrollment, to prevent processing delays, applicants or
enrollees who, from the information provided on the application,
appear to meet eligibility requirements shall be enrolled upon
timely payment of premiums. The enrollee must provide all
required verifications within 30 days of enrollment notification
of the eligibility determination or coverage from the program
shall be terminated. Enrollees who are determined to be
ineligible when verifications are provided shall be disenrolled
from the program.
Sec. 97. Minnesota Statutes 1998, section 256L.06,
subdivision 3, is amended to read:
Subd. 3. [ADMINISTRATION AND COMMISSIONER'S DUTIES.] (a)
Premiums are dedicated to the commissioner for MinnesotaCare.
(b) The commissioner shall develop and implement procedures
to: (1) require enrollees to report changes in income; (2)
adjust sliding scale premium payments, based upon changes in
enrollee income; and (3) disenroll enrollees from MinnesotaCare
for failure to pay required premiums. Beginning July 1, 1998,
Failure to pay includes payment with a dishonored check and, a
returned automatic bank withdrawal, or a refused credit card or
debit card payment. The commissioner may demand a guaranteed
form of payment, including a cashier's check or a money order,
as the only means to replace a dishonored check, returned, or
refused payment.
(c) Premiums are calculated on a calendar month basis and
may be paid on a monthly, quarterly, or annual basis, with the
first payment due upon notice from the commissioner of the
premium amount required. The commissioner shall inform
applicants and enrollees of these premium payment options.
Premium payment is required before enrollment is complete and to
maintain eligibility in MinnesotaCare.
(d) Nonpayment of the premium will result in disenrollment
from the plan within one calendar month after the due date.
Persons disenrolled for nonpayment or who voluntarily terminate
coverage from the program may not reenroll until four calendar
months have elapsed. Persons disenrolled for nonpayment who pay
all past due premiums as well as current premiums due, including
premiums due for the period of disenrollment, within 20 days of
disenrollment, shall be reenrolled retroactively to the first
day of disenrollment. Persons disenrolled for nonpayment or who
voluntarily terminate coverage from the program may not reenroll
for four calendar months unless the person demonstrates good
cause for nonpayment. Good cause does not exist if a person
chooses to pay other family expenses instead of the premium.
The commissioner shall define good cause in rule.
Sec. 98. Minnesota Statutes 1998, section 256L.07, is
amended to read:
256L.07 [ELIGIBILITY FOR SUBSIDIZED PREMIUMS BASED ON
SLIDING SCALE MINNESOTACARE.]
Subdivision 1. [GENERAL REQUIREMENTS.] (a) Children
enrolled in the original children's health plan as of September
30, 1992, children who enrolled in the MinnesotaCare program
after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross
incomes that are equal to or less than 150 percent of the
federal poverty guidelines are eligible for subsidized premium
payments without meeting the requirements of subdivision 2, as
long as they maintain continuous coverage in the MinnesotaCare
program or medical assistance. Children who apply for
MinnesotaCare on or after the implementation date of the
employer-subsidized health coverage program as described in Laws
1998, chapter 407, article 5, section 45, who have family gross
incomes that are equal to or less than 150 percent of the
federal poverty guidelines, must meet the requirements of
subdivision 2 to be eligible for MinnesotaCare.
(b) Families enrolled in MinnesotaCare under section
256L.04, subdivision 1, whose income increases above 275 percent
of the federal poverty guidelines, are no longer eligible for
the program and shall be disenrolled by the commissioner.
Individuals enrolled in MinnesotaCare under section 256L.04,
subdivision 7, whose income increases above 175 percent of the
federal poverty guidelines are no longer eligible for the
program and shall be disenrolled by the commissioner. For
persons disenrolled under this subdivision, MinnesotaCare
coverage terminates the last day of the calendar month following
the month in which the commissioner determines that the income
of a family or individual, determined over a four-month period
as required by section 256L.15, subdivision 2, exceeds program
income limits.
(c) Notwithstanding paragraph (b), individuals and families
may remain enrolled in MinnesotaCare if ten percent of their
annual income is less than the annual premium for a policy with
a $500 deductible available through the Minnesota comprehensive
health association. Individuals and families who are no longer
eligible for MinnesotaCare under this subdivision shall be given
an 18-month notice period from the date that ineligibility is
determined before disenrollment.
Subd. 2. [MUST NOT HAVE ACCESS TO EMPLOYER-SUBSIDIZED
COVERAGE.] (a) To be eligible for subsidized premium payments
based on a sliding scale, a family or individual must not have
access to subsidized health coverage through an employer and
must not have had access to employer-subsidized coverage through
a current employer for 18 months prior to application or
reapplication. A family or individual whose employer-subsidized
coverage is lost due to an employer terminating health care
coverage as an employee benefit during the previous 18 months is
not eligible.
(b) For purposes of this requirement, subsidized health
coverage means health coverage for which the employer pays at
least 50 percent of the cost of coverage for the employee or
dependent, or a higher percentage as specified by the
commissioner. Children are eligible for employer-subsidized
coverage through either parent, including the noncustodial
parent. The commissioner must treat employer contributions to
Internal Revenue Code Section 125 plans and any other employer
benefits intended to pay health care costs as qualified employer
subsidies toward the cost of health coverage for employees for
purposes of this subdivision.
Subd. 3. [OTHER HEALTH COVERAGE.] (a) Families and
individuals enrolled in the MinnesotaCare program must have no
health coverage while enrolled or for at least four months prior
to application and renewal. Children enrolled in the original
children's health plan and children in families with income
equal to or less than 150 percent of the federal poverty
guidelines, who have other health insurance, are eligible if the
other health coverage meets the requirements of Minnesota Rules,
part 9506.0020, subpart 3, item B. coverage:
(1) lacks two or more of the following:
(i) basic hospital insurance;
(ii) medical-surgical insurance;
(iii) prescription drug coverage;
(iv) dental coverage; or
(v) vision coverage;
(2) requires a deductible of $100 or more per person per
year; or
(3) lacks coverage because the child has exceeded the
maximum coverage for a particular diagnosis or the policy
excludes a particular diagnosis.
The commissioner may change this eligibility criterion for
sliding scale premiums in order to remain within the limits of
available appropriations. The requirement of no health coverage
does not apply to newborns.
(b) For purposes of this section, Medical assistance,
general assistance medical care, and civilian health and medical
program of the uniformed service, CHAMPUS, are not considered
insurance or health coverage for purposes of the four-month
requirement described in this subdivision.
(c) For purposes of this section subdivision, Medicare Part
A or B coverage under title XVIII of the Social Security Act,
United States Code, title 42, sections 1395c to 1395w-4, is
considered health coverage. An applicant or enrollee may not
refuse Medicare coverage to establish eligibility for
MinnesotaCare.
(d) Applicants who were recipients of medical assistance or
general assistance medical care within one month of application
must meet the provisions of this subdivision and subdivision 2.
Subd. 4. [FAMILIES WITH CHILDREN IN NEED OF CHEMICAL
DEPENDENCY TREATMENT.] Premiums for families with children when
a parent has been determined to be in need of chemical
dependency treatment pursuant to an assessment conducted by the
county under section 626.556, subdivision 10, or a case plan
under section 257.071 or 260.191, subdivision 1e, who are
eligible for MinnesotaCare under section 256L.04, subdivision 1,
may be paid by the county of residence of the person in need of
treatment for one year from the date the family is determined to
be eligible or if the family is currently enrolled in
MinnesotaCare from the date the person is determined to be in
need of chemical dependency treatment. Upon renewal, the family
is responsible for any premiums owed under section 256L.15. If
the family is not currently enrolled in MinnesotaCare, the local
county human services agency shall determine whether the family
appears to meet the eligibility requirements and shall assist
the family in applying for the MinnesotaCare program.
Sec. 99. Minnesota Statutes 1998, section 256L.15,
subdivision 1, is amended to read:
Subdivision 1. [PREMIUM DETERMINATION.] Families with
children and individuals shall pay a premium determined
according to a sliding fee based on the cost of coverage as a
percentage of the family's gross family income. Pregnant women
and children under age two are exempt from the provisions of
section 256L.06, subdivision 3, paragraph (b), clause (3),
requiring disenrollment for failure to pay premiums. For
pregnant women, this exemption continues until the first day of
the month following the 60th day postpartum. Women who remain
enrolled during pregnancy or the postpartum period, despite
nonpayment of premiums, shall be disenrolled on the first of the
month following the 60th day postpartum for the penalty period
that otherwise applies under section 256L.06, unless they begin
paying premiums.
Sec. 100. Minnesota Statutes 1998, section 256L.15,
subdivision 1b, is amended to read:
Subd. 1b. [PAYMENTS NONREFUNDABLE.] Only MinnesotaCare
premiums are not refundable paid for future months of coverage
for which a health plan capitation fee has not been paid may be
refunded.
Sec. 101. Minnesota Statutes 1998, section 256L.15,
subdivision 2, is amended to read:
Subd. 2. [SLIDING FEE SCALE TO DETERMINE PERCENTAGE OF
GROSS INDIVIDUAL OR FAMILY INCOME.] (a) The commissioner shall
establish a sliding fee scale to determine the percentage of
gross individual or family income that households at different
income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on
the enrollee's gross individual or family income during the
previous four months. The sliding fee scale must contain
separate tables based on enrollment of one, two, or three or
more persons. The sliding fee scale begins with a premium of
1.5 percent of gross individual or family income for individuals
or families with incomes below the limits for the medical
assistance program for families and children in effect on
January 1, 1999, and proceeds through the following evenly
spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 8.8
percent. These percentages are matched to evenly spaced income
steps ranging from the medical assistance income limit for
families and children in effect on January 1, 1999, to 275
percent of the federal poverty guidelines for the applicable
family size, up to a family size of five. The sliding fee scale
for a family of five must be used for families of more than
five. The sliding fee scale and percentages are not subject to
the provisions of chapter 14. If a family or individual reports
increased income after enrollment, premiums shall not be
adjusted until eligibility renewal.
(b) Enrolled individuals and families whose gross annual
income increases above 275 percent of the federal poverty
guideline shall pay the maximum premium. The maximum premium is
defined as a base charge for one, two, or three or more
enrollees so that if all MinnesotaCare cases paid the maximum
premium, the total revenue would equal the total cost of
MinnesotaCare medical coverage and administration. In this
calculation, administrative costs shall be assumed to equal ten
percent of the total. The costs of medical coverage for
pregnant women and children under age two and the enrollees in
these groups shall be excluded from the total. The maximum
premium for two enrollees shall be twice the maximum premium for
one, and the maximum premium for three or more enrollees shall
be three times the maximum premium for one.
Sec. 102. Minnesota Statutes 1998, section 626.556,
subdivision 10i, is amended to read:
Subd. 10i. [ADMINISTRATIVE RECONSIDERATION OF FINAL
DETERMINATION OF MALTREATMENT.] (a) An individual or facility
that the commissioner or a local social service agency
determines has maltreated a child, or the child's designee,
regardless of the determination, who contests the investigating
agency's final determination regarding maltreatment, may request
the investigating agency to reconsider its final determination
regarding maltreatment. The request for reconsideration must be
submitted in writing to the investigating agency within 15
calendar days after receipt of notice of the final determination
regarding maltreatment.
(b) If the investigating agency denies the request or fails
to act upon the request within 15 calendar days after receiving
the request for reconsideration, the person or facility entitled
to a fair hearing under section 256.045 may submit to the
commissioner of human services a written request for a hearing
under that section.
(c) If, as a result of the reconsideration, the
investigating agency changes the final determination of
maltreatment, that agency shall notify the parties specified in
subdivisions 10b, 10d, and 10f.
(d) If an individual or facility contests the investigating
agency's final determination regarding maltreatment by
requesting a fair hearing under section 256.045, the
commissioner of human services shall assure that the hearing is
conducted and a decision is reached within 90 days of receipt of
the request for a hearing. The time for action on the decision
may be extended for as many days as the hearing is postponed or
the record is held open for the benefit of either party.
Sec. 103. Laws 1995, chapter 178, article 2, section 46,
subdivision 10, is amended to read:
Subd. 10. [ADDITIONAL WAIVER REQUEST FOR EMPLOYED DISABLED
PERSONS.] The commissioner shall seek a federal waiver in order
to implement a work incentive for disabled persons eligible for
medical assistance who are not residents of long-term care
facilities when determining their eligibility for medical
assistance. The waiver shall request authorization to establish
a medical assistance earned income disregard for employed
disabled persons who, but for earned income, are eligible for
SSDI and who receive require personal care assistance under the
Medical Assistance Program. The disregard shall be equivalent
to the threshold amount applied to persons who qualify under
section 1619(b) of the Social Security Act, except that when a
disabled person's earned income reaches the maximum income
permitted at the threshold under section 1619(b), the person
shall retain medical assistance eligibility and must contribute
to the costs of medical care on a sliding fee basis.
Sec. 104. Laws 1997, chapter 225, article 4, section 4, is
amended to read:
Sec. 4. [SENIOR DRUG PROGRAM.]
The commissioner shall administer the senior drug program
so that the costs to the state total no more than $4,000,000
plus the amount of the rebate. The commissioner is authorized
to discontinue enrollment in order to meet this level of funding.
The commissioner shall report to the legislature the
estimated costs of the senior drug program without funding
caps. The report shall be included as part of the November and
February forecasts.
The commissioner of finance shall annually reimburse the
general fund with health care access funds for the estimated
increased costs in the QMB/SLMB program directly associated with
the senior drug program. This reimbursement shall sunset June
30, 2001.
Sec. 105. [CHARITY CARE DATA COLLECTION.]
The commissioner of health shall determine a definition for
charity care and bad debt that distinguishes these two terms for
inpatient and ambulatory care. The commissioner shall use these
definitions as a basis for collecting data on uncompensated care
in hospitals, surgical centers, and health care clinics located
in Minnesota.
Sec. 106. [MINNESOTACARE APPLICATION SIMPLIFICATION.]
The commissioner of human services shall develop a one page
preapplication form for the MinnesotaCare program and may
develop a pilot project that involves using this form in
community health clinics, community health offices, and
disproportionate share hospitals to determine the feasibility of
using a one page application form for MinnesotaCare. As part of
this pilot project, the commissioner shall track the number of
individuals determined to be eligible from the preapplication
form, the number determined to be eligible upon the completion
of the full application, and for families with children the cost
of providing the care to those found eligible.
Sec. 107. [EXPANSION OF SPECIAL EDUCATION SERVICES.]
The commissioner of human services shall examine
opportunities to expand the scope of providers eligible for
reimbursement for medical assistance services listed in a
child's individual education plan based on state and federal
requirements for provider qualifications. The commissioner
shall complete these activities, in consultation with the
commissioner of children, families, and learning, by December
1999 and seek necessary federal approval.
Sec. 108. [HOME-BASED MENTAL HEALTH SERVICES.]
By January 1, 2000, the commissioner of human services
shall amend Minnesota Rules under the expedited process of
Minnesota Statutes, section 14.389, to effect the following
changes:
(1) amend Minnesota Rules, part 9505.0324, subpart 2, to
permit a county board to contract with any agency qualified
under Minnesota Rules, part 9505.0324, subparts 4 and 5, as an
eligible provider of home-based mental health services;
(2) amend Minnesota Rules, part 9505.0324, subpart 2, to
permit children's mental health collaboratives approved by the
children's cabinet under Minnesota Statutes, section 245.493, to
provide or to contract with any agency qualified under Minnesota
Rules, part 9505.0324, subparts 4 and 5, as an eligible provider
of home-based mental health services.
Sec. 109. [MEDICARE SUPPLEMENTAL COVERAGE FOR LOW-INCOME
SENIORS.]
The commissioner of health, in consultation with the
commissioners of human services and commerce, shall study the
extent and type of Medicare supplemental coverage for low-income
seniors. The commissioner shall also study the qualified
Medicare beneficiaries eligible under Minnesota Statutes,
section 256B.057, subdivision 3, in terms of developing a
comprehensive set of services to supplement Medicare that these
individuals may need to ensure independence and control of their
lives. The commissioner shall make recommendations on the
cost-effectiveness of expanding the benefits offered to
qualified Medicare beneficiaries including the feasibility of
the state providing health care coverage options to low-income
seniors that would provide a comprehensive set of services and
would build on existing or new Medicare products. The
commissioner shall also study the fiscal impact of mandating
coverage for Medicare supplemental products to include long-term
care services, including home health services, homemaker
services, and nursing facilities services and the fiscal
implications of the state paying the premiums for this coverage
for low-income seniors, including potential savings to the
medical assistance program. The commissioner shall report to
the legislature on the findings of the study with any
recommendations by January 15, 2000.
