Minnesota Legislature
Office of the Revisor of Statutes
Minnesota Session Laws - 2001, 1st Special Session
Key: (1) language to be deleted (2) new language
CHAPTER 9-S.F.No. 4
An act relating to the operation of state government;
modifying provisions relating to health; health
department; health care; human services; human
services department; continuing care; consumer
information; long-term care; mental health and civil
commitment; assistance programs; nursing services
agencies; workforce and recruitment; child welfare and
foster care; child support licensing and licensing
background studies; vital statistics; patient
protection; criminal justice; driving while impaired;
appropriating money for health and human services and
criminal justice; amending Minnesota Statutes 2000,
sections 13.46, subdivision 4; 13.461, subdivision 17;
13B.06, subdivision 7; 15A.083, subdivision 4; 45.027,
subdivision 6; 62A.095, subdivision 1; 62A.48,
subdivision 4, by adding subdivisions; 62D.17,
subdivision 1; 62J.152, subdivision 8; 62J.38;
62J.451, subdivision 5; 62J.692, subdivision 7, by
adding a subdivision; 62M.02, subdivision 21; 62Q.56;
62Q.58; 62S.01, by adding subdivisions; 62S.26;
103I.101, subdivision 6; 103I.112; 103I.208,
subdivisions 1, 2; 103I.235, subdivision 1; 103I.525,
subdivisions 2, 6, 8, 9; 103I.531, subdivisions 2, 6,
8, 9; 103I.535, subdivisions 2, 6, 8, 9; 103I.541,
subdivisions 2b, 4, 5; 103I.545; 116L.11, subdivision
4; 116L.12, subdivisions 4, 5; 116L.13, subdivision 1;
121A.15, by adding subdivisions; 135A.14, by adding a
subdivision; 137.38, subdivision 1; 144.057; 144.0721,
subdivision 1; 144.1202, subdivision 4; 144.122;
144.1464; 144.148, subdivision 2; 144.1491,
subdivision 1; 144.212, subdivisions 2a, 3, 5, 7, 8,
9, 11; 144.214, subdivisions 1, 3, 4; 144.215,
subdivisions 1, 3, 4, 6, 7; 144.217; 144.218; 144.221,
subdivisions 1, 3; 144.222, subdivision 2; 144.223;
144.225, subdivisions 1, 2, 2a, 3, 7, as amended;
144.226, subdivisions 1, 3, 4; 144.227; 144.395,
subdivision 2; 144.551, subdivision 1; 144.98,
subdivision 3; 144A.071, subdivisions 1, 1a, 2, 4a;
144A.073, subdivisions 2, as amended, 4; 144A.44,
subdivision 1; 144A.4605, subdivision 4; 144D.03,
subdivision 2; 144D.04, subdivisions 2, 3; 144D.06;
145.881, subdivision 2; 145A.15, subdivision 1, by
adding a subdivision; 145A.16, subdivision 1, by
adding a subdivision; 148.212; 148.284; 148B.21,
subdivision 6a; 148B.22, subdivision 3; 150A.10, by
adding a subdivision; 157.16, subdivision 3; 157.22,
as amended; 169A.07; 169A.20, subdivision 3; 169A.25;
169A.26; 169A.27; 169A.275; 169A.283, subdivision 1;
169A.40, subdivision 3; 169A.63, subdivision 1;
171.29, subdivision 2; 214.104; 241.272, subdivision
6; 241.32, by adding a subdivision; 241.45; 242.192;
243.51, subdivisions 1, 3; 245.462, subdivisions 8,
18, by adding subdivisions; 245.474, by adding a
subdivision; 245.4871, subdivisions 10, 27, by adding
a subdivision; 245.4875, subdivision 2; 245.4876,
subdivision 1, by adding a subdivision; 245.488, by
adding a subdivision; 245.4885, subdivision 1;
245.4886, subdivision 1; 245.814, subdivision 1;
245.99, subdivision 4; 245A.02, subdivisions 1, 9, by
adding a subdivision; 245A.03, subdivisions 2, 2b, by
adding a subdivision; 245A.035, subdivision 1;
245A.04, subdivisions 3, 3a, 3b, 3c, 3d, 6, 11, by
adding a subdivision; 245A.05; 245A.06; 245A.07;
245A.08; 245A.13, subdivisions 7, 8; 245A.16,
subdivision 1; 245B.08, subdivision 3; 252.275,
subdivision 4b; 252A.02, subdivisions 12, 13, by
adding a subdivision; 252A.111, subdivision 6;
252A.16, subdivision 1; 252A.19, subdivision 2;
252A.20, subdivision 1; 253B.02, subdivisions 10, 13;
253B.03, subdivisions 5, 10, by adding a subdivision;
253B.04, subdivisions 1, 1a, by adding a subdivision;
253B.045, subdivision 6; 253B.05, subdivision 1;
253B.065, subdivision 5; 253B.066, subdivision 1;
253B.07, subdivisions 1, 2, 7; 253B.09, subdivision 1;
253B.10, subdivision 4; 254B.02, subdivision 3;
254B.03, subdivision 1; 254B.04, subdivision 1;
254B.09, by adding a subdivision; 256.01, subdivisions
2, as amended, 18, by adding a subdivision; 256.045,
subdivisions 3, 3b, 4; 256.476, subdivisions 1, 2, 3,
4, 5, 8, by adding a subdivision; 256.741,
subdivisions 1, 5, 8; 256.955, subdivisions 2a, 2b;
256.9657, subdivision 2; 256.969, subdivision 3a, by
adding a subdivision; 256.975, by adding subdivisions;
256.979, subdivisions 5, 6; 256.98, subdivision 8;
256B.04, by adding a subdivision; 256B.055,
subdivision 3a; 256B.056, subdivisions 1a, 3, 4, 4b,
5, by adding subdivisions; 256B.057, subdivisions 2,
3, 7, 9, by adding a subdivision; 256B.0625,
subdivisions 3b, 7, 13, 13a, 17, 17a, 18a, 19a, 19c,
20, 30, 34, by adding subdivisions; 256B.0627,
subdivisions 1, 2, 4, 5, 7, 8, 10, 11, by adding
subdivisions; 256B.0635, subdivisions 1, 2; 256B.0644;
256B.0911, subdivisions 1, 3, 5, 6, 7, by adding
subdivisions; 256B.0913, subdivisions 1, 2, 4, 5, 6,
7, 8, 9, 10, 11, 12, 13, 14; 256B.0915, subdivisions
1d, 3, 5; 256B.0916, subdivisions 7, 9, by adding a
subdivision; 256B.0917, subdivision 7, by adding a
subdivision; 256B.092, subdivision 5; 256B.093,
subdivision 3; 256B.095; 256B.0951, subdivisions 1, 3,
4, 5, 7, by adding subdivisions; 256B.0952,
subdivisions 1, 4; 256B.19, subdivision 1c; 256B.431,
subdivisions 2e, 17, by adding subdivisions; 256B.433,
subdivision 3a; 256B.434, subdivision 4, by adding
subdivisions; 256B.49, by adding subdivisions;
256B.5012, by adding a subdivision; 256B.69,
subdivisions 4, 5c, 23, by adding a subdivision;
256B.75; 256B.76; 256D.03, subdivision 3; 256D.053,
subdivision 1; 256D.35, by adding subdivisions;
256D.425, subdivision 1; 256D.44, subdivision 5;
256I.05, subdivisions 1d, 1e, by adding a subdivision;
256J.08, subdivision 55a, by adding a subdivision;
256J.09, subdivisions 1, 2, 3, by adding subdivisions;
256J.21, subdivision 2; 256J.24, subdivisions 2, 9,
10; 256J.26, subdivision 1; 256J.31, subdivisions 4,
12; 256J.32, subdivisions 4, 7a; 256J.37, subdivision
9; 256J.39, subdivision 2; 256J.42, subdivisions 1, 3,
4, by adding a subdivision; 256J.45, subdivisions 1,
2; 256J.46, subdivisions 1, 2a; 256J.48, by adding a
subdivision; 256J.49, subdivisions 2, 13, by adding a
subdivision; 256J.50, subdivisions 1, 7, 10, by adding
a subdivision; 256J.515; 256J.52, subdivisions 2, 6;
256J.53, subdivision 1; 256J.56; 256J.57, subdivision
2; 256J.62, subdivisions 2a, 9; 256J.625, subdivisions
1, 2, 4; 256J.645; 256J.751; 256K.03, subdivision 1;
256K.07; 256K.25, subdivisions 1, 3, 4, 5, 6; 256L.03,
by adding a subdivision; 256L.05, subdivision 2;
256L.06, subdivision 3; 256L.07, subdivision 2;
256L.12, by adding a subdivision; 256L.15, subdivision
1; 256L.16; 256L.17, subdivision 2; 257.0725;
260C.201, subdivision 1, as amended; 260C.301,
subdivision 3, as amended; 260C.317, subdivision 4;
261.062; 268.0122, subdivision 2; 326.38; 357.021,
subdivisions 6, 7; 393.07, by adding a subdivision;
518.5513, subdivision 5; 518.575, subdivision 1;
518.5851, by adding a subdivision; 518.5853, by adding
a subdivision; 518.6111, subdivision 5; 518.6195;
518.64, subdivision 2, as amended; 518.641,
subdivisions 1, 2, 3, by adding a subdivision;
548.091, subdivision 1a; 611.23; 626.556, subdivisions
10, as amended, 10b, 10d, as amended, 10e, 10f, 10i,
as amended, 11, 12; 626.557, subdivisions 3, 9d, 12b;
626.5572, subdivision 17; 626.559, subdivision 2; Laws
1995, chapter 178, article 2, section 36; Laws 1995,
chapter 207, article 3, section 21, as amended; Laws
1997, chapter 203, article 9, section 21, as amended;
Laws 1999, chapter 152, section 1; Laws 1999, chapter
152, section 4; Laws 1999, chapter 245, article 3,
section 45, as amended; Laws 1999, chapter 245,
article 4, section 110; Laws 1999, chapter 245,
article 10, section 10, as amended; Laws 2000, chapter
364, section 2; Laws 2001, chapter 154, section 1,
subdivision 1; Laws 2001, chapter 161, section 45;
proposing coding for new law in Minnesota Statutes,
chapters 62D; 62Q; 62S; 116L; 144; 144A; 145; 145A;
169A; 214; 244; 245A; 246; 256; 256B; 256I; 256J;
299A; 325F; repealing Minnesota Statutes 2000,
sections 116L.12, subdivisions 2, 7; 121A.15,
subdivision 6; 144.148, subdivision 8; 144.1761;
144.217, subdivision 4; 144.219; 144A.16; 145.9245;
145.927; 252A.111, subdivision 3; 256.476, subdivision
7; 256B.0635, subdivision 3; 256B.0911, subdivisions
2, 2a, 4, 9; 256B.0912; 256B.0913, subdivisions 3,
15a, 15b, 15c, 16; 256B.0915, subdivisions 3a, 3b, 3c;
256B.0951, subdivision 6; 256B.19, subdivision 1b;
256B.434, subdivision 5; 256B.49, subdivisions 1, 2,
3, 4, 5, 6, 7, 8, 9, 10; 256D.066; 256J.08,
subdivision 50a; 256J.12, subdivision 3; 256J.43;
256J.44; 256J.46, subdivision 1a; 256J.49, subdivision
11; 256J.53, subdivision 4; 256L.02, subdivision 4;
518.641, subdivisions 4, 5; Laws 1995, chapter 178,
article 2, section 48, subdivision 6; Minnesota Rules,
parts 4655.6810; 4655.6820; 4655.6830; 4658.1600;
4658.1605; 4658.1610; 4658.1690; 9505.2390; 9505.2395;
9505.2396; 9505.2400; 9505.2405; 9505.2410; 9505.2413;
9505.2415; 9505.2420; 9505.2425; 9505.2426; 9505.2430;
9505.2435; 9505.2440; 9505.2445; 9505.2450; 9505.2455;
9505.2458; 9505.2460; 9505.2465; 9505.2470; 9505.2473;
9505.2475; 9505.2480; 9505.2485; 9505.2486; 9505.2490;
9505.2495; 9505.2496; 9505.2500; 9505.3010; 9505.3015;
9505.3020; 9505.3025; 9505.3030; 9505.3035; 9505.3040;
9505.3065; 9505.3085; 9505.3135; 9505.3500; 9505.3510;
9505.3520; 9505.3530; 9505.3535; 9505.3540; 9505.3545;
9505.3550; 9505.3560; 9505.3570; 9505.3575; 9505.3580;
9505.3585; 9505.3600; 9505.3610; 9505.3620; 9505.3622;
9505.3624; 9505.3626; 9505.3630; 9505.3635; 9505.3640;
9505.3645; 9505.3650; 9505.3660; 9505.3670; 9543.3000;
9543.3010; 9543.3020; 9543.3030; 9543.3040; 9543.3050;
9543.3060; 9543.3080; 9543.3090; 9546.0010; 9546.0020;
9546.0030; 9546.0040; 9546.0050; 9546.0060.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
DEPARTMENT OF HEALTH
Section 1. Minnesota Statutes 2000, section 62J.152,
subdivision 8, is amended to read:
Subd. 8. [REPEALER.] This section and sections 62J.15 and
62J.156 are repealed effective July 1, 2001 2005.
Sec. 2. Minnesota Statutes 2000, section 62J.451,
subdivision 5, is amended to read:
Subd. 5. [HEALTH CARE ELECTRONIC DATA INTERCHANGE
SYSTEM.] (a) The health data institute shall establish an
electronic data interchange system that electronically
transmits, collects, archives, and provides users of data with
the data necessary for their specific interests, in order to
promote a high quality, cost-effective, consumer-responsive
health care system. This public-private information system
shall be developed to make health care claims processing and
financial settlement transactions more efficient and to provide
an efficient, unobtrusive method for meeting the shared
electronic data interchange needs of consumers, group
purchasers, providers, and the state.
(b) The health data institute shall operate the Minnesota
center for health care electronic data interchange established
in section 62J.57, and shall integrate the goals, objectives,
and activities of the center with those of the health data
institute's electronic data interchange system.
Sec. 3. Minnesota Statutes 2000, section 103I.101,
subdivision 6, is amended to read:
Subd. 6. [FEES FOR VARIANCES.] The commissioner shall
charge a nonrefundable application fee of $120 $150 to cover the
administrative cost of processing a request for a variance or
modification of rules adopted by the commissioner under this
chapter.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 4. Minnesota Statutes 2000, section 103I.112, is
amended to read:
103I.112 [FEE EXEMPTIONS FOR STATE AND LOCAL GOVERNMENT.]
(a) The commissioner of health may not charge fees required
under this chapter to a federal agency, state agency, or a local
unit of government or to a subcontractor performing work for the
state agency or local unit of government.
(b) "Local unit of government" means a statutory or home
rule charter city, town, county, or soil and water conservation
district, watershed district, an organization formed for the
joint exercise of powers under section 471.59, a board of health
or community health board, or other special purpose district or
authority with local jurisdiction in water and related land
resources management.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 5. Minnesota Statutes 2000, section 103I.208,
subdivision 1, is amended to read:
Subdivision 1. [WELL NOTIFICATION FEE.] The well
notification fee to be paid by a property owner is:
(1) for a new well, $120 $150, which includes the state
core function fee;
(2) for a well sealing, $20 $30 for each well, which
includes the state core function fee, except that for monitoring
wells constructed on a single property, having depths within a
25 foot range, and sealed within 48 hours of start of
construction, a single fee of $20 $30; and
(3) for construction of a dewatering well, $120 $150, which
includes the state core function fee, for each well except a
dewatering project comprising five or more wells shall be
assessed a single fee of $600 $750 for the wells recorded on the
notification.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 6. Minnesota Statutes 2000, section 103I.208,
subdivision 2, is amended to read:
Subd. 2. [PERMIT FEE.] The permit fee to be paid by a
property owner is:
(1) for a well that is not in use under a maintenance
permit, $100 $125 annually;
(2) for construction of a monitoring well, $120 $150, which
includes the state core function fee;
(3) for a monitoring well that is unsealed under a
maintenance permit, $100 $125 annually;
(4) for monitoring wells used as a leak detection device at
a single motor fuel retail outlet, a single petroleum bulk
storage site excluding tank farms, or a single agricultural
chemical facility site, the construction permit fee
is $120 $150, which includes the state core function fee, per
site regardless of the number of wells constructed on the site,
and the annual fee for a maintenance permit for unsealed
monitoring wells is $100 $125 per site regardless of the number
of monitoring wells located on site;
(5) for a groundwater thermal exchange device, in addition
to the notification fee for wells, $120 $150, which includes the
state core function fee;
(6) for a vertical heat exchanger, $120 $150;
(7) for a dewatering well that is unsealed under a
maintenance permit, $100 $125 annually for each well, except a
dewatering project comprising more than five wells shall be
issued a single permit for $500 $625 annually for wells recorded
on the permit; and
(8) for excavating holes for the purpose of installing
elevator shafts, $120 $150 for each hole.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 7. Minnesota Statutes 2000, section 103I.235,
subdivision 1, is amended to read:
Subdivision 1. [DISCLOSURE OF WELLS TO BUYER.] (a) Before
signing an agreement to sell or transfer real property, the
seller must disclose in writing to the buyer information about
the status and location of all known wells on the property, by
delivering to the buyer either a statement by the seller that
the seller does not know of any wells on the property, or a
disclosure statement indicating the legal description and
county, and a map drawn from available information showing the
location of each well to the extent practicable. In the
disclosure statement, the seller must indicate, for each well,
whether the well is in use, not in use, or sealed.
(b) At the time of closing of the sale, the disclosure
statement information, name and mailing address of the buyer,
and the quartile, section, township, and range in which each
well is located must be provided on a well disclosure
certificate signed by the seller or a person authorized to act
on behalf of the seller.
(c) A well disclosure certificate need not be provided if
the seller does not know of any wells on the property and the
deed or other instrument of conveyance contains the statement:
"The Seller certifies that the Seller does not know of any wells
on the described real property."
(d) If a deed is given pursuant to a contract for deed, the
well disclosure certificate required by this subdivision shall
be signed by the buyer or a person authorized to act on behalf
of the buyer. If the buyer knows of no wells on the property, a
well disclosure certificate is not required if the following
statement appears on the deed followed by the signature of the
grantee or, if there is more than one grantee, the signature of
at least one of the grantees: "The Grantee certifies that the
Grantee does not know of any wells on the described real
property." The statement and signature of the grantee may be on
the front or back of the deed or on an attached sheet and an
acknowledgment of the statement by the grantee is not required
for the deed to be recordable.
(e) This subdivision does not apply to the sale, exchange,
or transfer of real property:
(1) that consists solely of a sale or transfer of severed
mineral interests; or
(2) that consists of an individual condominium unit as
described in chapters 515 and 515B.
(f) For an area owned in common under chapter 515 or 515B
the association or other responsible person must report to the
commissioner by July 1, 1992, the location and status of all
wells in the common area. The association or other responsible
person must notify the commissioner within 30 days of any change
in the reported status of wells.
(g) For real property sold by the state under section
92.67, the lessee at the time of the sale is responsible for
compliance with this subdivision.
(h) If the seller fails to provide a required well
disclosure certificate, the buyer, or a person authorized to act
on behalf of the buyer, may sign a well disclosure certificate
based on the information provided on the disclosure statement
required by this section or based on other available information.
(i) A county recorder or registrar of titles may not record
a deed or other instrument of conveyance dated after October 31,
1990, for which a certificate of value is required under section
272.115, or any deed or other instrument of conveyance dated
after October 31, 1990, from a governmental body exempt from the
payment of state deed tax, unless the deed or other instrument
of conveyance contains the statement made in accordance with
paragraph (c) or (d) or is accompanied by the well disclosure
certificate containing all the information required by paragraph
(b) or (d). The county recorder or registrar of titles must not
accept a certificate unless it contains all the required
information. The county recorder or registrar of titles shall
note on each deed or other instrument of conveyance accompanied
by a well disclosure certificate that the well disclosure
certificate was received. The notation must include the
statement "No wells on property" if the disclosure certificate
states there are no wells on the property. The well disclosure
certificate shall not be filed or recorded in the records
maintained by the county recorder or registrar of titles. After
noting "No wells on property" on the deed or other instrument of
conveyance, the county recorder or registrar of titles shall
destroy or return to the buyer the well disclosure certificate.
The county recorder or registrar of titles shall collect from
the buyer or the person seeking to record a deed or other
instrument of conveyance, a fee of $20 $30 for receipt of a
completed well disclosure certificate. By the tenth day of each
month, the county recorder or registrar of titles shall transmit
the well disclosure certificates to the commissioner of health.
By the tenth day after the end of each calendar quarter, the
county recorder or registrar of titles shall transmit to the
commissioner of health $17.50 $27.50 of the fee for each well
disclosure certificate received during the quarter. The
commissioner shall maintain the well disclosure certificate for
at least six years. The commissioner may store the certificate
as an electronic image. A copy of that image shall be as valid
as the original.
(j) No new well disclosure certificate is required under
this subdivision if the buyer or seller, or a person authorized
to act on behalf of the buyer or seller, certifies on the deed
or other instrument of conveyance that the status and number of
wells on the property have not changed since the last previously
filed well disclosure certificate. The following statement, if
followed by the signature of the person making the statement, is
sufficient to comply with the certification requirement of this
paragraph: "I am familiar with the property described in this
instrument and I certify that the status and number of wells on
the described real property have not changed since the last
previously filed well disclosure certificate." The
certification and signature may be on the front or back of the
deed or on an attached sheet and an acknowledgment of the
statement is not required for the deed or other instrument of
conveyance to be recordable.
(k) The commissioner in consultation with county recorders
shall prescribe the form for a well disclosure certificate and
provide well disclosure certificate forms to county recorders
and registrars of titles and other interested persons.
(l) Failure to comply with a requirement of this
subdivision does not impair:
(1) the validity of a deed or other instrument of
conveyance as between the parties to the deed or instrument or
as to any other person who otherwise would be bound by the deed
or instrument; or
(2) the record, as notice, of any deed or other instrument
of conveyance accepted for filing or recording contrary to the
provisions of this subdivision.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 8. Minnesota Statutes 2000, section 103I.525,
subdivision 2, is amended to read:
Subd. 2. [APPLICATION FEE.] The application fee for a well
contractor's license is $50 $75. The commissioner may not act
on an application until the application fee is paid.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 9. Minnesota Statutes 2000, section 103I.525,
subdivision 6, is amended to read:
Subd. 6. [LICENSE FEE.] The fee for a well contractor's
license is $250, except the fee for an individual well
contractor's license is $50 $75.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 10. Minnesota Statutes 2000, section 103I.525,
subdivision 8, is amended to read:
Subd. 8. [RENEWAL.] (a) A licensee must file an
application and a renewal application fee to renew the license
by the date stated in the license.
(b) The renewal application fee shall be set by the
commissioner under section 16A.1285 for a well contractor's
license is $250.
(c) The renewal application must include information that
the applicant has met continuing education requirements
established by the commissioner by rule.
(d) At the time of the renewal, the commissioner must have
on file all properly completed well reports, well sealing
reports, reports of excavations to construct elevator shafts,
well permits, and well notifications for work conducted by the
licensee since the last license renewal.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 11. Minnesota Statutes 2000, section 103I.525,
subdivision 9, is amended to read:
Subd. 9. [INCOMPLETE OR LATE RENEWAL.] If a licensee fails
to submit all information required for renewal in subdivision 8
or submits the application and information after the required
renewal date:
(1) the licensee must include an additional a late fee set
by the commissioner of $75; and
(2) the licensee may not conduct activities authorized by
the well contractor's license until the renewal application,
renewal application fee, late fee, and all other information
required in subdivision 8 are submitted.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 12. Minnesota Statutes 2000, section 103I.531,
subdivision 2, is amended to read:
Subd. 2. [APPLICATION FEE.] The application fee for a
limited well/boring contractor's license is $50 $75. The
commissioner may not act on an application until the application
fee is paid.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 13. Minnesota Statutes 2000, section 103I.531,
subdivision 6, is amended to read:
Subd. 6. [LICENSE FEE.] The fee for a limited well/boring
contractor's license is $50 $75.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 14. Minnesota Statutes 2000, section 103I.531,
subdivision 8, is amended to read:
Subd. 8. [RENEWAL.] (a) A person must file an application
and a renewal application fee to renew the limited well/boring
contractor's license by the date stated in the license.
(b) The renewal application fee shall be set by the
commissioner under section 16A.1285 for a limited well/boring
contractor's license is $75.
(c) The renewal application must include information that
the applicant has met continuing education requirements
established by the commissioner by rule.
(d) At the time of the renewal, the commissioner must have
on file all properly completed well sealing reports, well
permits, vertical heat exchanger permits, and well notifications
for work conducted by the licensee since the last license
renewal.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 15. Minnesota Statutes 2000, section 103I.531,
subdivision 9, is amended to read:
Subd. 9. [INCOMPLETE OR LATE RENEWAL.] If a licensee fails
to submit all information required for renewal in subdivision 8
or submits the application and information after the required
renewal date:
(1) the licensee must include an additional a late fee set
by the commissioner of $75; and
(2) the licensee may not conduct activities authorized by
the limited well/boring contractor's license until the renewal
application, renewal application fee, and late fee, and all
other information required in subdivision 8 are submitted.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 16. Minnesota Statutes 2000, section 103I.535,
subdivision 2, is amended to read:
Subd. 2. [APPLICATION FEE.] The application fee for an
elevator shaft contractor's license is $50 $75. The
commissioner may not act on an application until the application
fee is paid.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 17. Minnesota Statutes 2000, section 103I.535,
subdivision 6, is amended to read:
Subd. 6. [LICENSE FEE.] The fee for an elevator shaft
contractor's license is $50 $75.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 18. Minnesota Statutes 2000, section 103I.535,
subdivision 8, is amended to read:
Subd. 8. [RENEWAL.] (a) A person must file an application
and a renewal application fee to renew the license by the date
stated in the license.
(b) The renewal application fee shall be set by the
commissioner under section 16A.1285 for an elevator shaft
contractor's license is $75.
(c) The renewal application must include information that
the applicant has met continuing education requirements
established by the commissioner by rule.
(d) At the time of renewal, the commissioner must have on
file all reports and permits for elevator shaft work conducted
by the licensee since the last license renewal.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 19. Minnesota Statutes 2000, section 103I.535,
subdivision 9, is amended to read:
Subd. 9. [INCOMPLETE OR LATE RENEWAL.] If a licensee fails
to submit all information required for renewal in subdivision 8
or submits the application and information after the required
renewal date:
(1) the licensee must include an additional a late fee set
by the commissioner of $75; and
(2) the licensee may not conduct activities authorized by
the elevator shaft contractor's license until the renewal
application, renewal application fee, and late fee, and all
other information required in subdivision 8 are submitted.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 20. Minnesota Statutes 2000, section 103I.541,
subdivision 2b, is amended to read:
Subd. 2b. [APPLICATION FEE.] The application fee for a
monitoring well contractor registration is $50 $75. The
commissioner may not act on an application until the application
fee is paid.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 21. Minnesota Statutes 2000, section 103I.541,
subdivision 4, is amended to read:
Subd. 4. [RENEWAL.] (a) A person must file an application
and a renewal application fee to renew the registration by the
date stated in the registration.
(b) The renewal application fee shall be set by the
commissioner under section 16A.1285 for a monitoring well
contractor's registration is $75.
(c) The renewal application must include information that
the applicant has met continuing education requirements
established by the commissioner by rule.
(d) At the time of the renewal, the commissioner must have
on file all well reports, well sealing reports, well permits,
and notifications for work conducted by the registered person
since the last registration renewal.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 22. Minnesota Statutes 2000, section 103I.541,
subdivision 5, is amended to read:
Subd. 5. [INCOMPLETE OR LATE RENEWAL.] If a registered
person submits a renewal application after the required renewal
date:
(1) the registered person must include an additional a late
fee set by the commissioner of $75; and
(2) the registered person may not conduct activities
authorized by the monitoring well contractor's registration
until the renewal application, renewal application fee, late
fee, and all other information required in subdivision 4 are
submitted.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 23. Minnesota Statutes 2000, section 103I.545, is
amended to read:
103I.545 [REGISTRATION OF DRILLING MACHINES REQUIRED.]
Subdivision 1. [DRILLING MACHINE.] (a) A person may not
use a drilling machine such as a cable tool, rotary tool, hollow
rod tool, or auger for a drilling activity requiring a license
or registration under this chapter unless the drilling machine
is registered with the commissioner.
(b) A person must apply for the registration on forms
prescribed by the commissioner and submit a $50 $75 registration
fee.
(c) A registration is valid for one year.
Subd. 2. [PUMP HOIST.] (a) A person may not use a machine
such as a pump hoist for an activity requiring a license or
registration under this chapter to repair wells or borings, seal
wells or borings, or install pumps unless the machine is
registered with the commissioner.
(b) A person must apply for the registration on forms
prescribed by the commissioner and submit a $50 $75 registration
fee.
(c) A registration is valid for one year.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 24. Minnesota Statutes 2000, section 121A.15, is
amended by adding a subdivision to read:
Subd. 3a. [DISCLOSURES REQUIRED.] (a) This paragraph
applies to any written information about immunization
requirements for enrollment in a school or child care facility
that:
(1) is provided to a person to be immunized or enrolling or
enrolled in a school or child care facility, or to the person's
parent or guardian if the person is under 18 years of age and
not emancipated; and
(2) is provided by the department of health; the department
of children, families, and learning; the department of human
services; an immunization provider; or a school or child care
facility.
Such written information must describe the exemptions from
immunizations permitted under subdivision 3, paragraphs (c) and
(d). The information on exemptions from immunizations provided
according to this paragraph must be in a font size at least
equal to the font size of the immunization requirements, in the
same font style as the immunization requirements, and on the
same page of the written document as the immunization
requirements.