Sec. 110. [PROGRAMS FOR SENIOR CITIZENS.]
The commissioner of human services shall study the
eligibility criteria of and benefits provided to persons age 65
and over through the array of cash assistance and health care
programs administered by the department, and the extent to which
these programs can be combined, simplified, or coordinated to
reduce administrative costs and improve access. The
commissioner shall also study potential barriers to enrollment
for low-income seniors who would otherwise deplete resources
necessary to maintain independent community living. At a
minimum, the study must include an evaluation of asset
requirements and enrollment sites. The commissioner shall
report study findings and recommendations to the legislature by
June 30, 2001.
Sec. 111. [AMENDING MEDICAL ASSISTANCE RULES.]
By January 1, 2001, the commissioner of human services
shall amend Minnesota Rules, parts 9505.0323; 9505.0324;
9505.0326; and 9505.0327, as necessary to implement the changes
outlined in Minnesota Statutes, section 256B.0625, subdivision
35.
Sec. 112. [REQUEST FOR WAIVER.]
By October 1, 1999, the commissioner of human services or
health shall request a waiver from the federal Department of
Health and Human Services to implement Minnesota Statutes,
256B.0951, subdivision 7.
Sec. 113. [DENTAL ACCESS STUDY.]
The commissioner of human services, in consultation with
the commissioner of health, dental care providers,
representatives of community clinics, client advocacy groups,
and counties, shall review the dental access problem, evaluate
the effects of the dental access initiatives adopted by the 1999
legislature, and make recommendations on other actions that
could improve dental access for public program recipients. The
commissioner shall present a progress report to the legislature
by January 15, 2000, and shall present a final report to the
legislature by January 15, 2001.
Sec. 114. [REPORT ON RATE SETTING AND RISK ADJUSTMENT.]
The commissioner of human services shall report to the
legislature, by January 15, 2000, on the current rate setting
process for state prepaid health care programs, rate setting and
risk adjustment methods in other states, and the results of the
application of risk adjustment on a trial basis in Minnesota for
calendar year 1999. The report must also present an analysis of
the feasibility of requiring prepaid health plans to report
vendor costs rather than charges, an analysis of capitation rate
equalization for MinnesotaCare and the prepaid medical
assistance program, an analysis of the fiscal impact on state
and county government of repealing Minnesota Statutes 1998,
section 256B.69, subdivision 5d, and recommendations for
providing actuarial and market analyses related to setting
prepaid health plan rates to the legislature on a timely basis
that would allow this information to be used in the
appropriations process.
Sec. 115. [REPORT ON PREPAID MEDICAL ASSISTANCE PROGRAM.]
The commissioner of human services shall present
recommendations to the legislature, by December 15, 1999, on
methods for implementing county board authority under the
prepaid medical assistance program.
Sec. 116. [PHYSICIAN AND PROFESSIONAL SERVICES PAYMENT
METHODOLOGY CONVERSION.]
The commissioner of human services shall submit a proposal
to the legislature by January 15, 2000, detailing the medical
assistance physician and professional services payment
methodology conversion to resource based relative value scale.
Sec. 117. [RECOMMENDATIONS FOR DEFINITION OF SPECIALIZED
MAINTENANCE THERAPY.]
The commissioner of human services shall develop
recommendations for definitions of specialized maintenance
therapy for each type of covered therapy, in consultation with
representatives of professional therapy associations, providers
who work with patients who need long-term specialized
maintenance therapy, and patient advocates. The commissioner
shall provide the recommended definitions to the chairs of the
house health and human services finance committee and the senate
health and family security budget division, by November 15, 1999.
Sec. 118. [DENTAL HYGIENIST DEMONSTRATION PROJECT.]
(a) The commissioner of human services may develop
demonstration projects utilizing dental hygienists outside a
traditional dental office to provide dental hygiene services to
limited access patients. Notwithstanding Minnesota Statutes,
section 150A.10, subdivision 1, a licensed dental hygienist may
provide screening services, education, prophylaxis, and
application of topical fluorides under general supervision as
defined in Minnesota Rules, part 3100.0100, subpart 21, without
the patient being first examined by a licensed dentist.
Services under this section must be authorized by a licensed
dentist and must be performed by a licensed dental hygienist and
may be performed at a location other than the usual place of
practice of the dentist or dental hygienist. For purposes of
this section, "limited access patient" means a patient who the
commissioner determines is unable to receive regular dental
services in a dental office due to age, disability, or
geographic location.
(b) The commissioner shall report to the legislature by
January 15, 2001, on whether this demonstration project has been
effective in improving access to dental services for limited
access patients.
Sec. 119. [REPORTS ON ALTERNATIVE RESOURCE ALLOCATION
METHODS AND PARENTS OF MINORS.]
(a) The commissioner of human services shall consider and
evaluate administrative methods other than the current resource
allocation system for the home and community-based waiver for
persons with mental retardation and related conditions. In
developing the alternatives, the commissioner shall consult with
county commissioners from large and small counties, county
agencies, consumers, advocates, and providers. The commissioner
shall report to the chairs of the senate health and family
security budget division and house health and human services
finance committee by January 15, 2000.
(b) By January 15, 2000, the commissioner of human services
shall present recommendations to the legislature on the
conditions under which parents of minors may be reimbursed for
services, consistent with federal requirements, health and
safety, the child's needs, and not supplanting typical parental
responsibilities.
Sec. 120. [REPEALER.]
Minnesota Statutes 1998, sections 256B.74, subdivisions 2
and 5; and 462A.208, are repealed.
Sec. 121. [EFFECTIVE DATE.]
(a) Sections 3, 5, 45, and 97 are effective July 1, 2000.
(b) Section 56 is effective upon federal approval.
ARTICLE 5
STATE-OPERATED SERVICES;
CHEMICAL DEPENDENCY; MENTAL HEALTH; LAND CONVEYANCES
Section 1. Minnesota Statutes 1998, section 16C.10,
subdivision 5, is amended to read:
Subd. 5. [SPECIFIC PURCHASES.] The solicitation process
described in this chapter is not required for acquisition of the
following:
(1) merchandise for resale purchased under policies
determined by the commissioner;
(2) farm and garden products which, as determined by the
commissioner, may be purchased at the prevailing market price on
the date of sale;
(3) goods and services from the Minnesota correctional
facilities;
(4) goods and services from rehabilitation facilities and
sheltered workshops that are certified by the commissioner of
economic security;
(5) goods and services for use by a community-based
residential facility operated by the commissioner of human
services;
(6) goods purchased at auction or when submitting a sealed
bid at auction provided that before authorizing such an action,
the commissioner consult with the requesting agency to determine
a fair and reasonable value for the goods considering factors
including, but not limited to, costs associated with submitting
a bid, travel, transportation, and storage. This fair and
reasonable value must represent the limit of the state's bid;
and
(7) utility services where no competition exists or where
rates are fixed by law or ordinance.
Sec. 2. Minnesota Statutes 1998, section 245.462,
subdivision 4, is amended to read:
Subd. 4. [CASE MANAGER MANAGEMENT SERVICE PROVIDER.] (a)
"Case manager management service provider" means an individual a
case manager or case manager associate 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 including, but not limited
to, social work, psychology, or nursing from an accredited
college or university and. A case manager must 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.
(b) Supervision for a case manager during the first year of
service providing case management services shall be one hour per
week of clinical supervision from a case management supervisor.
After the first year, the case manager shall receive regular
ongoing supervision totaling 38 hours per year, of which at
least one hour per month must be clinical supervision regarding
individual service delivery with a case management supervisor.
The remainder may be provided by a case manager with two years
of experience. Group supervision may not constitute more than
one-half of the required supervision hours. Clinical
supervision must be documented in the client record.
(c) A case manager with a bachelor's degree who is not
licensed, registered, or certified by a health-related licensing
board must receive 30 hours of continuing education and training
in mental illness and mental health services annually.
(d) A case manager with a bachelor's degree but without
2,000 hours of supervised experience described in paragraph (a),
must complete 40 hours of training approved by the commissioner
covering case management skills and the characteristics and
needs of adults with serious and persistent mental illness.
(e) Case managers without a bachelor's degree must meet one
of the requirements in clauses (1) to (3):
(1) have three or four years of experience as a case
manager associate;
(2) be a registered nurse without a bachelor's degree and
have a combination of specialized training in psychiatry and
work experience consisting of community interaction and
involvement or community discharge planning in a mental health
setting totaling three years; or
(3) be a person who qualified as a case manager under the
1998 department of human service federal waiver provision and
meet the continuing education and mentoring requirements in this
section.
(f) A case manager associate (CMA) must work under the
direction of a case manager or case management supervisor and
must be at least 21 years of age. A case manager associate must
also have a high school diploma or its equivalent and meet one
of the following criteria:
(1) have an associate of arts degree in one of the
behavioral sciences or human services;
(2) be a registered nurse without a bachelor's degree;
(3) within the previous ten years, have three years of life
experience with serious and persistent mental illness as defined
in section 245.462, subdivision 20; or as a child had severe
emotional disturbance as defined in section 245.4871,
subdivision 6; or have three years life experience as a primary
caregiver to an adult with serious and persistent mental illness
within the previous ten years;
(4) have 6,000 hours work experience as a nondegreed state
hospital technician; or
(5) be a mental health practitioner as defined in section
245.462, subdivision 17, clause (2).
Individuals meeting one of the criteria in clauses (1) to
(4) may qualify as a case manager after four years of supervised
work experience as a case manager associate. Individuals
meeting the criteria in clause (5) may qualify as a case manager
after three years of supervised experience as a case manager
associate.
Case management associates must have 40 hours preservice
training under paragraph (d) and receive at least 40 hours of
continuing education in mental illness and mental health
services annually. Case manager associates shall receive at
least five hours of mentoring per week from a case management
mentor. A "case management mentor" means a qualified,
practicing case manager or case management supervisor who
teaches or advises and provides intensive training and clinical
supervision to one or more case manager associates. Mentoring
may occur while providing direct services to consumers in the
office or in the field and may be provided to individuals or
groups of case manager associates. At least two mentoring hours
per week must be individual and face-to-face.
(g) A case management supervisor must meet the criteria for
mental health professionals, as specified in section 245.462,
subdivision 18.
(h) Until June 30, 1999, An immigrant who does not have the
qualifications specified in this subdivision may provide case
management services to adult immigrants with serious and
persistent mental illness who are members of the same ethnic
group as the case manager if the person: (1) is currently
enrolled in and is actively pursuing credits toward the
completion of a bachelor's degree in one of the behavioral
sciences or a related field including, but not limited to,
social work, psychology, or nursing 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 this subdivision are
met.
(b) The commissioner may approve waivers submitted by
counties to allow case managers without a bachelor's degree but
with 6,000 hours of supervised experience in the delivery of
services to adults with mental illness if the person:
(1) meets the qualifications for a mental health
practitioner in subdivision 26;
(2) has completed 40 hours of training approved by the
commissioner in case management skills and in the
characteristics and needs of adults with serious and persistent
mental illness; and
(3) demonstrates that the 6,000 hours of supervised
experience are in identifying functional needs of persons with
mental illness, coordinating assessment information and making
referrals to appropriate service providers, coordinating a
variety of services to support and treat persons with mental
illness, and monitoring to ensure appropriate provision of
services. The county board is responsible to verify that all
qualifications, including content of supervised experience, have
been met.
Sec. 3. Minnesota Statutes 1998, section 245.462,
subdivision 17, is amended to read:
Subd. 17. [MENTAL HEALTH PRACTITIONER.] "Mental health
practitioner" means a person providing services to persons with
mental illness who is qualified in at least one of the following
ways:
(1) holds a bachelor's degree in one of the behavioral
sciences or related fields from an accredited college or
university and:
(i) has at least 2,000 hours of supervised experience in
the delivery of services to persons with mental illness; or
(ii) is fluent in the non-English language of the ethnic
group to which at least 50 percent of the practitioner's clients
belong, completes 40 hours of training in the delivery of
services to persons with mental illness, and receives clinical
supervision from a mental health professional at least once a
week until the requirement of 2,000 hours of supervised
experience is met;
(2) has at least 6,000 hours of supervised experience in
the delivery of services to persons with mental illness;
(3) is a graduate student in one of the behavioral sciences
or related fields and is formally assigned by an accredited
college or university to an agency or facility for clinical
training; or
(4) holds a master's or other graduate degree in one of the
behavioral sciences or related fields from an accredited college
or university and has less than 4,000 hours post-master's
experience in the treatment of mental illness.
Sec. 4. Minnesota Statutes 1998, section 245.4711,
subdivision 1, is amended to read:
Subdivision 1. [AVAILABILITY OF CASE MANAGEMENT SERVICES.]
(a) By January 1, 1989, the county board shall provide case
management services for all adults with serious and persistent
mental illness who are residents of the county and who request
or consent to the services and to each adult for whom the court
appoints a case manager. Staffing ratios must be sufficient to
serve the needs of the clients. The case manager must meet the
requirements in section 245.462, subdivision 4.
(b) Case management services provided to adults with
serious and persistent mental illness eligible for medical
assistance must be billed to the medical assistance program
under sections 256B.02, subdivision 8, and 256B.0625.
(c) Case management services are eligible for reimbursement
under the medical assistance program. Costs associated with
mentoring, supervision, and continuing education may be included
in the reimbursement rate methodology used for case management
services under the medical assistance program.
Sec. 5. Minnesota Statutes 1998, section 245.4712,
subdivision 2, is amended to read:
Subd. 2. [DAY TREATMENT SERVICES PROVIDED.] (a) Day
treatment services must be developed as a part of the community
support services available to adults with serious and persistent
mental illness residing in the county. Adults may be required
to pay a fee according to section 245.481. Day treatment
services must be designed to:
(1) provide a structured environment for treatment;
(2) provide support for residing in the community;
(3) prevent placement in settings that are more intensive,
costly, or restrictive than necessary and appropriate to meet
client need;
(4) coordinate with or be offered in conjunction with a
local education agency's special education program; and
(5) operate on a continuous basis throughout the year.
(b) For purposes of complying with medical assistance
requirements, an adult day treatment program may choose among
the methods of clinical supervision specified in:
(1) Minnesota Rules, part 9505.0323, subpart 1, item F;
(2) Minnesota Rules, part 9505.0324, subpart 6, item F; or
(3) Minnesota Rules, part 9520.0800, subparts 2 to 6.
A day treatment program may demonstrate compliance with
these clinical supervision requirements by obtaining
certification from the commissioner under Minnesota Rules, parts
9520.0750 to 9520.0870, or by documenting in its own records
that it complies with one of the above methods.
(c) County boards may request a waiver from including day
treatment services if they can document that:
(1) an alternative plan of care exists through the county's
community support services for clients who would otherwise need
day treatment services;
(2) day treatment, if included, would be duplicative of
other components of the community support services; and
(3) county demographics and geography make the provision of
day treatment services cost ineffective and infeasible.
Sec. 6. Minnesota Statutes 1998, section 245.4871,
subdivision 4, is amended to read:
Subd. 4. [CASE MANAGER MANAGEMENT SERVICE PROVIDER.] (a)
"Case manager management service provider" means an individual a
case manager or case manager associate 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 including, but not
limited to, social work, psychology, or nursing 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 shall receive regular ongoing supervision totaling
38 hours per year, of which at least one hour per month must be
clinical supervision regarding individual service delivery with
a case management supervisor. The remainder may be provided by
a case manager with two years of experience. Group supervision
may not constitute more than one-half of the required
supervision hours.
(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
one hour 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) Case managers who have a bachelor's degree but are not
licensed, registered, or certified by a health-related licensing
board must receive 30 hours of continuing education and training
in severe emotional disturbance and mental health services
annually.
(i) Case managers without a bachelor's degree must meet one
of the requirements in clauses (1) to (3):
(1) have three or four years of experience as a case
manager associate;
(2) be a registered nurse without a bachelor's degree who
has a combination of specialized training in psychiatry and work
experience consisting of community interaction and involvement
or community discharge planning in a mental health setting
totaling three years; or
(3) be a person who qualified as a case manager under the
1998 department of human service federal waiver provision and
meets the continuing education and mentoring requirements in
this section.
(j) A case manager associate (CMA) must work under the
direction of a case manager or case management supervisor and
must be at least 21 years of age. A case manager associate must
also have a high school diploma or its equivalent and meet one
of the following criteria:
(1) have an associate of arts degree in one of the
behavioral sciences or human services;
(2) be a registered nurse without a bachelor's degree;
(3) have three years of life experience as a primary
caregiver to a child with serious emotional disturbance as
defined in section 245.4871, subdivision 6, within the previous
ten years;
(4) have 6,000 hours work experience as a nondegreed state
hospital technician; or
(5) be a mental health practitioner as defined in section
245.462, subdivision 17, clause (2).
Individuals meeting one of the criteria in clauses (1) to
(4) may qualify as a case manager after four years of supervised
work experience as a case manager associate. Individuals
meeting the criteria in clause (5) may qualify as a case manager
after three years of supervised experience as a case manager
associate.
Case manager associates must have 40 hours of preservice
training under paragraph (e), clause (1), and receive at least
40 hours of continuing education in severe emotional disturbance
and mental health service annually. Case manager associates
shall receive at least five hours of mentoring per week from a
case management mentor. A "case management mentor" means a
qualified, practicing case manager or case management supervisor
who teaches or advises and provides intensive training and
clinical supervision to one or more case manager associates.
Mentoring may occur while providing direct services to consumers
in the office or in the field and may be provided to individuals
or groups of case manager associates. At least two mentoring
hours per week must be individual and face-to-face.
(k) A case management supervisor must meet the criteria for
a mental health professional as specified in section 245.4871,
subdivision 27.
(l) Until June 30, 1999, An immigrant who does not have the
qualifications specified in this subdivision may provide case
management services to child immigrants with severe emotional
disturbance of the same ethnic group as the immigrant if the
person:
(1) is currently enrolled in and 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.
(i) The commissioner may approve waivers submitted by
counties to allow case managers without a bachelor's degree but
with 6,000 hours of supervised experience in the delivery of
services to children with severe emotional disturbance if the
person:
(1) meets the qualifications for a mental health
practitioner in subdivision 26;
(2) has completed 40 hours of training approved by the
commissioner in case management skills and in the
characteristics and needs of children with severe emotional
disturbance; and
(3) demonstrates that the 6,000 hours of supervised
experience are in identifying functional needs of children with
severe emotional disturbance, coordinating assessment
information and making referrals to appropriate service
providers, coordinating a variety of services to support and
treat children with severe emotional disturbance, and monitoring
to ensure appropriate provision of services. The county board
is responsible to verify that all qualifications, including
content of supervised experience, have been met.
Sec. 7. Minnesota Statutes 1998, section 245.4871,
subdivision 26, is amended to read:
Subd. 26. [MENTAL HEALTH PRACTITIONER.] "Mental health
practitioner" means a person providing services to children with
emotional disturbances. A mental health practitioner must have
training and experience in working with children. A mental
health practitioner must be qualified in at least one of the
following ways:
(1) holds a bachelor's degree in one of the behavioral
sciences or related fields from an accredited college or
university and:
(i) has at least 2,000 hours of supervised experience in
the delivery of mental health services to children with
emotional disturbances; or
(ii) is fluent in the non-English language of the ethnic
group to which at least 50 percent of the practitioner's clients
belong, completes 40 hours of training in the delivery of
services to children with emotional disturbances, and receives
clinical supervision from a mental health professional at least
once a week until the requirement of 2,000 hours of supervised
experience is met;
(2) has at least 6,000 hours of supervised experience in
the delivery of mental health services to children with
emotional disturbances;
(3) is a graduate student in one of the behavioral sciences
or related fields and is formally assigned by an accredited
college or university to an agency or facility for clinical
training; or
(4) holds a master's or other graduate degree in one of the
behavioral sciences or related fields from an accredited college
or university and has less than 4,000 hours post-master's
experience in the treatment of emotional disturbance.
Sec. 8. Minnesota Statutes 1998, section 245.4881,
subdivision 1, is amended to read:
Subdivision 1. [AVAILABILITY OF CASE MANAGEMENT SERVICES.]
(a) By April 1, 1992, the county board shall provide case
management services for each child with severe emotional
disturbance who is a resident of the county and the child's
family who request or consent to the services. Staffing ratios
must be sufficient to serve the needs of the clients. The case
manager must meet the requirements in section 245.4871,
subdivision 4.
(b) Except as permitted by law and the commissioner under
demonstration projects, case management services provided to
children with severe emotional disturbance eligible for medical
assistance must be billed to the medical assistance program
under sections 256B.02, subdivision 8, and 256B.0625.
(c) Case management services are eligible for reimbursement
under the medical assistance program. Costs of mentoring,
supervision, and continuing education may be included in the
reimbursement rate methodology used for case management services
under the the medical assistance program.
Sec. 9. [246.0136] [PLANNING FOR TRANSITION OF REGIONAL
TREATMENT CENTERS AND OTHER STATE-OPERATED SERVICES TO
ENTERPRISE ACTIVITIES.]
Subdivision 1. [PLANNING FOR ENTERPRISE ACTIVITIES.] The
commissioner of human services is directed to study and make
recommendations to the legislature on establishing enterprise
activities within state-operated services. Before implementing
an enterprise activity, the commissioner must obtain statutory
authorization for its implementation, except that the
commissioner has authority to implement enterprise activities
for adolescent services and to establish a public group practice
without statutory authorization. Enterprise activities are
defined as the range of services, which are delivered by state
employees, needed by people with disabilities and are fully
funded by public or private third-party health insurance or
other revenue sources available to clients that provide
reimbursement for the services provided. Enterprise activities
within state-operated services shall specialize in caring for
vulnerable people for whom no other providers are available or
for whom state-operated services may be the provider selected by
the payer. In subsequent biennia after an enterprise activity
is established within a state-operated service, the base state
appropriation for that state-operated service shall be reduced
proportionate to the size of the enterprise activity.
Subd. 2. [REQUIRED COMPONENTS OF ANY PROPOSAL;
CONSIDERATIONS.] In any proposal for an enterprise activity
brought to the legislature by the commissioner, the commissioner
must demonstrate that there is public or private third-party
health insurance or other revenue available to the people
served, that the anticipated revenues to be collected will fully
fund the services, that there will be sufficient funds for cash
flow purposes, and that access to services by vulnerable
populations served by state-operated services will not be
limited by implementation of an enterprise activity. In
studying the feasibility of establishing an enterprise activity,
the commissioner must consider:
(1) creating public or private partnerships to facilitate
client access to needed services;
(2) administrative simplification and efficiencies
throughout the state-operated services system;
(3) converting or disposing of buildings not utilized and
surplus lands; and
(4) exploring the efficiencies and benefits of establishing
state-operated services as an independent state agency.
Sec. 10. Minnesota Statutes 1998, section 246.18,
subdivision 6, is amended to read:
Subd. 6. [COLLECTIONS DEDICATED.] Except for
state-operated programs and services funded through a direct
appropriation from the legislature, money received within the
regional treatment center system for the following
state-operated services is dedicated to the commissioner for the
provision of those services:
(1) community-based residential and day training and
habilitation services for mentally retarded persons;
(2) community health clinic services;
(3) accredited hospital outpatient department services;
(4) certified rehabilitation agency and rehabilitation
hospital services; or
(5) community-based transitional support services for
adults with serious and persistent mental illness. Except for
state-operated programs funded through a direct appropriation
from the legislature, any state-operated program or service
established and operated as an enterprise activity, shall retain
the revenues earned in an interest-bearing account.
When the commissioner determines the intent to transition
from a direct appropriation to enterprise activity for which the
commissioner has authority, all collections for the targeted
state-operated service shall be retained and deposited into an
interest-bearing account. At the end of the fiscal year, prior
to establishing the enterprise activity, collections up to the
amount of the appropriation for the targeted service shall be
deposited to the general fund. All funds in excess of the
amount of the appropriation will be retained and used by the
enterprise activity for cash flow purposes.
These funds must be deposited in the state treasury in a
revolving account and funds in the revolving account are
appropriated to the commissioner to operate the services
authorized, and any unexpended balances do not cancel but are
available until spent.
Sec. 11. Minnesota Statutes 1998, section 252.46,
subdivision 6, is amended to read:
Subd. 6. [VARIANCES.] (a) A variance from the minimum or
maximum payment rates in subdivisions 2 and 3 may be granted by
the commissioner when the vendor requests and the county board
submits to the commissioner a written variance request on forms
supplied by the commissioner with the recommended payment rates.
(b) A variance to the rate maximum may be utilized for
costs associated with compliance with state administrative
rules, compliance with court orders, capital costs required for
continued licensure, increased insurance costs, start-up and
conversion costs for supported employment, direct service staff
salaries and benefits, transportation, and other program related
costs when any one of the criteria criterion in clauses (1) to
(4) is also met:
(1) change is necessary to comply with licensing citations;
(2) a licensed vendor currently serving fewer than 70
persons with payment rates of 80 percent or less of the
statewide average rates and with clients meeting the behavioral
or medical criteria under clause (3) approved by the
commissioner as a significant program change under section
252.28;
(3) (1) A determination of need under section 252.28 is
approved for a significant program change is approved by the
commissioner under section 252.28 that is necessary for a vendor
to provide authorized services to a new client or clients with
very severe self-injurious or assaultive behavior, or medical
conditions requiring delivery of physician-prescribed medical
interventions requiring one-to-one staffing for at least 15
minutes each time they are performed, or to a new client or
clients directly discharged to the vendor's program from a
regional treatment center; or
(4) there is a need to maintain required staffing levels in
order to provide authorized services approved by the
commissioner under section 252.28, that is necessitated by a
significant and permanent decrease in licensed capacity or
clientele.
The county shall review the adequacy of services provided
by vendors whose payment rates are 80 percent or more of the
statewide average rates and 50 percent or more of the vendor's
clients meet the behavioral or medical criteria in clause (3).
A variance under this paragraph may be approved only if the
costs to the medical assistance program do not exceed the
medical assistance costs for all clients served by the
alternatives and all clients remaining in the existing services.
one or more clients who meet one or more of the following
criteria:
(a) the client is a new client and:
(i) exhibits severe behavior as indicated on the screening
document;
(ii) periodically requires one-to-one staff time for at
least 15 minutes at a time to deliver physician prescribed
medical interventions; or
(iii) has been discharged directly to the vendor's program
from a regional treatment center or the Minnesota extended
treatment option.
(b) the client is an existing client who has developed one
of the following changed circumstances which increases costs
that are not covered by the vendor's current rate, and for whom
a significant program change is necessary to ensure the
continued provision of authorized services to that client:
(i) severe behavior as indicated on the screening document;
(ii) a medical condition periodically requiring one-to-one
staff time for at least 15 minutes at a time to deliver
physician prescribed medical interventions; or
(iii) a permanent decrease in skill functioning, as
verified by medical reports or assessments;
(2) A licensing determination requires a program change
that the vendor cannot comply with due to funding restraints;
(3) A determination of need under section 252.28 is
approved for a significant and permanent decrease in licensed
capacity and the vendor demonstrates the need to retain certain
staffing levels to serve the remaining clients; or
(4) In cases where conditions in clauses (1) to (3) do not
apply, but a determination of need under section 252.28 is
approved for an unusual circumstance which exists that
significantly impacts the type or amount of services delivered,
as evidenced by documentation presented by the vendor and with
the concurrence of the commissioner.
(b) (c) A variance to the rate minimum may be granted when:
(1) the county board contracts for increased services from
a vendor and for some or all individuals receiving services from
the vendor lower per unit fixed costs result; or
(2) when the actual costs of delivering authorized service
over a 12-month contract period have decreased.
(c) (d) The written variance request under this subdivision
must include documentation that all the following criteria have
been met:
(1) The commissioner and the county board have both
conducted a review and have identified a need for a change in
the payment rates and recommended an effective date for the
change in the rate.
(2) The vendor documents efforts to reallocate current
staff and any additional staffing needs cannot be met by using
temporary special needs rate exceptions under Minnesota Rules,
parts 9510.1020 to 9510.1140.
(3) The vendor documents that financial resources have been
reallocated before applying for a variance. No variance may be
granted for equipment, supplies, or other capital expenditures
when depreciation expense for repair and replacement of such
items is part of the current rate.
(4) For variances related to loss of clientele, the vendor
documents the other program and administrative expenses, if any,
that have been reduced.
(5) The county board submits verification of the conditions
for which the variance is requested, a description of the nature
and cost of the proposed changes, and how the county will
monitor the use of money by the vendor to make necessary changes
in services.
(6) The county board's recommended payment rates do not
exceed 95 percent of the greater of 125 percent of the current
statewide median or 125 percent of the regional average payment
rates, whichever is higher, for each of the regional commission
districts under sections 462.381 to 462.396 in which the vendor
is located except for the following: when a variance is
recommended to allow authorized service delivery to new clients
with severe self-injurious or assaultive behaviors or with
medical conditions requiring delivery of physician prescribed
medical interventions, or to persons being directly discharged
from a regional treatment center or Minnesota extended treatment
options to the vendor's program, those persons must be assigned
a payment rate of 200 percent of the current statewide average
rates. All other clients receiving services from the vendor
must be assigned a payment rate equal to the vendor's current
rate unless the vendor's current rate exceeds 95 percent of 125
percent of the statewide median or 125 percent of the regional
average payment rates, whichever is higher. When the vendor's
rates exceed 95 percent of 125 percent of the statewide median
or 125 percent of the regional average rates, the maximum rates
assigned to all other clients must be equal to the greater of 95
percent of 125 percent of the statewide median or 125 percent of
the regional average rates. The maximum payment rate that may
be recommended for the vendor under these conditions is
determined by multiplying the number of clients at each limit by
the rate corresponding to that limit and then dividing the sum
by the total number of clients.
(d) (e) The commissioner shall have 60 calendar days from
the date of the receipt of the complete request to accept or
reject it, or the request shall be deemed to have been granted.
If the commissioner rejects the request, the commissioner shall
state in writing the specific objections to the request and the
reasons for its rejection.
Sec. 12. Minnesota Statutes 1998, section 253B.045, is
amended by adding a subdivision to read:
Subd. 5. [HEALTH PLAN COMPANY; DEFINITION.] For purposes
of this section, "health plan company" has the meaning given it
in section 62Q.01, subdivision 4, and also includes a
demonstration provider as defined in section 256B.69,
subdivision 2, paragraph (b), a county or group of counties
participating in county-based purchasing according to section
256B.692, and a children's mental health collaborative under
contract to provide medical assistance for individuals enrolled
in the prepaid medical assistance and MinnesotaCare programs
according to sections 245.493 to 245.496.
Sec. 13. Minnesota Statutes 1998, section 253B.045, is
amended by adding a subdivision to read:
Subd. 6. [COVERAGE.] A health plan company must provide
coverage, according to the terms of the policy, contract, or
certificate of coverage, for all medically necessary covered
services as determined by section 62Q.53 provided to an enrollee
that are ordered by the court under this chapter.
Sec. 14. Minnesota Statutes 1998, section 253B.07,
subdivision 1, is amended to read:
Subdivision 1. [PREPETITION SCREENING.] (a) Prior to
filing a petition for commitment of or early intervention for a
proposed patient, an interested person shall apply to the
designated agency in the county of the proposed patient's
residence or presence for conduct of a preliminary
investigation, except when the proposed patient has been
acquitted of a crime under section 611.026 and the county
attorney is required to file a petition for commitment. The
designated agency shall appoint a screening team to conduct an
investigation which shall include:
(i) a personal interview with the proposed patient and
other individuals who appear to have knowledge of the condition
of the proposed patient. If the proposed patient is not
interviewed, reasons must be documented;
(ii) identification and investigation of specific alleged
conduct which is the basis for application;
(iii) identification, exploration, and listing of the
reasons for rejecting or recommending alternatives to
involuntary placement; and
(iv) in the case of a commitment based on mental illness,
the following information, if it is known or available:
information that may be relevant to the administration of
neuroleptic medications, if necessary, including the existence
of a declaration under section 253B.03, subdivision 6d, or a
health care directive under chapter 145C or a guardian,
conservator, proxy, or agent with authority to make health care
decisions for the proposed patient; information regarding the
capacity of the proposed patient to make decisions regarding
administration of neuroleptic medication; and whether the
proposed patient is likely to consent or refuse consent to
administration of the medication; and
(v) seeking input from the proposed patient's health plan
company to provide the court with information about services the
enrollee needs and the least restrictive alternatives.