(b) Before immunizing a person, an immunization provider
must provide the person, or the person's parent or guardian if
the person is under 18 years of age and not emancipated, with
the following information in writing:
(1) a list of the immunizations required for enrollment in
a school or child care facility;
(2) a description of the exemptions from immunizations
permitted under subdivision 3, paragraphs (c) and (d);
(3) a list of additional immunizations currently
recommended by the commissioner; and
(4) in accordance with federal law, a copy of the vaccine
information sheet from the federal Department of Health and
Human Services that lists possible adverse reactions to the
immunization to be provided.
Sec. 25. Minnesota Statutes 2000, section 121A.15, is
amended by adding a subdivision to read:
Subd. 12. [MODIFICATIONS TO SCHEDULE.] (a) The
commissioner of health may adopt modifications to the
immunization requirements of this section. A proposed
modification made under this subdivision must be part of the
current immunization recommendations of each of the following
organizations: the United States Public Health Service's
Advisory Committee on Immunization Practices, the American
Academy of Family Physicians, and the American Academy of
Pediatrics. In proposing a modification to the immunization
schedule, the commissioner must:
(1) consult with the commissioner of children, families,
and learning; the commissioner of human services; the chancellor
of the Minnesota state colleges and universities; and the
president of the University of Minnesota; and
(2) consider the following criteria: the epidemiology of
the disease, the morbidity and mortality rates for the disease,
the safety and efficacy of the vaccine, the cost of a
vaccination program, the cost of enforcing vaccination
requirements, and a cost-benefit analysis of the vaccination.
(b) Before a proposed modification may be adopted, the
commissioner must notify the chairs of the house and senate
committees with jurisdiction over health policy issues. If the
chairs of the relevant standing committees determine a public
hearing regarding the proposed modifications is in order, the
hearing must be scheduled within 60 days of receiving notice
from the commissioner. If a hearing is scheduled, the
commissioner may not adopt any proposed modifications until
after the hearing is held.
(c) The commissioner shall comply with the requirements of
chapter 14 regarding the adoption of any proposed modifications
to the immunization schedule.
(d) In addition to the publication requirements of chapter
14, the commissioner of health must inform all immunization
providers of any adopted modifications to the immunization
schedule in a timely manner.
Sec. 26. Minnesota Statutes 2000, section 135A.14, is
amended by adding a subdivision to read:
Subd. 7. [MODIFICATIONS TO SCHEDULE.] (a) The commissioner
of health may adopt modifications to the immunization
requirements of this section. A proposed modification made
under this subdivision must be part of the current immunization
recommendations of each of the following organizations: the
United States Public Health Service's Advisory Committee on
Immunization Practices, the American Academy of Family
Physicians, and the American Academy of Pediatrics. In
proposing a modification to the immunization schedule, the
commissioner must:
(1) consult with the commissioner of children, families,
and learning; the commissioner of human services; the chancellor
of the Minnesota state colleges and universities; and the
president of the University of Minnesota; and
(2) consider the following criteria: the epidemiology of
the disease, the morbidity and mortality rates for the disease,
the safety and efficacy of the vaccine, the cost of a
vaccination program, the cost of enforcing vaccination
requirements, and a cost-benefit analysis of the vaccination.
(b) Before a proposed modification may be adopted, the
commissioner must notify the chairs of the house and senate
committees with jurisdiction over health policy issues. If the
chairs of the relevant standing committees determine a public
hearing regarding the proposed modifications is in order, the
hearing must be scheduled within 60 days of receiving notice
from the commissioner. If a hearing is scheduled, the
commissioner may not adopt any proposed modifications until
after the hearing is held.
(c) The commissioner shall comply with the requirements of
chapter 14 regarding the adoption of any proposed modifications
to the immunization schedule.
(d) In addition to the publication requirements of chapter
14, the commissioner of health must inform all immunization
providers of any adopted modifications to the immunization
schedule in a timely manner.
Sec. 27. [144.0751] [HEALTH STANDARDS.]
(a) Safe drinking water or air quality standards
established or revised by the commissioner of health must:
(1) be based on scientifically acceptable, peer-reviewed
information; and
(2) include a reasonable margin of safety to adequately
protect the health of infants, children, and adults by taking
into consideration risks to each of the following health
outcomes: reproductive development and function, respiratory
function, immunologic suppression or hypersensitization,
development of the brain and nervous system, endocrine
(hormonal) function, cancer, general infant and child
development, and any other important health outcomes identified
by the commissioner.
(b) For purposes of this section, "peer-reviewed" means a
scientifically based review conducted by individuals with
substantial knowledge and experience in toxicology, health risk
assessment, or other related fields as determined by the
commissioner.
Sec. 28. Minnesota Statutes 2000, section 144.1202,
subdivision 4, is amended to read:
Subd. 4. [AGREEMENT; CONDITIONS OF IMPLEMENTATION.] (a) An
agreement entered into before August 2, 2002 2003, 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 2003. If an
agreement is not entered into by August 1, 2002 2003, any rules
adopted under this section are repealed effective August 1, 2002
2003.
(b) An agreement authorized under subdivision 1 must be
approved by law before it may be implemented.
Sec. 29. [144.1205] [RADIOACTIVE MATERIAL; SOURCE AND
SPECIAL NUCLEAR MATERIAL; FEES; INSPECTION.]
Subdivision 1. [APPLICATION AND LICENSE RENEWAL FEE.] When
a license is required for radioactive material or source or
special nuclear material by a rule adopted under section
144.1202, subdivision 2, an application fee according to
subdivision 4 must be paid upon initial application for a
license. The licensee must renew the license 60 days before the
expiration date of the license by paying a license renewal fee
equal to the application fee under subdivision 4. The
expiration date of a license is the date set by the United
States Nuclear Regulatory Commission before transfer of the
licensing program under section 144.1202 and thereafter as
specified by rule of the commissioner of health.
Subd. 2. [ANNUAL FEE.] A licensee must pay an annual fee
at least 60 days before the anniversary date of the issuance of
the license. The annual fee is an amount equal to 80 percent of
the application fee under subdivision 4, rounded to the nearest
whole dollar.
Subd. 3. [FEE CATEGORIES; INCORPORATION OF FEDERAL
LICENSING CATEGORIES.] (a) Fee categories under this section are
equivalent to the licensing categories used by the United States
Nuclear Regulatory Commission under Code of Federal Regulations,
title 10, parts 30 to 36, 39, 40, 70, 71, and 150, except as
provided in paragraph (b).
(b) The category of "Academic, small" is the type of
license required for the use of radioactive materials in a
teaching institution. Radioactive materials are limited to ten
radionuclides not to exceed a total activity amount of one curie.
Subd. 4. [APPLICATION FEE.] A licensee must pay an
application fee as follows:
Radioactive material, Application U.S. Nuclear Regulatory
source and fee Commission licensing
special material category as reference
Type A broadscope $20,000 Medical institution type A
Type B broadscope $15,000 Research and development
type B
Type C broadscope $10,000 Academic type C
Medical use $4,000 Medical
Medical institution
Medical private practice
Mobile nuclear
medical laboratory $4,000 Mobile medical laboratory
Medical special use
sealed sources $6,000 Teletherapy
High dose rate remote
afterloaders
Stereotactic
radiosurgery devices
In vitro testing $2,300 In vitro testing
laboratories
Measuring gauge,
sealed sources $2,000 Fixed gauges
Portable gauges
Analytical instruments
Measuring systems - other
Gas chromatographs $1,200 Gas chromatographs
Manufacturing and
distribution $14,700 Manufacturing and
distribution - other
Distribution only $8,800 Distribution of
radioactive material
for commercial use only
Other services $1,500 Other services
Nuclear medicine
pharmacy $4,100 Nuclear pharmacy
Waste disposal $9,400 Waste disposal service
prepackage
Waste disposal service
processing/repackage
Waste storage only $7,000 To receive and store
radioactive material waste
Industrial
radiography $8,400 Industrial radiography
fixed location
Industrial radiography
portable/temporary sites
Irradiator -
self-shielded $4,100 Irradiators self-shielded
less than 10,000 curies
Irradiator -
less than 10,000 Ci $7,500 Irradiators less than
10,000 curies
Irradiator -
more than 10,000 Ci $11,500 Irradiators greater than
10,000 curies
Research and
development,
no distribution $4,100 Research and development
Radioactive material
possession only $1,000 Byproduct possession only
Source material $1,000 Source material shielding
Special nuclear
material, less than
200 grams $1,000 Special nuclear material
plutonium-neutron sources
less than 200 grams
Pacemaker
manufacturing $1,000 Pacemaker byproduct
and/or special nuclear
material - medical
institution
General license
distribution $2,100 General license
distribution
General license
distribution, exempt $1,500 General license
distribution -
certain exempt items
Academic, small $1,000 Possession limit of ten
radionuclides, not to
exceed a total of one curie
of activity
Veterinary $2,000 Veterinary use
Well logging $5,000 Well logging
Subd. 5. [PENALTY FOR LATE PAYMENT.] An annual fee or a
license renewal fee submitted to the commissioner after the due
date specified by rule must be accompanied by an additional
amount equal to 25 percent of the fee due.
Subd. 6. [INSPECTIONS.] The commissioner of health shall
make periodic safety inspections of the radioactive material and
source and special nuclear material of a licensee. The
commissioner shall prescribe the frequency of safety inspections
by rule.
Subd. 7. [RECOVERY OF REINSPECTION COST.] If the
commissioner finds serious violations of public health standards
during an inspection under subdivision 6, the licensee must pay
all costs associated with subsequent reinspection of the
source. The costs shall be the actual costs incurred by the
commissioner and include, but are not limited to, labor,
transportation, per diem, materials, legal fees, testing, and
monitoring costs.
Subd. 8. [RECIPROCITY FEE.] A licensee submitting an
application for reciprocal recognition of a materials license
issued by another agreement state or the United States Nuclear
Regulatory Commission for a period of 180 days or less during a
calendar year must pay one-half of the application fee specified
under subdivision 4. For a period of 181 days or more, the
licensee must pay the entire application fee under subdivision 4.
Subd. 9. [FEES FOR LICENSE AMENDMENTS.] A licensee must
pay a fee to amend a license as follows:
(1) to amend a license requiring no license review
including, but not limited to, facility name change or removal
of a previously authorized user, no fee;
(2) to amend a license requiring review including, but not
limited to, addition of isotopes, procedure changes, new
authorized users, or a new radiation safety officer, $200; and
(3) to amend a license requiring review and a site visit
including, but not limited to, facility move or addition of
processes, $400.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 30. Minnesota Statutes 2000, section 144.122, is
amended to read:
144.122 [LICENSE, PERMIT, AND SURVEY FEES.]
(a) The state commissioner of health, by rule, may
prescribe reasonable procedures and fees for filing with the
commissioner as prescribed by statute and for the issuance of
original and renewal permits, licenses, registrations, and
certifications issued under authority of the commissioner. The
expiration dates of the various licenses, permits,
registrations, and certifications as prescribed by the rules
shall be plainly marked thereon. Fees may include application
and examination fees and a penalty fee for renewal applications
submitted after the expiration date of the previously issued
permit, license, registration, and certification. The
commissioner may also prescribe, by rule, reduced fees for
permits, licenses, registrations, and certifications when the
application therefor is submitted during the last three months
of the permit, license, registration, or certification period.
Fees proposed to be prescribed in the rules shall be first
approved by the department of finance. All fees proposed to be
prescribed in rules shall be reasonable. The fees shall be in
an amount so that the total fees collected by the commissioner
will, where practical, approximate the cost to the commissioner
in administering the program. All fees collected shall be
deposited in the state treasury and credited to the state
government special revenue fund unless otherwise specifically
appropriated by law for specific purposes.
(b) The commissioner may charge a fee for voluntary
certification of medical laboratories and environmental
laboratories, and for environmental and medical laboratory
services provided by the department, without complying with
paragraph (a) or chapter 14. Fees charged for environment and
medical laboratory services provided by the department must be
approximately equal to the costs of providing the services.
(c) The commissioner may develop a schedule of fees for
diagnostic evaluations conducted at clinics held by the services
for children with handicaps program. All receipts generated by
the program are annually appropriated to the commissioner for
use in the maternal and child health program.
(d) The commissioner, for fiscal years 1996 and beyond,
shall set license fees for hospitals and nursing homes that are
not boarding care homes at the following levels:
Joint Commission on Accreditation of Healthcare
Organizations (JCAHO hospitals) $1,017
$7,055
Non-JCAHO hospitals $762 plus $34 per bed
$4,680 plus $234 per bed
Nursing home $78 plus $19 per bed
$183 plus $91 per bed
For fiscal years 1996 and beyond, The commissioner shall
set license fees for outpatient surgical centers, boarding care
homes, and supervised living facilities at the following levels:
Outpatient surgical centers $517
$1,512
Boarding care homes $78 plus $19 per bed
$183 plus $91 per bed
Supervised living facilities $78 plus $19 per bed
$183 plus $91 per bed.
(e) Unless prohibited by federal law, the commissioner of
health shall charge applicants the following fees to cover the
cost of any initial certification surveys required to determine
a provider's eligibility to participate in the Medicare or
Medicaid program:
Prospective payment surveys for $ 900
hospitals
Swing bed surveys for nursing homes $1,200
Psychiatric hospitals $1,400
Rural health facilities $1,100
Portable X-ray providers $ 500
Home health agencies $1,800
Outpatient therapy agencies $ 800
End stage renal dialysis providers $2,100
Independent therapists $ 800
Comprehensive rehabilitation $1,200
outpatient facilities
Hospice providers $1,700
Ambulatory surgical providers $1,800
Hospitals $4,200
Other provider categories or Actual surveyor costs:
additional resurveys required average surveyor cost x
to complete initial certification number of hours for the
survey process.
These fees shall be submitted at the time of the
application for federal certification and shall not be
refunded. All fees collected after the date that the imposition
of fees is not prohibited by federal law shall be deposited in
the state treasury and credited to the state government special
revenue fund.
Sec. 31. Minnesota Statutes 2000, section 144.1464, is
amended to read:
144.1464 [SUMMER HEALTH CARE INTERNS.]
Subdivision 1. [SUMMER INTERNSHIPS.] The commissioner of
health, through a contract with a nonprofit organization as
required by subdivision 4, shall award grants to hospitals and,
clinics, nursing facilities, and home care providers to
establish a secondary and post-secondary summer health care
intern program. The purpose of the program is to expose
interested secondary and post-secondary pupils to various
careers within the health care profession.
Subd. 2. [CRITERIA.] (a) The commissioner, through the
organization under contract, shall award grants to
hospitals and, clinics, nursing facilities, and home care
providers that agree to:
(1) provide secondary and post-secondary summer health care
interns with formal exposure to the health care profession;
(2) provide an orientation for the secondary and
post-secondary summer health care interns;
(3) pay one-half the costs of employing the secondary and
post-secondary summer health care intern, based on an overall
hourly wage that is at least the minimum wage but does not
exceed $6 an hour;
(4) interview and hire secondary and post-secondary pupils
for a minimum of six weeks and a maximum of 12 weeks; and
(5) employ at least one secondary student for each
post-secondary student employed, to the extent that there are
sufficient qualifying secondary student applicants.
(b) In order to be eligible to be hired as a secondary
summer health intern by a hospital or, clinic, nursing facility,
or home care provider, a pupil must:
(1) intend to complete high school graduation requirements
and be between the junior and senior year of high school; and
(2) be from a school district in proximity to the facility;
and
(3) provide the facility with a letter of recommendation
from a health occupations or science educator.
(c) In order to be eligible to be hired as a post-secondary
summer health care intern by a hospital or clinic, a pupil must:
(1) intend to complete a health care training program or a
two-year or four-year degree program and be planning on
enrolling in or be enrolled in that training program or degree
program; and
(2) be enrolled in a Minnesota educational institution or
be a resident of the state of Minnesota; priority must be given
to applicants from a school district or an educational
institution in proximity to the facility; and
(3) provide the facility with a letter of recommendation
from a health occupations or science educator.
(d) Hospitals and, clinics, nursing facilities, and home
care providers awarded grants may employ pupils as secondary and
post-secondary summer health care interns beginning on or after
June 15, 1993, if they agree to pay the intern, during the
period before disbursement of state grant money, with money
designated as the facility's 50 percent contribution towards
internship costs.
Subd. 3. [GRANTS.] The commissioner, through the
organization under contract, shall award separate grants to
hospitals and, clinics, nursing facilities, and home care
providers meeting the requirements of subdivision 2. The grants
must be used to pay one-half of the costs of employing secondary
and post-secondary pupils in a hospital or, clinic, nursing
facility, or home care setting during the course of the
program. No more than 50 percent of the participants may be
post-secondary students, unless the program does not receive
enough qualified secondary applicants per fiscal year. No more
than five pupils may be selected from any secondary or
post-secondary institution to participate in the program and no
more than one-half of the number of pupils selected may be from
the seven-county metropolitan area.
Subd. 4. [CONTRACT.] The commissioner shall contract with
a statewide, nonprofit organization representing facilities at
which secondary and post-secondary summer health care interns
will serve, to administer the grant program established by this
section. Grant funds that are not used in one fiscal year may
be carried over to the next fiscal year. The organization
awarded the grant shall provide the commissioner with any
information needed by the commissioner to evaluate the program,
in the form and at the times specified by the commissioner.
Sec. 32. Minnesota Statutes 2000, section 144.148,
subdivision 2, is amended to read:
Subd. 2. [PROGRAM.] (a) The commissioner of health shall
award rural hospital capital improvement grants to eligible
rural hospitals. Except as provided in paragraph (b), a grant
shall not exceed $300,000 $500,000 per hospital. 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.
(b) A grant shall not exceed $1,500,000 per eligible rural
hospital that also satisfies the following criteria:
(1) is the only hospital in a county;
(2) has 25 or fewer licensed hospital beds with a net
hospital operating margin not greater than an average of two
percent over the three fiscal years prior to application;
(3) is located in a medically underserved community (MUC)
or a health professional shortage area (HPSA);
(4) is located near a migrant worker employment site and
regularly treats significant numbers of migrant workers and
their families; and
(5) has not previously received a grant under this section
prior to July 1, 1999.
Sec. 33. [144.1499] [PROMOTION OF HEALTH CARE AND
LONG-TERM CARE CAREERS.]
The commissioner of health, in consultation with an
organization representing health care employers, long-term care
employers, and educational institutions, may make grants to
qualifying consortia as defined in section 116L.11, subdivision
4, for intergenerational programs to encourage middle and high
school students to work and volunteer in health care and
long-term care settings. To qualify for a grant under this
section, a consortium shall:
(1) develop a health and long-term care careers curriculum
that provides career exploration and training in national skill
standards for health care and long-term care and that is
consistent with Minnesota graduation standards and other related
requirements;
(2) offer programs for high school students that provide
training in health and long-term care careers with credits that
articulate into post-secondary programs; and
(3) provide technical support to the participating health
care and long-term care employer to enable the use of the
employer's facilities and programs for kindergarten to grade 12
health and long-term care careers education.
Sec. 34. [144.1502] [DENTISTS LOAN FORGIVENESS.]
Subdivision 1. [DEFINITION.] For purposes of this section,
"qualifying educational loans" means government, commercial, and
foundation loans for actual costs paid for tuition, reasonable
education expenses, and reasonable living expenses related to
the graduate or undergraduate education of a dentist.
Subd. 2. [CREATION OF ACCOUNT; LOAN FORGIVENESS
PROGRAM.] A dentist education account is established in the
general fund. The commissioner of health shall use money from
the account to establish a loan forgiveness program for dentists
who agree to care for substantial numbers of state public
program participants and other low- to moderate-income uninsured
patients.
Subd. 3. [ELIGIBILITY.] To be eligible to participate in
the loan forgiveness program, a dental student must submit an
application to the commissioner of health while attending a
program of study designed to prepare the individual to become a
licensed dentist. For fiscal year 2002, applicants may have
graduated from a dentistry program in calendar year 2001. A
dental student who is accepted into the loan forgiveness program
must sign a contract to agree to serve a minimum three-year
service obligation during which at least 25 percent of the
dentist's yearly patient encounters are delivered to state
public program enrollees or patients receiving sliding fee
schedule discounts through a formal sliding fee schedule meeting
the standards established by the United States Department of
Health and Human Services under Code of Federal Regulations,
title 42, section 51, chapter 303. The service obligation shall
begin no later than March 31 of the first year following
completion of training. If fewer applications are submitted by
dental students than there are participant slots available, the
commissioner may consider applications submitted by dental
program graduates who are licensed dentists. Dentists selected
for loan forgiveness must comply with all terms and conditions
of this section.
Subd. 4. [LOAN FORGIVENESS.] The commissioner of health
may accept up to 14 applicants per year for participation in the
loan forgiveness program. Applicants are responsible for
securing their own loans. The commissioner shall select
participants based on their suitability for practice serving
public program patients, as indicated by experience or
training. The commissioner shall give preference to applicants
who have attended a Minnesota dentistry educational institution
and to applicants closest to completing their training. For
each year that a participant meets the service obligation
required under subdivision 3, up to a maximum of four years, the
commissioner shall make annual disbursements directly to the
participant equivalent to $10,000 per year of service, not to
exceed $40,000 or the balance of the qualifying educational
loans, whichever is less. Before receiving loan repayment
disbursements and as requested, the participant must complete
and return to the commissioner an affidavit of practice form
provided by the commissioner verifying that the participant is
practicing as required under subdivision 3. The participant
must provide the commissioner with verification that the full
amount of loan repayment disbursement received by the
participant has been applied toward the designated loans. After
each disbursement, verification must be received by the
commissioner and approved before the next loan repayment
disbursement is made. Participants who move their practice
remain eligible for loan repayment as long as they practice as
required under subdivision 3.
Subd. 5. [PENALTY FOR NONFULFILLMENT.] If a participant
does not fulfill the service commitment under subdivision 3, the
commissioner of health shall collect from the participant 100
percent of any payments made for qualified educational loans and
interest at a rate established according to section 270.75. The
commissioner shall deposit the money collected in the dentist
education account established under subdivision 2.
Subd. 6. [SUSPENSION OR WAIVER OF OBLIGATION.] Payment or
service obligations cancel in the event of a participant's
death. The commissioner of health may waive or suspend payment
or service obligations in cases of total and permanent
disability or long-term temporary disability lasting for more
than two years. The commissioner shall evaluate all other
requests for suspension or waivers on a case-by-case basis and
may grant a waiver of all or part of the money owed as a result
of a nonfulfillment penalty if emergency circumstances prevented
fulfillment of the required service commitment.
Sec. 35. Minnesota Statutes 2000, section 144.226,
subdivision 4, is amended to read:
Subd. 4. [VITAL RECORDS SURCHARGE.] In addition to any fee
prescribed under subdivision 1, there is a nonrefundable
surcharge of $3 $2 for each certified and noncertified birth or
death record, and for a certification that the record cannot be
found. The local or state registrar shall forward this amount
to the state treasurer to be deposited into the state government
special revenue fund. This surcharge shall not be charged under
those circumstances in which no fee for a birth or death record
is permitted under subdivision 1, paragraph (a). This surcharge
requirement expires June 30, 2002.
Sec. 36. Minnesota Statutes 2000, section 144.395,
subdivision 2, is amended to read:
Subd. 2. [EXPENDITURES.] (a) Up to five percent of the
fair market value of the fund on the preceding July 1, must be
spent to reduce the human and economic consequences of tobacco
use among the youth of this state through state and local
tobacco prevention measures and efforts, and for other public
health initiatives.
(b) Notwithstanding paragraph (a), on January 1, 2000, up
to five percent of the fair market value of the fund is
appropriated to the commissioner of health to distribute as
grants under section 144.396, subdivisions 5 and 6, in
accordance with allocations in paragraph (c), clauses (1) and
(2). Up to $200,000 of this appropriation is available to the
commissioner to conduct the statewide assessments described in
section 144.396, subdivision 3.
(c) Beginning July 1, 2000, and on July 1 of each year
thereafter, the money in paragraph (a) is appropriated as
follows, except as provided in paragraphs (d) and (e):
(1) 67 percent to the commissioner of health to distribute
as grants under section 144.396, subdivision 5, to fund
statewide tobacco use prevention initiatives aimed at youth;
(2) 16.5 percent to the commissioner of health to
distribute as grants under section 144.396, subdivision 6, to
fund local public health initiatives aimed at tobacco use
prevention in coordination with other local health-related
efforts to achieve measurable improvements in health among
youth; and
(3) 16.5 percent to the commissioner of health to
distribute in accordance with section 144.396, subdivision 7.
(d) A maximum of $150,000 of each annual appropriation to
the commissioner of health in paragraphs (b) and (c) may be used
by the commissioner for administrative expenses associated with
implementing this section.
(e) Beginning July 1, 2001, $1,100,000 $1,250,000 of each
annual appropriation to the commissioner under paragraph (c),
clause (1), may be used to provide base level funding for the
commissioner's tobacco prevention and control programs and
activities. This appropriation must occur before any other
appropriation under this subdivision.
Sec. 37. Minnesota Statutes 2000, section 144.551,
subdivision 1, is amended to read:
Subdivision 1. [RESTRICTED CONSTRUCTION OR MODIFICATION.]
(a) The following construction or modification may not be
commenced:
(1) any erection, building, alteration, reconstruction,
modernization, improvement, extension, lease, or other
acquisition by or on behalf of a hospital that increases the bed
capacity of a hospital, relocates hospital beds from one
physical facility, complex, or site to another, or otherwise
results in an increase or redistribution of hospital beds within
the state; and
(2) the establishment of a new hospital.
(b) This section does not apply to:
(1) construction or relocation within a county by a
hospital, clinic, or other health care facility that is a
national referral center engaged in substantial programs of
patient care, medical research, and medical education meeting
state and national needs that receives more than 40 percent of
its patients from outside the state of Minnesota;
(2) a project for construction or modification for which a
health care facility held an approved certificate of need on May
1, 1984, regardless of the date of expiration of the
certificate;
(3) a project for which a certificate of need was denied
before July 1, 1990, if a timely appeal results in an order
reversing the denial;
(4) a project exempted from certificate of need
requirements by Laws 1981, chapter 200, section 2;
(5) a project involving consolidation of pediatric
specialty hospital services within the Minneapolis-St. Paul
metropolitan area that would not result in a net increase in the
number of pediatric specialty hospital beds among the hospitals
being consolidated;
(6) a project involving the temporary relocation of
pediatric-orthopedic hospital beds to an existing licensed
hospital that will allow for the reconstruction of a new
philanthropic, pediatric-orthopedic hospital on an existing site
and that will not result in a net increase in the number of
hospital beds. Upon completion of the reconstruction, the
licenses of both hospitals must be reinstated at the capacity
that existed on each site before the relocation;
(7) the relocation or redistribution of hospital beds
within a hospital building or identifiable complex of buildings
provided the relocation or redistribution does not result in:
(i) an increase in the overall bed capacity at that site; (ii)
relocation of hospital beds from one physical site or complex to
another; or (iii) redistribution of hospital beds within the
state or a region of the state;
(8) relocation or redistribution of hospital beds within a
hospital corporate system that involves the transfer of beds
from a closed facility site or complex to an existing site or
complex provided that: (i) no more than 50 percent of the
capacity of the closed facility is transferred; (ii) the
capacity of the site or complex to which the beds are
transferred does not increase by more than 50 percent; (iii) the
beds are not transferred outside of a federal health systems
agency boundary in place on July 1, 1983; and (iv) the
relocation or redistribution does not involve the construction
of a new hospital building;
(9) a construction project involving up to 35 new beds in a
psychiatric hospital in Rice county that primarily serves
adolescents and that receives more than 70 percent of its
patients from outside the state of Minnesota;
(10) a project to replace a hospital or hospitals with a
combined licensed capacity of 130 beds or less if: (i) the new
hospital site is located within five miles of the current site;
and (ii) the total licensed capacity of the replacement
hospital, either at the time of construction of the initial
building or as the result of future expansion, will not exceed
70 licensed hospital beds, or the combined licensed capacity of
the hospitals, whichever is less;
(11) the relocation of licensed hospital beds from an
existing state facility operated by the commissioner of human
services to a new or existing facility, building, or complex
operated by the commissioner of human services; from one
regional treatment center site to another; or from one building
or site to a new or existing building or site on the same
campus;
(12) the construction or relocation of hospital beds
operated by a hospital having a statutory obligation to provide
hospital and medical services for the indigent that does not
result in a net increase in the number of hospital beds; or
(13) a construction project involving the addition of up to
31 new beds in an existing nonfederal hospital in Beltrami
county; or
(14) a construction project involving the addition of up to
eight new beds in an existing nonfederal hospital in Otter Tail
county with 100 licensed acute care beds.
Sec. 38. Minnesota Statutes 2000, section 144.98,
subdivision 3, is amended to read:
Subd. 3. [FEES.] (a) An application for certification
under subdivision 1 must be accompanied by the biennial fee
specified in this subdivision. The fees are for:
(1) nonrefundable base certification fee, $500 $1,200; and
(2) test category certification fees:
Test Category Certification Fee
Clean water program bacteriology $200 $600
Safe drinking water program bacteriology $600
Clean water program inorganic chemistry,
fewer than four constituents $100 $600
Safe drinking water program inorganic chemistry,
four or more constituents $300 $600
Clean water program chemistry metals,
fewer than four constituents $200 $800
Safe drinking water program chemistry metals,
four or more constituents $500 $800
Resource conservation and recovery program
chemistry metals $800
Clean water program volatile organic compounds $600 $1,200
Safe drinking water program
volatile organic compounds $1,200
Resource conservation and recovery program
volatile organic compounds $1,200
Underground storage tank program
volatile organic compounds $1,200
Clean water program other organic compounds $600 $1,200
Safe drinking water program other organic compounds $1,200
Resource conservation and recovery program
other organic compounds $1,200
(b) The total biennial certification fee is the base fee
plus the applicable test category fees. The biennial
certification fee for a contract laboratory is 1.5 times the
total certification fee.
(c) Laboratories located outside of this state that require
an on-site survey will be assessed an additional $1,200 $2,500
fee.