(b) In conducting the investigation required by this
subdivision, the screening team shall have access to all
relevant medical records of proposed patients currently in
treatment facilities. Data collected pursuant to this clause
shall be considered private data on individuals. The
prepetition screening report is not admissible in any court
proceedings unrelated to the commitment proceedings.
(c) When the prepetition screening team recommends
commitment, a written report shall be sent to the county
attorney for the county in which the petition is to be filed.
(d) The prepetition screening team shall refuse to support
a petition if the investigation does not disclose evidence
sufficient to support commitment. Notice of the prepetition
screening team's decision shall be provided to the prospective
petitioner.
(e) If the interested person wishes to proceed with a
petition contrary to the recommendation of the prepetition
screening team, application may be made directly to the county
attorney, who may determine whether or not to proceed with the
petition. Notice of the county attorney's determination shall
be provided to the interested party.
(f) If the proposed patient has been acquitted of a crime
under section 611.026, the county attorney shall apply to the
designated county agency in the county in which the acquittal
took place for a preliminary investigation unless substantially
the same information relevant to the proposed patient's current
mental condition, as could be obtained by a preliminary
investigation, is part of the court record in the criminal
proceeding or is contained in the report of a mental examination
conducted in connection with the criminal proceeding. If a
court petitions for commitment pursuant to the rules of criminal
or juvenile procedure or a county attorney petitions pursuant to
acquittal of a criminal charge under section 611.026, the
prepetition investigation, if required by this section, shall be
completed within seven days after the filing of the petition.
Sec. 15. Minnesota Statutes 1998, section 253B.185, is
amended by adding a subdivision to read:
Subd. 6. [AFTERCARE AND CASE MANAGEMENT.] The state, in
collaboration with the designated agency, is responsible for
arranging and funding the aftercare and case management services
for persons under commitment as sexual psychopathic
personalities and sexually dangerous persons discharged after
July 1, 1999.
Sec. 16. Minnesota Statutes 1998, section 254B.01, is
amended by adding a subdivision to read:
Subd. 7. [ROOM AND BOARD RATE.] "Room and board rate"
means a rate set for shelter, fuel, food, utilities, household
supplies, and other costs necessary to provide room and board
for a person in need of chemical dependency services.
Sec. 17. Minnesota Statutes 1998, section 254B.03,
subdivision 2, is amended to read:
Subd. 2. [CHEMICAL DEPENDENCY SERVICES FUND PAYMENT.] (a)
Payment from the chemical dependency fund is limited to payments
for services other than detoxification that, if located outside
of federally recognized tribal lands, would be required to be
licensed by the commissioner as a chemical dependency treatment
or rehabilitation program under sections 245A.01 to 245A.16, and
services other than detoxification provided in another state
that would be required to be licensed as a chemical dependency
program if the program were in the state. Out of state vendors
must also provide the commissioner with assurances that the
program complies substantially with state licensing requirements
and possesses all licenses and certifications required by the
host state to provide chemical dependency treatment. Hospitals
may apply for and receive licenses to be eligible vendors,
notwithstanding the provisions of section 245A.03. Except for
chemical dependency transitional rehabilitation programs,
vendors receiving payments from the chemical dependency fund
must not require copayment from a recipient of benefits for
services provided under this subdivision. Payment from the
chemical dependency fund shall be made for necessary room and
board costs provided by vendors certified according to section
254B.05, or in a community hospital licensed by the commissioner
of health according to sections 144.50 to 144.56 to a client who
is:
(1) determined to meet the criteria for placement in a
residential chemical dependency treatment program according to
rules adopted under section 254A.03, subdivision 3; and
(2) concurrently receiving a chemical dependency treatment
service in a program licensed by the commissioner and reimbursed
by the chemical dependency fund.
(b) A county may, from its own resources, provide chemical
dependency services for which state payments are not made. A
county may elect to use the same invoice procedures and obtain
the same state payment services as are used for chemical
dependency services for which state payments are made under this
section if county payments are made to the state in advance of
state payments to vendors. When a county uses the state system
for payment, the commissioner shall make monthly billings to the
county using the most recent available information to determine
the anticipated services for which payments will be made in the
coming month. Adjustment of any overestimate or underestimate
based on actual expenditures shall be made by the state agency
by adjusting the estimate for any succeeding month.
(c) The commissioner shall coordinate chemical dependency
services and determine whether there is a need for any proposed
expansion of chemical dependency treatment services. The
commissioner shall deny vendor certification to any provider
that has not received prior approval from the commissioner for
the creation of new programs or the expansion of existing
program capacity. The commissioner shall consider the
provider's capacity to obtain clients from outside the state
based on plans, agreements, and previous utilization history,
when determining the need for new treatment services.
Sec. 18. Minnesota Statutes 1998, section 254B.05,
subdivision 1, is amended to read:
Subdivision 1. [LICENSURE REQUIRED.] Programs licensed by
the commissioner are eligible vendors. Hospitals may apply for
and receive licenses to be eligible vendors, notwithstanding the
provisions of section 245A.03. American Indian programs located
on federally recognized tribal lands that provide chemical
dependency primary treatment, extended care, transitional
residence, or outpatient treatment services, and are licensed by
tribal government are eligible vendors. Detoxification programs
are not eligible vendors. Programs that are not licensed as a
chemical dependency residential or nonresidential treatment
program by the commissioner or by tribal government are not
eligible vendors. To be eligible for payment under the
Consolidated Chemical Dependency Treatment Fund, a vendor of a
chemical dependency service must participate in the Drug and
Alcohol Abuse Normative Evaluation System and the treatment
accountability plan.
Effective January 1, 2000, vendors of room and board are
eligible for chemical dependency fund payment if the vendor:
(1) is certified by the county or tribal governing body as
having rules prohibiting residents bringing chemicals into the
facility or using chemicals while residing in the facility and
provide consequences for infractions of those rules;
(2) has a current contract with a county or tribal
governing body;
(3) is determined to meet applicable health and safety
requirements;
(4) is not a jail or prison; and
(5) is not concurrently receiving funds under chapter 256I
for the recipient.
Sec. 19. Minnesota Statutes 1998, section 256.01,
subdivision 6, is amended to read:
Subd. 6. [ADVISORY TASK FORCES.] The commissioner may
appoint advisory task forces to provide consultation on any of
the programs under the commissioner's administration and
supervision. A task force shall expire and the compensation,
terms of office and removal of members shall be as provided in
section 15.059. Notwithstanding section 15.059, the
commissioner may pay a per diem of $35 to consumers and family
members whose participation is needed in legislatively
authorized state-level task forces, and whose participation on
the task force is not as a paid representative of any agency,
organization, or association.
Sec. 20. Minnesota Statutes 1998, section 256B.0625,
subdivision 20, is amended to read:
Subd. 20. [MENTAL HEALTH CASE MANAGEMENT.] (a) To the
extent authorized by rule of the state agency, medical
assistance covers case management services to persons with
serious and persistent mental illness and children with severe
emotional disturbance. Services provided under this section
must meet the relevant standards in sections 245.461 to
245.4888, the Comprehensive Adult and Children's Mental Health
Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and
9505.0322, excluding subpart 10.
(b) Entities meeting program standards set out in rules
governing family community support services as defined in
section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for
children with severe emotional disturbance when these services
meet the program standards in Minnesota Rules, parts 9520.0900
to 9520.0926 and 9505.0322, excluding subparts 6 and 10.
(c) Medical assistance and MinnesotaCare payment for mental
health case management shall be made on a monthly basis. In
order to receive payment for an eligible child, the provider
must document at least a face-to-face contact with the child,
the child's parents, or the child's legal representative. To
receive payment for an eligible adult, the provider must
document:
(1) at least a face-to-face contact with the adult or the
adult's legal representative; or
(2) at least a telephone contact with the adult or the
adult's legal representative and document a face-to-face contact
with the adult or the adult's legal representative within the
preceding two months.
(d) Payment for mental health case management provided by
county or state staff shall be based on the monthly rate
methodology under section 256B.094, subdivision 6, paragraph
(b), with separate rates calculated for child welfare and mental
health, and within mental health, separate rates for children
and adults.
(e) Payment for mental health case management provided by
county-contracted vendors shall be based on a monthly rate
negotiated by the host county. The negotiated rate must not
exceed the rate charged by the vendor for the same service to
other payers. If the service is provided by a team of
contracted vendors, the county may negotiate a team rate with a
vendor who is a member of the team. The team shall determine
how to distribute the rate among its members. No reimbursement
received by contracted vendors shall be returned to the county,
except to reimburse the county for advance funding provided by
the county to the vendor.
(f) If the service is provided by a team which includes
contracted vendors and county or state staff, the costs for
county or state staff participation in the team shall be
included in the rate for county-provided services. In this
case, the contracted vendor and the county may each receive
separate payment for services provided by each entity in the
same month. In order to prevent duplication of services, the
county must document, in the recipient's file, the need for team
case management and a description of the roles of the team
members.
(g) The commissioner shall calculate the nonfederal share
of actual medical assistance and general assistance medical care
payments for each county, based on the higher of calendar year
1995 or 1996, by service date, project that amount forward to
1999, and transfer one-half of the result from medical
assistance and general assistance medical care to each county's
mental health grants under sections 245.4886 and 256E.12 for
calendar year 1999. The annualized minimum amount added to each
county's mental health grant shall be $3,000 per year for
children and $5,000 per year for adults. The commissioner may
reduce the statewide growth factor in order to fund these
minimums. The annualized total amount transferred shall become
part of the base for future mental health grants for each county.
(h) Any net increase in revenue to the county as a result
of the change in this section must be used to provide expanded
mental health services as defined in sections 245.461 to
245.4888, the Comprehensive Adult and Children's Mental Health
Acts, excluding inpatient and residential treatment. For
adults, increased revenue may also be used for services and
consumer supports which are part of adult mental health projects
approved under Laws 1997, chapter 203, article 7, section 25.
For children, increased revenue may also be used for respite
care and nonresidential individualized rehabilitation services
as defined in section 245.492, subdivisions 17 and 23.
"Increased revenue" has the meaning given in Minnesota Rules,
part 9520.0903, subpart 3.
(i) Notwithstanding section 256B.19, subdivision 1, the
nonfederal share of costs for mental health case management
shall be provided by the recipient's county of responsibility,
as defined in sections 256G.01 to 256G.12, from sources other
than federal funds or funds used to match other federal funds.
(j) The commissioner may suspend, reduce, or terminate the
reimbursement to a provider that does not meet the reporting or
other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, is
responsible for any federal disallowances. The county may share
this responsibility with its contracted vendors.
(k) The commissioner shall set aside a portion of the
federal funds earned under this section to repay the special
revenue maximization account under section 256.01, subdivision
2, clause (15). The repayment is limited to:
(1) the costs of developing and implementing this section;
and
(2) programming the information systems.
(l) Notwithstanding section 256.025, subdivision 2,
payments to counties for case management expenditures under this
section shall only be made from federal earnings from services
provided under this section. Payments to contracted vendors
shall include both the federal earnings and the county share.
(m) Notwithstanding section 256B.041, county payments for
the cost of mental health case management services provided by
county or state staff shall not be made to the state treasurer.
For the purposes of mental health case management services
provided by county or state staff under this section, the
centralized disbursement of payments to counties under section
256B.041 consists only of federal earnings from services
provided under this section.
(n) Case management services under this subdivision do not
include therapy, treatment, legal, or outreach services.
(o) If the recipient is a resident of a nursing facility,
intermediate care facility, or hospital, and the recipient's
institutional care is paid by medical assistance, payment for
case management services under this subdivision is limited to
the last 30 days of the recipient's residency in that facility
and may not exceed more than two months in a calendar year.
(p) Payment for case management services under this
subdivision shall not duplicate payments made under other
program authorities for the same purpose.
(q) By July 1, 2000, the commissioner shall evaluate the
effectiveness of the changes required by this section, including
changes in number of persons receiving mental health case
management, changes in hours of service per person, and changes
in caseload size.
(r) For each calendar year beginning with the calendar year
2001, the annualized amount of state funds for each county
determined under paragraph (g) shall be adjusted by the county's
percentage change in the average number of clients per month who
received case management under this section during the fiscal
year that ended six months prior to the calendar year in
question, in comparison to the prior fiscal year.
(s) For counties receiving the minimum allocation of $3,000
or $5,000 described in paragraph (g), the adjustment in
paragraph (r) shall be determined so that the county receives
the higher of the following amounts:
(1) a continuation of the minimum allocation in paragraph
(g); or
(2) an amount based on that county's average number of
clients per month who received case management under this
section during the fiscal year that ended six months prior to
the calendar year in question, in comparison to the prior fiscal
year, times the average statewide grant per person per month for
counties not receiving the minimum allocation.
(t) The adjustments in paragraphs (r) and (s) shall be
calculated separately for children and adults.
Sec. 21. Laws 1995, chapter 207, article 8, section 41, as
amended by Laws 1997, chapter 203, article 7, section 25, is
amended to read:
Sec. 41. [245.4661] [PILOT PROJECTS TO TEST PROVIDE
ALTERNATIVES TO DELIVERY OF ADULT MENTAL HEALTH SERVICES.]
Subdivision 1. [AUTHORIZATION FOR PILOT PROJECTS.] The
commissioner of human services may approve pilot projects to
test provide alternatives to or the enhanced enhance
coordination of the delivery of mental health services required
under the Minnesota Comprehensive Adult Mental Health Act,
Minnesota Statutes, sections 245.461 to 245.486.
Subd. 2. [PROGRAM DESIGN AND IMPLEMENTATION.] (a) The
pilot projects shall be established to design, plan, and improve
the mental health service delivery system for adults with
serious and persistent mental illness that would:
(1) provide an expanded array of services from which
clients can choose services appropriate to their needs;
(2) be based on purchasing strategies that improve access
and coordinate services without cost shifting;
(3) incorporate existing state facilities and resources
into the community mental health infrastructure through creative
partnerships with local vendors; and
(4) utilize existing categorical funding streams and
reimbursement sources in combined and creative ways, except
appropriations to regional treatment centers and all funds that
are attributable to the operation of state-operated services are
excluded unless appropriated specifically by the legislature for
a purpose consistent with this section.
(b) All projects funded by January 1, 1997, must complete
the planning phase and be operational by June 30, 1997; all
projects funded by January 1, 1998, must be operational by June
30, 1998.
Subd. 3. [PROGRAM EVALUATION.] Evaluation of each project
will be based on outcome evaluation criteria negotiated with
each project prior to implementation.
Subd. 4. [NOTICE OF PROJECT DISCONTINUATION.] Each project
may be discontinued for any reason by the project's managing
entity or the commissioner of human services, after 90 days'
written notice to the other party.
Subd. 5. [PLANNING FOR PILOT PROJECTS.] Each local plan
for a pilot project must be developed under the direction of the
county board, or multiple county boards acting jointly, as the
local mental health authority. The planning process for each
pilot shall include, but not be limited to, mental health
consumers, families, advocates, local mental health advisory
councils, local and state providers, representatives of state
and local public employee bargaining units, and the department
of human services. As part of the planning process, the county
board or boards shall designate a managing entity responsible
for receipt of funds and management of the pilot project.
Subd. 6. [DUTIES OF COMMISSIONER.] (a) For purposes of the
pilot projects, the commissioner shall facilitate integration of
funds or other resources as needed and requested by each
project. These resources may include:
(1) residential services funds administered under Minnesota
Rules, parts 9535.2000 to 9535.3000, in an amount to be
determined by mutual agreement between the project's managing
entity and the commissioner of human services after an
examination of the county's historical utilization of facilities
located both within and outside of the county and licensed under
Minnesota Rules, parts 9520.0500 to 9520.0690;
(2) community support services funds administered under
Minnesota Rules, parts 9535.1700 to 9535.1760;
(3) other mental health special project funds;
(4) medical assistance, general assistance medical care,
MinnesotaCare and group residential housing if requested by the
project's managing entity, and if the commissioner determines
this would be consistent with the state's overall health care
reform efforts; and
(5) regional treatment center nonfiscal resources to the
extent agreed to by the project's managing entity and the
regional treatment center.
(b) The commissioner shall consider the following criteria
in awarding start-up and implementation grants for the pilot
projects:
(1) the ability of the proposed projects to accomplish the
objectives described in subdivision 2;
(2) the size of the target population to be served; and
(3) geographical distribution.