(d) Fees must be set so that the total fees support the
laboratory certification program. Direct costs of the
certification service include program administration,
inspections, the agency's general support costs, and attorney
general costs attributable to the fee function.
(e) A change fee shall be assessed if a laboratory requests
additional analytes or methods at any time other than when
applying for or renewing its certification. The change fee is
equal to the test category certification fee for the analyte.
(f) A variance fee shall be assessed if a laboratory
requests and is granted a variance from a rule adopted under
this section. The variance fee is $500 per variance.
(g) Refunds or credits shall not be made for analytes or
methods requested but not approved.
(h) Certification of a laboratory shall not be awarded
until all fees are paid.
Sec. 39. Minnesota Statutes 2000, section 144A.44,
subdivision 1, is amended to read:
Subdivision 1. [STATEMENT OF RIGHTS.] A person who
receives home care services has these rights:
(1) the right to receive written information about rights
in advance of receiving care or during the initial evaluation
visit before the initiation of treatment, including what to do
if rights are violated;
(2) the right to receive care and services according to a
suitable and up-to-date plan, and subject to accepted medical or
nursing standards, to take an active part in creating and
changing the plan and evaluating care and services;
(3) the right to be told in advance of receiving care about
the services that will be provided, the disciplines that will
furnish care, the frequency of visits proposed to be furnished,
other choices that are available, and the consequences of these
choices including the consequences of refusing these services;
(4) the right to be told in advance of any change in the
plan of care and to take an active part in any change;
(5) the right to refuse services or treatment;
(6) the right to know, in advance, any limits to the
services available from a provider, and the provider's grounds
for a termination of services;
(7) the right to know in advance of receiving care whether
the services are covered by health insurance, medical
assistance, or other health programs, the charges for services
that will not be covered by Medicare, and the charges that the
individual may have to pay;
(8) the right to know what the charges are for services, no
matter who will be paying the bill;
(9) the right to know that there may be other services
available in the community, including other home care services
and providers, and to know where to go for information about
these services;
(10) the right to choose freely among available providers
and to change providers after services have begun, within the
limits of health insurance, medical assistance, or other health
programs;
(11) the right to have personal, financial, and medical
information kept private, and to be advised of the provider's
policies and procedures regarding disclosure of such
information;
(12) the right to be allowed access to records and written
information from records in accordance with section 144.335;
(13) the right to be served by people who are properly
trained and competent to perform their duties;
(14) the right to be treated with courtesy and respect, and
to have the patient's property treated with respect;
(15) the right to be free from physical and verbal abuse;
(16) the right to reasonable, advance notice of changes in
services or charges, including at least ten days' advance notice
of the termination of a service by a provider, except in cases
where:
(i) the recipient of services engages in conduct that
alters the conditions of employment as specified in the
employment contract between the home care provider and the
individual providing home care services, or creates an abusive
or unsafe work environment for the individual providing home
care services; or
(ii) an emergency for the informal caregiver or a
significant change in the recipient's condition has resulted in
service needs that exceed the current service provider agreement
and that cannot be safely met by the home care provider;
(17) the right to a coordinated transfer when there will be
a change in the provider of services;
(18) the right to voice grievances regarding treatment or
care that is, or fails to be, furnished, or regarding the lack
of courtesy or respect to the patient or the patient's property;
(19) the right to know how to contact an individual
associated with the provider who is responsible for handling
problems and to have the provider investigate and attempt to
resolve the grievance or complaint;
(20) the right to know the name and address of the state or
county agency to contact for additional information or
assistance; and
(21) the right to assert these rights personally, or have
them asserted by the patient's family or guardian when the
patient has been judged incompetent, without retaliation.
Sec. 40. Minnesota Statutes 2000, section 144A.4605,
subdivision 4, is amended to read:
Subd. 4. [LICENSE REQUIRED.] (a) A housing with services
establishment registered under chapter 144D that is required to
obtain a home care license must obtain an assisted living home
care license according to this section or a class A or class E
license according to rule. A housing with services
establishment that obtains a class E license under this
subdivision remains subject to the payment limitations in
sections 256B.0913, subdivision 5, paragraph (h), and 256B.0915,
subdivision 3, paragraph (g).
(b) A board and lodging establishment registered for
special services as of December 31, 1996, and also registered as
a housing with services establishment under chapter 144D, must
deliver home care services according to sections 144A.43 to
144A.48, and may apply for a waiver from requirements under
Minnesota Rules, parts 4668.0002 to 4668.0240, to operate a
licensed agency under the standards of section 157.17. Such
waivers as may be granted by the department will expire upon
promulgation of home care rules implementing section 144A.4605.
(c) An adult foster care provider licensed by the
department of human services and registered under chapter 144D
may continue to provide health-related services under its foster
care license until the promulgation of home care rules
implementing this section.
(d) An assisted living home care provider licensed under
this section must comply with the disclosure provisions of
section 325F.691 to the extent they are applicable.
[EFFECTIVE DATE.] This section is effective October 1, 2001.
Sec. 41. Minnesota Statutes 2000, section 144D.03,
subdivision 2, is amended to read:
Subd. 2. [REGISTRATION INFORMATION.] The establishment
shall provide the following information to the commissioner in
order to be registered:
(1) the business name, street address, and mailing address
of the establishment;
(2) the name and mailing address of the owner or owners of
the establishment and, if the owner or owners are not natural
persons, identification of the type of business entity of the
owner or owners, and the names and addresses of the officers and
members of the governing body, or comparable persons for
partnerships, limited liability corporations, or other types of
business organizations of the owner or owners;
(3) the name and mailing address of the managing agent,
whether through management agreement or lease agreement, of the
establishment, if different from the owner or owners, and the
name of the on-site manager, if any;
(4) verification that the establishment has entered into an
elderly housing with services contract, as required in section
144D.04, with each resident or resident's representative;
(5) verification that the establishment is complying with
the requirements of section 325F.691, if applicable;
(5) (6) the name and address of at least one natural person
who shall be responsible for dealing with the commissioner on
all matters provided for in sections 144D.01 to 144D.06, and on
whom personal service of all notices and orders shall be made,
and who shall be authorized to accept service on behalf of the
owner or owners and the managing agent, if any; and
(6) (7) the signature of the authorized representative of
the owner or owners or, if the owner or owners are not natural
persons, signatures of at least two authorized representatives
of each owner, one of which shall be an officer of the owner.
Personal service on the person identified under clause (5)
(6) by the owner or owners in the registration shall be
considered service on the owner or owners, and it shall not be a
defense to any action that personal service was not made on each
individual or entity. The designation of one or more
individuals under this subdivision shall not affect the legal
responsibility of the owner or owners under sections 144D.01 to
144D.06.
[EFFECTIVE DATE.] This section is effective October 1, 2001.
Sec. 42. Minnesota Statutes 2000, section 144D.04,
subdivision 2, is amended to read:
Subd. 2. [CONTENTS OF CONTRACT.] An elderly housing with
services contract, which need not be entitled as such to comply
with this section, shall include at least the following elements
in itself or through supporting documents or attachments:
(1) name, street address, and mailing address of the
establishment;
(2) the name and mailing address of the owner or owners of
the establishment and, if the owner or owners is not a natural
person, identification of the type of business entity of the
owner or owners;
(3) the name and mailing address of the managing agent,
through management agreement or lease agreement, of the
establishment, if different from the owner or owners;
(4) the name and address of at least one natural person who
is authorized to accept service on behalf of the owner or owners
and managing agent;
(5) statement describing the registration and licensure
status of the establishment and any provider providing
health-related or supportive services under an arrangement with
the establishment;
(6) term of the contract;
(7) description of the services to be provided to the
resident in the base rate to be paid by resident;
(8) description of any additional services available for an
additional fee from the establishment directly or through
arrangements with the establishment;
(9) fee schedules outlining the cost of any additional
services;
(10) description of the process through which the contract
may be modified, amended, or terminated;
(11) description of the establishment's complaint
resolution process available to residents including the
toll-free complaint line for the office of ombudsman for older
Minnesotans;
(12) the resident's designated representative, if any;
(13) the establishment's referral procedures if the
contract is terminated;
(14) criteria used by the establishment to determine who
may continue to reside in the elderly housing with services
establishment;
(15) billing and payment procedures and requirements;
(16) statement regarding the ability of residents to
receive services from service providers with whom the
establishment does not have an arrangement; and
(17) statement regarding the availability of public funds
for payment for residence or services in the establishment.
[EFFECTIVE DATE.] This section is effective October 1, 2001.
Sec. 43. Minnesota Statutes 2000, section 144D.04,
subdivision 3, is amended to read:
Subd. 3. [CONTRACTS IN PERMANENT FILES.] Elderly housing
with services contracts and related documents executed by each
resident or resident's representative shall be maintained by the
establishment in files from the date of execution until three
years after the contract is terminated. The contracts and the
written disclosures required under section 325F.691, if
applicable, shall be made available for on-site inspection by
the commissioner upon request at any time.
[EFFECTIVE DATE.] This section is effective October 1, 2001.
Sec. 44. Minnesota Statutes 2000, section 144D.06, is
amended to read:
144D.06 [OTHER LAWS.]
A housing with services establishment shall obtain and
maintain all other licenses, permits, registrations, or other
governmental approvals required of it in addition to
registration under this chapter. A housing with services
establishment is subject to the provisions of section 325F.691
and chapter 504B.
[EFFECTIVE DATE.] This section is effective October 1, 2001.
Sec. 45. [145.56] [SUICIDE PREVENTION.]
Subdivision 1. [SUICIDE PREVENTION PLAN.] The commissioner
of health shall refine, coordinate, and implement the state's
suicide prevention plan using an evidence-based, public health
approach focused on prevention, in collaboration with the
commissioner of human services; the commissioner of public
safety; the commissioner of children, families, and learning;
and appropriate agencies, organizations, and institutions in the
community.
Subd. 2. [COMMUNITY-BASED PROGRAMS.] (a) The commissioner
shall establish a grant program to fund:
(1) community-based programs to provide education,
outreach, and advocacy services to populations who may be at
risk for suicide;
(2) community-based programs that educate community helpers
and gatekeepers, such as family members, spiritual leaders,
coaches, and business owners, employers, and coworkers on how to
prevent suicide by encouraging help-seeking behaviors;
(3) community-based programs that educate populations at
risk for suicide and community helpers and gatekeepers that must
include information on the symptoms of depression and other
psychiatric illnesses, the warning signs of suicide, skills for
preventing suicides, and making or seeking effective referrals
to intervention and community resources; and
(4) community-based programs to provide evidence-based
suicide prevention and intervention education to school staff,
parents, and students in grades kindergarten through 12.
Subd. 3. [WORKPLACE AND PROFESSIONAL EDUCATION.] (a) The
commissioner shall promote the use of employee assistance and
workplace programs to support employees with depression and
other psychiatric illnesses and substance abuse disorders, and
refer them to services. In promoting these programs, the
commissioner shall collaborate with employer and professional
associations, unions, and safety councils.
(b) The commissioner shall provide training and technical
assistance to local public health and other community-based
professionals to provide for integrated implementation of best
practices for preventing suicides.
Subd. 4. [COLLECTION AND REPORTING SUICIDE DATA.] The
commissioner shall coordinate with federal, regional, local, and
other state agencies to collect, analyze, and annually issue a
public report on Minnesota-specific data on suicide and suicidal
behaviors.
Subd. 5. [PERIODIC EVALUATIONS; BIENNIAL REPORTS.] The
commissioner shall conduct periodic evaluations of the impact of
and outcomes from implementation of the state's suicide
prevention plan and each of the activities specified in this
section. By July 1, 2002, and July 1 of each even-numbered year
thereafter, the commissioner shall report the results of these
evaluations to the chairs of the policy and finance committees
in the house and senate with jurisdiction over health and human
services issues.
Sec. 46. Minnesota Statutes 2000, section 145.881,
subdivision 2, is amended to read:
Subd. 2. [DUTIES.] The advisory task force shall meet on a
regular basis to perform the following duties:
(a) review and report on the health care needs of mothers
and children throughout the state of Minnesota;
(b) review and report on the type, frequency and impact of
maternal and child health care services provided to mothers and
children under existing maternal and child health care programs,
including programs administered by the commissioner of health;
(c) establish, review, and report to the commissioner a
list of program guidelines and criteria which the advisory task
force considers essential to providing an effective maternal and
child health care program to low income populations and high
risk persons and fulfilling the purposes defined in section
145.88;
(d) review staff recommendations of the department of
health regarding maternal and child health grant awards before
the awards are made;
(e) make recommendations to the commissioner for the use of
other federal and state funds available to meet maternal and
child health needs;
(f) make recommendations to the commissioner of health on
priorities for funding the following maternal and child health
services: (1) prenatal, delivery and postpartum care, (2)
comprehensive health care for children, especially from birth
through five years of age, (3) adolescent health services, (4)
family planning services, (5) preventive dental care, (6)
special services for chronically ill and handicapped children
and (7) any other services which promote the health of mothers
and children; and
(g) make recommendations to the commissioner of health on
the process to distribute, award and administer the maternal and
child health block grant funds; and
(h) review the measures that are used to define the
variables of the funding distribution formula in section
145.882, subdivision 4, every two years and make recommendations
to the commissioner of health for changes based upon principles
established by the advisory task force for this purpose.
Sec. 47. [145.9268] [COMMUNITY CLINIC GRANTS.]
Subdivision 1. [DEFINITION.] For purposes of this section,
"eligible community clinic" means:
(1) a clinic that provides services under conditions as
defined in Minnesota Rules, part 9505.0255, and utilizes a
sliding fee scale to determine eligibility for charity care;
(2) an Indian tribal government or Indian health service
unit; or
(3) a consortium of clinics comprised of entities under
clause (1) or (2).
Subd. 2. [GRANTS AUTHORIZED.] The commissioner of health
shall award grants to eligible community clinics to improve the
ongoing viability of Minnesota's clinic-based safety net
providers. Grants shall be awarded to support the capacity of
eligible community clinics to serve low-income populations,
reduce current or future uncompensated care burdens, or provide
for improved care delivery infrastructure. The commissioner
shall award grants to community clinics in metropolitan and
rural areas of the state, and shall ensure geographic
representation in grant awards among all regions of the state.
Subd. 3. [ALLOCATION OF GRANTS.] (a) To receive a grant
under this section, an eligible community clinic must submit an
application to the commissioner of health by the deadline
established by the commissioner. A grant may be awarded upon
the signing of a grant contract. Community clinics may apply
for and the commissioner may award grants for one-year or
two-year periods.
(b) An application must be on a form and contain
information as specified by the commissioner but at a minimum
must contain:
(1) a description of the purpose or project for which grant
funds will be used;
(2) a description of the problem or problems the grant
funds will be used to address; and
(3) a description of achievable objectives, a workplan, and
a timeline for implementation and completion of processes or
projects enabled by the grant.
(c) The commissioner shall review each application to
determine whether the application is complete and whether the
applicant and the project are eligible for a grant. In
evaluating applications according to paragraph (d), the
commissioner shall establish criteria including, but not limited
to: the priority level of the project; the applicant's
thoroughness and clarity in describing the problem grant funds
are intended to address; a description of the applicant's
proposed project; the manner in which the applicant will
demonstrate the effectiveness of any projects undertaken; and
evidence of efficiencies and effectiveness gained through
collaborative efforts. The commissioner may also take into
account other relevant factors, including, but not limited to,
the percentage for which uninsured patients represent the
applicant's patient base and the degree to which grant funds
will be used to support services increasing access to health
care services. 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 an applicant. The
commissioner has discretion over the number of grants awarded.
(d) In determining which eligible community clinics will
receive grants under this section, the commissioner shall give
preference to those grant applications that show evidence of
collaboration with other eligible community clinics, hospitals,
health care providers, or community organizations. In addition,
the commissioner shall give priority, in declining order, to
grant applications for projects that:
(1) provide a direct offset to expenses incurred for
services provided to the clinic's target population;
(2) establish, update, or improve information, data
collection, or billing systems;
(3) procure, modernize, remodel, or replace equipment used
in the delivery of direct patient care at a clinic;
(4) provide improvements for care delivery, such as
increased translation and interpretation services; or
(5) other projects determined by the commissioner to
improve the ability of applicants to provide care to the
vulnerable populations they serve.
(e) A grant awarded to an eligible community clinic may not
exceed $300,000 per eligible community clinic. For an applicant
applying as a consortium of clinics, a grant may not exceed
$300,000 per clinic included in the consortium. The
commissioner has discretion over the number of grants awarded.
Subd. 4. [EVALUATION AND REPORT.] The commissioner of
health shall evaluate the overall effectiveness of the grant
program. The commissioner shall collect progress reports to
evaluate the grant program from the eligible community clinics
receiving grants. Every two years, as part of this evaluation,
the commissioner shall report to the legislature on priority
areas for grants set under subdivision 3 and provide any
recommendations for adding or changing priority areas.
Sec. 48. [145.928] [ELIMINATING HEALTH DISPARITIES.]
Subdivision 1. [GOAL; ESTABLISHMENT.] It is the goal of
the state, by 2010, to decrease by 50 percent the disparities in
infant mortality rates and adult and child immunization rates
for American Indians and populations of color, as compared with
rates for whites. To do so and to achieve other measurable
outcomes, the commissioner of health shall establish a program
to close the gap in the health status of American Indians and
populations of color as compared with whites in the following
priority areas: infant mortality, breast and cervical cancer
screening, HIV/AIDS and sexually transmitted infections, adult
and child immunizations, cardiovascular disease, diabetes, and
accidental injuries and violence.
Subd. 2. [STATE-COMMUNITY PARTNERSHIPS; PLAN.] The
commissioner, in partnership with culturally-based community
organizations; the Indian affairs council under section 3.922;
the council on affairs of Chicano/Latino people under section
3.9223; the council on Black Minnesotans under section 3.9225;
the council on Asian-Pacific Minnesotans under section 3.9226;
community health boards as defined in section 145A.02; and
tribal governments, shall develop and implement a comprehensive,
coordinated plan to reduce health disparities in the health
disparity priority areas identified in subdivision 1.
Subd. 3. [MEASURABLE OUTCOMES.] The commissioner, in
consultation with the community partners listed in subdivision
2, shall establish measurable outcomes to achieve the goal
specified in subdivision 1 and to determine the effectiveness of
the grants and other activities funded under this section in
reducing health disparities in the priority areas identified in
subdivision 1. The development of measurable outcomes must be
completed before any funds are distributed under this section.
Subd. 4. [STATEWIDE ASSESSMENT.] The commissioner shall
enhance current data tools to ensure a statewide assessment of
the risk behaviors associated with the health disparity priority
areas identified in subdivision 1. The statewide assessment
must be used to establish a baseline to measure the effect of
activities funded under this section. To the extent feasible,
the commissioner shall conduct the assessment so that the
results may be compared to national data.
Subd. 5. [TECHNICAL ASSISTANCE.] The commissioner shall
provide the necessary expertise to grant applicants to ensure
that submitted proposals are likely to be successful in reducing
the health disparities identified in subdivision 1. The
commissioner shall provide grant recipients with guidance and
training on best or most promising strategies to use to reduce
the health disparities identified in subdivision 1. The
commissioner shall also assist grant recipients in the
development of materials and procedures to evaluate local
community activities.
Subd. 6. [PROCESS.] (a) The commissioner, in consultation
with the community partners listed in subdivision 2, shall
develop the criteria and procedures used to allocate grants
under this section. In developing the criteria, the
commissioner shall establish an administrative cost limit for
grant recipients. At the time a grant is awarded, the
commissioner must provide a grant recipient with information on
the outcomes established according to subdivision 3.
(b) A grant recipient must coordinate its activities to
reduce health disparities with other entities receiving funds
under this section that are in the grant recipient's service
area.
Subd. 7. [COMMUNITY GRANT PROGRAM; IMMUNIZATION RATES AND
INFANT MORTALITY RATES.] (a) The commissioner shall award grants
to eligible applicants for local or regional projects and
initiatives directed at reducing health disparities in one or
both of the following priority areas:
(1) decreasing racial and ethnic disparities in infant
mortality rates; or
(2) increasing adult and child immunization rates in
nonwhite racial and ethnic populations.
(b) The commissioner may award up to 20 percent of the
funds available as planning grants. Planning grants must be
used to address such areas as community assessment, coordination
activities, and development of community supported strategies.
(c) Eligible applicants may include, but are not limited
to, faith-based organizations, social service organizations,
community nonprofit organizations, community health boards,
tribal governments, and community clinics. Applicants must
submit proposals to the commissioner. A proposal must specify
the strategies to be implemented to address one or both of the
priority areas listed in paragraph (a) and must be targeted to
achieve the outcomes established according to subdivision 3.
(d) The commissioner shall give priority to applicants who
demonstrate that their proposed project or initiative:
(1) is supported by the community the applicant will serve;
(2) is research-based or based on promising strategies;
(3) is designed to complement other related community
activities;
(4) utilizes strategies that positively impact both
priority areas;
(5) reflects racially and ethnically appropriate
approaches; and
(6) will be implemented through or with community-based
organizations that reflect the race or ethnicity of the
population to be reached.
Subd. 8. [COMMUNITY GRANT PROGRAM; OTHER HEALTH
DISPARITIES.] (a) The commissioner shall award grants to
eligible applicants for local or regional projects and
initiatives directed at reducing health disparities in one or
more of the following priority areas:
(1) decreasing racial and ethnic disparities in morbidity
and mortality rates from breast and cervical cancer;
(2) decreasing racial and ethnic disparities in morbidity
and mortality rates from HIV/AIDS and sexually transmitted
infections;
(3) decreasing racial and ethnic disparities in morbidity
and mortality rates from cardiovascular disease;
(4) decreasing racial and ethnic disparities in morbidity
and mortality rates from diabetes; or
(5) decreasing racial and ethnic disparities in morbidity
and mortality rates from accidental injuries or violence.
(b) The commissioner may award up to 20 percent of the
funds available as planning grants. Planning grants must be
used to address such areas as community assessment, determining
community priority areas, coordination activities, and
development of community supported strategies.
(c) Eligible applicants may include, but are not limited
to, faith-based organizations, social service organizations,
community nonprofit organizations, community health boards, and
community clinics. Applicants shall submit proposals to the
commissioner. A proposal must specify the strategies to be
implemented to address one or more of the priority areas listed
in paragraph (a) and must be targeted to achieve the outcomes
established according to subdivision 3.
(d) The commissioner shall give priority to applicants who
demonstrate that their proposed project or initiative:
(1) is supported by the community the applicant will serve;
(2) is research-based or based on promising strategies;
(3) is designed to complement other related community
activities;
(4) utilizes strategies that positively impact more than
one priority area;
(5) reflects racially and ethnically appropriate
approaches; and
(6) will be implemented through or with community-based
organizations that reflect the race or ethnicity of the
population to be reached.
Subd. 9. [HEALTH OF FOREIGN-BORN PERSONS.] (a) The
commissioner shall distribute funds to community health boards
for health screening and follow-up services for tuberculosis for
foreign-born persons. Funds shall be distributed based on the
following formula:
(1) $1,500 per foreign-born person with pulmonary
tuberculosis in the community health board's service area;
(2) $500 per foreign-born person with extrapulmonary
tuberculosis in the community health board's service area;
(3) $500 per month of directly observed therapy provided by
the community health board for each uninsured foreign-born
person with pulmonary or extrapulmonary tuberculosis; and
(4) $50 per foreign-born person in the community health
board's service area.
(b) Payments must be made at the end of each state fiscal
year. The amount paid per tuberculosis case, per month of
directly observed therapy, and per foreign-born person must be
proportionately increased or decreased to fit the actual amount
appropriated for that fiscal year.
Subd. 10. [TRIBAL GOVERNMENTS.] The commissioner shall
award grants to American Indian tribal governments for
implementation of community interventions to reduce health
disparities for the priority areas listed in subdivisions 7 and
8. A community intervention must be targeted to achieve the
outcomes established according to subdivision 3. Tribal
governments must submit proposals to the commissioner and must
demonstrate partnerships with local public health entities. The
distribution formula shall be determined by the commissioner, in
consultation with the tribal governments.
Subd. 11. [COORDINATION.] The commissioner shall
coordinate the projects and initiatives funded under this
section with other efforts at the local, state, or national
level to avoid duplication and promote complementary efforts.
Subd. 12. [EVALUATION.] Using the outcomes established
according to subdivision 3, the commissioner shall conduct a
biennial evaluation of the community grant programs, community
health board activities, and tribal government activities funded
under this section. Grant recipients, tribal governments, and
community health boards shall cooperate with the commissioner in
the evaluation and shall provide the commissioner with the
information needed to conduct the evaluation.
Subd. 13. [REPORT.] The commissioner shall submit a
biennial report to the legislature on the local community
projects, tribal government, and community health board
prevention activities funded under this section. These reports
must include information on grant recipients, activities that
were conducted using grant funds, evaluation data, and outcome
measures, if available. These reports are due by January 15 of
every other year, beginning in the year 2003.
Subd. 14. [SUPPLANTATION OF EXISTING FUNDS.] Funds
received under this section must be used to develop new programs
or expand current programs that reduce health disparities.
Funds must not be used to supplant current county or tribal
expenditures.
Sec. 49. Minnesota Statutes 2000, section 145A.15,
subdivision 1, is amended to read:
Subdivision 1. [ESTABLISHMENT.] (a) The commissioner of
health shall expand the current grant program to fund additional
projects designed to prevent child abuse and neglect and reduce
juvenile delinquency by promoting positive parenting, resiliency
in children, and a healthy beginning for children by providing
early intervention services for families in need. Grant dollars
shall be available to train paraprofessionals to provide in-home
intervention services and to allow public health nurses to do
case management of services. The grant program shall provide
early intervention services for families in need and will
include:
(1) expansion of current public health nurse and family
aide home visiting programs and public health home visiting
projects which prevent child abuse and neglect, prevent juvenile
delinquency, and build resiliency in children;
(2) early intervention to promote a healthy and nurturing
beginning;
(3) distribution of educational and public information
programs and materials in hospital maternity divisions,
well-baby clinics, obstetrical clinics, and community clinics;
and
(4) training of home visitors in skills necessary for
comprehensive home visiting which promotes a healthy and
nurturing beginning for the child.
(b) No new grants shall be awarded under this section after
June 30, 2001. Grant contracts awarded and in effect under this
section as of July 1, 2001, shall continue until their
expiration date.
Sec. 50. Minnesota Statutes 2000, section 145A.15, is
amended by adding a subdivision to read:
Subd. 5. [EXPIRATION.] This section expires June 30, 2003.
Sec. 51. Minnesota Statutes 2000, section 145A.16,
subdivision 1, is amended to read:
Subdivision 1. [ESTABLISHMENT.] The commissioner shall
establish a grant program to fund universally offered home
visiting programs designed to serve all live births in
designated geographic areas. The commissioner shall designate
the geographic area to be served by each program. At least one
program must provide home visiting services to families within
the seven-county metropolitan area, and at least one program
must provide home visiting services to families outside the
metropolitan area. The purpose of the program is to strengthen
families and to promote positive parenting and healthy child
development. No new grants shall be awarded under this section
after June 30, 2001. Competitive grant contracts awarded and in
effect under this section as of July 1, 2001, shall expire
December 31, 2003.
Sec. 52. Minnesota Statutes 2000, section 145A.16, is
amended by adding a subdivision to read:
Subd. 10. [EXPIRATION.] This section expires December 31,
2003.
Sec. 53. [145A.17] [FAMILY HOME VISITING PROGRAMS.]
Subdivision 1. [ESTABLISHMENT; GOALS.] The commissioner
shall establish a program to fund family home visiting programs
designed to foster a healthy beginning for children in families
at or below 200 percent of the federal poverty guidelines,
prevent child abuse and neglect, reduce juvenile delinquency,
promote positive parenting and resiliency in children, and
promote family health and economic self-sufficiency. A program
funded under this section must serve families at or below 200
percent of the federal poverty guidelines, and other families
determined to be at risk, including but not limited to being at
risk for child abuse, child neglect, or juvenile delinquency.
Programs must give priority for services to families considered
to be in need of services, including but not limited to families
with:
(1) adolescent parents;
(2) a history of alcohol or other drug abuse;
(3) a history of child abuse, domestic abuse, or other
types of violence;
(4) a history of domestic abuse, rape, or other forms of
victimization;
(5) reduced cognitive functioning;
(6) a lack of knowledge of child growth and development
stages;
(7) low resiliency to adversities and environmental
stresses; or
(8) insufficient financial resources to meet family needs.
Subd. 2. [ALLOCATION OF FUNDS.] The commissioner shall
distribute funds available under this section to community
health boards, as defined in section 145A.02, and to tribal
governments. Funds shall be distributed to community health
boards as follows: (1) each community health board shall
receive an allocation of $25,000 per year; and (2) remaining
funds available to community health boards shall be distributed
according to the formula in section 256J.625, subdivision 3.
The commissioner, in consultation with tribal governments, shall
establish a formula for distributing funds to tribal governments.
Subd. 3. [REQUIREMENTS FOR PROGRAMS; PROCESS.] (a) Before
a community health board or tribal government may receive an
allocation under subdivision 2, a community health board or
tribal government must submit a proposal to the commissioner
that includes identification, based on a community assessment,
of the populations at or below 200 percent of the federal
poverty guidelines that will be served and the other populations
that will be served. Each program that receives funds must:
(1) use either a broad community-based or selective
community-based strategy to provide preventive and early
intervention home visiting services;
(2) offer a home visit by a trained home visitor. If a
home visit is accepted, the first home visit must occur
prenatally or as soon after birth as possible and must include a
public health nursing assessment by a public health nurse;
(3) offer, at a minimum, information on infant care, child
growth and development, positive parenting, preventing diseases,
preventing exposure to environmental hazards, and support
services available in the community;
(4) provide information on and referrals to health care
services, if needed, including information on health care
coverage for which the child or family may be eligible; and
provide information on preventive services, developmental
assessments, and the availability of public assistance programs
as appropriate;
(5) provide youth development programs;
(6) recruit home visitors who will represent, to the extent
possible, the races, cultures, and languages spoken by families
that may be served;
(7) train and supervise home visitors in accordance with
the requirements established under subdivision 4;
(8) maximize resources and minimize duplication by
coordinating activities with local social and human services
organizations, education organizations, and other appropriate
governmental entities and community-based organizations and
agencies; and
(9) utilize appropriate racial and ethnic approaches to
providing home visiting services.
(b) Funds available under this section shall not be used
for medical services. The commissioner shall establish an
administrative cost limit for recipients of funds. The outcome
measures established under subdivision 6 must be specified to
recipients of funds at the time the funds are distributed.
(c) Data collected on individuals served by the home
visiting programs must remain confidential and must not be
disclosed by providers of home visiting services without a
specific informed written consent that identifies disclosures to
be made. Upon request, agencies providing home visiting
services must provide recipients with information on
disclosures, including the names of entities and individuals
receiving the information and the general purpose of the
disclosure. Prospective and current recipients of home visiting
services must be told and informed in writing that written
consent for disclosure of data is not required for access to
home visiting services.
Subd. 4. [TRAINING.] The commissioner shall establish
training requirements for home visitors and minimum requirements
for supervision by a public health nurse. The requirements for
nurses must be consistent with chapter 148. Training must
include child development, positive parenting techniques,
screening and referrals for child abuse and neglect, and diverse
cultural practices in child rearing and family systems.
Subd. 5. [TECHNICAL ASSISTANCE.] The commissioner shall
provide administrative and technical assistance to each program,
including assistance in data collection and other activities
related to conducting short- and long-term evaluations of the
programs as required under subdivision 7. The commissioner may
request research and evaluation support from the University of
Minnesota.
Subd. 6. [OUTCOME MEASURES.] The commissioner shall
establish outcomes to determine the impact of family home
visiting programs funded under this section on the following
areas:
(1) appropriate utilization of preventive health care;
(2) rates of substantiated child abuse and neglect;
(3) rates of unintentional child injuries;
(4) rates of children who are screened and who pass early
childhood screening; and
(5) any additional qualitative goals and quantitative
measures established by the commissioner.
Subd. 7. [EVALUATION.] Using the qualitative goals and
quantitative outcome measures established under subdivisions 1
and 6, the commissioner shall conduct ongoing evaluations of the
programs funded under this section. Community health boards and
tribal governments shall cooperate with the commissioner in the
evaluations and shall provide the commissioner with the
information necessary to conduct the evaluations. As part of
the ongoing evaluations, the commissioner shall rate the impact
of the programs on the outcome measures listed in subdivision 6,
and shall periodically determine whether home visiting programs
are the best way to achieve the qualitative goals established
under subdivisions 1 and 6. If the commissioner determines that
home visiting programs are not the best way to achieve these
goals, the commissioner shall provide the legislature with
alternative methods for achieving them.
Subd. 8. [REPORT.] By January 15, 2002, and January 15 of
each even-numbered year thereafter, the commissioner shall
submit a report to the legislature on the family home visiting
programs funded under this section and on the results of the
evaluations conducted under subdivision 7.
Subd. 9. [NO SUPPLANTING OF EXISTING FUNDS.] Funding
available under this section may be used only to supplement, not
to replace, nonstate funds being used for home visiting services
as of July 1, 2001.
Sec. 54. Minnesota Statutes 2000, section 157.16,
subdivision 3, is amended to read:
Subd. 3. [ESTABLISHMENT FEES; DEFINITIONS.] (a) The
following fees are required for food and beverage service
establishments, hotels, motels, lodging establishments, and
resorts licensed under this chapter. Food and beverage service
establishments must pay the highest applicable fee under
paragraph (e), clause (1), (2), (3), or (4), and establishments
serving alcohol must pay the highest applicable fee under
paragraph (e), clause (6) or (7). The license fee for new
operators previously licensed under this chapter for the same
calendar year is one-half of the appropriate annual license fee,
plus any penalty that may be required. The license fee for
operators opening on or after October 1 is one-half of the
appropriate annual license fee, plus any penalty that may be
required.
(b) All food and beverage service establishments, except
special event food stands, and all hotels, motels, lodging
establishments, and resorts shall pay an annual base fee of
$100 $145.
(c) A special event food stand shall pay a flat fee
of $30 $35 annually. "Special event food stand" means a fee
category where food is prepared or served in conjunction with
celebrations, county fairs, or special events from a special
event food stand as defined in section 157.15.
(d) In addition to the base fee in paragraph (b), each food
and beverage service establishment, other than a special event
food stand, and each hotel, motel, lodging establishment, and
resort shall pay an additional annual fee for each fee category
as specified in this paragraph:
(1) Limited food menu selection, $30 $40. "Limited food
menu selection" means a fee category that provides one or more
of the following:
(i) prepackaged food that receives heat treatment and is
served in the package;
(ii) frozen pizza that is heated and served;
(iii) a continental breakfast such as rolls, coffee, juice,
milk, and cold cereal;
(iv) soft drinks, coffee, or nonalcoholic beverages; or
(v) cleaning for eating, drinking, or cooking utensils,
when the only food served is prepared off site.
(2) Small establishment, including boarding establishments,
$55 $75. "Small establishment" means a fee category that has no
salad bar and meets one or more of the following:
(i) possesses food service equipment that consists of no
more than a deep fat fryer, a grill, two hot holding containers,
and one or more microwave ovens;
(ii) serves dipped ice cream or soft serve frozen desserts;
(iii) serves breakfast in an owner-occupied bed and
breakfast establishment;
(iv) is a boarding establishment; or
(v) meets the equipment criteria in clause (3), item (i) or
(ii), and has a maximum patron seating capacity of not more than
50.
(3) Medium establishment, $150 $210. "Medium establishment"
means a fee category that meets one or more of the following:
(i) possesses food service equipment that includes a range,
oven, steam table, salad bar, or salad preparation area;
(ii) possesses food service equipment that includes more
than one deep fat fryer, one grill, or two hot holding
containers; or
(iii) is an establishment where food is prepared at one
location and served at one or more separate locations.
Establishments meeting criteria in clause (2), item (v),
are not included in this fee category.
(4) Large establishment, $250 $350. "Large establishment"
means either:
(i) a fee category that (A) meets the criteria in clause
(3), items (i) or (ii), for a medium establishment, (B) seats
more than 175 people, and (C) offers the full menu selection an
average of five or more days a week during the weeks of
operation; or
(ii) a fee category that (A) meets the criteria in clause
(3), item (iii), for a medium establishment, and (B) prepares
and serves 500 or more meals per day.
(5) Other food and beverage service, including food carts,
mobile food units, seasonal temporary food stands, and seasonal
permanent food stands, $30 $40.
(6) Beer or wine table service, $30 $40. "Beer or wine
table service" means a fee category where the only alcoholic
beverage service is beer or wine, served to customers seated at
tables.
(7) Alcoholic beverage service, other than beer or wine
table service, $75 $105.
"Alcohol beverage service, other than beer or wine table
service" means a fee category where alcoholic mixed drinks are
served or where beer or wine are served from a bar.
(8) Lodging per sleeping accommodation unit, $4 $6,
including hotels, motels, lodging establishments, and resorts,
up to a maximum of $400 $600. "Lodging per sleeping
accommodation unit" means a fee category including the number of
guest rooms, cottages, or other rental units of a hotel, motel,
lodging establishment, or resort; or the number of beds in a
dormitory.
(9) First public swimming pool, $100 $140; each additional
public swimming pool, $50 $80. "Public swimming pool" means a
fee category that has the meaning given in Minnesota Rules, part
4717.0250, subpart 8.
(10) First spa, $50 $80; each additional spa, $25 $40.
"Spa pool" means a fee category that has the meaning given in
Minnesota Rules, part 4717.0250, subpart 9.
(11) Private sewer or water, $30 $40. "Individual private
water" means a fee category with a water supply other than a
community public water supply as defined in Minnesota Rules,
chapter 4720. "Individual private sewer" means a fee category
with an individual sewage treatment system which uses subsurface
treatment and disposal.
(e) A fee is not required for a food and beverage service
establishment operated by a school as defined in sections
120A.05, subdivisions 9, 11, 13, and 17 and 120A.22.
(f) A fee of $150 for review of the construction plans must
accompany the initial license application for food and beverage
service establishments, hotels, motels, lodging establishments,
or resorts.
(g) (f) When existing food and beverage service
establishments, hotels, motels, lodging establishments, or
resorts are extensively remodeled, a fee of $150 must be
submitted with the remodeling plans.
(h) (g) Seasonal temporary food stands and special event
food stands are not required to submit construction or
remodeling plans for review.
[EFFECTIVE DATE.] This section is effective January 1, 2002.
Sec. 55. Minnesota Statutes 2000, section 157.22, as
amended by Laws 2001, chapter 65, section 1, is amended to read:
157.22 [EXEMPTIONS.]
This chapter shall not be construed to apply to:
(1) interstate carriers under the supervision of the United
States Department of Health and Human Services;
(2) any building constructed and primarily used for
religious worship;
(3) any building owned, operated, and used by a college or
university in accordance with health regulations promulgated by
the college or university under chapter 14;
(4) any person, firm, or corporation whose principal mode
of business is licensed under sections 28A.04 and 28A.05, is
exempt at that premises from licensure as a food or beverage
establishment; provided that the holding of any license pursuant
to sections 28A.04 and 28A.05 shall not exempt any person, firm,
or corporation from the applicable provisions of this chapter or
the rules of the state commissioner of health relating to food
and beverage service establishments;
(5) family day care homes and group family day care homes
governed by sections 245A.01 to 245A.16;
(6) nonprofit senior citizen centers for the sale of
home-baked goods;
(7) fraternal or patriotic organizations that are tax
exempt under section 501(c)(3), 501(c)(4), 501(c)(6), 501(c)(7),
501(c)(10), or 501(c)(19) of the Internal Revenue Code of 1986,
or organizations related to or affiliated with such fraternal or
patriotic organizations. Such organizations may organize events
at which home-prepared food is donated by organization members
for sale at the events, provided:
(i) the event is not a circus, carnival, or fair;
(ii) the organization controls the admission of persons to
the event, the event agenda, or both; and
(iii) the organization's licensed kitchen is not used in
any manner for the event; and
(8) food not prepared at an establishment and brought in by
individuals attending a potluck event for consumption at the
potluck event. An organization sponsoring a potluck event under
this clause may advertise the potluck event to the public
through any means. Individuals who are not members of an
organization sponsoring a potluck event under this clause may
attend the potluck event and consume the food at the event.
Licensed food establishments other than schools cannot be
sponsors of potluck events. A school may sponsor and hold
potluck events in areas of the school other than the school's
kitchen, provided that the school's kitchen is not used in any
manner for the potluck event. For purposes of this clause,
"school" means a public school as defined in section 120A.05,
subdivisions 9, 11, 13, and 17, or a nonpublic school, church,
or religious organization at which a child is provided with
instruction in compliance with sections 120A.22 and 120A.24.
Potluck event food shall not be brought into a licensed food
establishment kitchen; and
(9) a home school in which a child is provided instruction
at home.
Sec. 56. Minnesota Statutes 2000, section 326.38, is
amended to read:
326.38 [LOCAL REGULATIONS.]
Any city having a system of waterworks or sewerage, or any
town in which reside over 5,000 people exclusive of any
statutory cities located therein, or the metropolitan airports
commission, may, by ordinance, adopt local regulations providing
for plumbing permits, bonds, approval of plans, and inspections
of plumbing, which regulations are not in conflict with the
plumbing standards on the same subject prescribed by the state
commissioner of health. No city or such town shall prohibit
plumbers licensed by the state commissioner of health from
engaging in or working at the business, except cities and
statutory cities which, prior to April 21, 1933, by ordinance
required the licensing of plumbers. Any city by ordinance may
prescribe regulations, reasonable standards, and inspections and
grant permits to any person, firm, or corporation engaged in the
business of installing water softeners, who is not licensed as a
master plumber or journeyman plumber by the state commissioner
of health, to connect water softening and water filtering
equipment to private residence water distribution systems, where
provision has been previously made therefor and openings left
for that purpose or by use of cold water connections to a
domestic water heater; where it is not necessary to rearrange,
make any extension or alteration of, or addition to any pipe,
fixture or plumbing connected with the water system except to
connect the water softener, and provided the connections so made
comply with minimum standards prescribed by the state
commissioner of health.
Sec. 57. [325F.72] [DISCLOSURE OF SPECIAL CARE STATUS
REQUIRED.]
Subdivision 1. [PERSONS TO WHOM DISCLOSURE IS
REQUIRED.] Housing with services establishments, as defined in
sections 144D.01 to 144D.07, that secure, segregate, or provide
a special program or special unit for residents with a diagnosis
of probable Alzheimer's disease or a related disorder or that
advertise, market, or otherwise promote the establishment as
providing specialized care for Alzheimer's disease or a related
disorder are considered a "special care unit." All special care
units shall provide a written disclosure to the following:
(1) the commissioner of health, if requested;
(2) the office of ombudsman for older Minnesotans; and
(3) each person seeking placement within a residence, or
the person's authorized representative, before an agreement to
provide the care is entered into.
Subd. 2. [CONTENT.] Written disclosure shall include, but
is not limited to, the following:
(1) a statement of the overall philosophy and how it
reflects the special needs of residents with Alzheimer's disease
or other dementias;
(2) the criteria for determining who may reside in the
special care unit;
(3) the process used for assessment and establishment of
the service plan or agreement, including how the plan is
responsive to changes in the resident's condition;
(4) staffing credentials, job descriptions, and staff
duties and availability, including any training specific to
dementia;
(5) physical environment as well as design and security
features that specifically address the needs of residents with
Alzheimer's disease or other dementias;
(6) frequency and type of programs and activities for
residents of the special care unit;
(7) involvement of families in resident care and
availability of family support programs;
(8) fee schedules for additional services to the residents
of the special care unit; and
(9) a statement that residents will be given a written
notice 30 days prior to changes in the fee schedule.
Subd. 3. [DUTY TO UPDATE.] Substantial changes to
disclosures must be reported to the parties listed in
subdivision 1 at the time the change is made.
Subd. 4. [REMEDY.] The attorney general may seek the
remedies set forth in section 8.31 for repeated and intentional
violations of this section. However, no private right of action
may be maintained as provided under section 8.31, subdivision 3a.
[EFFECTIVE DATE.] This section is effective October 1, 2001.
Sec. 58. [RECOMMENDATIONS; INCENTIVES FOR MAGNET
HOSPITALS.]
The commissioner of health shall develop recommendations
for incentives that may be implemented to increase the number of
magnet hospitals in Minnesota. These recommendations must be
reported by December 1, 2001 to the chairs of the house and
senate committees with jurisdiction over health and human
services policy and finance issues.
Sec. 59. [STUDY; FACTORS INFLUENCING PATIENT CARE AND
PATIENT SAFETY.]
The commissioner of health, in consultation with relevant
stakeholders, shall review available research and literature and
identify the major factors influencing patient care and patient
safety, including but not limited to staffing levels for nurses
and other health care professionals in health care facilities.
This report must be coordinated, to the extent possible, with
other studies relating to health quality and patient safety
authorized by the 2001 legislature. The commissioner shall
report findings from the study, including recommendations on
ongoing analysis and measurement of these factors for the
Minnesota health care system, to the chairs of the policy and
finance committees in the house and senate with jurisdiction
over health and human services issues by February 15, 2002.
Sec. 60. [STUDY; IMPACT OF WORKFORCE SHORTAGE ON HEALTH
CARE COSTS.]
The commissioner of health shall review available data,
research, and literature and assess the effects of health care
labor availability and its impact on health care costs. The
commissioner shall report findings and recommendations to the
chairs of the policy and finance committees in the house and
senate with jurisdiction over health and human services issues
by February 15, 2002.
Sec. 61. [MEDICATIONS DISPENSED IN SCHOOLS STUDY.]
(a) The commissioner of health, in consultation with the
board of nursing, shall study the relationship between the Nurse
Practice Act, Minnesota Statutes, sections 148.171 to 148.285;
and 121A.22, which specifies the administration of medications
in schools and the activities authorized under these sections,
including the administration of prescription and nonprescription
medications and medications needed by students to manage a
chronic illness. The commissioner shall also make
recommendations on necessary statutory changes needed to promote
student health and safety in relation to administering
medications in schools and addressing the changing health needs
of students.
(b) The commissioner shall convene a work group to assist
in the study and recommendations. The work group shall consist
of representatives of the commissioner of human services; the
commissioner of children, families, and learning; the board of
nursing; the board of teaching; school nurses; parents; school
administrators; school board associations; the American Academy
of Pediatrics; and the Minnesota Nurse's Association.
(c) The commissioner shall submit these recommendations and
any recommended statutory changes to the legislature by January
15, 2002.
Sec. 62. [REPEALER.]
(a) Minnesota Statutes 2000, section 144.148, subdivision
8, is repealed.
(b) Minnesota Statutes 2000, sections 121A.15, subdivision
6; and 145.927, are repealed.
[EFFECTIVE DATE.] Paragraph (a) of this section is
effective the day following final enactment.
ARTICLE 2
HEALTH CARE
Section 1. Minnesota Statutes 2000, section 62A.095,
subdivision 1, is amended to read:
Subdivision 1. [APPLICABILITY.] (a) No health plan shall
be offered, sold, or issued to a resident of this state, or to
cover a resident of this state, unless the health plan complies
with subdivision 2.
(b) Health plans providing benefits under health care
programs administered by the commissioner of human services are
not subject to the limits described in subdivision 2 but are
subject to the right of subrogation provisions under section
256B.37 and the lien provisions under section 256.015; 256B.042;
256D.03, subdivision 8; or 256L.03, subdivision 6.
Sec. 2. Minnesota Statutes 2000, section 62J.692,
subdivision 7, is amended to read:
Subd. 7. [TRANSFERS FROM THE COMMISSIONER OF HUMAN
SERVICES.] (a) The amount transferred according to section
256B.69, subdivision 5c, paragraph (a), clause (1), 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 distribution 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 paragraph.
(b) Fifty percent of the amount transferred according to
section 256B.69, subdivision 5c, paragraph (a), clause (2),
shall be distributed by the commissioner to the University of
Minnesota board of regents for the purposes described in
sections 137.38 to 137.40. Of the remaining amount transferred
according to section 256B.69, subdivision 5c, paragraph (a),
clause (2), 24 percent of the amount shall be distributed by the
commissioner to the Hennepin County Medical Center for clinical
medical education. The remaining 26 percent of the amount
transferred shall be distributed by the commissioner in
accordance with subdivision 7a. If the federal approval is not
obtained for the matching funds under section 256B.69,
subdivision 5c, paragraph (a), clause (2), 100 percent of the
amount transferred under this paragraph shall be distributed by
the commissioner to the University of Minnesota board of regents
for the purposes described in sections 137.38 to 137.40.
Sec. 3. Minnesota Statutes 2000, section 62J.692, is
amended by adding a subdivision to read:
Subd. 7a. [CLINICAL MEDICAL EDUCATION INNOVATIONS
GRANTS.] (a) The commissioner shall award grants to teaching
institutions and clinical training sites for projects that
increase dental access for underserved populations and promote
innovative clinical training of dental professionals. In
awarding the grants, the commissioner, in consultation with the
commissioner of human services, shall consider the following:
(1) potential to successfully increase access to an
underserved population;
(2) the long-term viability of the project to improve
access beyond the period of initial funding;
(3) evidence of collaboration between the applicant and
local communities;
(4) the efficiency in the use of the funding; and
(5) the priority level of the project in relation to state
clinical education, access, and workforce goals.
(b) The commissioner shall periodically evaluate the
priorities in awarding the innovations grants in order to ensure
that the priorities meet the changing workforce needs of the
state.
Sec. 4. Minnesota Statutes 2000, section 137.38,
subdivision 1, is amended to read:
Subdivision 1. [CONDITION.] If the board of regents
accepts the funding appropriated for amount transferred under
section 62J.692, subdivision 7, paragraph (b), to be used for
the purposes described in sections 137.38 to 137.40, it shall
comply with the duties for which the appropriations are transfer
is made.
Sec. 5. Minnesota Statutes 2000, section 150A.10, is
amended by adding a subdivision to read:
Subd. 1a. [LIMITED AUTHORIZATION FOR DENTAL
HYGIENISTS.] (a) Notwithstanding subdivision 1, a dental
hygienist licensed under this chapter may be employed or
retained by a health care facility to perform dental hygiene
services described under paragraph (b) without the patient first
being examined by a licensed dentist if the dental hygienist:
(1) has two years practical clinical experience with a
licensed dentist within the preceding five years; and
(2) has entered into a collaborative agreement with a
licensed dentist that designates authorization for the services
provided by the dental hygienist.
(b) The dental hygiene services authorized to be performed
by a dental hygienist under this subdivision are limited to
removal of deposits and stains from the surfaces of the teeth,
application of topical preventive or prophylactic agents,
polishing and smoothing restorations, removal of marginal
overhangs, performance of preliminary charting, taking of
radiographs, and performance of root planing and soft-tissue
curettage. The dental hygienist shall not place pit and fissure
sealants, unless the patient has been recently examined and the
treatment planned by a licensed dentist. The dental hygienist
shall not perform injections of anesthetic agents or the
administration of nitrous oxide unless under the indirect
supervision of a licensed dentist. The performance of dental
hygiene services in a health care facility is limited to
patients, students, and residents of the facility.
(c) A collaborating dentist must be licensed under this
chapter and may enter into a collaborative agreement with no
more than four dental hygienists. The collaborative agreement
must include:
(1) consideration for medically compromised patients and
medical conditions for which a dental evaluation and treatment
plan must occur prior to the provision of dental hygiene
services; and
(2) a period of time in which an examination by a dentist
should occur.
The collaborative agreement must be maintained by the dentist
and the dental hygienist and must be made available to the board
upon request.
(d) For the purposes of this subdivision, a "health care
facility" is limited to a hospital; nursing home; home health
agency; group home serving the elderly, disabled, or juveniles;
state-operated facility licensed by the commissioner of human
services or the commissioner of corrections; and federal, state,
or local public health facility, community clinic, or tribal
clinic.
(e) For purposes of this subdivision, a "collaborative
agreement" means a written agreement with a licensed dentist who
authorizes and accepts responsibility for the services performed
by the dental hygienist. The services authorized under this
subdivision and the collaborative agreement may be performed
without the presence of a licensed dentist and may be performed
at a location other than the usual place of practice of the
dentist or dental hygienist and without a dentist's diagnosis
and treatment plan, unless specified in the collaborative
agreement.
Sec. 6. Minnesota Statutes 2000, section 256.01,
subdivision 2, as amended by Laws 2001, chapter 178, article 1,
section 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 or a tribal social services 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 and human services 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 program formerly codified in
sections 256.72 to 256.87, 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 and the AFDC program
formerly codified in sections 256.72 to 256.87, 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 program
formerly codified in sections 256.72 to 256.87, 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 prescription 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. Rebate agreements for prescription drugs
delivered on or after July 1, 2002, must include rebates for
individuals covered under the prescription drug program who are
under 65 years of age. 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) Have the authority to administer the federal drug
rebate program for drugs purchased under the medical assistance
program as allowed by section 1927 of title XIX of the Social
Security Act and according to the terms and conditions of
section 1927. Rebates shall be collected for all drugs that
have been dispensed or administered in an outpatient setting and
that are from manufacturers who have signed a rebate agreement
with the United States Department of Health and Human Services.
(22) (23) 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) (24) 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) (25) Incorporate cost reimbursement claims from First
Call Minnesota and Greater Twin Cities United Way 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 and Greater Twin
Cities United Way according to normal department payment
schedules.
(25) (26) Develop recommended standards for foster care
homes that address the components of specialized therapeutic
services to be provided by foster care homes with those services.
[EFFECTIVE DATE.] This section is effective 30 days
following final enactment.
Sec. 7. Minnesota Statutes 2000, section 256.955,
subdivision 2a, is amended to read:
Subd. 2a. [ELIGIBILITY.] An individual satisfying the
following requirements and the requirements described in
subdivision 2, paragraph (d), is eligible for the prescription
drug program:
(1) is at least 65 years of age or older; and
(2) is eligible as a qualified Medicare beneficiary
according to section 256B.057, subdivision 3 or, 3a, or, 3b,
clause (1), or is eligible under section 256B.057, subdivision 3
or, 3a, or 3b, clause (1), and is also eligible for medical
assistance or general assistance medical care with a spenddown
as defined in section 256B.056, subdivision 5.
[EFFECTIVE DATE.] This section is effective January 1, 2002.
Sec. 8. Minnesota Statutes 2000, section 256.955,
subdivision 2b, is amended to read:
Subd. 2b. [ELIGIBILITY.] Effective July 1, 2002, an
individual satisfying the following requirements and the
requirements described in subdivision 2, paragraph (d), is
eligible for the prescription drug program:
(1) is under 65 years of age; and
(2) is eligible as a qualified Medicare beneficiary
according to section 256B.057, subdivision 3, or 3a or is
eligible under section 256B.057, subdivision 3, or 3a and is
also eligible for medical assistance or general assistance
medical care with a spenddown as defined in section 256B.056,
subdivision 5.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 9. [256.956] [PURCHASING ALLIANCE STOP-LOSS FUND.]
Subdivision 1. [DEFINITIONS.] For purposes of this
section, the following definitions apply:
(a) "Commissioner" means the commissioner of human services.
(b) "Health plan" means a policy, contract, or certificate
issued by a health plan company to a qualifying purchasing
alliance. Any health plan issued to the members of a qualifying
purchasing alliance must meet the requirements of chapter 62L.
(c) "Health plan company" means:
(1) a health carrier as defined under section 62A.011,
subdivision 2;
(2) a community integrated service network operating under
chapter 62N; or
(3) an accountable provider network operating under chapter
62T.
(d) "Qualifying employer" means an employer who:
(1) is a member of a qualifying purchasing alliance;
(2) has at least one employee but no more than ten
employees or is a sole proprietor or farmer;
(3) did not offer employer-subsidized health care coverage
to its employees for at least 12 months prior to joining the
purchasing alliance; and
(4) is offering health coverage through the purchasing
alliance to all employees who work at least 20 hours per week
unless the employee is eligible for Medicare.
For purposes of this subdivision, "employer-subsidized health
coverage" means health coverage for which the employer pays at
least 50 percent of the cost of coverage for the employee.
(e) "Qualifying enrollee" means an employee of a qualifying
employer or the employee's dependent covered by a health plan.
(f) "Qualifying purchasing alliance" means a purchasing
alliance as defined in section 62T.01, subdivision 2, that:
(1) meets the requirements of chapter 62T;
(2) services a geographic area located in outstate
Minnesota, excluding the city of Duluth; and
(3) is organized and operating before May 1, 2001.
The criteria used by the qualifying purchasing alliance for
membership must be approved by the commissioner of health. A
qualifying purchasing alliance may begin enrolling qualifying
employers after July 1, 2001, with enrollment ending by December
31, 2003.
Subd. 2. [CREATION OF ACCOUNT.] A purchasing alliance
stop-loss fund account is established in the general fund. The
commissioner shall use the money to establish a stop-loss fund
from which a health plan company may receive reimbursement for
claims paid for qualifying enrollees. The account consists of
money appropriated by the legislature. Money from the account
must be used for the stop-loss fund.
Subd. 3. [REIMBURSEMENT.] (a) A health plan company may
receive reimbursement from the fund for 90 percent of the
portion of the claim that exceeds $30,000 but not of the portion
that exceeds $100,000 in a calendar year for a qualifying
enrollee.
(b) Claims shall be reported and funds shall be distributed
on a calendar-year basis. Claims shall be eligible for
reimbursement only for the calendar year in which the claims
were paid.
(c) Once claims paid on behalf of a qualifying enrollee
reach $100,000 in a given calendar year, no further claims may
be submitted for reimbursement on behalf of that enrollee in
that calendar year.
Subd. 4. [REQUEST PROCESS.] (a) Each health plan company
must submit a request for reimbursement from the fund on a form
prescribed by the commissioner. Requests for payment must be
submitted no later than April 1 following the end of the
calendar year for which the reimbursement request is being made,
beginning April 1, 2002.
(b) The commissioner may require a health plan company to
submit claims data as needed in connection with the
reimbursement request.
Subd. 5. [DISTRIBUTION.] (a) The commissioner shall
calculate the total claims reimbursement amount for all
qualifying health plan companies for the calendar year for which
claims are being reported and shall distribute the stop-loss
funds on an annual basis.
(b) In the event that the total amount requested for
reimbursement by the health plan companies for a calendar year
exceeds the funds available for distribution for claims paid by
all health plan companies during the same calendar year, the
commissioner shall provide for the pro rata distribution of the
available funds. Each health plan company shall be eligible to
receive only a proportionate amount of the available funds as
the health plan company's total eligible claims paid compares to
the total eligible claims paid by all health plan companies.
(c) In the event that funds available for distribution for
claims paid by all health plan companies during a calendar year
exceed the total amount requested for reimbursement by all
health plan companies during the same calendar year, any excess
funds shall be reallocated for distribution in the next calendar
year.
Subd. 6. [DATA.] Upon the request of the commissioner,
each health plan company shall furnish such data as the
commissioner deems necessary to administer the fund. The
commissioner may require that such data be submitted on a per
enrollee, aggregate, or categorical basis. Any data submitted
under this section shall be classified as private data or
nonpublic data as defined in section 13.02.
Subd. 7. [DELEGATION.] The commissioner may delegate any
or all of the commissioner's administrative duties to another
state agency or to a private contractor.
Subd. 8. [REPORT.] The commissioner of commerce, in
consultation with the office of rural health and the qualifying
purchasing alliances, shall evaluate the extent to which the
purchasing alliance stop-loss fund increases the availability of
employer-subsidized health care coverage for residents residing
in the geographic areas served by the qualifying purchasing
alliances. A preliminary report must be submitted to the
legislature by February 15, 2003, and a final report must be
submitted by February 15, 2004.
Subd. 9. [SUNSET.] This section shall expire January 1,
2005.