(c) The commissioner shall review overall status of the
projects initiatives at least every two years and recommend any
legislative changes needed by January 15 of each odd-numbered
year.
(d) The commissioner may waive administrative rule
requirements which are incompatible with the implementation of
the pilot project.
(e) The commissioner may exempt the participating counties
from fiscal sanctions for noncompliance with requirements in
laws and rules which are incompatible with the implementation of
the pilot project.
(f) The commissioner may award grants to an entity
designated by a county board or group of county boards to pay
for start-up and implementation costs of the pilot project.
Subd. 7. [DUTIES OF COUNTY BOARD.] The county board, or
other entity which is approved to administer a pilot project,
shall:
(1) administer the project in a manner which is consistent
with the objectives described in subdivision 2 and the planning
process described in subdivision 5;
(2) assure that no one is denied services for which they
would otherwise be eligible; and
(3) provide the commissioner of human services with timely
and pertinent information through the following methods:
(i) submission of community social services act plans and
plan amendments;
(ii) submission of social services expenditure and grant
reconciliation reports, based on a coding format to be
determined by mutual agreement between the project's managing
entity and the commissioner; and
(iii) submission of data and participation in an evaluation
of the pilot projects, to be designed cooperatively by the
commissioner and the projects.
Sec. 22. Laws 1997, chapter 203, article 9, section 19, is
amended to read:
Sec. 19. [TRANSITION FOR THE COMPULSIVE GAMBLING TREATMENT
PROGRAM.]
The commissioner of human services shall conduct a
transition of treatment programs for compulsive gambling from
the treatment center model to a model in which reimbursement for
treatment of an individual compulsive gambler from an approved
provider is on a fee-for-service basis on the following schedule:
(1) one-third of compulsive gamblers treated through the
program must receive services paid for from the individual
treatment reimbursement model beginning October 1, 1997;
(2) two-thirds of compulsive gamblers treated through the
program must receive services paid for from the individual
treatment reimbursement model beginning July 1, 1998; and
(3) 100 percent of compulsive gamblers treated through the
program must receive treatment paid for from the individual
treatment reimbursement model beginning July 1, 1999 2000.
Sec. 23. Laws 1998, chapter 407, article 7, section 2,
subdivision 3, is amended to read:
Subd. 3. [LAND DESCRIPTION.] That part of the Northeast
Quarter (NE l/4) of Section 30 29, Township 45 North, Range 30
West, Crow Wing county, Minnesota, described as follows:
Commencing at the southeast corner of said Northeast
quarter; thence North 00 degrees 46 minutes 05 seconds
West, bearing based on the Crow Wing county Coordinate
Database NAD 83/94, 1520.06 feet along the east line of
said Northeast quarter to the point of beginning; thence
continue North 00 degrees 46 minutes 05 seconds West 634.14
feet along said east line of the Northeast quarter; thence
South 89 degrees 13 minutes 20 seconds West 550.00 feet;
thence South 18 degrees 57 minutes 23 seconds East 115.59
feet; thence South 42 degrees 44 minutes 39 seconds East
692.37 feet; thence South 62 degrees 46 minutes 19 seconds
East 20.24 feet; thence North 89 degrees 13 minutes 55
seconds East 33.00 feet to the point of beginning.
Containing 4.69 acres, more or less. Subject to the
right-of-way of the Township road along the east side
thereof, subject to other easements, reservations, and
restrictions of record, if any.
Sec. 24. [ESTABLISHMENT AND PURPOSE OF THE SUPPORTIVE
HOUSING AND MANAGED CARE PILOT PROJECT.]
Subdivision 1. [ESTABLISHMENT AND PURPOSE.] If funding is
available, the commissioner of human services may establish a
supportive housing and managed care pilot project to determine
whether integrating the delivery of housing, supportive
services, and health care into a single, flexible program will
reduce public expenditures on homeless individuals, increase
their employment rates, and provide a new alternative to
providing services to a hard-to-serve population.
The commissioner of human services may create a block grant
program for counties for the purpose of providing rent subsidies
and supportive services to eligible individuals. Minimum
project and application requirements may be developed by the
commissioner in cooperation with counties and their nonprofit
partners with the goal to provide the maximum flexibility in
program design. If any funds are available, the funds must be
coordinated with health care services for eligible individuals.
Subd. 2. [COUNTY ELIGIBILITY.] If the commissioner
establishes the pilot project under subdivision 1, a county may
request funding for the purposes of the pilot project if the
county:
(1) agrees to develop, in cooperation with nonprofit
partners, a supportive housing and managed care pilot project
that integrates the delivery of housing, support services, and
health care for eligible individuals or agrees to contract with
an existing integrated program; and
(2) develops a method for evaluating the quality of the
integrated services provided and the amount of any resulting
cost savings to the county and state.
Subd. 3. [PARTICIPANT ELIGIBILITY.] In order to be
eligible for the pilot project, a county must determine that an
individual:
(1) meets the eligibility requirements of the group
residential housing program under Minnesota Statutes, section
256I.04, subdivision 1;
(2) is a homeless person or a person at risk of
homelessness. For purposes of this pilot project, "homeless
person" means a person who is living, or at imminent risk of
living, on the street, in a shelter, or is evicted from a
dwelling or discharged from a regional human services center,
community hospital, or residential treatment program, and has no
appropriate housing available and lacks the resources necessary
to access permanent housing as determined by the county
requesting funding under the pilot project; and
(3) is a person with mental illness, a history of substance
abuse, or a person with HIV.
Subd. 4. [FUNDING.] If the commissioner establishes the
pilot project under subdivision 1, a county may request funding
from the commissioner for a specified number of eligible
participants for the pilot project. The commissioner shall
review the request for compliance with subdivisions 1 to 3 and
may approve or disapprove the request. The commissioner shall
transfer funding to be allocated to participating counties as a
block grant and paid on a monthly basis.
Subd. 5. [REPORT.] If the commissioner establishes the
pilot project under subdivision 1, participating counties and
the commissioner of human services shall collaborate to prepare
and issue an annual report beginning December 1, 2001, to the
appropriate committee chairs in the senate and house on the use
of state resources, including other funds leveraged for this
initiative, the status of individuals being served in the pilot
project, and the cost-effectiveness of the pilot project. The
commissioner shall provide data that may be needed to evaluate
the pilot project to counties that request the data.
Subd. 6. [SUNSET.] The pilot project shall sunset June 30,
2005.
Sec. 25. [CONVEYANCE OF STATE LANDS TO COUNTY OF ISANTI.]
(a) Notwithstanding Minnesota Statutes, sections 94.09 to
94.16, the commissioner of human services, through the
commissioner of administration, may transfer to the county of
Isanti the lands described in paragraph (c), for no
consideration. The commissioner of human services and the
county may attach to the transfer conditions that they agree are
appropriate, including conditions that relate to water and sewer
service. The deed to convey the property must contain a clause
that the property shall revert to the state if the property
ceases to be used for a public purpose.
(b) The conveyance must be in a form approved by the
attorney general.
(c) The land that may be transferred consists of 21.9
acres, more or less, and is described as follows:
That part of the Southwest Quarter of the Southeast Quarter
and that part of Government Lot 4, both in Section 32,
Township 36, Range 23, Isanti County, Minnesota, described
jointly as follows: Commencing at the southwest corner of
the Southwest Quarter of the Southeast Quarter of Section
32; thence North 89 degrees 45 minutes 12 seconds East,
assumed bearing, along the south line of said SW 1/4 of SE
1/4, a distance of 609.48 feet; thence North 1 degree 30
minutes 30 seconds West, a distance of 149.17 feet to the
point of beginning of the parcel to be herein described;
thence continuing North 1 degrees 30 minutes 30 seconds
West, a distance of 1113.59 feet; thence South 89 degrees
59 minutes 36 seconds West, a distance of 496.41 feet;
thence southwesterly along a tangential curve concave to
the southeast, radius 318.10 feet, central angle 90 degrees
16 minutes 37 seconds, for an arc length of 501.21 feet;
thence South 0 degrees 17 minutes 01 seconds East, tangent
to said curve, for a distance of 86.59 feet; thence
southerly along a tangential curve concave to the west,
radius 398.10 feet, central angle 29 degrees 47 minutes 02
seconds, for an arc length of 206.94 feet; thence south 29
degrees 30 minutes 01 seconds West, tangent to said curve,
for a distance of 34.23 feet; thence southerly along a
tangential curve concave to the east, radius 318.10 feet,
central angle 29 degrees 49 minutes 32 seconds, for an arc
length of 165.59 feet; thence South 0 degrees 19 minutes 31
seconds East, tangent to said curve for a distance of
320.65 feet to the point of intersection with a line that
bears West (North 90 degrees 00 minutes West) from the
point of beginning; thence East (North 90 degrees 00
minutes East), a distance of 951.22 feet to the point of
beginning.
Subject to the existing city of Cambridge water main
easement.
(d) The county of Isanti may use the land for economic
development. Economic development is a public purpose within
the meaning of the term as used in Laws 1990, chapter 610,
article 1, section 12, subdivision 5, and sales or conveyances
to private parties shall be considered economic development.
Property conveyed by the state under this section shall not
revert to the state if it is conveyed or otherwise encumbered by
the county as part of the county economic development activity.
Sec. 26. [CONVEYANCE OF STATE LAND TO CITY OF CAMBRIDGE.]
(a) Notwithstanding Minnesota Statutes, sections 94.09 to
94.16, the commissioner of human services, through the
commissioner of administration, may transfer to the city of
Cambridge the lands described in paragraph (c), for no
consideration. The commissioner of human services and the city
may attach to the transfer conditions that they agree are
appropriate, including conditions that relate to water and sewer
service. The deed to convey the property must contain a clause
that the property shall revert to the state if the property
ceases to be used for a public purpose.
(b) The conveyance must be in a form approved by the
attorney general.
(c) Subject to the right-of-way for state trunk highway No.
293 and south Dellwood street and subject to other easements,
reservations, road or street right-of-ways, and restrictions of
record, if any, the land to be conveyed may include all or part
of any of the parcels described as follows:
(1) that part of the Northeast Quarter of the Northeast
Quarter of Section 5, Township 35, Range 23, Isanti County,
Minnesota, lying north of a line drawn parallel with and 50
feet north of the center line of State Highway No. 293, as
laid out and constructed and lying westerly of the
following described line:
Commencing at a point where the West line of the
right-of-way of the Great Northern Railway Company
(presently the Burlington Northern and Santa Fe Railway)
intersects the North line of said Section 5, said point now
being the intersection of the North line of said Section 5
with the center line of State Trunk Highway No. 65 as now
laid out and constructed (presently known as South Main
Street); thence on a bearing of West and along the North
line of said Section 5 a distance of 539.5 feet to the
point of beginning of the line to be herein described;
thence on a bearing of South, a distance of 451.75 feet to
the point of intersection with a line drawn parallel with
and distant 50 feet north of the center line of State
Highway No. 293, as laid out and constructed and there
terminating. Containing 1/4 acre, more or less.
(2) that part of the Northwest Quarter of the Southeast
Quarter and that part of Governments Lots 3 and 4, all in
Section 32, Township 36, Range 23, Isanti County,
Minnesota, described jointly as follows:
Commencing at the East quarter corner of Section 32,
Township 36, Range 23, Isanti County, Minnesota; thence
South 89 degrees 44 minutes 35 seconds West, assumed
bearing, along the east-west quarter line of said Section
32, a distance of 2251.43 feet; thence South 1 degree 48
minutes 40 seconds East, a distance of 344.47 feet to the
south line of Lot 30 of Auditor's Subdivision No. 9; thence
South 89 degrees 35 minutes 5 seconds West, along said
south line and the westerly projection thereof, a distance
of 740.00 feet to the point of beginning of the parcel to
be herein described; thence North 89 degrees 35 minutes, 05
seconds East, retracing the last described course, a
distance of 534.66 feet to the northwest corner of the
recorded plat of RIVERWOOD VILLAGE; thence South 2 degrees
40 minutes 50 seconds East, a distance of 338.38 feet,
along the westerly line of said RIVERWOOD VILLAGE to the
southwest corner of said RIVERWOOD VILLAGE; thence North 89
degrees 44 minutes 50 seconds East, along the south line of
said RIVERWOOD VILLAGE, a distance of 1074.56 feet; thence
South 3 degrees 35 minutes 15 seconds East, a distance of
258.66 feet; thence southwesterly along a tangential curve
concave to the northwest, radius 318.10 feet, central angle
93 degrees 34 minutes 51 seconds for an arc length of
519.56 feet; thence South 89 degrees 59 minutes 37 seconds
West tangent to said curve for a distance of 825.86 feet;
thence southwesterly along a tangential curve concave to
the southeast, radius 398.10 feet, central angle 70 degrees
55 minutes 13 seconds, for an arc length of 492.76 feet;
thence South 89 degrees 51 minutes 30 seconds West, not
tangent to the last described curve for a distance of
523.31 feet; thence South 1 degree 57 minutes 33 seconds
West, a distance of 29.59 feet; thence South 89 degrees 57
minutes 55 seconds West, a distance of 1020 feet, more or
less, to the easterly shoreline of the Rum River; thence
northerly along said easterly shoreline to the point of
intersection with a line that bears North 45 degrees 24
minutes 55 seconds West from the point of beginning; thence
South 45 degrees 24 minutes 55 seconds East, along said
line, a distance of 180 feet, more or less, to the point of
beginning. Containing 48 acres, more or less.
(3) that part of the Northwest Quarter of the Northeast
Quarter and that part of the Northeast Quarter of the
Northwest Quarter, both in Section 5, Township 35, Range
23, Isanti County, Minnesota, described jointly as follows:
Beginning at the northwest corner of the NW 1/4 of NE 1/4
of Section 5; thence North 89 degrees 45 minutes 12 seconds
East, assumed bearing, along the north line of said NW 1/4
of NE 1/4, a distance of 1321.82 feet to the northeast
corner of said NW 1/4 of NE 1/4 thence South 4 degrees 04
minutes 02 seconds West, along the east line of said NW 1/4
of NE 1/4, a distance of 452.83 feet; thence South 89
degrees 45 minutes 02 seconds West, a distance of 1393.6
feet; thence northwesterly, along a nontangential curve
concave to the northeast, radius 318.17 feet, central angle
75 degrees 28 minutes 03 seconds, for an arc length of
419.08 feet (the chord of said curve bears North 38 degrees
03 minutes 32 seconds West and has a length of 389.44
feet); thence North 0 degrees 19 minutes 31 seconds West,
tangent to said curve, for a distance of 142.65 feet to the
north line of the NE 1/4 of NW 1/4 of said Section 5;
thence North 89 degrees 32 minutes 15 seconds East, along
said north line, a distance of 344.81 feet to the point of
beginning. Containing 16 acres, more or less.
(4) that part of the Southwest Quarter of the Southeast
Quarter, that part of the Northwest Quarter of the
Southeast Quarter and that part of Government Lot 4, all in
Section 32, Township 36, Range 23, Isanti County,
Minnesota, described jointly as follows:
Beginning at the southwest corner of the SW 1/4 of SE 1/4
of Section 32; thence North 89 degrees 45 minutes 12
seconds East, assumed bearing, along the south line of said
SW 1/4 of SE 1/4, a distance of 1321.82 feet to the
southeast corner of said SW 1/4 of SE 1/4 thence North 2
degrees 40 minutes 49 seconds West, along the east line of
said SW 1/4 of SE 1/4 and along the east line of the NW 1/4
of SE 1/4, a distance of 1465.32 feet; thence southwesterly
along a nontangential curve concave to the northwest,
radius 398.10 feet, central angle 60 degrees 52 minutes 54
seconds, for an arc length of 423.02 feet (said curve has a
chord that bears South 59 degrees 33 minutes 09 seconds
West and a chord length of 403.40 feet); thence South 89
degrees 59 minutes 37 seconds West, tangent to said curve,
for a distance of 825.68 feet; thence southwesterly along a
tangential curve concave to the southeast, radius 318.10
feet, central angle 90 degrees 16 minutes 37 seconds, for
an arc length of 501.21 feet; thence South 0 degrees 17
minutes 01 seconds East, tangent to said curve, for a
distance of 86.59 feet; thence southerly along a tangential
curve concave to the West, radius 398.10 feet, central
angle 29 degrees 47 minutes 02 seconds, for an arc length
of 206.94 feet; thence South 29 degrees 30 minutes 01
seconds West tangent to said curve, for a distance of 34.23
feet; thence southerly along a tangential curve concave to
the east, radius 318.20 feet, central angle 29 degrees 49
minutes 32 seconds for an arc length of 165.59 feet; thence
South 0 degrees 19 minutes 31 seconds East, tangent to said
curve, for a distance of 475.17 feet to the south line of
Government Lot 4, Section 32; thence North 89 degrees 32
minutes 15 seconds East, along said south line, a distance
of 344.81 feet to the point of beginning. Containing 44.9
acres, more or less.