Sec. 10. [256.958] [RETIRED DENTIST PROGRAM.]
Subdivision 1. [PROGRAM.] The commissioner of human
services shall establish a program to reimburse a retired
dentist for the dentist's license fee and for the reasonable
cost of malpractice insurance compared to other dentists in the
community in exchange for the dentist providing 100 hours of
dental services on a volunteer basis within a 12-month period at
a community dental clinic or a dental training clinic located at
a Minnesota state college or university.
Subd. 2. [DOCUMENTATION.] Upon completion of the required
hours, the retired dentist shall submit to the commissioner the
following:
(1) documentation of the service provided;
(2) the cost of malpractice insurance for the 12-month
period; and
(3) the cost of the license.
Subd. 3. [REIMBURSEMENT.] Upon receipt of the information
described in subdivision 2, the commissioner shall provide
reimbursement to the retired dentist for the cost of malpractice
insurance for the previous 12-month period and the cost of the
license.
Sec. 11. [256.959] [DENTAL PRACTICE DONATION PROGRAM.]
Subdivision 1. [ESTABLISHMENT.] The commissioner of human
services shall establish a dental practice donation program that
coordinates the donation of a qualifying dental practice to a
qualified charitable organization and assists in locating a
dentist licensed under chapter 150A who wishes to maintain the
dental practice.
Subd. 2. [QUALIFYING DENTAL PRACTICE.] To qualify for the
dental practice donation program, a dental practice must meet
the following requirements:
(1) the dental practice must be owned by the donating
dentist;
(2) the dental practice must be located in a designated
underserved area of the state as defined by the commissioner;
and
(3) the practice must be equipped with the basic dental
equipment necessary to maintain a dental practice as determined
by the commissioner.
Subd. 3. [COORDINATION.] The commissioner shall establish
a procedure for dentists to donate their dental practices to a
qualified charitable organization. The commissioner shall
authorize a practice for donation only if it meets the
requirements of subdivision 2 and there is a licensed dentist
who is interested in entering into an agreement as described in
subdivision 4. Upon donation of the practice, the commissioner
shall provide the donating dentist with a statement verifying
that a donation of the practice was made to a qualifying
charitable organization for purposes of state and federal income
tax returns.
Subd. 4. [DONATED DENTAL PRACTICE AGREEMENT.] (a) A
dentist accepting the donated practice must enter into an
agreement with the qualified charitable organization to maintain
the dental practice for a minimum of five years at the donated
practice site and to provide services to underserved populations
up to a preagreed percentage of patients served.
(b) The agreement must include the terms for the recovery
of the donated dental practice if the dentist accepting the
practice does not fulfill the service commitment required under
this subdivision.
(c) Any costs associated with operating the dental practice
during the service commitment time period are the financial
responsibility of the dentist accepting the practice.
Sec. 12. Minnesota Statutes 2000, section 256.9657,
subdivision 2, is amended to read:
Subd. 2. [HOSPITAL SURCHARGE.] (a) Effective October 1,
1992, each Minnesota hospital except facilities of the federal
Indian Health Service and regional treatment centers shall pay
to the medical assistance account a surcharge equal to 1.4
percent of net patient revenues excluding net Medicare revenues
reported by that provider to the health care cost information
system according to the schedule in subdivision 4.
(b) Effective July 1, 1994, the surcharge under paragraph
(a) is increased to 1.56 percent.
(c) Notwithstanding the Medicare cost finding and allowable
cost principles, the hospital surcharge is not an allowable cost
for purposes of rate setting under sections 256.9685 to 256.9695.
Sec. 13. Minnesota Statutes 2000, section 256.969, is
amended by adding a subdivision to read:
Subd. 26. [GREATER MINNESOTA PAYMENT ADJUSTMENT AFTER JUNE
30, 2001.] (a) For admissions occurring after June 30, 2001, the
commissioner shall pay fee-for-service inpatient admissions for
the diagnosis-related groups specified in paragraph (b) at
hospitals located outside of the seven-county metropolitan area
at the higher of:
(1) the hospital's current payment rate for the diagnostic
category to which the diagnosis-related group belongs, exclusive
of disproportionate population adjustments received under
subdivision 9 and hospital payment adjustments received under
subdivision 23; or
(2) 90 percent of the average payment rate for that
diagnostic category for hospitals located within the
seven-county metropolitan area, exclusive of disproportionate
population adjustments received under subdivision 9 and hospital
payment adjustments received under subdivisions 20 and 23. The
commissioner may adjust this percentage each year so that the
estimated payment increases under this paragraph are equal to
the funding provided under section 256B.195 for this purpose.
(b) The payment increases provided in paragraph (a) apply
to the following diagnosis-related groups, as they fall within
the diagnostic categories:
(1) 370 cesarean section with complicating diagnosis;
(2) 371 cesarean section without complicating diagnosis;
(3) 372 vaginal delivery with complicating diagnosis;
(4) 373 vaginal delivery without complicating diagnosis;
(5) 386 extreme immaturity and respiratory distress
syndrome, neonate;
(6) 388 full-term neonates with other problems;
(7) 390 prematurity without major problems;
(8) 391 normal newborn;
(9) 385 neonate, died or transferred to another acute care
facility;
(10) 425 acute adjustment reaction and psychosocial
dysfunction;
(11) 430 psychoses;
(12) 431 childhood mental disorders; and
(13) 164-167 appendectomy.
Sec. 14. Minnesota Statutes 2000, section 256B.04, is
amended by adding a subdivision to read:
Subd. 1b. [CONTRACT FOR ADMINISTRATIVE SERVICES FOR
AMERICAN INDIAN CHILDREN.] Notwithstanding subdivision 1, the
commissioner may contract with federally recognized Indian
tribes with a reservation in Minnesota for the provision of
early and periodic screening, diagnosis, and treatment
administrative services for American Indian children, according
to Code of Federal Regulations, title 42, section 441, subpart
B, and Minnesota Rules, part 9505.1693 et seq., when the tribe
chooses to provide such services. 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. Notwithstanding Minnesota
Rules, part 9505.1748, subpart 1, the commissioner, the local
agency, and the tribe may contract with any entity for the
provision of early and periodic screening, diagnosis, and
treatment administrative services.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 15. Minnesota Statutes 2000, section 256B.055,
subdivision 3a, is amended to read:
Subd. 3a. [MFIP-S FAMILIES; FAMILIES ELIGIBLE UNDER PRIOR
AFDC RULES WITH CHILDREN.] (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. Beginning July 1, 2002, medical
assistance may be paid for a person who is a child under the age
of 18, or age 18 if a full-time student in a secondary school,
or in the equivalent level of vocational or technical training,
and reasonably expected to complete the program before reaching
age 19; the parent of a dependent child, including a pregnant
woman; or a caretaker relative of a dependent child.
(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, 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.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 16. Minnesota Statutes 2000, section 256B.056,
subdivision 1a, is amended to read:
Subd. 1a. [INCOME AND ASSETS GENERALLY.] Unless
specifically required by state law or rule or federal law or
regulation, the methodologies used in counting income and assets
to determine eligibility for medical assistance for persons
whose eligibility category is based on blindness, disability, or
age of 65 or more years, the methodologies for the supplemental
security income program shall be used. Increases in benefits
under title II of the Social Security Act shall not be counted
as income for purposes of this subdivision until July 1 of each
year. Effective upon federal approval, for children eligible
under section 256B.055, subdivision 12, or for home and
community-based waiver services whose eligibility for medical
assistance is determined without regard to parental income,
child support payments, including any payments made by an
obligor in satisfaction of or in addition to a temporary or
permanent order for child support, and social security payments
are not counted as income. For families and children, which
includes all other eligibility categories, the methodologies
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,
shall be used, except that effective July 1, 2002, the $90 and
$30 and one-third earned income disregards shall not apply and
the disregard specified in subdivision 1c shall apply.
Effective upon federal approval, in-kind contributions to, and
payments made on behalf of, a recipient, by an obligor, in
satisfaction of or in addition to a temporary or permanent order
for child support or maintenance, shall be considered income to
the recipient. For these purposes, a "methodology" does not
include an asset or income standard, or accounting method, or
method of determining effective dates.
[EFFECTIVE DATE.] This section is effective July 1, 2001.
Sec. 17. Minnesota Statutes 2000, section 256B.056, is
amended by adding a subdivision to read:
Subd. 1b. [AGED, BLIND, AND DISABLED INCOME
METHODOLOGY.] The $20 general income disregard allowed under the
supplemental security income program is included in the standard
and shall not be allowed as a deduction from income for a person
eligible under section 256B.055, subdivisions 7, 7a, and 12.
[EFFECTIVE DATE.] This section is effective July 1, 2001.
Sec. 18. Minnesota Statutes 2000, section 256B.056, is
amended by adding a subdivision to read:
Subd. 1c. [FAMILIES WITH CHILDREN INCOME METHODOLOGY.] (a)
For children ages one to five whose eligibility is determined
under section 256B.057, subdivision 2, 21 percent of countable
earned income shall be disregarded for up to four months.
(b) For families with children whose eligibility is
determined using the standard specified in section 256B.056,
subdivision 4, paragraph (c), 17 percent of countable earned
income shall be disregarded for up to four months.
(c) If the disregard has been applied to the wage earner's
income for four months, the disregard shall not be applied again
until the wage earner's income has not been considered in
determining medical assistance eligibility for 12 consecutive
months.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 19. Minnesota Statutes 2000, section 256B.056,
subdivision 3, is amended to read:
Subd. 3. [ASSET LIMITATIONS FOR ELDERLY AND DISABLED
INDIVIDUALS.] To be eligible for medical assistance, a person
must not individually own more than $3,000 in assets, or if a
member of a household with two family members, husband and wife,
or parent and child, the household must not own more than $6,000
in assets, plus $200 for each additional legal dependent. In
addition to these maximum amounts, an eligible individual or
family may accrue interest on these amounts, but they must be
reduced to the maximum at the time of an eligibility
redetermination. The accumulation of the clothing and personal
needs allowance according to section 256B.35 must also be
reduced to the maximum at the time of the eligibility
redetermination. The value of assets that are not considered in
determining eligibility for medical assistance is the value of
those assets excluded under the AFDC state plan as of July 16,
1996, as required by the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (PRWORA), Public Law
Number 104-193, for families and children, and the supplemental
security income program for aged, blind, and disabled persons,
with the following exceptions:
(a) Household goods and personal effects are not considered.
(b) Capital and operating assets of a trade or business
that the local agency determines are necessary to the person's
ability to earn an income are not considered.
(c) Motor vehicles are excluded to the same extent excluded
by the supplemental security income program.
(d) Assets designated as burial expenses are excluded to
the same extent excluded by the supplemental security income
program.
(e) Effective upon federal approval, for a person who no
longer qualifies as an employed person with a disability due to
loss of earnings, assets allowed while eligible for medical
assistance under section 256B.057, subdivision 9, are not
considered for 12 months, beginning with the first month of
ineligibility as an employed person with a disability, to the
extent that the person's total assets remain within the allowed
limits of section 256B.057, subdivision 9, paragraph (b).
Sec. 20. Minnesota Statutes 2000, section 256B.056, is
amended by adding a subdivision to read:
Subd. 3c. [ASSET LIMITATIONS FOR FAMILIES AND CHILDREN.] A
household of two or more persons must not own more than $30,000
in total net assets, and a household of one person must not own
more than $15,000 in total net assets. In addition to these
maximum amounts, an eligible individual or family may accrue
interest on these amounts, but they must be reduced to the
maximum at the time of an eligibility redetermination. The
value of assets that are not considered in determining
eligibility for medical assistance for families and children is
the value of those assets excluded under the AFDC state plan as
of July 16, 1996, as required by the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law
Number 104-193, with the following exceptions:
(1) household goods and personal effects are not
considered;
(2) capital and operating assets of a trade or business up
to $200,000 are not considered;
(3) one motor vehicle is excluded for each person of legal
driving age who is employed or seeking employment;
(4) one burial plot and all other burial expenses equal to
the supplemental security income program asset limit are not
considered for each individual;
(5) court-ordered settlements up to $10,000 are not
considered;
(6) individual retirement accounts and funds are not
considered; and
(7) assets owned by children are not considered.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 21. Minnesota Statutes 2000, section 256B.056,
subdivision 4, is amended to read:
Subd. 4. [INCOME.] (a) To be eligible for medical
assistance, a person eligible under section 256B.055,
subdivision subdivisions 7, not receiving supplemental security
income program payments, and 7a, and 12, may have income up to
100 percent of the federal poverty guidelines. 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.
(b) To be eligible for medical assistance, 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. Effective July 1, 2000, the base AFDC standard in effect
on July 16, 1996, 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.
(c) Effective July 1, 2002, to be eligible for medical
assistance, families and children may have an income up to 100
percent of the federal poverty guidelines for the family size.
(d) In computing income to determine eligibility of persons
under paragraphs (a) to (c) 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.
[EFFECTIVE DATE.] This section is effective July 1, 2001.
Sec. 22. Minnesota Statutes 2000, section 256B.056,
subdivision 4b, is amended to read:
Subd. 4b. [INCOME VERIFICATION.] The local agency shall
not require a monthly income verification form for a recipient
who is a resident of a long-term care facility and who has
monthly earned income of $80 or less. The commissioner or
county agency shall use electronic verification as the primary
method of income verification. If there is a discrepancy
between reported income and electronically verified income, an
individual may be required to submit additional verification.
Sec. 23. Minnesota Statutes 2000, section 256B.056,
subdivision 5, is amended to read:
Subd. 5. [EXCESS INCOME.] A person who has excess income
is eligible for medical assistance if the person has expenses
for medical care that are more than the amount of the person's
excess income, computed by deducting incurred medical expenses
from the excess income to reduce the excess to the income
standard specified in subdivision 4 5c. The person shall elect
to have the medical expenses deducted at the beginning of a
one-month budget period or at the beginning of a six-month
budget period. The commissioner shall allow persons eligible
for assistance on a one-month spenddown basis under this
subdivision to elect to pay the monthly spenddown amount in
advance of the month of eligibility to the state agency in order
to maintain eligibility on a continuous basis. If the recipient
does not pay the spenddown amount on or before the 20th of the
month, the recipient is ineligible for this option for the
following month. The local agency shall code the Medicaid
Management Information System (MMIS) to indicate that the
recipient has elected this option. The state agency shall
convey recipient eligibility information relative to the
collection of the spenddown to providers through the Electronic
Verification System (EVS). A recipient electing advance payment
must pay the state agency the monthly spenddown amount on or
before the 20th of the month in order to be eligible for this
option in the following month.
[EFFECTIVE DATE.] This section is effective July 1, 2001.
Sec. 24. Minnesota Statutes 2000, section 256B.056, is
amended by adding a subdivision to read:
Subd. 5c. [EXCESS INCOME STANDARD.] (a) The excess income
standard for families with children is the standard specified in
subdivision 4.
(b) The excess income standard for a person whose
eligibility is based on blindness, disability, or age of 65 or
more years is 70 percent of the federal poverty guidelines for
the family size. Effective July 1, 2002, the excess income
standard for this paragraph shall equal 75 percent of the
federal poverty guidelines.
[EFFECTIVE DATE.] This section is effective July 1, 2001.
Sec. 25. Minnesota Statutes 2000, section 256B.057,
subdivision 2, is amended to read:
Subd. 2. [CHILDREN.] Except as specified in subdivision
1b, effective July 1, 2002, a child one through five 18 years of
age in a family whose countable income is less no greater than
133 170 percent of the federal poverty guidelines for the same
family size, is eligible for medical assistance. A child six
through 18 years of age, who was born after September 30, 1983,
in a family whose countable income is less than 100 percent of
the federal poverty guidelines for the same family size is
eligible for medical assistance.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 26. Minnesota Statutes 2000, 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 100 percent of the federal poverty guidelines,
and whose assets are no more than $10,000 for a single
individual and $18,000 for a married couple or family of two or
more, 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. 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 July 1 of each year.
[EFFECTIVE DATE.] This section is effective July 1, 2001.
Sec. 27. Minnesota Statutes 2000, section 256B.057,
subdivision 7, is amended to read:
Subd. 7. [WAIVER OF MAINTENANCE OF EFFORT REQUIREMENT.]
Unless a federal waiver of the maintenance of effort requirement
of section 2105(d) of title XXI of the Balanced Budget Act of
1997, Public Law Number 105-33, Statutes at Large, volume 111,
page 251, is granted by the federal Department of Health and
Human Services by September 30, 1998, eligibility for children
under age 21 must be determined without regard to asset
standards established in section 256B.056, subdivision 3 3c.
The commissioner of human services shall publish a notice in the
State Register upon receipt of a federal waiver.
Sec. 28. Minnesota Statutes 2000, section 256B.057,
subdivision 9, is amended 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) is at least 16 but less than 65 years of age;
(3) meets the asset limits in paragraph (b); and
(4) pays a premium, if required, under paragraph (c).
Any spousal income or assets shall be disregarded for purposes
of eligibility and premium determinations.
After the month of enrollment, a person enrolled in medical
assistance under this subdivision who is temporarily unable to
work and without receipt of earned income due to a medical
condition, as verified by a physician, may retain eligibility
for up to four calendar months.
(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 equal to
or greater than 200 than 100 percent of federal poverty
guidelines for the applicable family size must pay a premium to
be eligible for medical assistance under this subdivision. 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 based on the person's gross earned and unearned income
and the applicable family size using a sliding fee scale
established by the commissioner, which begins at one percent of
income at 100 percent of the federal poverty guidelines and
increases to 7.5 percent of income for those with incomes at or
above 300 percent of the federal poverty guidelines. Annual
adjustments in the premium schedule based upon changes in the
federal poverty guidelines shall be effective for premiums due
in July of each year.
(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 or 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.
[EFFECTIVE DATE.] This section is effective November 1,
2001.
Sec. 29. Minnesota Statutes 2000, section 256B.057, is
amended by adding a subdivision to read:
Subd. 10. [CERTAIN PERSONS NEEDING TREATMENT FOR BREAST OR
CERVICAL CANCER.] (a) Medical assistance may be paid for a
person who:
(1) has been screened for breast or cervical cancer by the
Minnesota breast and cervical cancer control program, and
program funds have been used to pay for the person's screening;
(2) according to the person's treating health professional,
needs treatment, including diagnostic services necessary to
determine the extent and proper course of treatment, for breast
or cervical cancer, including precancerous conditions and early
stage cancer;
(3) meets the income eligibility guidelines for the
Minnesota breast and cervical cancer control program;
(4) is under age 65;
(5) is not otherwise eligible for medical assistance under
United States Code, title 42, section 1396(a)(10)(A)(i); and
(6) is not otherwise covered under creditable coverage, as
defined under United States Code, title 42, section 300gg(c).
(b) Medical assistance provided for an eligible person
under this subdivision shall be limited to services provided
during the period that the person receives treatment for breast
or cervical cancer.
(c) A person meeting the criteria in paragraph (a) is
eligible for medical assistance without meeting the eligibility
criteria relating to income and assets in section 256B.056,
subdivisions 1a to 5b.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 30. Minnesota Statutes 2000, section 256B.0625,
subdivision 3b, is amended 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. 31. Minnesota Statutes 2000, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 5a. [INTENSIVE EARLY INTERVENTION BEHAVIOR THERAPY
SERVICES FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS.] (a)
[COVERAGE.] Medical assistance covers home-based intensive early
intervention behavior therapy for children with autism spectrum
disorders. Children with autism spectrum disorder, and their
custodial parents or foster parents, may access other covered
services to treat autism spectrum disorder, and are not required
to receive intensive early intervention behavior therapy
services under this subdivision. Intensive early intervention
behavior therapy does not include coverage for services to treat
developmental disorders of language, early onset psychosis,
Rett's disorder, selective mutism, social anxiety disorder,
stereotypic movement disorder, dementia, obsessive compulsive
disorder, schizoid personality disorder, avoidant personality
disorder, or reactive attachment disorder. If a child with
autism spectrum disorder is diagnosed to have one or more of
these conditions, intensive early intervention behavior therapy
includes coverage only for services necessary to treat the
autism spectrum disorder.
(b) [PURPOSE OF INTENSIVE EARLY INTERVENTION BEHAVIOR
THERAPY SERVICES (IEIBTS).] The purpose of IEIBTS is to improve
the child's behavioral functioning, to prevent development of
challenging behaviors, to eliminate autistic behaviors, to
reduce the risk of out-of-home placement, and to establish
independent typical functioning in language and social
behavior. The procedures used to accomplish these goals are
based upon research in applied behavior analysis.
(c) [ELIGIBLE CHILDREN.] A child is eligible to initiate
IEIBTS if, the child meets the additional eligibility criteria
in paragraph (d) and in a diagnostic assessment by a mental
health professional who is not under the employ of the service
provider, the child:
(1) is found to have an autism spectrum disorder;
(2) has a current IQ of either untestable, or at least 30;
(3) if nonverbal, initiated behavior therapy by 42 months
of age;
(4) if verbal, initiated behavior therapy by 48 months of
age; or
(5) if having an IQ of at least 50, initiated behavior
therapy by 84 months of age.
To continue after six-month individualized treatment plan (ITP)
reviews, at least one of the child's custodial parents or foster
parents must participate in an average of at least five hours of
documented behavior therapy per week for six months, and
consistently implement behavior therapy recommendations 24 hours
a day. To continue after six-month individualized treatment
plan (ITP) reviews, the child must show documented progress
toward mastery of six-month benchmark behavior objectives. The
maximum number of months during which services may be billed is
54, or up to the month of August in the first year in which the
child completes first grade, whichever comes last. If
significant progress towards treatment goals has not been
achieved after 24 months of treatment, treatment must be
discontinued.
(d) [ADDITIONAL ELIGIBILITY CRITERIA.] A child is eligible
to initiate IEIBTS if:
(1) in medical and diagnostic assessments by medical and
mental health professionals, it is determined that the child
does not have severe or profound mental retardation;
(2) an accurate assessment of the child's hearing has been
performed, including audiometry if the brain stem auditory
evokes response;
(3) a blood lead test has been performed prior to
initiation of treatment; and
(4) an EEG or neurologic evaluation is done, prior to
initiation of treatment, if the child has a history of staring
spells or developmental regression.
(e) [COVERED SERVICES.] The focus of IEIBTS must be to
treat the principal diagnostic features of the autism spectrum
disorder. All IEIBTS must be delivered by a team of
practitioners under the consistent supervision of a single
clinical supervisor. A mental health professional must develop
the ITP for IEIBTS. The ITP must include six-month benchmark
behavior objectives. All behavior therapy must be based upon
research in applied behavior analysis, with an emphasis upon
positive reinforcement of carefully task-analyzed skills for
optimum rates of progress. All behavior therapy must be
consistently applied and generalized throughout the 24-hour day
and seven-day week by all of the child's regular care
providers. When placing the child in school activities, a
majority of the peers must have no mental health diagnosis, and
the child must have sufficient social skills to succeed with 80
percent of the school activities. Reactive consequences, such
as redirection, correction, positive practice, or time-out, must
be used only when necessary to improve the child's success when
proactive procedures alone have not been effective. IEIBTS must
be delivered by a team of behavior therapy practitioners who are
employed under the direction of the same agency. The team may
deliver up to 200 billable hours per year of direct clinical
supervisor services, up to 700 billable hours per year of senior
behavior therapist services, and up to 1,800 billable hours per
year of direct behavior therapist services. A one-hour clinical
review meeting for the child, parents, and staff must be
scheduled 50 weeks a year, at which behavior therapy is reviewed
and planned. At least one-quarter of the annual clinical
supervisor billable hours shall consist of on-site clinical
meeting time. At least one-half of the annual senior behavior
therapist billable hours shall consist of direct services to the
child or parents. All of the behavioral therapist billable
hours shall consist of direct on-site services to the child or
parents. None of the senior behavior therapist billable hours
or behavior therapist billable hours shall consist of clinical
meeting time. If there is any regression of the autistic
spectrum disorder after 12 months of therapy, a neurologic
consultation must be performed.
(f) [PROVIDER QUALIFICATIONS.] The provider agency must be
capable of delivering consistent applied behavior analysis
(ABA)-based behavior therapy in the home. The site director of
the agency must be a mental health professional and a board
certified behavior analyst certified by the behavior analyst
certification board. Each clinical supervisor must be a
certified associate behavior analyst certified by the behavior
analyst certification board or have equivalent experience in
applied behavior analysis.
(g) [SUPERVISION REQUIREMENTS.] (1) Each behavior therapist
practitioner must be continuously supervised while in the home
until the practitioner has mastered competencies for independent
practice. Each behavior therapist must have mastered three
credits of academic content and practice in an applied behavior
analysis sequence at an accredited university before providing
more than 12 months of therapy. A college degree or minimum
hours of experience are not required. Each behavior therapist
must continue training through weekly direct observation by the
senior behavior therapist, through demonstrated performance in
clinical meetings with the clinical supervisor, and annual
training in applied behavior analysis.
(2) Each senior behavior therapist practitioner must have
mastered the senior behavior therapy competencies, completed one
year of practice as a behavior therapist, and six months of
co-therapy training with another senior behavior therapist or
have an equivalent amount of experience in applied behavior
analysis. Each senior behavior therapist must have mastered 12
credits of academic content and practice in an applied behavior
analysis sequence at an accredited university before providing
more than 12 months of senior behavior therapy. Each senior
behavior therapist must continue training through demonstrated
performance in clinical meetings with the clinical supervisor,
and annual training in applied behavior analysis.
(3) Each clinical supervisor practitioner must have
mastered the clinical supervisor and family consultation
competencies, completed two years of practice as a senior
behavior therapist and one year of co-therapy training with
another clinical supervisor, or equivalent experience in applied
behavior analysis. Each clinical supervisor must continue
training through annual training in applied behavior analysis.
(h) [PLACE OF SERVICE.] IEIBTS are provided primarily in
the child's home and community. Services may be provided in the
child's natural school or preschool classroom, home of a
relative, natural recreational setting, or day care.
(i) [PRIOR AUTHORIZATION REQUIREMENTS.] Prior authorization
shall be required for services provided after 200 hours of
clinical supervisor, 700 hours of senior behavior therapist, or
1,800 hours of behavior therapist services per year.
(j) [PAYMENT RATES.] The following payment rates apply:
(1) for an IEIBTS clinical supervisor practitioner under
supervision of a mental health professional, the lower of the
submitted charge or $67 per hour unit;
(2) for an IEIBTS senior behavior therapist practitioner
under supervision of a mental health professional, the lower of
the submitted charge or $37 per hour unit; or
(3) for an IEIBTS behavior therapist practitioner under
supervision of a mental health professional, the lower of the
submitted charge or $27 per hour unit.
An IEIBTS practitioner may receive payment for travel time which
exceeds 50 minutes one-way. The maximum payment allowed will be
$0.51 per minute for up to a maximum of 300 hours per year.
For any week during which the above charges are made to
medical assistance, payments for the following services are
excluded: supervising mental health professional hours and
personal care attendant, home-based mental health,
family-community support, or mental health behavioral aide hours.
(k) [REPORT.] The commissioner shall collect evidence of
the effectiveness of intensive early intervention behavior
therapy services and present a report to the legislature by July
1, 2006.
[EFFECTIVE DATE.] This section is effective January 1, 2003.
Sec. 32. Minnesota Statutes 2000, 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.
The commissioner shall publish conditions for prohibiting
payment for specific drugs after considering the formulary
committee's recommendations. An honorarium of $100 per meeting
and reimbursement for mileage shall be paid to each committee
member in attendance.
(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, except that
the dispensing fee for intravenous solutions which must be
compounded by the pharmacist shall be $8 per bag, $14 per bag
for cancer chemotherapy products, and $30 per bag for total
parenteral nutritional products dispensed in one liter
quantities, or $44 per bag for total parenteral nutritional
products dispensed in quantities greater than one liter. 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, except that where a drug has
had its wholesale price reduced as a result of the actions of
the National Association of Medicaid Fraud Control Units, the
estimated actual acquisition cost shall be the reduced average
wholesale price, without the nine percent deduction. 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.
(e) The basis for determining the amount of payment for
drugs administered in an outpatient setting shall be the lower
of the usual and customary cost submitted by the provider; the
average wholesale price minus five percent; or the maximum
allowable cost set by the federal government under United States
Code, title 42, chapter 7, section 1396r-8(e) and Code of
Federal Regulations, title 42, section 447.332, or by the
commissioner under paragraph (c).
[EFFECTIVE DATE.] This section is effective 30 days
following final enactment.
Sec. 33. Minnesota Statutes 2000, section 256B.0625,
subdivision 13a, is amended to read:
Subd. 13a. [DRUG UTILIZATION REVIEW BOARD.] A nine-member
drug utilization review board is established. The board is
comprised of at least three but no more than four licensed
physicians actively engaged in the practice of medicine in
Minnesota; at least three licensed pharmacists actively engaged
in the practice of pharmacy in Minnesota; and one consumer
representative; the remainder to be made up of health care
professionals who are licensed in their field and have
recognized knowledge in the clinically appropriate prescribing,
dispensing, and monitoring of covered outpatient drugs. The
board shall be staffed by an employee of the department who
shall serve as an ex officio nonvoting member of the board. The
members of the board shall be appointed by the commissioner and
shall serve three-year terms. The members shall be selected
from lists submitted by professional associations. The
commissioner shall appoint the initial members of the board for
terms expiring as follows: three members for terms expiring
June 30, 1996; three members for terms expiring June 30, 1997;
and three members for terms expiring June 30, 1998. Members may
be reappointed once. The board shall annually elect a chair
from among the members.