EXCEPTING THEREFROM that parcel described on Quit Claim
Deed from the State of Minnesota to Wilfred R. and June E.
Norman, filed in Book 92 of Deeds, page 647, in the office
of the County Recorder, Isanti County, Minnesota.
ALSO EXCEPTING THEREFROM that parcel described on Quit
Claim Deed from the State of Minnesota to Frank C. Brody
and Lorraine D.S. Brody, filed in Book 102 of Deeds, page
232, in the office of the County Recorder, Isanti County,
Minnesota.
(d) The city of Cambridge may use the land for economic
development. Economic development is a public purpose within
the meaning of the term as used in Laws 1990, chapter 610,
article 1, section 12, subdivision 5, and sales or conveyances
to private parties shall be considered economic development.
Property conveyed by the state under this section shall not
revert to the state if it is conveyed or otherwise encumbered by
the city as a part of the city economic development activity.
Sec. 27. [CONVEYANCE OF CITY LAND TO STATE OF MINNESOTA.]
(a) The commissioner of administration may accept all, or
any part of, the land described in paragraph (d) from the city
of Cambridge, after the city council passes a resolution which
declares the property is surplus to its needs.
(b) The conveyance shall be in a form approved by the
attorney general.
(c) The conveyance may be subject to a scenic easement, as
defined in Minnesota Statutes, section 103F.311, subdivision 6.
The easement shall be under the custodial control of the
commissioner of natural resources and only required on the
portion of conveyed land that is designated for inclusion in the
wild and scenic river system under Minnesota Statutes, section
103F.325. The scenic easement shall allow for continued use of
any existing structures located within the easement and for
development of walking paths or trails within the easement.
(d) Subject to the right-of-way for state trunk highway No.
293, and subject to other easements, reservations, street
right-of-ways, and restrictions of record, if any, the land to
be conveyed may include all, or part of, the parcel described as
follows:
That part of Government Lot 4 and that part of the
Northeast Quarter of the Northwest Quarter, all in Section
5, Township 35, Range 23, Isanti County, Minnesota,
described jointly as follows: Commencing at the Northeast
corner of the Northwest Quarter of Section 5, thence South
89 degrees 47 minutes 10 seconds West, assumed bearing
along the north line of the Northwest Quarter of Section 5,
a distance of 656.00 feet to the point of beginning of the
parcel to be herein described, thence South 00 degrees 03
minutes 35 seconds East, a distance of 350.00 feet, thence
South 89 degrees 47 minutes 10 seconds West, parallel with
the north line of said Northwest Quarter of Section 5 to
the easterly shoreline of the Rum River, thence
northeasterly along said easterly shoreline to the north
line of the Northwest Quarter of Section 5, thence North 89
degrees 47 minutes 10 seconds East, along said north line
to the point of beginning.
Sec. 28. [REPORT TO LEGISLATURE ON ESTABLISHING ENTERPRISE
ACTIVITIES WITHIN STATE-OPERATED SERVICES.]
The commissioner of human services shall report and make
recommendations to the legislature, by December 15, 1999, on
establishing enterprise activities within state-operated
services, under Minnesota Statutes, section 246.0136, and their
status.
Sec. 29. [REPEALER.]
Minnesota Statutes 1998, section 254A.145, is repealed.
ARTICLE 6
ASSISTANCE PROGRAMS
Section 1. Minnesota Statutes 1998, section 256D.051,
subdivision 2a, is amended to read:
Subd. 2a. [DUTIES OF COMMISSIONER.] In addition to any
other duties imposed by law, the commissioner shall:
(1) based on this section and section 256D.052 and Code of
Federal Regulations, title 7, section 273.7, supervise the
administration of food stamp employment and training services to
county agencies;
(2) disburse money appropriated for food stamp employment
and training services to county agencies based upon the county's
costs as specified in section 256D.06 256D.051, subdivision 6c;
(3) accept and supervise the disbursement of any funds that
may be provided by the federal government or from other sources
for use in this state for food stamp employment and training
services;
(4) cooperate with other agencies including any agency of
the United States or of another state in all matters concerning
the powers and duties of the commissioner under this section and
section 256D.052; and
(5) in cooperation with the commissioner of economic
security, ensure that each component of an employment and
training program carried out under this section is delivered
through a statewide workforce development system, unless the
component is not available locally through such a system.
Sec. 2. Minnesota Statutes 1998, section 256D.051, is
amended by adding a subdivision to read:
Subd. 6c. [PROGRAM FUNDING.] Within the limits of
available resources, the commissioner shall reimburse the actual
costs of county agencies and their employment and training
service providers for the provision of food stamp employment and
training services, including participant support services,
direct program services, and program administrative activities.
The cost of services for each county's food stamp employment and
training program shall not exceed an average of $400 per
participant. No more than 15 percent of program funds may be
used for administrative activities. The county agency may
expend county funds in excess of the limits of this subdivision
without state reimbursement.
Program funds shall be allocated based on the county's
average number of food stamp cases as compared to the statewide
total number of such cases. The average number of cases shall
be based on counts of cases as of March 31, June 30, September
30, and December 31 of the previous calendar year. The
commissioner may reallocate unexpended money appropriated under
this section to those county agencies that demonstrate a need
for additional funds.
Sec. 3. Minnesota Statutes 1998, section 256D.053,
subdivision 1, is amended to read:
Subdivision 1. [PROGRAM ESTABLISHED.] For the period of
July 1, 1998, to June 30, 1999, The Minnesota food assistance
program is established to provide food assistance to legal
noncitizens residing in this state who are ineligible to
participate in the federal Food Stamp Program solely due to the
provisions of section 402 or 403 of Public Law Number 104-193,
as authorized by Title VII of the 1997 Emergency Supplemental
Appropriations Act, Public Law Number 105-18, and as amended by
Public Law Number 105-185.
Beginning July 1, 2000, the Minnesota food assistance
program is limited to those noncitizens described in this
subdivision who are 50 years of age or older.
Sec. 4. Minnesota Statutes 1998, section 256D.06,
subdivision 5, is amended to read:
Subd. 5. Any applicant, otherwise eligible for general
assistance and possibly eligible for maintenance benefits from
any other source shall (a) make application for those benefits
within 30 days of the general assistance application; and (b)
execute an interim assistance authorization agreement on a form
as directed by the commissioner. The commissioner shall review
a denial of an application for other maintenance benefits and
may require a recipient of general assistance to file an appeal
of the denial if appropriate. If found eligible for benefits
from other sources, and a payment received from another source
relates to the period during which general assistance was also
being received, the recipient shall be required to reimburse the
county agency for the interim assistance paid. Reimbursement
shall not exceed the amount of general assistance paid during
the time period to which the other maintenance benefits apply
and shall not exceed the state standard applicable to that time
period. The commissioner shall adopt rules authorizing county
agencies or other client representatives to retain from the
amount recovered under an interim assistance agreement 25
percent plus actual reasonable fees, costs, and disbursements of
appeals and litigation, of providing special assistance to the
recipient in processing the recipient's claim for maintenance
benefits from another source. The money retained under this
section shall be from the state share of the recovery. The
commissioner or the county agency may contract with qualified
persons to provide the special assistance. The rules adopted by
the commissioner shall include the methods by which county
agencies shall identify, refer, and assist recipients who may be
eligible for benefits under federal programs for the disabled.
This subdivision does not require repayment of per diem payments
made to shelters for battered women pursuant to section 256D.05,
subdivision 3.
Sec. 5. Minnesota Statutes 1998, section 256J.02,
subdivision 2, is amended to read:
Subd. 2. [USE OF MONEY.] State money appropriated for
purposes of this section and TANF block grant money must be used
for:
(1) financial assistance to or on behalf of any minor child
who is a resident of this state under section 256J.12;
(2) employment and training services under this chapter or
chapter 256K;
(3) emergency financial assistance and services under
section 256J.48;
(4) diversionary assistance under section 256J.47; and
(5) the health care and human services training and
retention program under chapter 116L, for costs associated with
families with children with incomes below 200 percent of the
federal poverty guidelines;
(6) the pathways program under section 116L.04, subdivision
1a;
(7) welfare-to-work extended employment services for MFIP
participants with severe impairment to employment as defined in
section 268A.15, subdivision 1a;
(8) the family homeless prevention and assistance program
under section 462A.204;
(9) the rent assistance for family stabilization
demonstration project under section 462A.205; and
(10) program administration under this chapter.
Sec. 6. Minnesota Statutes 1998, section 256J.08,
subdivision 11, is amended to read:
Subd. 11. [CAREGIVER.] "Caregiver" means a minor child's
natural or adoptive parent or parents and stepparent who live in
the home with the minor child. For purposes of determining
eligibility for this program, caregiver also means any of the
following individuals, if adults, who live with and provide care
and support to a minor child when the minor child's natural or
adoptive parent or parents or stepparents do not reside in the
same home: legal custodian or guardian, grandfather,
grandmother, brother, sister, half-brother, half-sister,
stepbrother, stepsister, uncle, aunt, first cousin or first
cousin once removed, nephew, niece, person of preceding
generation as denoted by prefixes of "great," "great-great," or
"great-great-great," or a spouse of any person named in the
above groups even after the marriage ends by death or divorce.
Sec. 7. Minnesota Statutes 1998, section 256J.08,
subdivision 24, is amended to read:
Subd. 24. [DISREGARD.] "Disregard" means earned income
that is not counted when determining initial eligibility or
ongoing eligibility and calculating the amount of the assistance
payment for participants. The commissioner shall determine the
amount of the disregard according to section 256J.24,
subdivision 10.
Sec. 8. Minnesota Statutes 1998, section 256J.08, is
amended by adding a subdivision to read:
Subd. 28a. [ENCUMBRANCE.] "Encumbrance" means a legal
claim against real or personal property that is payable upon the
sale of that property.
Sec. 9. Minnesota Statutes 1998, section 256J.08, is
amended by adding a subdivision to read:
Subd. 55a. [MFIP STANDARD OF NEED.] "MFIP standard of need"
means the appropriate standard used to determine MFIP benefit
payments for the MFIP unit and applies to:
(1) the transitional standard, sections 256J.08,
subdivision 85, and 256J.24, subdivision 5;
(2) the shared household standard, section 256J.24,
subdivision 9; and
(3) the interstate transition standard, section 256J.43.
Sec. 10. Minnesota Statutes 1998, section 256J.08,
subdivision 65, is amended to read:
Subd. 65. [PARTICIPANT.] "Participant" means a person who
is currently receiving cash assistance and or the food portion
available through MFIP-S MFIP as funded by TANF and the food
stamp program. A person who fails to withdraw or access
electronically any portion of the person's cash and food
assistance payment by the end of the payment month, who makes a
written request for closure before the first of a payment month
and repays cash and food assistance electronically issued for
that payment month within that payment month, or who returns any
uncashed assistance check and food coupons and withdraws from
the program is not a participant. A person who withdraws a cash
or food assistance payment by electronic transfer or receives
and cashes a cash an MFIP assistance check or food coupons and
is subsequently determined to be ineligible for assistance for
that period of time is a participant, regardless whether that
assistance is repaid. The term "participant" includes the
caregiver relative and the minor child whose needs are included
in the assistance payment. A person in an assistance unit who
does not receive a cash and food assistance payment because the
person has been suspended from MFIP-S or because the person's
need falls below the $10 minimum payment level MFIP is a
participant.
Sec. 11. Minnesota Statutes 1998, section 256J.08,
subdivision 82, is amended to read:
Subd. 82. [SANCTION.] "Sanction" means the reduction of a
family's assistance payment by a specified percentage of
the applicable transitional MFIP standard of need because: a
nonexempt participant fails to comply with the requirements of
sections 256J.52 to 256J.55; a parental caregiver fails without
good cause to cooperate with the child support enforcement
requirements; or a participant fails to comply with the
insurance, tort liability, or other requirements of this chapter.
Sec. 12. Minnesota Statutes 1998, section 256J.08,
subdivision 83, is amended to read:
Subd. 83. [SIGNIFICANT CHANGE.] "Significant change" means
a decline in gross income of 36 percent the amount of the
disregard as defined in subdivision 24 or more from the income
used to determine the grant for the current month.
Sec. 13. Minnesota Statutes 1998, section 256J.08,
subdivision 86a, is amended to read:
Subd. 86a. [UNRELATED MEMBER.] "Unrelated member" means an
individual in the household who does not meet the definition of
an eligible caregiver, but does not include an individual who
provides child care to a child in the assistance unit.
Sec. 14. Minnesota Statutes 1998, section 256J.11,
subdivision 2, is amended to read:
Subd. 2. [NONCITIZENS; FOOD PORTION.] (a) For the period
September 1, 1997, to October 31, 1997, noncitizens who do not
meet one of the exemptions in section 412 of the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996,
but were residing in this state as of July 1, 1997, are eligible
for the 6/10 of the average value of food stamps for the same
family size and composition until MFIP-S is operative in the
noncitizen's county of financial responsibility and thereafter,
the 6/10 of the food portion of MFIP-S. However, federal food
stamp dollars cannot be used to fund the food portion of MFIP-S
benefits for an individual under this subdivision.
(b) For the period November 1, 1997, to June 30, 1999,
noncitizens who do not meet one of the exemptions in section 412
of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, and are receiving cash assistance
under the AFDC, family general assistance, MFIP or MFIP-S
programs are eligible for the average value of food stamps for
the same family size and composition until MFIP-S is operative
in the noncitizen's county of financial responsibility and
thereafter, the food portion of MFIP-S. However, federal food
stamp dollars cannot be used to fund the food portion of MFIP-S
benefits for an individual under this subdivision State dollars
shall fund the food portion of a noncitizen's MFIP benefits when
federal food stamp dollars cannot be used to fund those
benefits. The assistance provided under this subdivision, which
is designated as a supplement to replace lost benefits under the
federal food stamp program, must be disregarded as income in all
programs that do not count food stamps as income where the
commissioner has the authority to make the income disregard
determination for the program.
(c) The commissioner shall submit a state plan to the
secretary of agriculture to allow the commissioner to purchase
federal Food Stamp Program benefits in an amount equal to the
MFIP-S food portion for each legal noncitizen receiving MFIP-S
assistance who is ineligible to participate in the federal Food
Stamp Program solely due to the provisions of section 402 or 403
of Public Law Number 104-193, as authorized by Title VII of the
1997 Emergency Supplemental Appropriations Act, Public Law
Number 105-18. The commissioner shall enter into a contract as
necessary with the secretary to use the existing federal Food
Stamp Program benefits delivery system for the purposes of
administering the food portion of MFIP-S under this subdivision.
Sec. 15. Minnesota Statutes 1998, section 256J.11,
subdivision 3, is amended to read:
Subd. 3. [BENEFITS FUNDED WITH STATE MONEY.] Legal adult
noncitizens who have resided in the country for four years or
more as a lawful permanent resident, whose benefits are funded
entirely with state money, and who are under 70 years of age,
must, as a condition of eligibility:
(1) be enrolled in a literacy class, English as a second
language class, or a citizen class;
(2) be applying for admission to a literacy class, English
as a second language class, and is on a waiting list;
(3) be in the process of applying for a waiver from the
Immigration and Naturalization Service of the English language
or civics requirements of the citizenship test;
(4) have submitted an application for citizenship to the
Immigration and Naturalization Service and is waiting for a
testing date or a subsequent swearing in ceremony; or
(5) have been denied citizenship due to a failure to pass
the test after two attempts or because of an inability to
understand the rights and responsibilities of becoming a United
States citizen, as documented by the Immigration and
Naturalization Service or the county.
If the county social service agency determines that a legal
noncitizen subject to the requirements of this subdivision will
require more than one year of English language training, then
the requirements of clause (1) or (2) shall be imposed after the
legal noncitizen has resided in the country for three years.
Individuals who reside in a facility licensed under chapter
144A, 144D, 245A, or 256I are exempt from the requirements of
this subdivision.