The commissioner shall, with the advice of the board:
(1) implement a medical assistance retrospective and
prospective drug utilization review program as required by
United States Code, title 42, section 1396r-8(g)(3);
(2) develop and implement the predetermined criteria and
practice parameters for appropriate prescribing to be used in
retrospective and prospective drug utilization review;
(3) develop, select, implement, and assess interventions
for physicians, pharmacists, and patients that are educational
and not punitive in nature;
(4) establish a grievance and appeals process for
physicians and pharmacists under this section;
(5) publish and disseminate educational information to
physicians and pharmacists regarding the board and the review
program;
(6) adopt and implement procedures designed to ensure the
confidentiality of any information collected, stored, retrieved,
assessed, or analyzed by the board, staff to the board, or
contractors to the review program that identifies individual
physicians, pharmacists, or recipients;
(7) establish and implement an ongoing process to (i)
receive public comment regarding drug utilization review
criteria and standards, and (ii) consider the comments along
with other scientific and clinical information in order to
revise criteria and standards on a timely basis; and
(8) adopt any rules necessary to carry out this section.
The board may establish advisory committees. The
commissioner may contract with appropriate organizations to
assist the board in carrying out the board's duties. The
commissioner may enter into contracts for services to develop
and implement a retrospective and prospective review program.
The board shall report to the commissioner annually on the
date the Drug Utilization Review Annual Report is due to the
Health Care Financing Administration. This report is to cover
the preceding federal fiscal year. The commissioner shall make
the report available to the public upon request. The report
must include information on the activities of the board and the
program; the effectiveness of implemented interventions;
administrative costs; and any fiscal impact resulting from the
program. An honorarium of $50 $100 per meeting and
reimbursement for mileage shall be paid to each board member in
attendance.
Sec. 34. Minnesota Statutes 2000, section 256B.0625,
subdivision 17, is amended to read:
Subd. 17. [TRANSPORTATION COSTS.] (a) Medical assistance
covers transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by
nonambulatory persons in obtaining emergency or nonemergency
medical care when paid directly to an ambulance company, common
carrier, or other recognized providers of transportation
services. For the purpose of this subdivision, a person who is
incapable of transport by taxicab or bus shall be considered to
be nonambulatory.
(b) Medical assistance covers special transportation, as
defined in Minnesota Rules, part 9505.0315, subpart 1, item F,
if the provider receives and maintains a current physician's
order by the recipient's attending physician certifying that the
recipient has a physical or mental impairment that would
prohibit the recipient from safely accessing and using a bus,
taxi, other commercial transportation, or private automobile.
Special transportation includes driver-assisted service to
eligible individuals. Driver-assisted service includes
passenger pickup at and return to the individual's residence or
place of business, assistance with admittance of the individual
to the medical facility, and assistance in passenger securement
or in securing of wheelchairs or stretchers in the vehicle. The
commissioner shall establish maximum medical assistance
reimbursement rates for special transportation services for
persons who need a wheelchair lift accessible van or
stretcher-equipped stretcher-accessible vehicle and for those
who do not need a wheelchair lift accessible van or
stretcher-equipped stretcher-accessible vehicle. The average of
these two rates per trip must not exceed $15 for the base rate
and $1.20 $1.40 per mile. Special transportation provided to
nonambulatory persons who do not need a wheelchair lift
accessible van or stretcher-equipped stretcher-accessible
vehicle, may be reimbursed at a lower rate than special
transportation provided to persons who need a wheelchair lift
accessible van or stretcher-equipped stretcher-accessible
vehicle.
[EFFECTIVE DATE.] This section is effective July 1, 2001.
Sec. 35. Minnesota Statutes 2000, section 256B.0625,
subdivision 17a, is amended to read:
Subd. 17a. [PAYMENT FOR AMBULANCE SERVICES.] Effective for
services rendered on or after July 1, 1999 2001, medical
assistance payments for ambulance services shall be increased by
five percent paid at the Medicare reimbursement rate or at the
medical assistance payment rate in effect on July 1, 2000,
whichever is greater.
Sec. 36. Minnesota Statutes 2000, section 256B.0625,
subdivision 18a, is amended to read:
Subd. 18a. [PAYMENT FOR MEALS AND LODGING ACCESS TO
MEDICAL SERVICES.] (a) Medical assistance reimbursement for
meals for persons traveling to receive medical care may not
exceed $5.50 for breakfast, $6.50 for lunch, or $8 for dinner.
(b) Medical assistance reimbursement for lodging for
persons traveling to receive medical care may not exceed $50 per
day unless prior authorized by the local agency.
(c) Medical assistance direct mileage reimbursement to the
eligible person or the eligible person's driver may not exceed
20 cents per mile.
(d) Medical assistance covers oral language interpreter
services when provided by an enrolled health care provider
during the course of providing a direct, person-to-person
covered health care service to an enrolled recipient with
limited English proficiency.
Sec. 37. Minnesota Statutes 2000, 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.
(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.
(f) Effective January 1, 2001, each federally qualified
health center and rural health clinic may elect to be paid
either under the prospective payment system established in
United States Code, title 42, section 1396a(aa) or under an
alternative payment methodology consistent with the requirements
of United States Code, title 42, section 1396a(aa) and approved
by the Health Care Financing Administration. The alternative
payment methodology shall be 100 percent of cost as determined
according to Medicare cost principles.
Sec. 38. Minnesota Statutes 2000, section 256B.0625,
subdivision 34, is amended to read:
Subd. 34. [INDIAN HEALTH SERVICES FACILITIES.] Medical
assistance payments and MinnesotaCare payments to facilities of
the Indian health service 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, for enrollees who are eligible for federal
financial participation, shall be at the option of the facility
in accordance with the rate published by the United States
Assistant Secretary for Health under the authority of United
States Code, title 42, sections 248(a) and 249(b). General
assistance medical care payments to facilities of the Indian
health services and facilities operated by a tribe or tribal
organization for the provision of outpatient medical care
services billed after June 30, 1990, must be in accordance with
the general assistance medical care rates paid for the same
services when provided in a facility other than a facility of
the Indian health service or a facility operated by a tribe or
tribal organization. MinnesotaCare payments for enrollees who
are not eligible for federal financial participation at
facilities of the Indian Health Service and facilities operated
by a tribe or tribal organization for the provision of
outpatient medical services must be in accordance with the
medical assistance rates paid for the same services when
provided in a facility other than a facility of the Indian
Health Service or a facility operated by a tribe or tribal
organization.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 39. Minnesota Statutes 2000, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 44. [TARGETED CASE MANAGEMENT SERVICES.] Medical
assistance covers case management services for vulnerable adults
and persons with developmental disabilities not receiving home
and community-based waiver services.
Sec. 40. Minnesota Statutes 2000, section 256B.0635,
subdivision 1, is amended to read:
Subdivision 1. [INCREASED EMPLOYMENT.] Beginning January
1, 1998 (a) Until June 30, 2002, medical assistance may be paid
for persons who received MFIP-S or medical assistance for
families and children in at least three of six months preceding
the month in which the person became ineligible for MFIP-S or
medical assistance, if the ineligibility was due to an increase
in hours of employment or employment income or due to the loss
of an earned income disregard. In addition, to receive
continued assistance under this section, persons who received
medical assistance for families and children but did not receive
MFIP-S must have had income less than or equal to the assistance
standard for their family size 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, increased by three percent
effective July 1, 2000, at the time medical assistance
eligibility began. A person who is eligible for extended
medical assistance is entitled to six months of assistance
without reapplication, unless the assistance unit ceases to
include a dependent child. For a person under 21 years of age,
medical assistance may not be discontinued within the six-month
period of extended eligibility until it has been determined that
the person is not otherwise eligible for medical assistance.
Medical assistance may be continued for an additional six months
if the person meets all requirements for the additional six
months, according to title XIX of the Social Security Act, as
amended by section 303 of the Family Support Act of 1988, Public
Law Number 100-485.
(b) Beginning July 1, 2002, medical assistance for families
and children may be paid for persons who were eligible under
section 256B.055, subdivision 3a, in at least three of six
months preceding the month in which the person became ineligible
under that section if the ineligibility was due to an increase
in hours of employment or employment income or due to the loss
of an earned income disregard. A person who is eligible for
extended medical assistance is entitled to six months of
assistance without reapplication, unless the assistance unit
ceases to include a dependent child, except medical assistance
may not be discontinued for that dependent child under 21 years
of age within the six-month period of extended eligibility until
it has been determined that the person is not otherwise eligible
for medical assistance. Medical assistance may be continued for
an additional six months if the person meets all requirements
for the additional six months, according to title XIX of the
Social Security Act, as amended by section 303 of the Family
Support Act of 1988, Public Law Number 100-485.
[EFFECTIVE DATE.] This section is effective July 1, 2001.
Sec. 41. Minnesota Statutes 2000, section 256B.0635,
subdivision 2, is amended to read:
Subd. 2. [INCREASED CHILD OR SPOUSAL SUPPORT.] Beginning
January 1, 1998 (a) Until June 30, 2002, medical assistance may
be paid for persons who received MFIP-S or medical assistance
for families and children in at least three of the six months
preceding the month in which the person became ineligible for
MFIP-S or medical assistance, if the ineligibility was the
result of the collection of child or spousal support under part
D of title IV of the Social Security Act. In addition, to
receive continued assistance under this section, persons who
received medical assistance for families and children but did
not receive MFIP-S must have had income less than or equal to
the assistance standard for their family size 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 increased by three
percent effective July 1, 2000, at the time medical assistance
eligibility began. A person who is eligible for extended
medical assistance under this subdivision is entitled to four
months of assistance without reapplication, unless the
assistance unit ceases to include a dependent child. For a
person under 21 years of age, except medical assistance may not
be discontinued for that dependent child under 21 years of age
within the four-month period of extended eligibility until it
has been determined that the person is not otherwise eligible
for medical assistance.
(b) Beginning July 1, 2002, medical assistance for families
and children may be paid for persons who were eligible under
section 256B.055, subdivision 3a, in at least three of the six
months preceding the month in which the person became ineligible
under that section if the ineligibility was the result of the
collection of child or spousal support under part D of title IV
of the Social Security Act. A person who is eligible for
extended medical assistance under this subdivision is entitled
to four months of assistance without reapplication, unless the
assistance unit ceases to include a dependent child, except
medical assistance may not be discontinued for that dependent
child under 21 years of age within the four-month period of
extended eligibility until it has been determined that the
person is not otherwise eligible for medical assistance.
[EFFECTIVE DATE.] This section is effective July 1, 2001.
Sec. 42. [256B.0637] [PRESUMPTIVE ELIGIBILITY FOR CERTAIN
PERSONS NEEDING TREATMENT FOR BREAST OR CERVICAL CANCER.]
Medical assistance is available during a presumptive
eligibility period for persons who meet the criteria in section
256B.057, subdivision 10. For purposes of this section, the
presumptive eligibility period begins on the date on which an
entity designated by the commissioner determines, based on
preliminary information, that the person meets the criteria in
section 256B.057, subdivision 10. The presumptive eligibility
period ends on the day on which a determination is made as to
the person's eligibility, except that if an application is not
submitted by the last day of the month following the month
during which the determination based on preliminary information
is made, the presumptive eligibility period ends on that last
day of the month.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 43. Minnesota Statutes 2000, section 256B.0644, is
amended to read:
256B.0644 [PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER
OTHER STATE HEALTH CARE PROGRAMS.]
A vendor of medical care, as defined in section 256B.02,
subdivision 7, and a health maintenance organization, as defined
in chapter 62D, must participate as a provider or contractor in
the medical assistance program, general assistance medical care
program, and MinnesotaCare as a condition of participating as a
provider in health insurance plans and programs or contractor
for state employees established under section 43A.18, the public
employees insurance program under section 43A.316, for health
insurance plans offered to local statutory or home rule charter
city, county, and school district employees, the workers'
compensation system under section 176.135, and insurance plans
provided through the Minnesota comprehensive health association
under sections 62E.01 to 62E.19. The limitations on insurance
plans offered to local government employees shall not be
applicable in geographic areas where provider participation is
limited by managed care contracts with the department of human
services. For providers other than health maintenance
organizations, participation in the medical assistance program
means that (1) the provider accepts new medical assistance,
general assistance medical care, and MinnesotaCare patients or
(2) at least 20 percent of the provider's patients are covered
by medical assistance, general assistance medical care, and
MinnesotaCare as their primary source of coverage. Patients
seen on a volunteer basis by the provider at a location other
than the provider's usual place of practice may be considered in
meeting this participation requirement. The commissioner shall
establish participation requirements for health maintenance
organizations. The commissioner shall provide lists of
participating medical assistance providers on a quarterly basis
to the commissioner of employee relations, the commissioner of
labor and industry, and the commissioner of commerce. Each of
the commissioners shall develop and implement procedures to
exclude as participating providers in the program or programs
under their jurisdiction those providers who do not participate
in the medical assistance program. The commissioner of employee
relations shall implement this section through contracts with
participating health and dental carriers.
Sec. 44. [256B.0924] [TARGETED CASE MANAGEMENT SERVICES
FOR VULNERABLE ADULTS AND PERSONS WITH DEVELOPMENTAL
DISABILITIES.]
Subdivision 1. [PURPOSE.] The state recognizes that
targeted case management services can decrease the need for more
costly services such as multiple emergency room visits or
hospitalizations by linking eligible individuals with less
costly services available in the community.
Subd. 2. [DEFINITIONS.] For purposes of this section, the
following terms have the meanings given:
(a) "Targeted case management" means services which will
assist medical assistance eligible persons to gain access to
needed medical, social, educational, and other services.
Targeted case management does not include therapy, treatment,
legal, or outreach services.
(b) "Targeted case management for adults" means activities
that coordinate and link social and other services designed to
help eligible persons gain access to needed protective services,
social, health care, mental health, habilitative, educational,
vocational, recreational, advocacy, legal, chemical, health, and
other related services.
Subd. 3. [ELIGIBILITY.] Persons are eligible to receive
targeted case management services under this section if the
requirements in paragraphs (a) and (b) are met.
(a) The person must be assessed and determined by the local
county agency to:
(1) be age 18 or older;
(2) be receiving medical assistance;
(3) have significant functional limitations; and
(4) be in need of service coordination to attain or
maintain living in an integrated community setting.
(b) The person must be a vulnerable adult in need of adult
protection as defined in section 626.5572, or is an adult with
mental retardation as defined in section 252A.02, subdivision 2,
or a related condition as defined in section 252.27, subdivision
1a, and is not receiving home and community-based waiver
services.
Subd. 4. [TARGETED CASE MANAGEMENT SERVICE
ACTIVITIES.] (a) For persons with mental retardation or a
related condition, targeted case management services must meet
the provisions of section 256B.092.
(b) For persons not eligible as a person with mental
retardation or a related condition, targeted case management
service activities include:
(1) an assessment of the person's need for targeted case
management services;
(2) the development of a written personal service plan;
(3) a regular review and revision of the written personal
service plan with the recipient and the recipient's legal
representative, and others as identified by the recipient, to
ensure access to necessary services and supports identified in
the plan;
(4) effective communication with the recipient and the
recipient's legal representative and others identified by the
recipient;
(5) coordination of referrals for needed services with
qualified providers;
(6) coordination and monitoring of the overall service
delivery to ensure the quality and effectiveness of services;
(7) assistance to the recipient and the recipient's legal
representative to help make an informed choice of services;
(8) advocating on behalf of the recipient when service
barriers are encountered or referring the recipient and the
recipient's legal representative to an independent advocate;
(9) monitoring and evaluating services identified in the
personal service plan to ensure personal outcomes are met and to
ensure satisfaction with services and service delivery;
(10) conducting face-to-face monitoring with the recipient
at least twice a year;
(11) completing and maintain necessary documentation that
supports verifies the activities in this section;
(12) coordinating with the medical assistance facility
discharge planner in the 180-day period prior to the recipient's
discharge into the community; and
(13) a personal service plan developed and reviewed at
least annually with the recipient and the recipient's legal
representative. The personal service plan must be revised when
there is a change in the recipient's status. The personal
service plan must identify:
(i) the desired personal short and long-term outcomes;
(ii) the recipient's preferences for services and supports,
including development of a person-centered plan if requested;
and
(iii) formal and informal services and supports based on
areas of assessment, such as: social, health, mental health,
residence, family, educational and vocational, safety, legal,
self-determination, financial, and chemical health as determined
by the recipient and the recipient's legal representative and
the recipient's support network.
Subd. 5. [PROVIDER STANDARDS.] County boards or providers
who contract with the county are eligible to receive medical
assistance reimbursement for adult targeted case management
services. To qualify as a provider of targeted case management
services the vendor must:
(1) have demonstrated the capacity and experience to
provide the activities of case management services defined in
subdivision 4;
(2) be able to coordinate and link community resources
needed by the recipient;
(3) have the administrative capacity and experience to
serve the eligible population in providing services and to
ensure quality of services under state and federal requirements;
(4) have a financial management system that provides
accurate documentation of services and costs under state and
federal requirements;
(5) have the capacity to document and maintain individual
case records complying with state and federal requirements;
(6) coordinate with county social service agencies
responsible for planning for community social services under
chapters 256E and 256F; conducting adult protective
investigations under section 626.557, and conducting prepetition
screenings for commitments under section 253B.07;
(7) coordinate with health care providers to ensure access
to necessary health care services;
(8) have a procedure in place that notifies the recipient
and the recipient's legal representative of any conflict of
interest if the contracted targeted case management service
provider also provides the recipient's services and supports and
provides information on all potential conflicts of interest and
obtains the recipient's informed consent and provides the
recipient with alternatives; and
(9) have demonstrated the capacity to achieve the following
performance outcomes: access, quality, and consumer
satisfaction.
Subd. 6. [PAYMENT FOR TARGETED CASE MANAGEMENT.] (a)
Medical assistance and MinnesotaCare payment for targeted case
management shall be made on a monthly basis. In order to
receive payment for an eligible adult, the provider must
document at least one contact per month and not more than two
consecutive months without a face-to-face contact with the adult
or the adult's legal representative.
(b) Payment for targeted case management provided by county
staff under this subdivision shall be based on the monthly rate
methodology under section 256B.094, subdivision 6, paragraph
(b), calculated as one combined average rate together with adult
mental health case management under section 256B.0625,
subdivision 20, except for calendar year 2002. In calendar year
2002, the rate for case management under this section shall be
the same as the rate for adult mental health case management in
effect as of December 31, 2001. Billing and payment must
identify the recipient's primary population group to allow
tracking of revenues.
(c) Payment for targeted 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.
(d) If the service is provided by a team that includes
contracted vendors and county staff, the costs for county staff
participation on 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 targeted case management and
a description of the different roles of the team members.
(e) Notwithstanding section 256B.19, subdivision 1, the
nonfederal share of costs for targeted 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.
(f) The commissioner may suspend, reduce, or terminate
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.
(g) The commissioner shall set aside five percent of the
federal funds received under this section for use in reimbursing
the state for costs of developing and implementing this section.
(h) Notwithstanding section 256.025, subdivision 2,
payments to counties for targeted 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.
(i) Notwithstanding section 256B.041, county payments for
the cost of case management services provided by county staff
shall not be made to the state treasurer. For the purposes of
targeted case management services provided by county 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.
(j) 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
targeted case management services under this subdivision is
limited to the last 180 days of the recipient's residency in
that facility and may not exceed more than six months in a
calendar year.
(k) Payment for targeted case management services under
this subdivision shall not duplicate payments made under other
program authorities for the same purpose.
(l) Any growth in targeted case management services and
cost increases under this section shall be the responsibility of
the counties.
Subd. 7. [IMPLEMENTATION AND EVALUATION.] The commissioner
of human services in consultation with county boards shall
establish a program to accomplish the provisions of subdivisions
1 to 6. The commissioner in consultation with county boards
shall establish performance measures to evaluate the
effectiveness of the targeted case management services. If a
county fails to meet agreed upon performance measures, the
commissioner may authorize contracted providers other than the
county. Providers contracted by the commissioner shall also be
subject to the standards in subdivision 6.
[EFFECTIVE DATE.] This section is effective January 1, 2002.
Sec. 45. Minnesota Statutes 2000, section 256B.19,
subdivision 1c, is amended to read:
Subd. 1c. [ADDITIONAL PORTION OF NONFEDERAL SHARE.] In
addition to any payment required under subdivision 1b, (a)
Hennepin county shall be responsible for a monthly transfer
payment of $1,500,000, due before noon on the 15th of each month
and the University of Minnesota shall be responsible for a
monthly transfer payment of $500,000 due before noon on the 15th
of each month, beginning July 15, 1995. These sums shall be
part of the designated governmental unit's portion of the
nonfederal share of medical assistance costs, but shall not be
subject to payback provisions of section 256.025.
(b) Beginning July 1, 2001, Hennepin county's payment under
paragraph (a) shall be $2,066,000 each month.
(c) Beginning July 1, 2001, the commissioner shall increase
annual capitation payments to metropolitan health plan under
section 256B.69 for the prepaid medical assistance program by
approximately $3,400,000, plus any available federal matching
funds, to recognize higher than average medical education costs.
Sec. 46. [256B.195] [ADDITIONAL INTERGOVERNMENTAL
TRANSFERS; HOSPITAL PAYMENTS.]
Subdivision 1. [FEDERAL APPROVAL REQUIRED.] Sections
145.9268, 256.969, subdivision 26, and this section are
contingent on federal approval of the intergovernmental
transfers and payments to safety net hospitals and community
clinics authorized under this section. These sections are also
contingent on current payment, by the government entities, of
intergovernmental transfers under section 256B.19 and this
section.
Subd. 2. [PAYMENTS FROM GOVERNMENTAL ENTITIES.] (a) In
addition to any payment required under section 256B.19,
effective July 15, 2001, the following government entities shall
make the payments indicated before noon on the 15th of each
month:
(1) Hennepin county, $2,000,000; and
(2) Ramsey county, $1,000,000.
(b) These sums shall be part of the designated governmental
unit's portion of the nonfederal share of medical assistance
costs. Of these payments, Hennepin county shall pay 71 percent
directly to Hennepin County Medical Center, and Ramsey county
shall pay 71 percent directly to Regions hospital. The counties
must provide certification to the commissioner of payments to
hospitals under this subdivision.
Subd. 3. [PAYMENTS TO CERTAIN SAFETY NET PROVIDERS.] (a)
Effective July 15, 2001, the commissioner shall make the
following payments to the hospitals indicated after noon on the
15th of each month:
(1) to Hennepin County Medical Center, any federal matching
funds available to match the payments received by the medical
center under subdivision 2, to increase payments for medical
assistance admissions and to recognize higher medical assistance
costs in institutions that provide high levels of charity care;
and
(2) to Regions hospital, any federal matching funds
available to match the payments received by the hospital under
subdivision 2, to increase payments for medical assistance
admissions and to recognize higher medical assistance costs in
institutions that provide high levels of charity care.
(b) Effective July 15, 2001, the following percentages of
the transfers under subdivision 2 shall be retained by the
commissioner for deposit each month into the general fund:
(1) 18 percent, plus any federal matching funds, shall be
allocated for the following purposes:
(i) during the fiscal year beginning July 1, 2001, of the
amount available under this clause, 39.7 percent shall be
allocated to make increased hospital payments under section
256.969, subdivision 26; 34.2 percent shall be allocated to fund
the amounts due from small rural hospitals, as defined in
section 144.148, for overpayments under section 256.969,
subdivision 5a, resulting from a determination that medical
assistance and general assistance payments exceeded the charge
limit during the period from 1994 to 1997; and 26.1 percent
shall be allocated to the commissioner of health for rural
hospital capital improvement grants under section 144.148; and
(ii) during fiscal years beginning on or after July 1,
2002, of the amount available under this clause, 55 percent
shall be allocated to make increased hospital payments under
section 256.969, subdivision 26, and 45 percent shall be
allocated to the commissioner of health for rural hospital
capital improvement grants under section 144.148; and
(2) 11 percent shall be allocated to the commissioner of
health to fund community clinic grants under section 145.9268.
(c) This subdivision shall apply to fee-for-service
payments only and shall not increase capitation payments or
payments made based on average rates.
(d) Medical assistance rate or payment changes, including
those required to obtain federal financial participation under
section 62J.692, subdivision 8, shall precede the determination
of intergovernmental transfer amounts determined in this
subdivision. Participation in the intergovernmental transfer
program shall not result in the offset of any health care
provider's receipt of medical assistance payment increases other
than limits resulting from hospital-specific charge limits and
limits on disproportionate share hospital payments.
Subd. 4. [ADJUSTMENTS PERMITTED.] (a) The commissioner may
adjust the intergovernmental transfers under subdivision 2 and
the payments under subdivision 3, and payments and transfers
under subdivision 5, based on the commissioner's determination
of Medicare upper payment limits, hospital-specific charge
limits, and hospital-specific limitations on disproportionate
share payments. Any adjustments must be made on a proportional
basis. If participation by a particular hospital under this
section is limited, the commissioner shall adjust the payments
that relate to that hospital under subdivisions 2, 3, and 5 on a
proportional basis in order to allow the hospital to participate
under this section to the fullest extent possible and shall
increase other payments under subdivisions 2, 3, and 5 to the
extent allowable to maintain the overall level of payments under
this section. The commissioner may make adjustments under this
subdivision only after consultation with the counties and
hospitals identified in subdivisions 2 and 3, and, if
subdivision 5 receives federal approval, with the hospital and
educational institution identified in subdivision 5.
(b) The ratio of medical assistance payments specified in
subdivision 3 to the intergovernmental transfers specified in
subdivision 2 shall not be reduced except as provided under
paragraph (a).
Subd. 5. [INCLUSION OF FAIRVIEW UNIVERSITY MEDICAL
CENTER.] (a) Upon federal approval of the inclusion of Fairview
university medical center in the nonstate government category,
the commissioner shall establish an intergovernmental transfer
with the University of Minnesota in an amount determined by the
commissioner based on the increase in the Medicare upper payment
limit due solely to the inclusion of Fairview university medical
center as a nonstate government hospital and limited by
hospital-specific charge limits and the amount available under
the hospital-specific disproportionate share limit.
(b) The commissioner shall increase payments for medical
assistance admissions at Fairview University Medical Center by
71 percent of the transfer plus any federal matching payments on
that amount, to increase payments for medical assistance
admissions and to recognize higher medical assistance costs in
institutions that provide high levels of charity care. From
this payment, Fairview University Medical Center shall pay to
the University of Minnesota the cost of the transfer, on the
same day the payment is received. Eighteen percent of the
transfer plus any federal matching payments shall be used as
specified in subdivision 3, paragraph (b), clause (1). Payments
under section 256.969, subdivision 26, may be increased above
the 90 percent level specified in that subdivision within the
limits of additional funding available under this subdivision.
Eleven percent of the transfer shall be used to increase the
grants under section 145.9268.
Sec. 47. [256B.53] [DENTAL ACCESS GRANTS.]
(a) 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.
(b) 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:
(1) potential to successfully increase access to an
underserved population;
(2) the long-term viability of the project to improve
access beyond the period of initial funding;
(3) the efficiency in the use of the funding; and
(4) the experience of the applicants in providing services
to the target population.
(c) The commissioner shall consider grants for the
following:
(1) implementation of new programs or continued expansion
of current access programs that have demonstrated success in
providing dental services in underserved areas;
(2) a program for mobile or other types of outreach dental
clinics in underserved geographic areas;
(3) a program for school-based dental clinics in schools
with high numbers of children receiving medical assistance;
(4) a program testing new models of care that are sensitive
to the cultural needs of the recipients;
(5) a program creating new educational campaigns that
inform individuals of the importance of good oral health and the
link between dental disease and overall health status;
(6) a program that organizes a network of volunteer
dentists to provide dental services to public program recipients
or uninsured individuals; and
(7) a program that tests new delivery models by creating
partnerships between local providers and county public health
agencies.
(d) The commissioner shall evaluate the effects of the
dental access initiatives funded through the dental access
grants and submit a report to the legislature by January 15,
2003.
Sec. 48. [256B.55] [DENTAL ACCESS ADVISORY COMMITTEE.]
Subdivision 1. [ESTABLISHMENT.] The commissioner shall
establish a dental access advisory committee to monitor the
purchasing, administration, and coverage of dental care services
for the public health care programs to ensure dental care access
and quality for public program recipients.
Subd. 2. [MEMBERSHIP.] (a) The membership of the advisory
committee shall include, but is not limited to, representatives
of dentists, including a dentist practicing in the seven-county
metropolitan area and a dentist practicing outside the
seven-county metropolitan area; oral surgeons; pediatric
dentists; dental hygienists; community clinics; client advocacy
groups; public health; health service plans; the University of
Minnesota school of dentistry and the department of pediatrics;
and the commissioner of health.
(b) The advisory committee is governed by section 15.059
for membership terms and removal of members. Members shall not
receive per diem compensation or reimbursement for expenses.
Subd. 3. [DUTIES.] The advisory committee shall provide
recommendations on the following:
(1) how to reduce the administrative burden governing
dental care coverage policies in order to promote administrative
simplification, including prior authorization, coverage limits,
and co-payment collections;
(2) developing and implementing an action plan to improve
the oral health of children and persons with special needs in
the state;
(3) exploring alternative ways of purchasing and improving
access to dental services;
(4) developing ways to foster greater responsibility among
health care program recipients in seeking and obtaining dental
care, including initiatives to keep dental appointments and
comply with dental care plans;
(5) exploring innovative ways for dental providers to
schedule public program patients in order to reduce or minimize
the effect of appointment no shows;
(6) exploring ways to meet the barriers that may be present
in providing dental services to health care program recipients
such as language, culture, disability, and lack of
transportation; and
(7) exploring the possibility of pediatricians, family
physicians, and nurse practitioners providing basic oral health
screenings and basic preventive dental services.
Subd. 4. [REPORT.] The commissioner shall submit a report
by February 1, 2002, and by February 1, 2003, summarizing the
activities and recommendations of the advisory committee.
Subd. 5. [SUNSET.] Notwithstanding section 15.059,
subdivision 5, this section expires June 30, 2003.
Sec. 49. Minnesota Statutes 2000, section 256B.69,
subdivision 4, is amended to read:
Subd. 4. [LIMITATION OF CHOICE.] (a) The commissioner
shall develop criteria to determine when limitation of choice
may be implemented in the experimental counties. The criteria
shall ensure that all eligible individuals in the county have
continuing access to the full range of medical assistance
services as specified in subdivision 6.
(b) The commissioner shall exempt the following persons
from participation in the project, in addition to those who do
not meet the criteria for limitation of choice:
(1) persons eligible for medical assistance according to
section 256B.055, subdivision 1;
(2) persons eligible for medical assistance due to
blindness or disability as determined by the social security
administration or the state medical review team, unless:
(i) they are 65 years of age or older,; or
(ii) they reside in Itasca county or they reside in a
county in which the commissioner conducts a pilot project under
a waiver granted pursuant to section 1115 of the Social Security
Act;
(3) recipients who currently have private coverage through
a health maintenance organization;
(4) recipients who are eligible for medical assistance by
spending down excess income for medical expenses other than the
nursing facility per diem expense;
(5) recipients who receive benefits under the Refugee
Assistance Program, established under United States Code, title
8, section 1522(e);
(6) children who are both determined to be severely
emotionally disturbed and receiving case management services
according to section 256B.0625, subdivision 20; and
(7) adults who are both determined to be seriously and
persistently mentally ill and received case management services
according to section 256B.0625, subdivision 20; and
(8) persons eligible for medical assistance according to
section 256B.057, subdivision 10.
Children under age 21 who are in foster placement may enroll in
the project on an elective basis. Individuals excluded under
clauses (6) and (7) may choose to enroll on an elective basis.
(c) The commissioner may allow persons with a one-month
spenddown who are otherwise eligible to enroll to voluntarily
enroll or remain enrolled, if they elect to prepay their monthly
spenddown to the state.
(d) Beginning on or after July 1, 1997, The commissioner
may require those individuals to enroll in the prepaid medical
assistance program who otherwise would have been excluded
under paragraph (b), clauses (1) and, (3), and (8), and under
Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.
(e) Before limitation of choice is implemented, eligible
individuals shall be notified and after notification, shall be
allowed to choose only among demonstration providers. The
commissioner may assign an individual with private coverage
through a health maintenance organization, to the same health
maintenance organization for medical assistance coverage, if the
health maintenance organization is under contract for medical
assistance in the individual's county of residence. After
initially choosing a provider, the recipient is allowed to
change that choice only at specified times as allowed by the
commissioner. If a demonstration provider ends participation in
the project for any reason, a recipient enrolled with that
provider must select a new provider but may change providers
without cause once more within the first 60 days after
enrollment with the second provider.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 50. Minnesota Statutes 2000, section 256B.69,
subdivision 5c, is amended to read:
Subd. 5c. [MEDICAL EDUCATION AND RESEARCH 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 and demonstration projects operating under subdivision
23, to the medical education and research fund established under
section 62J.692; each year to the medical education and research
fund established under section 62J.692, the following:
(2) (1) an amount equal to the reduction in the prepaid
medical assistance and prepaid general assistance medical care
payments as specified in this clause. Until January 1, 2002,
the county medical assistance and general assistance medical
care capitation base rate prior to plan specific adjustments and
after the regional rate adjustments under section 256B.69,
subdivision 5b, shall be is reduced 6.3 percent for Hennepin
county, two percent for the remaining metropolitan counties, and
no reduction for nonmetropolitan Minnesota counties; and after
January 1, 2002, the county medical assistance and general
assistance medical care capitation base rate prior to plan
specific adjustments shall be is reduced 6.3 percent for
Hennepin county, two percent for the remaining metropolitan
counties, and 1.6 percent for nonmetropolitan Minnesota
counties. Nursing facility and elderly waiver payments and
demonstration project payments operating under subdivision 23
are excluded from this reduction. The amount calculated under
this clause shall not be adjusted for periods already paid due
to subsequent changes to the capitation payments; and
(2) beginning July 1, 2001, $2,537,000 from the capitation
rates paid under this section plus any federal matching funds on
this amount.
(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 fund.
Sec. 51. Minnesota Statutes 2000, section 256B.69, is
amended by adding a subdivision to read:
Subd. 6c. [DENTAL SERVICES DEMONSTRATION PROJECT.] The
commissioner shall establish a dental services demonstration
project in Crow Wing, Todd, Morrison, Wadena, and Cass counties
for provision of dental services to medical assistance, general
assistance medical care, and MinnesotaCare recipients. The
commissioner may contract on a prospective per capita payment
basis for these dental services with an organization licensed
under chapter 62C, 62D, or 62N in accordance with section
256B.037 or may establish and administer a fee-for-service
system for the reimbursement of dental services.
Sec. 52. Minnesota Statutes 2000, section 256B.69,
subdivision 23, is amended to read:
Subd. 23. [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES;
ELDERLY AND DISABLED PERSONS.] (a) The commissioner may
implement demonstration projects to create alternative
integrated delivery systems for acute and long-term care
services to elderly persons and persons with disabilities as
defined in section 256B.77, subdivision 7a, that provide
increased coordination, improve access to quality services, and
mitigate future cost increases. The commissioner may seek
federal authority to combine Medicare and Medicaid capitation
payments for the purpose of such demonstrations. Medicare funds
and services shall be administered according to the terms and
conditions of the federal waiver and demonstration provisions.
For the purpose of administering medical assistance funds,
demonstrations under this subdivision are subject to
subdivisions 1 to 22. The provisions of Minnesota Rules, parts
9500.1450 to 9500.1464, apply to these demonstrations, with the
exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457,
subpart 1, items B and C, which do not apply to persons
enrolling in demonstrations under this section. An initial open
enrollment period may be provided. Persons who disenroll from
demonstrations under this subdivision remain subject to
Minnesota Rules, parts 9500.1450 to 9500.1464. When a person is
enrolled in a health plan under these demonstrations and the
health plan's participation is subsequently terminated for any
reason, the person shall be provided an opportunity to select a
new health plan and shall have the right to change health plans
within the first 60 days of enrollment in the second health
plan. Persons required to participate in health plans under
this section who fail to make a choice of health plan shall not
be randomly assigned to health plans under these demonstrations.
Notwithstanding section 256L.12, subdivision 5, and Minnesota
Rules, part 9505.5220, subpart 1, item A, if adopted, for the
purpose of demonstrations under this subdivision, the
commissioner may contract with managed care organizations,
including counties, to serve only elderly persons eligible for
medical assistance, elderly and disabled persons, or disabled
persons only. For persons with primary diagnoses of mental
retardation or a related condition, serious and persistent
mental illness, or serious emotional disturbance, the
commissioner must ensure that the county authority has approved
the demonstration and contracting design. Enrollment in these
projects for persons with disabilities shall be voluntary until
July 1, 2001. The commissioner shall not implement any
demonstration project under this subdivision for persons with
primary diagnoses of mental retardation or a related condition,
serious and persistent mental illness, or serious emotional
disturbance, without approval of the county board of the county
in which the demonstration is being implemented.
Before implementation of a demonstration project for
disabled persons, the commissioner must provide information to
appropriate committees of the house of representatives and
senate and must involve representatives of affected disability
groups in the design of the demonstration projects.
(b) A nursing facility reimbursed under the alternative
reimbursement methodology in section 256B.434 may, in
collaboration with a hospital, clinic, or other health care
entity provide services under paragraph (a). The commissioner
shall amend the state plan and seek any federal waivers
necessary to implement this paragraph.
Sec. 53. Minnesota Statutes 2000, 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.
(c) Effective for services provided on or after July 1,
2002, rates that are based on the Medicare outpatient
prospective payment system shall be replaced by a budget neutral
prospective payment system that is derived using medical
assistance data. The commissioner shall provide a proposal to
the 2002 legislature to define and implement this provision.
Sec. 54. Minnesota Statutes 2000, section 256B.76, is
amended to read:
256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.]
(a) 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 cesarean
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;
(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) 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;
(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; and
(7) effective for services provided on or after January 1,
2002, payment for diagnostic examinations and dental x-rays
provided to children under age 21 shall be the lower of (i) the
submitted charge, or (ii) 85 percent of median 1999 charges.
(c) Effective for dental services rendered on or after
January 1, 2002, the commissioner may, within the limits of
available appropriation, increase reimbursements to dentists and
dental clinics deemed by the commissioner to be critical access
dental providers. Reimbursement to a critical access dental
provider may be increased by not more than 50 percent above the
reimbursement rate that would otherwise be paid to the
provider. Payments to health plan companies shall be adjusted
to reflect increased reimbursements to critical access dental
providers as approved by the commissioner. In determining which
dentists and dental clinics shall be deemed critical access
dental providers, the commissioner shall review:
(1) the utilization rate in the service area in which the
dentist or dental clinic operates for dental services to
patients covered by medical assistance, general assistance
medical care, or MinnesotaCare as their primary source of
coverage;
(2) the level of services provided by the dentist or dental
clinic to patients covered by medical assistance, general
assistance medical care, or MinnesotaCare as their primary
source of coverage; and
(3) whether the level of services provided by the dentist
or dental clinic is critical to maintaining adequate levels of
patient access within the service area.
In the absence of a critical access dental provider in a service
area, the commissioner may designate a dentist or dental clinic
as a critical access dental provider if the dentist or dental
clinic is willing to provide care to patients covered by medical
assistance, general assistance medical care, or MinnesotaCare at
a level which significantly increases access to dental care in
the service area.
(d) 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. 55. [256B.78] [MEDICAL ASSISTANCE DEMONSTRATION
PROJECT FOR FAMILY PLANNING SERVICES.]
(a) The commissioner of human services shall establish a
medical assistance demonstration project to determine whether
improved access to coverage of prepregnancy family planning
services reduces medical assistance and MFIP costs.
(b) This section is effective upon federal approval of the
demonstration project.
Sec. 56. Minnesota Statutes 2000, 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 5c, paragraph (b), or whose excess income is spent
down according to section 256B.056, subdivision 5, to that
standard 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 AFDC income disregard and deductions in
effect under the July 16, 1996, AFDC state plan. 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.
(k) For purposes of paragraphs (g) and (j), "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.
(l) 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.
[EFFECTIVE DATE.] This section is effective July 1, 2001.
Sec. 57. Minnesota Statutes 2000, section 256J.31,
subdivision 12, is amended to read:
Subd. 12. [RIGHT TO DISCONTINUE CASH ASSISTANCE.] A
participant who is not in vendor payment status may discontinue
receipt of the cash assistance portion of the MFIP assistance
grant and retain eligibility for child care assistance under
section 119B.05 and for medical assistance under sections
256B.055, subdivision 3a, and 256B.0635. For the months a
participant chooses to discontinue the receipt of the cash
portion of the MFIP grant, the assistance unit accrues months of
eligibility to be applied toward eligibility for child care
under section 119B.05 and for medical assistance under sections
256B.055, subdivision 3a, and 256B.0635.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 58. Minnesota Statutes 2000, section 256K.03,
subdivision 1, is amended to read:
Subdivision 1. [NOTIFICATION OF PROGRAM.] Except for the
provisions in this section, the provisions for the MFIP
application process shall be followed. Within two days after
receipt of a completed combined application form, the county
agency must refer to the provider the applicant who meets the
conditions under section 256K.02, and notify the applicant in
writing of the program including the following provisions:
(1) notification that, as part of the application process,
applicants are required to attend orientation, to be followed
immediately by a job search;
(2) the program provider, the date, time, and location of
the scheduled program orientation;
(3) the procedures for qualifying for and receiving
benefits under the program;
(4) the immediate availability of supportive services,
including, but not limited to, child care, transportation,
medical assistance, and other work-related aid; and
(5) the rights, responsibilities, and obligations of
participants in the program, including, but not limited to, the
grounds for exemptions and deferrals, the consequences for
refusing or failing to participate fully, and the appeal process.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 59. Minnesota Statutes 2000, section 256K.07, is
amended to read:
256K.07 [ELIGIBILITY FOR FOOD STAMPS, MEDICAL ASSISTANCE,
AND CHILD CARE.]
The participant shall be treated as an MFIP recipient for
food stamps, medical assistance, and child care eligibility
purposes. The participant who leaves the program as a result of
increased earnings from employment shall be eligible for
transitional medical assistance and child care without regard to
MFIP receipt in three of the six months preceding ineligibility.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 60. Minnesota Statutes 2000, section 256L.03, is
amended by adding a subdivision to read:
Subd. 5a. [CO-PAYMENTS FOR CERTAIN CHILDREN.] Effective
July 1, 2002, through June 30, 2006, the MinnesotaCare benefit
plan for children enrolled in MinnesotaCare who, in accordance
with section 256L.15, subdivision 1, paragraph (c), opt not to
pay a premium shall include a $5 co-payment for nonpreventive
physician services, chiropractic services, and hospital
outpatient services as determined by the commissioner.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 61. Minnesota Statutes 2000, section 256L.05,
subdivision 2, is amended to read:
Subd. 2. [COMMISSIONER'S DUTIES.] The commissioner shall
use individuals' social security numbers as identifiers for
purposes of administering the plan and conduct data matches to
verify income. Applicants shall submit evidence of individual
and family income, earned and unearned, such as the most recent
income tax return, wage slips, or other documentation that is
determined by the commissioner as necessary to verify income
eligibility or county agency shall use electronic verification
as the primary method of income verification. If there is a
discrepancy between reported income and electronically verified
income, an individual may be required to submit additional
verification. In addition, the commissioner shall perform
random audits to verify reported income and eligibility. The
commissioner may execute data sharing arrangements with the
department of revenue and any other governmental agency in order
to perform income verification related to eligibility and
premium payment under the MinnesotaCare program.
Sec. 62. Minnesota Statutes 2000, 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. Failure to pay includes
payment with a dishonored check, 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, 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
effective for the calendar month for which the premium was due.
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.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 63. Minnesota Statutes 2000, section 256L.07,
subdivision 2, is amended to read:
Subd. 2. [MUST NOT HAVE ACCESS TO EMPLOYER-SUBSIDIZED
COVERAGE.] (a) To be eligible, 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) This subdivision does not apply to a family or
individual who was enrolled in MinnesotaCare within six months
or less of reapplication and who no longer has
employer-subsidized coverage due to the employer terminating
health care coverage as an employee benefit.
(c) 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.
[EFFECTIVE DATE.] This section is effective July 1, 2001,
or upon receipt of federal approval, whichever is later.
Sec. 64. Minnesota Statutes 2000, section 256L.12, is
amended by adding a subdivision to read:
Subd. 11. [COVERAGE AT INDIAN HEALTH SERVICE
FACILITIES.] For American Indian enrollees of MinnesotaCare,
MinnesotaCare shall cover health care services provided at
Indian Health Service 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 Act, Public Law
Number 93-638, if those services would otherwise be covered
under section 256L.03. 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 organization, be made at the
rates authorized under sections 256.969, subdivision 16, and
256B.0625, subdivision 34, for those MinnesotaCare enrollees
eligible for coverage at medical assistance rates. For purposes
of this subdivision, "American Indian" has the meaning given to
persons to whom services will be provided for in the Code of
Federal Regulations, title 42, section 36.12.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 65. Minnesota Statutes 2000, section 256L.15,
subdivision 1, is amended to read:
Subdivision 1. [PREMIUM DETERMINATION.] (a) Families with
children and individuals shall pay a premium determined
according to a sliding fee based on a percentage of the family's
gross family income.
(b) 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.
(c) Effective July 1, 2002, through June 30, 2006, at their
option, children with gross family income at or below 217
percent of the federal poverty guidelines who are eligible for
MinnesotaCare in the first month following termination from
medical assistance shall not pay a premium for 12 months.
[EFFECTIVE DATE.] This section is effective July 1, 2002.
Sec. 66. Minnesota Statutes 2000, section 256L.16, is
amended to read:
256L.16 [PAYMENT RATES; SERVICES FOR FAMILIES AND CHILDREN
UNDER THE MINNESOTACARE HEALTH CARE REFORM WAIVER.]
Section 256L.11, subdivision 2, shall not apply to services
provided to children families with children who are eligible to
receive expanded services according to section 256L.03,
subdivision 1a 256L.04, subdivision 1, paragraph (a).
Sec. 67. Minnesota Statutes 2000, section 256L.17,
subdivision 2, is amended to read:
Subd. 2. [LIMIT ON TOTAL ASSETS.] (a) Effective April 1,
1997 July 1, 2002, or upon federal approval, whichever is later,
in order to be eligible for the MinnesotaCare program, a
household of two or more persons must not own more than $30,000
in total net assets, and a household of one person must not own
more than $15,000 in total net assets.
(b) For purposes of this subdivision, total net assets
include all assets, with the following exceptions:
(1) a homestead is not considered;
(2) household goods and personal effects are not
considered;
(3) any assets owned by children;
(4) vehicles used for employment;
(5) court-ordered settlements up to $10,000;
(6) individual retirement accounts; and
(7) capital and operating assets of a trade or business up
to $200,000 in net assets are not considered.
(c) If an asset excluded under paragraph (b) has a negative
value, the negative value shall be subtracted from the total net
assets under paragraph (a) assets are determined according to
section 256B.056, subdivision 3c.
[EFFECTIVE DATE.] This section is effective July 1, 2001.
Sec. 68. Laws 1995, chapter 178, article 2, section 36, is
amended to read:
Sec. 36. [EMPOWERMENT ZONES; ADMINISTRATIVE SIMPLIFICATION
OF WELFARE LAWS.]
(a) The commissioner of human services shall make
recommendations to effectuate the changes in federal laws and
regulations, state laws and rules, and the state plan to improve
the administrative efficiency of the aid to families with
dependent children, general assistance, work readiness, family
general assistance, medical assistance, general assistance
medical care, and food stamp programs. At a minimum, the
following administrative standards and procedures must be
changed.
The commissioner shall:
(1) require income or eligibility reviews no more
frequently than annually for cases in which income is normally
invariant, as in aid to families with dependent children cases
where the only source of household income is Supplemental Social
Security Income;
(2) permit households to report income annually when the
source of income is excluded, such as a minor's earnings;
(3) require income or eligibility reviews no more
frequently than annually for extended medical assistance cases;
(4) require income or eligibility reviews no more
frequently than annually for a medical assistance postpartum
client, where the client previously had eligibility under a
different basis prior to pregnancy or if other household members
have eligibility with the same income/basis that applies to the
client;
(5) (4) permit all income or eligibility reviews for foster
care medical assistance cases to use the short application form;
and
(6) (5) make dependent care expenses declaratory for
medical assistance; and
(7) permit households to only report gifts worth $100 or
more per month.
(b) The county's administrative savings resulting from
these changes may be allocated to fund any lawful purpose.
(c) The recommendations must be provided in a report to the
chairs of the appropriate legislative committees by August 1,
1995. The recommendations must include a list of the
administrative standards and procedures that require approval by
the federal government before implementation, and also which
administrative simplification standards and procedures may be
implemented by a county prior to receiving a federal waiver.
(d) The commissioner shall seek the necessary waivers from
the federal government as soon as possible to implement the
administrative simplification standards and procedures.
Sec. 69. Laws 1999, chapter 245, article 4, section 110,
is amended to read:
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 January 15, 2002.
Sec. 70. [REGULATORY SIMPLIFICATION FOR STATE HEALTH CARE
PROGRAM PROVIDERS.]
The commissioner of human services, in consultation with
providers participating in state health care programs, shall
identify nonfinancial barriers to increased provider enrollment
and provider retention in state health care programs, and shall
implement procedures to address these barriers. Areas to be
examined by the commissioner shall include, but are not limited
to, regulatory complexity and inconsistencies between state
health care programs, provider requirements, provision of
technical assistance to providers, responsiveness to provider
inquiries and complaints, claims processing turnaround times,
and policies for rejecting provider claims. The commissioner
shall report to the legislature by February 15, 2002, on any
changes to the administration of state health care programs that
will be implemented as a result of the study, and present
recommendations for any necessary changes in state law.
Sec. 71. [EXPAND DENTAL AUXILIARY PERSONNEL;
FOREIGN-TRAINED DENTISTS; DENTAL CLINICS.]
Subdivision 1. [DEVELOPMENT.] (a) The board of dentistry,
in consultation with the University of Minnesota school of
dentistry, the Minnesota state colleges and universities that
offer a dental auxiliary training program, the commissioner of
health, and licensed dentists and dental auxiliaries practicing
in private practice and at community clinics, shall develop new
expanded duties for registered dental assistants and dental
hygienists. The new duties must be performed under direct or
indirect supervision of a licensed dentist. These expanded
duties must be limited to reversible procedures, including, but
not limited to, placement, contouring, and adjustment of amalgam
restorations, temporary restorations, the alignment and
cementing of stainless steel crowns to primary teeth, and
application of pit and fissure sealants. These expanded duties
shall not include or imply a diagnosis or treatment plan, nor
include prescribing medications, cutting hard or soft tissue, or
any direct patient care in which formal training has not been
completed. The board shall establish the necessary educational
qualifications to perform the new duties.
(b) The board shall make recommendations to amend Minnesota
Statutes, chapter 150A, to permit a foreign-trained dentist to
practice as a dental hygienist or as a registered dental
assistant.
(c) The board shall submit the proposed changes to
Minnesota Statutes, chapter 150A, to the legislature by January
15, 2002.
Subd. 2. [DENTAL CLINICS.] The commissioner of health, in
consultation with the Minnesota state colleges and universities,
shall determine the capital improvements needed to establish
community-based dental clinics at state colleges and
universities to be used as training sites and as public
community-based dental clinics for public program recipients
during times when the school is not in session and the clinic is
not in use. The commissioner shall submit the necessary capital
improvement costs for start-up equipment and necessary
infrastructure as part of the 2002 legislative capital budget
requests.
Sec. 72. [NOTICE OF PREMIUM CHANGES IN THE EMPLOYED
PERSONS WITH DISABILITIES PROGRAM.]
The commissioner of human services shall provide notice to
all medical assistance recipients receiving coverage through the
employed persons with disabilities program under Minnesota
Statutes, section 256B.057, subdivision 9, of the first new
premium schedule in effect on November 1, 2001, at least two
months before the month in which the first new premium is due.
Sec. 73. [ADDITIONAL TRAINING REQUIREMENTS.]
The board of dentistry may make recommendations to the 2002
legislature on additional training requirements for dental
hygienists practicing under the limited authorization provided
in Minnesota Statutes, section 150A.10, subdivision 1a.
Sec. 74. [ELIGIBILITY EXCEPTION TO THE PRESCRIPTION DRUG
PROGRAM.]
Notwithstanding the requirements of Minnesota Statutes,
section 256.955, subdivision 2, paragraph (d), from March 1,
2001, to June 30, 2002, the definition of a "qualified
individual" in the prescription drug program established under
Minnesota Statutes, section 256.955, shall include an individual
who:
(1) was enrolled in the prescription drug program prior to
March 1, 2001;
(2) was enrolled in a Medicare risk plan prior to March 1,
2001, to which an annual prescription drug benefit of $400 was
added on March 1, 2001; and
(3) meets the requirements described in Minnesota Statutes,
section 256.955, subdivision 2, paragraph (d), clauses (1) and
(5), and subdivision 2a.
The prescription benefit offered by the Medicare risk plan shall
be primary to benefits provided under the prescription drug
program.
Sec. 75. [MINNESOTACARE ELIGIBILITY FOR SELF-EMPLOYED
FARMERS.]
(a) The commissioner of human services shall seek federal
approval to redefine in the MinnesotaCare program the definition
of "gross individual or gross family income" for farm
self-employed to mean income calculated using as a baseline the
adjusted gross income reported on the applicant's federal income
tax form for the previous year and adding back in reported
depreciation amounts that apply to the business in which the
family is currently engaged.
(b) Upon receipt of federal approval, the commissioner
shall notify the legislature. No change to the definition shall
be implemented without further action by the legislature.
Sec. 76. [REPEALER.]
(a) Minnesota Statutes 2000, section 256B.0635, subdivision
3, and 256B.19, subdivision 1b, are repealed effective July 1,
2001.
(b) Minnesota Statutes 2000, section 256L.02, subdivision
4, is repealed effective January 1, 2003.
ARTICLE 3
CONTINUING CARE
Section 1. Minnesota Statutes 2000, section 245A.13,
subdivision 7, is amended to read:
Subd. 7. [RATE RECOMMENDATION.] The commissioner of human
services may review rates of a residential program participating
in the medical assistance program which is in receivership and
that has needs or deficiencies documented by the department of
health or the department of human services. If the commissioner
of human services determines that a review of the rate
established under section 256B.501 sections 256B.5012 and
256B.5013 is needed, the commissioner shall:
(1) review the order or determination that cites the
deficiencies or needs; and
(2) determine the need for additional staff, additional
annual hours by type of employee, and additional consultants,
services, supplies, equipment, repairs, or capital assets
necessary to satisfy the needs or deficiencies.
Sec. 2. Minnesota Statutes 2000, section 245A.13,
subdivision 8, is amended to read:
Subd. 8. [ADJUSTMENT TO THE RATE.] Upon review of rates
under subdivision 7, the commissioner may adjust the residential
program's payment rate. The commissioner shall review the
circumstances, together with the residential program cost report
program's most recent income and expense report, to determine
whether or not the deficiencies or needs can be corrected or met
by reallocating residential program staff, costs, revenues,
or any other resources including any investments, efficiency
incentives, or allowances. If the commissioner determines that
any deficiency cannot be corrected or the need cannot be met
with the payment rate currently being paid, the commissioner
shall determine the payment rate adjustment by dividing the
additional annual costs established during the commissioner's
review by the residential program's actual resident days from
the most recent desk-audited cost income and expense report or
the estimated resident days in the projected receivership
period. The payment rate adjustment must meet the conditions in
Minnesota Rules, parts 9553.0010 to 9553.0080, and remains in
effect during the period of the receivership or until another
date set by the commissioner. Upon the subsequent sale,
closure, or transfer of the residential program, the
commissioner may recover amounts that were paid as payment rate
adjustments under this subdivision. This recovery shall be
determined through a review of actual costs and resident days in
the receivership period. The costs the commissioner finds to be
allowable shall be divided by the actual resident days for the
receivership period. This rate shall be compared to the rate
paid throughout the receivership period, with the difference
multiplied by resident days, being the amount to be repaid to
the commissioner. Allowable costs shall be determined by the
commissioner as those ordinary, necessary, and related to
resident care by prudent and cost-conscious management. The
buyer or transferee shall repay this amount to the commissioner
within 60 days after the commissioner notifies the buyer or
transferee of the obligation to repay. This provision does not
limit the liability of the seller to the commissioner pursuant
to section 256B.0641.
Sec. 3. Minnesota Statutes 2000, section 252.275,
subdivision 4b, is amended to read:
Subd. 4b. [GUARANTEED FLOOR.] Each county with an original
allocation for the preceding year that is equal to or less than
the guaranteed floor minimum index shall have a guaranteed floor
equal to its original allocation for the preceding year. Each
county with an original allocation for the preceding year that
is greater than the guaranteed floor minimum index shall have a
guaranteed floor equal to the lesser of clause (1) or (2):
(1) the county's original allocation for the preceding
year; or
(2) 70 percent of the county's reported expenditures
eligible for reimbursement during the 12 months ending on June
30 of the preceding calendar year.
For calendar year 1993, the guaranteed floor minimum index
shall be $20,000. For each subsequent year, the index shall be
adjusted by the projected change in the average value in the
United States Department of Labor Bureau of Labor Statistics
consumer price index (all urban) for that year.
Notwithstanding this subdivision, no county shall be
allocated a guaranteed floor of less than $1,000.
When the amount of funds available for allocation is less
than the amount available in the previous year, each county's
previous year allocation shall be reduced in proportion to the
reduction in the statewide funding, to establish each county's
guaranteed floor.
Sec. 4. Minnesota Statutes 2000, section 254B.02,
subdivision 3, is amended to read:
Subd. 3. [RESERVE ACCOUNT.] The commissioner shall
allocate money from the reserve account to counties that, during
the current fiscal year, have met or exceeded the base level of
expenditures for eligible chemical dependency services from
local money. The commissioner shall establish the base level
for fiscal year 1988 as the amount of local money used for
eligible services in calendar year 1986. In later years, the
base level must be increased in the same proportion as state
appropriations to implement Laws 1986, chapter 394, sections 8
to 20, are increased. The base level must be decreased if the
fund balance from which allocations are made under section
254B.02, subdivision 1, is decreased in later years. The local
match rate for the reserve account is the same rate as applied
to the initial allocation. Reserve account payments must not be
included when calculating the county adjustments made according
to subdivision 2. For counties providing medical assistance or
general assistance medical care through managed care plans on
January 1, 1996, the base year is fiscal year 1995. For
counties beginning provision of managed care after January 1,
1996, the base year is the most recent fiscal year before
enrollment in managed care begins. For counties providing
managed care, the base level will be increased or decreased in
proportion to changes in the fund balance from which allocations
are made under subdivision 2, but will be additionally increased
or decreased in proportion to the change in county adjusted
population made in subdivision 1, paragraphs (b) and
(c). Effective July 1, 2001, at the end of each biennium, any
funds deposited in the reserve account funds in excess of those
needed to meet obligations incurred under this section and
sections 254B.06 and 254B.09 shall cancel to the general fund.
Sec. 5. Minnesota Statutes 2000, section 254B.03,
subdivision 1, is amended to read:
Subdivision 1. [LOCAL AGENCY DUTIES.] (a) Every local
agency shall provide chemical dependency services to persons
residing within its jurisdiction who meet criteria established
by the commissioner for placement in a chemical dependency
residential or nonresidential treatment service. Chemical
dependency money must be administered by the local agencies
according to law and rules adopted by the commissioner under
sections 14.001 to 14.69.
(b) In order to contain costs, the county board shall, with
the approval of the commissioner of human services, select
eligible vendors of chemical dependency services who can provide
economical and appropriate treatment. Unless the local agency
is a social services department directly administered by a
county or human services board, the local agency shall not be an
eligible vendor under section 254B.05. The commissioner may
approve proposals from county boards to provide services in an
economical manner or to control utilization, with safeguards to
ensure that necessary services are provided. If a county
implements a demonstration or experimental medical services
funding plan, the commissioner shall transfer the money as
appropriate. If a county selects a vendor located in another
state, the county shall ensure that the vendor is in compliance
with the rules governing licensure of programs located in the
state.