Sec. 16. Minnesota Statutes 1998, section 256J.12,
subdivision 1a, is amended to read:
Subd. 1a. [30-DAY RESIDENCY REQUIREMENT.] An assistance
unit is considered to have established residency in this state
only when a child or caregiver has resided in this state for at
least 30 consecutive days with the intention of making the
person's home here and not for any temporary purpose. The birth
of a child in Minnesota to a member of the assistance unit does
not automatically establish the residency in this state under
this subdivision of the other members of the assistance unit.
Time spent in a shelter for battered women shall count toward
satisfying the 30-day residency requirement.
Sec. 17. Minnesota Statutes 1998, section 256J.12,
subdivision 2, is amended to read:
Subd. 2. [EXCEPTIONS.] (a) A county shall waive the 30-day
residency requirement where unusual hardship would result from
denial of assistance.
(b) For purposes of this section, unusual hardship means an
assistance unit:
(1) is without alternative shelter; or
(2) is without available resources for food.
(c) For purposes of this subdivision, the following
definitions apply (1) "metropolitan statistical area" is as
defined by the U.S. Census Bureau; (2) "alternative shelter"
includes any shelter that is located within the metropolitan
statistical area containing the county and for which the family
is eligible, provided the assistance unit does not have to
travel more than 20 miles to reach the shelter and has access to
transportation to the shelter. Clause (2) does not apply to
counties in the Minneapolis-St. Paul metropolitan statistical
area.
(d) Applicants are considered to meet the residency
requirement under subdivision 1a if they once resided in
Minnesota and:
(1) joined the United States armed services, returned to
Minnesota within 30 days of leaving the armed services, and
intend to remain in Minnesota; or
(2) left to attend school in another state, paid
nonresident tuition or Minnesota tuition rates under a
reciprocity agreement, and returned to Minnesota within 30 days
of graduation with the intent to remain in Minnesota.
(e) The 30-day residence requirement is met when:
(1) a minor child or a minor caregiver moves from another
state to the residence of a relative caregiver; and
(2) the minor caregiver applies for and receives family
cash assistance;
(3) the relative caregiver chooses not to be part of the
MFIP-S assistance unit; and
(4) the relative caregiver has resided in Minnesota for at
least 30 days prior to the date the assistance unit applies for
cash assistance.
(f) Ineligible mandatory unit members who have resided in
Minnesota for 12 months immediately before the unit's date of
application establish the other assistance unit members'
eligibility for the MFIP-S transitional standard.
(2) the relative caregiver has resided in Minnesota for at
least 30 consecutive days and:
(i) the minor caregiver applies for and receives MFIP; or
(ii) the relative caregiver applies for assistance for the
minor child but does not choose to be a member of the MFIP
assistance unit.
Sec. 18. Minnesota Statutes 1998, section 256J.14, is
amended to read:
256J.14 [ELIGIBILITY FOR PARENTING OR PREGNANT MINORS.]
(a) The definitions in this paragraph only apply to this
subdivision.
(1) "Household of a parent, legal guardian, or other adult
relative" means the place of residence of:
(i) a natural or adoptive parent;
(ii) a legal guardian according to appointment or
acceptance under section 260.242, 525.615, or 525.6165, and
related laws;
(iii) a caregiver as defined in section 256J.08,
subdivision 11; or
(iv) an appropriate adult relative designated by a county
agency.
(2) "Adult-supervised supportive living arrangement" means
a private family setting which assumes responsibility for the
care and control of the minor parent and minor child, or other
living arrangement, not including a public institution, licensed
by the commissioner of human services which ensures that the
minor parent receives adult supervision and supportive services,
such as counseling, guidance, independent living skills
training, or supervision.
(b) A minor parent and the minor child who is in the care
of the minor parent must reside in the household of a parent,
legal guardian, other adult relative, or in an adult-supervised
supportive living arrangement in order to receive MFIP-S MFIP
unless:
(1) the minor parent has no living parent, other adult
relative, or legal guardian whose whereabouts is known;
(2) no living parent, other adult relative, or legal
guardian of the minor parent allows the minor parent to live in
the parent's, other adult relative's, or legal guardian's home;
(3) the minor parent lived apart from the minor parent's
own parent or legal guardian for a period of at least one year
before either the birth of the minor child or the minor parent's
application for MFIP-S MFIP;
(4) the physical or emotional health or safety of the minor
parent or minor child would be jeopardized if the minor parent
and the minor child resided in the same residence with the minor
parent's parent, other adult relative, or legal guardian; or
(5) an adult supervised supportive living arrangement is
not available for the minor parent and child in the county in
which the minor parent and child currently reside. If an adult
supervised supportive living arrangement becomes available
within the county, the minor parent and child must reside in
that arrangement.
(c) The county agency shall inform minor applicants must be
informed both orally and in writing about the eligibility
requirements and, their rights and obligations under the MFIP-S
MFIP program, and any other applicable orientation information.
The county must advise the minor of the possible exemptions and
specifically ask whether one or more of these exemptions is
applicable. If the minor alleges one or more of these
exemptions, then the county must assist the minor in obtaining
the necessary verifications to determine whether or not these
exemptions apply.
(d) If the county worker has reason to suspect that the
physical or emotional health or safety of the minor parent or
minor child would be jeopardized if they resided with the minor
parent's parent, other adult relative, or legal guardian, then
the county worker must make a referral to child protective
services to determine if paragraph (b), clause (4), applies. A
new determination by the county worker is not necessary if one
has been made within the last six months, unless there has been
a significant change in circumstances which justifies a new
referral and determination.
(e) If a minor parent is not living with a parent, legal
guardian, or other adult relative due to paragraph (b), clause
(1), (2), or (4), the minor parent must reside, when possible,
in a living arrangement that meets the standards of paragraph
(a), clause (2).
(f) When a minor parent and minor child live with a parent,
other adult relative, legal guardian, or in an adult-supervised
supportive Regardless of living arrangement, MFIP-S MFIP must be
paid, when possible, in the form of a protective payment on
behalf of the minor parent and minor child according to section
256J.39, subdivisions 2 to 4.
Sec. 19. Minnesota Statutes 1998, section 256J.20,
subdivision 3, is amended to read:
Subd. 3. [OTHER PROPERTY LIMITATIONS.] To be eligible for
MFIP-S MFIP, the equity value of all nonexcluded real and
personal property of the assistance unit must not exceed $2,000
for applicants and $5,000 for ongoing participants. The value
of assets in clauses (1) to (20) must be excluded when
determining the equity value of real and personal property:
(1) a licensed vehicle up to a loan value of less than or
equal to $7,500. The county agency shall apply any excess loan
value as if it were equity value to the asset limit described in
this section. If the assistance unit owns more than one
licensed vehicle, the county agency shall determine the vehicle
with the highest loan value and count only the loan value over
$7,500, excluding: (i) the value of one vehicle per physically
disabled person when the vehicle is needed to transport the
disabled unit member; this exclusion does not apply to mentally
disabled people; (ii) the value of special equipment for a
handicapped member of the assistance unit; and (iii) any vehicle
used for long-distance travel, other than daily commuting, for
the employment of a unit member.
The county agency shall count the loan value of all other
vehicles and apply this amount as if it were equity value to the
asset limit described in this section. The value of special
equipment for a handicapped member of the assistance unit is
excluded. To establish the loan value of vehicles, a county
agency must use the N.A.D.A. Official Used Car Guide, Midwest
Edition, for newer model cars. When a vehicle is not listed in
the guidebook, or when the applicant or participant disputes the
loan value listed in the guidebook as unreasonable given the
condition of the particular vehicle, the county agency may
require the applicant or participant document the loan value by
securing a written statement from a motor vehicle dealer
licensed under section 168.27, stating the amount that the
dealer would pay to purchase the vehicle. The county agency
shall reimburse the applicant or participant for the cost of a
written statement that documents a lower loan value;
(2) the value of life insurance policies for members of the
assistance unit;
(3) one burial plot per member of an assistance unit;
(4) the value of personal property needed to produce earned
income, including tools, implements, farm animals, inventory,
business loans, business checking and savings accounts used at
least annually and used exclusively for the operation of a
self-employment business, and any motor vehicles if at least 50
percent of the vehicle's use is to produce income and if the
vehicles are essential for the self-employment business;
(5) the value of personal property not otherwise specified
which is commonly used by household members in day-to-day living
such as clothing, necessary household furniture, equipment, and
other basic maintenance items essential for daily living;
(6) the value of real and personal property owned by a
recipient of Supplemental Security Income or Minnesota
supplemental aid;
(7) the value of corrective payments, but only for the
month in which the payment is received and for the following
month;
(8) a mobile home or other vehicle used by an applicant or
participant as the applicant's or participant's home;
(9) money in a separate escrow account that is needed to
pay real estate taxes or insurance and that is used for this
purpose;
(10) money held in escrow to cover employee FICA, employee
tax withholding, sales tax withholding, employee worker
compensation, business insurance, property rental, property
taxes, and other costs that are paid at least annually, but less
often than monthly;
(11) monthly assistance, emergency assistance, and
diversionary payments for the current month's needs;
(12) the value of school loans, grants, or scholarships for
the period they are intended to cover;
(13) payments listed in section 256J.21, subdivision 2,
clause (9), which are held in escrow for a period not to exceed
three months to replace or repair personal or real property;
(14) income received in a budget month through the end of
the payment month;
(15) savings from earned income of a minor child or a minor
parent that are set aside in a separate account designated
specifically for future education or employment costs;
(16) the federal earned income credit, Minnesota working
family credit, state and federal income tax refunds, state
homeowners and renters credits under chapter 290A, property tax
rebates under Laws 1997, chapter 231, article 1, section 16, and
other federal or state tax rebates in the month received and the
following month;
(17) payments excluded under federal law as long as those
payments are held in a separate account from any nonexcluded
funds;
(18) money received by a participant of the corps to career
program under section 84.0887, subdivision 2, paragraph (b), as
a postservice benefit under the federal Americorps Act;
(19) the assets of children ineligible to receive MFIP-S
MFIP benefits because foster care or adoption assistance
payments are made on their behalf; and
(20) the assets of persons whose income is excluded under
section 256J.21, subdivision 2, clause (43).
Sec. 20. Minnesota Statutes 1998, section 256J.21,
subdivision 2, is amended to read:
Subd. 2. [INCOME EXCLUSIONS.] (a) The following must be
excluded in determining a family's available income:
(1) payments for basic care, difficulty of care, and
clothing allowances received for providing family foster care to
children or adults under Minnesota Rules, parts 9545.0010 to
9545.0260 and 9555.5050 to 9555.6265, and payments received and
used for care and maintenance of a third-party beneficiary who
is not a household member;
(2) reimbursements for employment training received through
the Job Training Partnership Act, United States Code, title 29,
chapter 19, sections 1501 to 1792b;
(3) reimbursement for out-of-pocket expenses incurred while
performing volunteer services, jury duty, or employment, or
informal carpooling arrangements directly related to employment;
(4) all educational assistance, except the county agency
must count graduate student teaching assistantships,
fellowships, and other similar paid work as earned income and,
after allowing deductions for any unmet and necessary
educational expenses, shall count scholarships or grants awarded
to graduate students that do not require teaching or research as
unearned income;
(5) loans, regardless of purpose, from public or private
lending institutions, governmental lending institutions, or
governmental agencies;
(6) loans from private individuals, regardless of purpose,
provided an applicant or participant documents that the lender
expects repayment;
(7)(i) state income tax refunds; and
(ii) federal income tax refunds;
(8)(i) federal earned income credits;
(ii) Minnesota working family credits;
(iii) state homeowners and renters credits under chapter
290A; and
(iv) property tax rebates under Laws 1997, chapter 231,
article 1, section 16; and
(v) other federal or state tax rebates;
(9) funds received for reimbursement, replacement, or
rebate of personal or real property when these payments are made
by public agencies, awarded by a court, solicited through public
appeal, or made as a grant by a federal agency, state or local
government, or disaster assistance organizations, subsequent to
a presidential declaration of disaster;
(10) the portion of an insurance settlement that is used to
pay medical, funeral, and burial expenses, or to repair or
replace insured property;
(11) reimbursements for medical expenses that cannot be
paid by medical assistance;
(12) payments by a vocational rehabilitation program
administered by the state under chapter 268A, except those
payments that are for current living expenses;
(13) in-kind income, including any payments directly made
by a third party to a provider of goods and services;
(14) assistance payments to correct underpayments, but only
for the month in which the payment is received;
(15) emergency assistance payments;
(16) funeral and cemetery payments as provided by section
256.935;
(17) nonrecurring cash gifts of $30 or less, not exceeding
$30 per participant in a calendar month;
(18) any form of energy assistance payment made through
Public Law Number 97-35, Low-Income Home Energy Assistance Act
of 1981, payments made directly to energy providers by other
public and private agencies, and any form of credit or rebate
payment issued by energy providers;
(19) Supplemental Security Income, including retroactive
payments;
(20) Minnesota supplemental aid, including retroactive
payments;
(21) proceeds from the sale of real or personal property;
(22) adoption assistance payments under section 259.67;
(23) state-funded family subsidy program payments made
under section 252.32 to help families care for children with
mental retardation or related conditions;
(24) interest payments and dividends from property that is
not excluded from and that does not exceed the asset limit;
(25) rent rebates;
(26) income earned by a minor caregiver or, minor child
through age 6, or a minor child who is at least a half-time
student in an approved elementary or secondary education
program;
(27) income earned by a caregiver under age 20 who is at
least a half-time student in an approved elementary or secondary
education program;
(28) MFIP-S MFIP child care payments under section 119B.05;
(29) all other payments made through MFIP-S MFIP to support
a caregiver's pursuit of greater self-support;
(30) income a participant receives related to shared living
expenses;
(31) reverse mortgages;
(32) benefits provided by the Child Nutrition Act of 1966,
United States Code, title 42, chapter 13A, sections 1771 to
1790;
(33) benefits provided by the women, infants, and children
(WIC) nutrition program, United States Code, title 42, chapter
13A, section 1786;
(34) benefits from the National School Lunch Act, United
States Code, title 42, chapter 13, sections 1751 to 1769e;
(35) relocation assistance for displaced persons under the
Uniform Relocation Assistance and Real Property Acquisition
Policies Act of 1970, United States Code, title 42, chapter 61,
subchapter II, section 4636, or the National Housing Act, United
States Code, title 12, chapter 13, sections 1701 to 1750jj;
(36) benefits from the Trade Act of 1974, United States
Code, title 19, chapter 12, part 2, sections 2271 to 2322;
(37) war reparations payments to Japanese Americans and
Aleuts under United States Code, title 50, sections 1989 to
1989d;
(38) payments to veterans or their dependents as a result
of legal settlements regarding Agent Orange or other chemical
exposure under Public Law Number 101-239, section 10405,
paragraph (a)(2)(E);
(39) income that is otherwise specifically excluded from
the MFIP-S program MFIP consideration in federal law, state law,
or federal regulation;
(40) security and utility deposit refunds;
(41) American Indian tribal land settlements excluded under
Public Law Numbers 98-123, 98-124, and 99-377 to the Mississippi
Band Chippewa Indians of White Earth, Leech Lake, and Mille Lacs
reservations and payments to members of the White Earth Band,
under United States Code, title 25, chapter 9, section 331, and
chapter 16, section 1407;
(42) all income of the minor parent's parent parents and
stepparent stepparents when determining the grant for the minor
parent in households that include a minor parent living with a
parent parents or stepparent stepparents on MFIP-S MFIP with
other children; and
(43) income of the minor parent's parent parents and
stepparent stepparents equal to 200 percent of the federal
poverty guideline for a family size not including the minor
parent and the minor parent's child in households that include a
minor parent living with a parent parents or stepparent
stepparents not on MFIP-S MFIP when determining the grant for
the minor parent. The remainder of income is deemed as
specified in section 256J.37, subdivision 1b;
(44) payments made to children eligible for relative
custody assistance under section 257.85;
(45) vendor payments for goods and services made on behalf
of a client unless the client has the option of receiving the
payment in cash; and
(46) the principal portion of a contract for deed payment.
Sec. 21. Minnesota Statutes 1998, section 256J.21,
subdivision 3, is amended to read:
Subd. 3. [INITIAL INCOME TEST.] The county agency shall
determine initial eligibility by considering all earned and
unearned income that is not excluded under subdivision 2. To be
eligible for MFIP-S MFIP, the assistance unit's countable income
minus the disregards in paragraphs (a) and (b) must be below the
transitional standard of assistance according to section 256J.24
for that size assistance unit.
(a) The initial eligibility determination must disregard
the following items:
(1) the employment disregard is 18 percent of the gross
earned income whether or not the member is working full time or
part time;
(2) dependent care costs must be deducted from gross earned
income for the actual amount paid for dependent care up to a
maximum of $200 per month for each child less than two years of
age, and $175 per month for each child two years of age and
older under this chapter and chapter 119B;
(3) all payments made according to a court order for
spousal support or the support of children not living in the
assistance unit's household shall be disregarded from the income
of the person with the legal obligation to pay support, provided
that, if there has been a change in the financial circumstances
of the person with the legal obligation to pay support since the
support order was entered, the person with the legal obligation
to pay support has petitioned for a modification of the support
order; and
(4) an allocation for the unmet need of an ineligible
spouse or an ineligible child under the age of 21 for whom the
caregiver is financially responsible and who lives with the
caregiver according to section 256J.36.
(b) Notwithstanding paragraph (a), when determining initial
eligibility for applicant units when at least one member has
received AFDC, family general assistance, MFIP, MFIP-R, work
first, or MFIP-S MFIP in this state within four months of the
most recent application for MFIP-S MFIP, apply the employment
disregard as defined in section 256J.08, subdivision 24, for all
unit members is 36 percent of the gross earned income.
After initial eligibility is established, the assistance
payment calculation is based on the monthly income test.
Sec. 22. Minnesota Statutes 1998, section 256J.21,
subdivision 4, is amended to read:
Subd. 4. [MONTHLY INCOME TEST AND DETERMINATION OF
ASSISTANCE PAYMENT.] The county agency shall determine ongoing
eligibility and the assistance payment amount according to the
monthly income test. To be eligible for MFIP-S MFIP, the result
of the computations in paragraphs (a) to (e) must be at least $1.
(a) Apply a 36 percent an income disregard as defined in
section 256J.08, subdivision 24, to gross earnings and subtract
this amount from the family wage level. If the difference is
equal to or greater than the transitional MFIP standard of need,
the assistance payment is equal to the transitional MFIP
standard of need. If the difference is less than
the transitional MFIP standard of need, the assistance payment
is equal to the difference. The employment disregard in this
paragraph must be deducted every month there is earned income.
(b) All payments made according to a court order for
spousal support or the support of children not living in the
assistance unit's household must be disregarded from the income
of the person with the legal obligation to pay support, provided
that, if there has been a change in the financial circumstances
of the person with the legal obligation to pay support since the
support order was entered, the person with the legal obligation
to pay support has petitioned for a modification of the court
order.
(c) An allocation for the unmet need of an ineligible
spouse or an ineligible child under the age of 21 for whom the
caregiver is financially responsible and who lives with the
caregiver must be made according to section 256J.36.
(d) Subtract unearned income dollar for dollar from
the transitional MFIP standard of need to determine the
assistance payment amount.
(e) When income is both earned and unearned, the amount of
the assistance payment must be determined by first treating
gross earned income as specified in paragraph (a). After
determining the amount of the assistance payment under paragraph
(a), unearned income must be subtracted from that amount dollar
for dollar to determine the assistance payment amount.
(f) When the monthly income is greater than the
transitional or family wage level MFIP standard of need after
applicable deductions and the income will only exceed the
standard for one month, the county agency must suspend the
assistance payment for the payment month.
Sec. 23. Minnesota Statutes 1998, section 256J.24,
subdivision 2, is amended to read:
Subd. 2. [MANDATORY ASSISTANCE UNIT COMPOSITION.] Except
for minor caregivers and their children who must be in a
separate assistance unit from the other persons in the
household, when the following individuals live together, they
must be included in the assistance unit:
(1) a minor child, including a pregnant minor;
(2) the minor child's minor siblings, minor half-siblings,
and minor step-siblings;
(3) the minor child's natural parents, adoptive parents,
and stepparents; and
(4) the spouse of a pregnant woman.
Sec. 24. Minnesota Statutes 1998, section 256J.24,
subdivision 3, is amended to read:
Subd. 3. [INDIVIDUALS WHO MUST BE EXCLUDED FROM AN
ASSISTANCE UNIT.] (a) The following individuals who are part of
the assistance unit determined under subdivision 2 are
ineligible to receive MFIP-S MFIP:
(1) individuals receiving Supplemental Security Income or
Minnesota supplemental aid;
(2) individuals living at home while performing
court-imposed, unpaid community service work due to a criminal
conviction;
(3) individuals disqualified from the food stamp program or
MFIP-S MFIP, until the disqualification ends;
(4) (3) children on whose behalf federal, state or local
foster care payments are made, except as provided in sections
256J.13, subdivision 2, and 256J.74, subdivision 2; and
(5) (4) children receiving ongoing monthly adoption
assistance payments under section 259.67.
(b) The exclusion of a person under this subdivision does
not alter the mandatory assistance unit composition.
Sec. 25. Minnesota Statutes 1998, section 256J.24,
subdivision 7, is amended to read:
Subd. 7. [FAMILY WAGE LEVEL STANDARD.] The family wage
level standard is 110 percent of the transitional standard under
subdivision 5 and is the standard used when there is earned
income in the assistance unit. As specified in section 256J.21,
earned income is subtracted from the family wage level to
determine the amount of the assistance payment. Not including
the family wage level standard, assistance payments may not
exceed the shared household standard or the transitional MFIP
standard of need for the assistance unit, whichever is less.
Sec. 26. Minnesota Statutes 1998, section 256J.24,
subdivision 8, is amended to read:
Subd. 8. [ASSISTANCE PAID TO ELIGIBLE ASSISTANCE UNITS.]
Except for assistance units where a nonparental caregiver is not
included in the grant, payments for shelter up to the amount of
the cash portion of MFIP-S MFIP benefits for which the
assistance unit is eligible shall be vendor paid for as many
months as the assistance unit is eligible or six months,
whichever comes first. The residual amount of the grant after
vendor payment, if any, must be paid to the MFIP-S MFIP
caregiver.
Sec. 27. Minnesota Statutes 1998, section 256J.24,
subdivision 9, is amended to read:
Subd. 9. [SHARED HOUSEHOLD STANDARD; MFIP-S MFIP.] (a)
Except as prohibited in paragraph (b), the county agency must
use the shared household standard when the household includes
one or more unrelated members, as that term is defined in
section 256J.08, subdivision 86a. The county agency must use
the shared household standard, unless a member of the assistance
unit is a victim of domestic violence and has an approved safety
plan, regardless of the number of unrelated members in the
household.
(b) The county agency must not use the shared household
standard when all unrelated members are one of the following:
(1) a recipient of public assistance benefits, including
food stamps, Supplemental Security Income, adoption assistance,
relative custody assistance, or foster care payments;
(2) a roomer or boarder, or a person to whom the assistance
unit is paying room or board;
(3) a minor child under the age of 18;
(4) a minor caregiver living with the minor caregiver's
parents or in an approved supervised living arrangement; or
(5) a caregiver who is not the parent of the minor child in
the assistance unit; or
(6) an individual who provides child care to a child in the
MFIP assistance unit.
(c) The shared household standard must be discontinued if
it is not approved by the United States Department of
Agriculture under the MFIP-S MFIP waiver.
Sec. 28. Minnesota Statutes 1998, section 256J.24, is
amended by adding a subdivision to read:
Subd. 10. [MFIP EXIT LEVEL.] (a) In state fiscal years
2000 and 2001, the commissioner shall adjust the MFIP earned
income disregard to ensure that most participants do not lose
eligibility for MFIP until their income reaches at least 120
percent of the federal poverty guidelines in effect in October
of each fiscal year. The adjustment to the disregard shall be
based on a household size of three, and the resulting earned
income disregard percentage must be applied to all household
sizes. The adjustment under this subdivision must be
implemented at the same time as the October food stamp
cost-of-living adjustment is reflected in the food portion of
MFIP transitional standard as required under subdivision 5a.
(b) In state fiscal year 2002 and thereafter, the earned
income disregard percentage must be the same as the percentage
implemented in October 2000.
Sec. 29. Minnesota Statutes 1998, section 256J.26,
subdivision 1, is amended to read:
Subdivision 1. [PERSON CONVICTED OF DRUG OFFENSES.] (a)
Applicants or participants who have been convicted of a drug
offense committed after July 1, 1997, may, if otherwise
eligible, receive AFDC or MFIP-S MFIP benefits subject to the
following conditions:
(1) Benefits for the entire assistance unit must be paid in
vendor form for shelter and utilities during any time the
applicant is part of the assistance unit.
(2) The convicted applicant or participant shall be subject
to random drug testing as a condition of continued eligibility
and following any positive test for an illegal controlled
substance is subject to the following sanctions:
(i) for failing a drug test the first time, the
participant's grant shall be reduced by ten percent of the
MFIP-S transitional MFIP standard of need, the shared household
standard, or the interstate transitional standard, whichever is
applicable prior to making vendor payments for shelter and
utility costs; or
(ii) for failing a drug test two or more times, the
residual amount of the participant's grant after making vendor
payments for shelter and utility costs, if any, must be reduced
by an amount equal to 30 percent of the MFIP-S transitional
standard, the shared household standard, or the interstate
transitional standard, whichever is applicable MFIP standard of
need.
(3) A participant who fails an initial drug test and is
under a sanction due to other MFIP program requirements is
subject to the sanction in clause (2)(ii).
(b) Applicants requesting only food stamps or participants
receiving only food stamps, who have been convicted of a drug
offense that occurred after July 1, 1997, may, if otherwise
eligible, receive food stamps if the convicted applicant or
participant is subject to random drug testing as a condition of
continued eligibility. Following a positive test for an illegal
controlled substance, the applicant is subject to the following
sanctions:
(1) for failing a drug test the first time, food stamps
shall be reduced by ten percent of the applicable food stamp
allotment; and
(2) for failing a drug test two or more times, food stamps
shall be reduced by an amount equal to 30 percent of the
applicable food stamp allotment.
(c) For the purposes of this subdivision, "drug offense"
means a conviction an offense that occurred after July 1, 1997,
of sections 152.021 to 152.025, 152.0261, or 152.096. Drug
offense also means a conviction in another jurisdiction of the
possession, use, or distribution of a controlled substance, or
conspiracy to commit any of these offenses, if the offense
occurred after July 1, 1997, and the conviction is a felony
offense in that jurisdiction, or in the case of New Jersey, a
high misdemeanor.
Sec. 30. Minnesota Statutes 1998, section 256J.30,
subdivision 2, is amended to read:
Subd. 2. [REQUIREMENT TO APPLY FOR OTHER BENEFITS.] An
applicant or participant must apply for, accept if eligible, and
follow through with appealing any denials of eligibility for
benefits from other programs for which the applicant or
participant is potentially eligible and which would, if
received, offset assistance payments. An applicant's or
participant's failure to complete application for these benefits
without good cause results in denial or termination of
assistance. Good cause for failure to apply for these benefits
is allowed when circumstances beyond the control of the
applicant or participant prevent the applicant or participant
from making an application.
Sec. 31. Minnesota Statutes 1998, section 256J.30,
subdivision 7, is amended to read:
Subd. 7. [DUE DATE OF MFIP-S MFIP HOUSEHOLD REPORT FORM.]
An MFIP-S MFIP household report form must be received by the
county agency by the eighth calendar day of the month following
the reporting period covered by the form. When the eighth
calendar day of the month falls on a weekend or holiday,
the MFIP-S MFIP household report form must be received by the
county agency the first working day that follows the eighth
calendar day. The county agency must send a notice of
termination because of a late or incomplete MFIP-S household
report form.
Sec. 32. Minnesota Statutes 1998, section 256J.30,
subdivision 8, is amended to read:
Subd. 8. [LATE MFIP-S MFIP HOUSEHOLD REPORT FORMS.]
Paragraphs (a) to (d) apply to the reporting requirements in
subdivision 7.
(a) When a caregiver submits the county agency receives an
incomplete MFIP-S MFIP household report form before the last
working day of the month on which a ten-day notice of
termination can be issued, the county agency must immediately
return the incomplete form on or before the ten-day notice
deadline or any previously sent ten-day notice of termination is
invalid and clearly state what the caregiver must do for the
form to be complete.
(b) When a complete MFIP-S household report form is not
received by a county agency before the last ten days of the
month in which the form is due, the county agency must send The
automated eligibility system must send a notice of proposed
termination of assistance to the assistance unit if a complete
MFIP household report form is not received by a county agency.
The automated notice must be mailed to the caregiver by
approximately the 16th of the month. When a caregiver submits
an incomplete form on or after the date a notice of proposed
termination has been sent, the termination is valid unless the
caregiver submits a complete form before the end of the month.
(c) An assistance unit required to submit an MFIP-S MFIP
household report form is considered to have continued its
application for assistance if a complete MFIP-S MFIP household
report form is received within a calendar month after the month
in which assistance was received the form was due and assistance
shall be paid for the period beginning with the first day of the
month in which the report was due that calendar month.
(d) A county agency must allow good cause exemptions from
the reporting requirements under subdivisions 5 and 6 when any
of the following factors cause a caregiver to fail to provide
the county agency with a completed MFIP-S MFIP household report
form before the end of the month in which the form is due:
(1) an employer delays completion of employment
verification;
(2) a county agency does not help a caregiver complete the
MFIP-S MFIP household report form when the caregiver asks for
help;
(3) a caregiver does not receive an MFIP-S MFIP household
report form due to mistake on the part of the department or the
county agency or due to a reported change in address;
(4) a caregiver is ill, or physically or mentally
incapacitated; or
(5) some other circumstance occurs that a caregiver could
not avoid with reasonable care which prevents the caregiver from
providing a completed MFIP-S MFIP household report form before
the end of the month in which the form is due.
Sec. 33. Minnesota Statutes 1998, section 256J.30,
subdivision 9, is amended to read:
Subd. 9. [CHANGES THAT MUST BE REPORTED.] A caregiver must
report the changes or anticipated changes specified in clauses
(1) to (16) (17) within ten days of the date they occur, within
ten days of the date the caregiver learns that the change will
occur, at the time of the periodic recertification of
eligibility under section 256J.32, subdivision 6, or within
eight calendar days of a reporting period as in subdivision 5 or
6, whichever occurs first. A caregiver must report other
changes at the time of the periodic recertification of
eligibility under section 256J.32, subdivision 6, or at the end
of a reporting period under subdivision 5 or 6, as applicable.
A caregiver must make these reports in writing to the county
agency. When a county agency could have reduced or terminated
assistance for one or more payment months if a delay in
reporting a change specified under clauses (1) to (16) had not
occurred, the county agency must determine whether a timely
notice under section 256J.31, subdivision 4, could have been
issued on the day that the change occurred. When a timely
notice could have been issued, each month's overpayment
subsequent to that notice must be considered a client error
overpayment under section 256J.38. Calculation of overpayments
for late reporting under clause (17) is specified in section
256J.09, subdivision 9. Changes in circumstances which must be
reported within ten days must also be reported on the MFIP-S
MFIP household report form for the reporting period in which
those changes occurred. Within ten days, a caregiver must
report:
(1) a change in initial employment;
(2) a change in initial receipt of unearned income;
(3) a recurring change in unearned income;
(4) a nonrecurring change of unearned income that exceeds
$30;
(5) the receipt of a lump sum;
(6) an increase in assets that may cause the assistance
unit to exceed asset limits;
(7) a change in the physical or mental status of an
incapacitated member of the assistance unit if the physical or
mental status is the basis of exemption from an MFIP-S work and
training MFIP employment services program;
(8) a change in employment status;
(9) a change in household composition, including births,
returns to and departures from the home of assistance unit
members and financially responsible persons, or a change in the
custody of a minor child information affecting an exception
under section 256J.24, subdivision 9;
(10) a change in health insurance coverage;
(11) the marriage or divorce of an assistance unit member;
(12) the death of a parent, minor child, or financially
responsible person;
(13) a change in address or living quarters of the
assistance unit;
(14) the sale, purchase, or other transfer of property;
(15) a change in school attendance of a custodial parent or
an employed child; and
(16) filing a lawsuit, a workers' compensation claim, or a
monetary claim against a third party; and
(17) a change in household composition, including births,
returns to and departures from the home of assistance unit
members and financially responsible persons, or a change in the
custody of a minor child.
Sec. 34. Minnesota Statutes 1998, section 256J.31,
subdivision 5,