(c) The calendar year 1998 2002 rate for vendors may not
increase more than three percent above the rate approved in
effect on January 1, 1997 2001. The calendar year 1999 2003
rate for vendors may not increase more than three percent above
the rate in effect on January 1, 1998 2002. The calendar years
2004 and 2005 rates may not exceed the rate in effect on January
1, 2003.
(d) A culturally specific vendor that provides assessments
under a variance under Minnesota Rules, part 9530.6610, shall be
allowed to provide assessment services to persons not covered by
the variance.
Sec. 6. Minnesota Statutes 2000, section 254B.04,
subdivision 1, is amended to read:
Subdivision 1. [ELIGIBILITY.] (a) Persons eligible for
benefits under Code of Federal Regulations, title 25, part 20,
persons eligible for medical assistance benefits under sections
256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6,
or who meet the income standards of section 256B.056,
subdivision 4, and persons eligible for general assistance
medical care under section 256D.03, subdivision 3, are entitled
to chemical dependency fund services. State money appropriated
for this paragraph must be placed in a separate account
established for this purpose.
Persons with dependent children who are determined to be in
need of chemical dependency treatment pursuant to an assessment
under section 626.556, subdivision 10, or a case plan under
section 260C.201, subdivision 6, or 260C.212, shall be assisted
by the local agency to access needed treatment services.
Treatment services must be appropriate for the individual or
family, which may include long-term care treatment or treatment
in a facility that allows the dependent children to stay in the
treatment facility. The county shall pay for out-of-home
placement costs, if applicable.
(b) A person not entitled to services under paragraph (a),
but with family income that is less than 60 percent of the state
median income for a family of like size and composition 215
percent of the federal poverty guidelines for the applicable
family size, shall be eligible to receive chemical dependency
fund services within the limit of funds available after persons
entitled to services under paragraph (a) have been
served appropriated for this group for the fiscal year. If
notified by the state agency of limited funds, a county must
give preferential treatment to persons with dependent children
who are in need of chemical dependency treatment pursuant to an
assessment under section 626.556, subdivision 10, or a case plan
under section 260C.201, subdivision 6, or 260C.212. A county
may spend money from its own sources to serve persons under this
paragraph. State money appropriated for this paragraph must be
placed in a separate account established for this purpose.
(c) Persons whose income is between 60 215 percent and 115
412 percent of the state median income federal poverty
guidelines for the applicable family size shall be eligible for
chemical dependency services on a sliding fee basis, within the
limit of funds available, after persons entitled to services
under paragraph (a) and persons eligible for services under
paragraph (b) have been served appropriated for this group for
the fiscal year. Persons eligible under this paragraph must
contribute to the cost of services according to the sliding fee
scale established under subdivision 3. A county may spend money
from its own sources to provide services to persons under this
paragraph. State money appropriated for this paragraph must be
placed in a separate account established for this purpose.
Sec. 7. Minnesota Statutes 2000, section 254B.09, is
amended by adding a subdivision to read:
Subd. 8. [PAYMENTS TO IMPROVE SERVICES TO AMERICAN
INDIANS.] The commissioner may set rates for chemical dependency
services according to the American Indian Health Improvement
Act, Public Law Number 94-437, for eligible vendors. These
rates shall supersede rates set in county purchase of service
agreements when payments are made on behalf of clients eligible
according to Public Law Number 94-437.
Sec. 8. Minnesota Statutes 2000, section 256.01, is
amended by adding a subdivision to read:
Subd. 19. [GRANTS FOR CASE MANAGEMENT SERVICES TO PERSONS
WITH HIV OR AIDS.] The commissioner may award grants to eligible
vendors for the development, implementation, and evaluation of
case management services for individuals infected with the human
immunodeficiency virus. HIV/AIDs case management services will
be provided to increase access to cost effective health care
services, to reduce the risk of HIV transmission, to ensure that
basic client needs are met, and to increase client access to
needed community supports or services.
Sec. 9. Minnesota Statutes 2000, section 256.476,
subdivision 1, is amended to read:
Subdivision 1. [PURPOSE AND GOALS.] The commissioner of
human services shall establish a consumer support grant
program to assist for individuals with functional limitations
and their families in purchasing and securing supports which the
individuals need to live as independently and productively in
the community as possible who wish to purchase and secure their
own supports. The commissioner and local agencies shall jointly
develop an implementation plan which must include a way to
resolve the issues related to county liability. The program
shall:
(1) make support grants or exception grants described in
subdivision 11 available to individuals or families as an
effective alternative to existing programs and services, such as
the developmental disability family support program, the
alternative care program, personal care attendant services, home
health aide services, and private duty nursing facility
services;
(2) provide consumers more control, flexibility, and
responsibility over the needed supports their services and
supports;
(3) promote local program management and decision making;
and
(4) encourage the use of informal and typical community
supports.
Sec. 10. Minnesota Statutes 2000, section 256.476,
subdivision 2, is amended to read:
Subd. 2. [DEFINITIONS.] For purposes of this section, the
following terms have the meanings given them:
(a) "County board" means the county board of commissioners
for the county of financial responsibility as defined in section
256G.02, subdivision 4, or its designated representative. When
a human services board has been established under sections
402.01 to 402.10, it shall be considered the county board for
the purposes of this section.
(b) "Family" means the person's birth parents, adoptive
parents or stepparents, siblings or stepsiblings, children or
stepchildren, grandparents, grandchildren, niece, nephew, aunt,
uncle, or spouse. For the purposes of this section, a family
member is at least 18 years of age.
(c) "Functional limitations" means the long-term inability
to perform an activity or task in one or more areas of major
life activity, including self-care, understanding and use of
language, learning, mobility, self-direction, and capacity for
independent living. For the purpose of this section, the
inability to perform an activity or task results from a mental,
emotional, psychological, sensory, or physical disability,
condition, or illness.
(d) "Informed choice" means a voluntary decision made by
the person or the person's legal representative, after becoming
familiarized with the alternatives to:
(1) select a preferred alternative from a number of
feasible alternatives;
(2) select an alternative which may be developed in the
future; and
(3) refuse any or all alternatives.
(e) "Local agency" means the local agency authorized by the
county board or, for counties not participating in the consumer
grant program by July 1, 2002, the commissioner, to carry out
the provisions of this section.
(f) "Person" or "persons" means a person or persons meeting
the eligibility criteria in subdivision 3.
(g) "Authorized representative" means an individual
designated by the person or their legal representative to act on
their behalf. This individual may be a family member, guardian,
representative payee, or other individual designated by the
person or their legal representative, if any, to assist in
purchasing and arranging for supports. For the purposes of this
section, an authorized representative is at least 18 years of
age.
(h) "Screening" means the screening of a person's service
needs under sections 256B.0911 and 256B.092.
(i) "Supports" means services, care, aids, home
environmental modifications, or assistance purchased by the
person or the person's family. Examples of supports include
respite care, assistance with daily living, and adaptive aids
assistive technology. For the purpose of this section,
notwithstanding the provisions of section 144A.43, supports
purchased under the consumer support program are not considered
home care services.
(j) "Program of origination" means the program the
individual transferred from when approved for the consumer
support grant program.
Sec. 11. Minnesota Statutes 2000, section 256.476,
subdivision 3, is amended to read:
Subd. 3. [ELIGIBILITY TO APPLY FOR GRANTS.] (a) A person
is eligible to apply for a consumer support grant if the person
meets all of the following criteria:
(1) the person is eligible for and has been approved to
receive services under medical assistance as determined under
sections 256B.055 and 256B.056 or the person is eligible for and
has been approved to receive services under alternative care
services as determined under section 256B.0913 or the person has
been approved to receive a grant under the developmental
disability family support program under section 252.32;
(2) the person is able to direct and purchase the person's
own care and supports, or the person has a family member, legal
representative, or other authorized representative who can
purchase and arrange supports on the person's behalf;
(3) the person has functional limitations, requires ongoing
supports to live in the community, and is at risk of or would
continue institutionalization without such supports; and
(4) the person will live in a home. For the purpose of
this section, "home" means the person's own home or home of a
person's family member. These homes are natural home settings
and are not licensed by the department of health or human
services.
(b) Persons may not concurrently receive a consumer support
grant if they are:
(1) receiving home and community-based services under
United States Code, title 42, section 1396h(c); personal care
attendant and home health aide services under section 256B.0625;
a developmental disability family support grant; or alternative
care services under section 256B.0913; or
(2) residing in an institutional or congregate care setting.
(c) A person or person's family receiving a consumer
support grant shall not be charged a fee or premium by a local
agency for participating in the program.
(d) The commissioner may limit the participation of nursing
facility residents, residents of intermediate care facilities
for persons with mental retardation, and the recipients of
services from federal waiver programs in the consumer support
grant program if the participation of these individuals will
result in an increase in the cost to the state.
(e) The commissioner shall establish a budgeted
appropriation each fiscal year for the consumer support grant
program. The number of individuals participating in the program
will be adjusted so the total amount allocated to counties does
not exceed the amount of the budgeted appropriation. The
budgeted appropriation will be adjusted annually to accommodate
changes in demand for the consumer support grants.
Sec. 12. Minnesota Statutes 2000, section 256.476,
subdivision 4, is amended to read:
Subd. 4. [SUPPORT GRANTS; CRITERIA AND LIMITATIONS.] (a) A
county board may choose to participate in the consumer support
grant program. If a county board chooses to participate in the
program, has not chosen to participate by July 1, 2002, the
commissioner shall contract with another county or other entity
to provide access to residents of the nonparticipating county
who choose the consumer support grant option. The commissioner
shall notify the county board in a county that has declined to
participate of the commissioner's intent to enter into a
contract with another county or other entity at least 30 days in
advance of entering into the contract. The local agency shall
establish written procedures and criteria to determine the
amount and use of support grants. These procedures must
include, at least, the availability of respite care, assistance
with daily living, and adaptive aids. The local agency may
establish monthly or annual maximum amounts for grants and
procedures where exceptional resources may be required to meet
the health and safety needs of the person on a time-limited
basis, however, the total amount awarded to each individual may
not exceed the limits established in subdivision 5, paragraph
(f) subdivision 11.
(b) Support grants to a person or a person's family will be
provided through a monthly subsidy payment and be in the form of
cash, voucher, or direct county payment to vendor. Support
grant amounts must be determined by the local agency. Each
service and item purchased with a support grant must meet all of
the following criteria:
(1) it must be over and above the normal cost of caring for
the person if the person did not have functional limitations;
(2) it must be directly attributable to the person's
functional limitations;
(3) it must enable the person or the person's family to
delay or prevent out-of-home placement of the person; and
(4) it must be consistent with the needs identified in the
service plan, when applicable.
(c) Items and services purchased with support grants must
be those for which there are no other public or private funds
available to the person or the person's family. Fees assessed
to the person or the person's family for health and human
services are not reimbursable through the grant.
(d) In approving or denying applications, the local agency
shall consider the following factors:
(1) the extent and areas of the person's functional
limitations;
(2) the degree of need in the home environment for
additional support; and
(3) the potential effectiveness of the grant to maintain
and support the person in the family environment or the person's
own home.
(e) At the time of application to the program or screening
for other services, the person or the person's family shall be
provided sufficient information to ensure an informed choice of
alternatives by the person, the person's legal representative,
if any, or the person's family. The application shall be made
to the local agency and shall specify the needs of the person
and family, the form and amount of grant requested, the items
and services to be reimbursed, and evidence of eligibility for
medical assistance or alternative care program.
(f) Upon approval of an application by the local agency and
agreement on a support plan for the person or person's family,
the local agency shall make grants to the person or the person's
family. The grant shall be in an amount for the direct costs of
the services or supports outlined in the service agreement.
(g) Reimbursable costs shall not include costs for
resources already available, such as special education classes,
day training and habilitation, case management, other services
to which the person is entitled, medical costs covered by
insurance or other health programs, or other resources usually
available at no cost to the person or the person's family.
(h) The state of Minnesota, the county boards participating
in the consumer support grant program, or the agencies acting on
behalf of the county boards in the implementation and
administration of the consumer support grant program shall not
be liable for damages, injuries, or liabilities sustained
through the purchase of support by the individual, the
individual's family, or the authorized representative under this
section with funds received through the consumer support grant
program. Liabilities include but are not limited to: workers'
compensation liability, the Federal Insurance Contributions Act
(FICA), or the Federal Unemployment Tax Act (FUTA). For
purposes of this section, participating county boards and
agencies acting on behalf of county boards are exempt from the
provisions of section 268.04.
Sec. 13. Minnesota Statutes 2000, section 256.476,
subdivision 5, is amended to read:
Subd. 5. [REIMBURSEMENT, ALLOCATIONS, AND REPORTING.] (a)
For the purpose of transferring persons to the consumer support
grant program from specific programs or services, such as the
developmental disability family support program and alternative
care program, personal care attendant assistant services, home
health aide services, or nursing facility private duty nursing
services, the amount of funds transferred by the commissioner
between the developmental disability family support program
account, the alternative care account, the medical assistance
account, or the consumer support grant account shall be based on
each county's participation in transferring persons to the
consumer support grant program from those programs and services.
(b) At the beginning of each fiscal year, county
allocations for consumer support grants shall be based on:
(1) the number of persons to whom the county board expects
to provide consumer supports grants;
(2) their eligibility for current program and services;
(3) the amount of nonfederal dollars expended on those
individuals for those programs and services or, in situations
where an individual is unable to obtain the support needed from
the program of origination due to the unavailability of service
providers at the time or the location where the supports are
needed, the allocation will be based on the county's best
estimate of the nonfederal dollars that would have been expended
if the services had been available allowed under subdivision 11;
and
(4) projected dates when persons will start receiving
grants. County allocations shall be adjusted periodically by
the commissioner based on the actual transfer of persons or
service openings, and the nonfederal dollars associated with
those persons or service openings, to the consumer support grant
program.
(c) The amount of funds transferred by the commissioner
from the alternative care account and the medical assistance
account for an individual may be changed if it is determined by
the county or its agent that the individual's need for support
has changed.
(d) The authority to utilize funds transferred to the
consumer support grant account for the purposes of implementing
and administering the consumer support grant program will not be
limited or constrained by the spending authority provided to the
program of origination.
(e) The commissioner shall may use up to five percent of
each county's allocation, as adjusted, for payments to that
county for administrative expenses, to be paid as a
proportionate addition to reported direct service expenditures.
(f) Except as provided in this paragraph, The county
allocation for each individual or individual's family cannot
exceed 80 percent of the total nonfederal dollars expended on
the individual by the program of origination except for the
developmental disabilities family support grant program which
can be approved up to 100 percent of the nonfederal dollars and
in situations as described in paragraph (b), clause (3). In
situations where exceptional need exists or the individual's
need for support increases, up to 100 percent of the nonfederal
dollars expended may be allocated to the county. Allocations
that exceed 80 percent of the nonfederal dollars expended on the
individual by the program of origination must be approved by the
commissioner. The remainder of the amount expended on the
individual by the program of origination will be used in the
following proportions: half will be made available to the
consumer support grant program and participating counties for
consumer training, resource development, and other costs, and
half will be returned to the state general fund the amount
allowed under subdivision 11.
(g) The commissioner may recover, suspend, or withhold
payments if the county board, local agency, or grantee does not
comply with the requirements of this section.
(h) Grant funds unexpended by consumers shall return to the
state once a year. The annual return of unexpended grant funds
shall occur in the quarter following the end of the state fiscal
year.
Sec. 14. Minnesota Statutes 2000, section 256.476,
subdivision 8, is amended to read:
Subd. 8. [COMMISSIONER RESPONSIBILITIES.] The commissioner
shall:
(1) transfer and allocate funds pursuant to this
section subdivision 11;
(2) determine allocations based on projected and actual
local agency use;
(3) monitor and oversee overall program spending;
(4) evaluate the effectiveness of the program;
(5) provide training and technical assistance for local
agencies and consumers to help identify potential applicants to
the program; and
(6) develop guidelines for local agency program
administration and consumer information; and
(7) apply for a federal waiver or take any other action
necessary to maximize federal funding for the program by
September 1, 1999.
Sec. 15. Minnesota Statutes 2000, section 256.476, is
amended by adding a subdivision to read:
Subd. 11. [CONSUMER SUPPORT GRANT PROGRAM AFTER JULY 1,
2001.] (a) Effective July 1, 2001, the commissioner shall
allocate consumer support grant resources to serve additional
individuals based on a review of Medicaid authorization and
payment information of persons eligible for a consumer support
grant from the most recent fiscal year. The commissioner shall
use the following methodology to calculate maximum allowable
monthly consumer support grant levels:
(1) for individuals whose program of origination is medical
assistance home care under section 256B.0627, the maximum
allowable monthly grant levels are calculated by:
(i) determining the nonfederal share of the average service
authorization for each home care rating;
(ii) calculating the overall ratio of actual payments to
service authorizations by program;
(iii) applying the overall ratio to the average service
authorization level of each home care rating;
(iv) adjusting the result for any authorized rate increases
provided by the legislature; and
(v) adjusting the result for the average monthly
utilization per recipient; and
(2) for persons with programs of origination other than the
program described in clause (1), the maximum grant level for an
individual shall not exceed the total of the nonfederal dollars
expended on the individual by the program of origination.
(b) Persons receiving consumer support grants prior to July
1, 2001, may continue to receive the grant amount established
prior to July 1, 2001.
(c) The commissioner may provide up to 200 exception
grants, including grants in use under paragraph (b). Eligible
persons shall be provided an exception grant in priority order
based upon the date of the commissioner's receipt of the county
request. The maximum allowable grant level for an exception
grant shall be based upon the nonfederal share of the average
service authorization from the most recent fiscal year for each
home care rating category. The amount of each exception grant
shall be based upon the commissioner's determination of the
nonfederal dollars that would have been expended if services had
been available for an individual who is unable to obtain the
support needed from the program of origination due to the
unavailability of qualified service providers at the time or the
location where the supports are needed.
Sec. 16. Minnesota Statutes 2000, section 256B.0625,
subdivision 7, is amended to read:
Subd. 7. [PRIVATE DUTY NURSING.] Medical assistance covers
private duty nursing services in a recipient's home. Recipients
who are authorized to receive private duty nursing services in
their home may use approved hours outside of the home during
hours when normal life activities take them outside of their
home and when, without the provision of private duty nursing,
their health and safety would be jeopardized. To use private
duty nursing 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 does not cover private
duty nursing services for residents of a hospital, nursing
facility, intermediate care facility, or a health care facility
licensed by the commissioner of health, except as authorized in
section 256B.64 for ventilator-dependent recipients in hospitals
or unless a resident who is otherwise eligible is on leave from
the facility and the facility either pays for the private duty
nursing services or forgoes the facility per diem for the leave
days that private duty nursing services are used. Total hours
of service and payment allowed for services outside the home
cannot exceed that which is otherwise allowed in an in-home
setting according to section 256B.0627. All private duty
nursing services must be provided according to the limits
established under section 256B.0627. Private duty nursing
services may not be reimbursed if the nurse is the spouse of the
recipient or the parent or foster care provider of a recipient
who is under age 18, or the recipient's legal guardian.
Sec. 17. Minnesota Statutes 2000, section 256B.0625,
subdivision 19a, is amended to read:
Subd. 19a. [PERSONAL CARE ASSISTANT SERVICES.] Medical
assistance covers personal care assistant services in a
recipient's home. To qualify for personal care assistant
services, recipients or responsible parties must be able to
identify the recipient's needs, direct and evaluate task
accomplishment, and provide for health and safety. Approved
hours may be used outside the home when normal life activities
take them outside the home and when, without the provision of
personal care, their health and safety would be jeopardized. To
use personal care assistant 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. Total hours for services,
whether actually performed inside or outside the recipient's
home, cannot exceed that which is otherwise allowed for personal
care assistant services in an in-home setting according to
section 256B.0627. Medical assistance does not cover personal
care assistant services for residents of a hospital, nursing
facility, intermediate care facility, health care facility
licensed by the commissioner of health, or unless a resident who
is otherwise eligible is on leave from the facility and the
facility either pays for the personal care assistant services or
forgoes the facility per diem for the leave days that personal
care assistant services are used. All personal care assistant
services must be provided according to section 256B.0627.
Personal care assistant services may not be reimbursed if the
personal care assistant is the spouse or legal guardian of the
recipient or the parent of a recipient under age 18, or the
responsible party or the foster care provider of a recipient who
cannot direct the recipient's own care unless, in the case of a
foster care provider, a county or state case manager visits the
recipient as needed, but not less than every six months, to
monitor the health and safety of the recipient and to ensure the
goals of the care plan are met. Parents of adult recipients,
adult children of the recipient or adult siblings of the
recipient may be reimbursed for personal care assistant services
if they are not the recipient's legal guardian and, if they are
granted a waiver under section 256B.0627. Until July 1, 2001,
and Notwithstanding the provisions of section 256B.0627,
subdivision 4, paragraph (b), clause (4), the noncorporate legal
guardian or conservator of an adult, who is not the responsible
party and not the personal care provider organization, may be
granted a hardship waiver under section 256B.0627, to be
reimbursed to provide personal care assistant services to the
recipient, and shall not be considered to have a service
provider interest for purposes of participation on the screening
team under section 256B.092, subdivision 7.
Sec. 18. Minnesota Statutes 2000, section 256B.0625,
subdivision 19c, is amended to read:
Subd. 19c. [PERSONAL CARE.] Medical assistance covers
personal care assistant 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 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 27; 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 assist the
recipient or responsible party and to 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. 19. Minnesota Statutes 2000, 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 30 180 days of the recipient's residency in that
facility and may not exceed more than two six 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. 20. Minnesota Statutes 2000, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 34. [TARGETED CASE MANAGEMENT.] For purposes of
subdivisions 43a to 43h, the following terms have the meanings
given them:
(1) "home care service recipients" means those individuals
receiving the following services under section 256B.0627:
skilled nursing visits, home health aide visits, private duty
nursing, personal care assistants, or therapies provided through
a home health agency;
(2) "home care targeted case management" means the
provision of targeted case management services for the purpose
of assisting home care service recipients to gain access to
needed services and supports so that they may remain in the
community;
(3) "institutions" means hospitals, consistent with Code of
Federal Regulations, title 42, section 440.10; regional
treatment center inpatient services, consistent with section
245.474; nursing facilities; and intermediate care facilities
for persons with mental retardation;
(4) "relocation targeted case management" means the
provision of targeted case management services for the purpose
of assisting recipients to gain access to needed services and
supports if they choose to move from an institution to the
community. Relocation targeted case management may be provided
during the last 180 consecutive days of an eligible recipient's
institutional stay; and
(5) "targeted case management" means case management
services provided to help recipients gain access to needed
medical, social, educational, and other services and supports.
Sec. 21. Minnesota Statutes 2000, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 43a. [ELIGIBILITY.] The following persons are
eligible for relocation targeted case management or home
care-targeted case management:
(1) medical assistance eligible persons residing in
institutions who choose to move into the community are eligible
for relocation targeted case management services; and
(2) medical assistance eligible persons receiving home care
services, who are not eligible for any other medical assistance
reimbursable case management service, are eligible for home
care-targeted case management services beginning January 1, 2003.
Sec. 22. Minnesota Statutes 2000, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 43b. [RELOCATION TARGETED CASE MANAGEMENT PROVIDER
QUALIFICATIONS.] The following qualifications and certification
standards must be met by providers of relocation targeted case
management:
(a) The commissioner must certify each provider of
relocation targeted case management before enrollment. The
certification process shall examine the provider's ability to
meet the requirements in this subdivision and other federal and
state requirements of this service. A certified relocation
targeted case management provider may subcontract with another
provider to deliver relocation targeted case management
services. Subcontracted providers must demonstrate the ability
to provide the services outlined in subdivision 43d.
(b) A relocation targeted case management provider is an
enrolled medical assistance provider who is determined by the
commissioner to have all of the following characteristics:
(1) the legal authority to provide public welfare under
sections 393.01, subdivision 7; and 393.07; or a federally
recognized Indian tribe;
(2) the demonstrated capacity and experience to provide the
components of case management to coordinate and link community
resources needed by the eligible population;
(3) the administrative capacity and experience to serve the
target population for whom it will provide services and ensure
quality of services under state and federal requirements;
(4) the legal authority to provide complete investigative
and protective services under section 626.556, subdivision 10;
and child welfare and foster care services under section 393.07,
subdivisions 1 and 2; or a federally recognized Indian tribe;
(5) a financial management system that provides accurate
documentation of services and costs under state and federal
requirements; and
(6) the capacity to document and maintain individual case
records under state and federal requirements.
A provider of targeted case management under subdivision 20 may
be deemed a certified provider of relocation targeted case
management.
Sec. 23. Minnesota Statutes 2000, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 43c. [HOME CARE TARGETED CASE MANAGEMENT PROVIDER
QUALIFICATIONS.] The following qualifications and certification
standards must be met by providers of home care targeted case
management.
(a) The commissioner must certify each provider of home
care targeted case management before enrollment. The
certification process shall examine the provider's ability to
meet the requirements in this subdivision and other state and
federal requirements of this service.
(b) A home care targeted case management provider is an
enrolled medical assistance provider who has a minimum of a
bachelor's degree or a license in a health or human services
field, and is determined by the commissioner to have all of the
following characteristics:
(1) the demonstrated capacity and experience to provide the
components of case management to coordinate and link community
resources needed by the eligible population;
(2) the administrative capacity and experience to serve the
target population for whom it will provide services and ensure
quality of services under state and federal requirements;
(3) a financial management system that provides accurate
documentation of services and costs under state and federal
requirements;
(4) the capacity to document and maintain individual case
records under state and federal requirements; and
(5) the capacity to coordinate with county administrative
functions.
Sec. 24. Minnesota Statutes 2000, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 43d. [ELIGIBLE SERVICES.] Services eligible for
medical assistance reimbursement as targeted case management
include:
(1) assessment of the recipient's need for targeted case
management services;
(2) development, completion, and regular review of a
written individual service plan, which is based upon the
assessment of the recipient's needs and choices, and which will
ensure access to medical, social, educational, and other related
services and supports;
(3) routine contact or communication with the recipient,
recipient's family, primary caregiver, legal representative,
substitute care provider, service providers, or other relevant
persons identified as necessary to the development or
implementation of the goals of the individual service plan;
(4) coordinating referrals for, and the provision of, case
management services for the recipient with appropriate service
providers, consistent with section 1902(a)(23) of the Social
Security Act;
(5) coordinating and monitoring the overall service
delivery to ensure quality of services, appropriateness, and
continued need;
(6) completing and maintaining necessary documentation that
supports and verifies the activities in this subdivision;
(7) traveling to conduct a visit with the recipient or
other relevant person necessary to develop or implement the
goals of the individual service plan; and
(8) coordinating with the institution discharge planner in
the 180-day period before the recipient's discharge.
Sec. 25. Minnesota Statutes 2000, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 43e. [TIME LINES.] The following time lines must be
met for assigning a case manager:
(1) for relocation targeted case management, an eligible
recipient must be assigned a case manager who visits the person
within 20 working days of requesting a case manager from their
county of financial responsibility as determined under chapter
256G. If a county agency does not provide case management
services as required, the recipient may, after written notice to
the county agency, obtain targeted relocation case management
services from a home care targeted case management provider, as
defined in subdivision 43c; and
(2) for home care targeted case management, an eligible
recipient must be assigned a case manager within 20 working days
of requesting a case manager from a home care targeted case
management provider, as defined in subdivision 43c.
Sec. 26. Minnesota Statutes 2000, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 43f. [EVALUATION.] The commissioner shall evaluate
the delivery of targeted case management, including, but not
limited to, access to case management services, consumer
satisfaction with case management services, and quality of case
management services.
Sec. 27. Minnesota Statutes 2000, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 43g. [CONTACT DOCUMENTATION.] The case manager must
document each face-to-face and telephone contact with the
recipient and others involved in the recipient's individual
service plan.
Sec. 28. Minnesota Statutes 2000, section 256B.0625, is
amended by adding a subdivision to read:
Subd. 43h. [PAYMENT RATES.] The commissioner shall set
payment rates for targeted case management under this
subdivision. Case managers may bill according to the following
criteria:
(1) for relocation targeted case management, case managers
may bill for direct case management activities, including
face-to-face and telephone contacts, in the 180 days preceding
an eligible recipient's discharge from an institution;
(2) for home care targeted case management, case managers
may bill for direct case management activities, including
face-to-face and telephone contacts; and
(3) billings for targeted case management services under
this subdivision shall not duplicate payments made under other
program authorities for the same purpose.
Sec. 29. Minnesota Statutes 2000, section 256B.0627,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITION.] (a) "Activities of daily
living" includes eating, toileting, grooming, dressing, bathing,
transferring, mobility, and positioning.
(b) "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. A
face-to-face assessment must include: documentation of health
status, determination of need, evaluation of service
effectiveness, identification of appropriate services, service
plan development or modification, coordination of services,
referrals and follow-up to appropriate payers and community
resources, completion of required reports, recommendation of
service authorization, and consumer education. Once the need
for personal care assistant services is determined under this
section, the county public health nurse or certified public
health nurse under contract with the county is responsible for
communicating this recommendation to the commissioner and the
recipient. A face-to-face assessment for personal
care assistant 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 the recipient's condition or
when there is a change in the need for personal care assistant
services. 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 effectiveness, 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) (c) "Care plan" means a written description of personal
care assistant services developed by the qualified
professional or the recipient's physician with the recipient or
responsible party to be used by the personal care assistant with
a copy provided to the recipient or responsible party.
(d) "Complex and regular private duty nursing care" means:
(1) complex care is private duty nursing provided to
recipients who are ventilator dependent or for whom a physician
has certified that were it not for private duty nursing the
recipient would meet the criteria for inpatient hospital
intensive care unit (ICU) level of care; and
(2) regular care is private duty nursing provided to all
other recipients.
(e) "Health-related functions" means functions that can be
delegated or assigned by a licensed health care professional
under state law to be performed by a personal care attendant.
(c) (f) "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 62 60 days for the
provision of home health services, or private duty nursing, or
at least once every 365 days for personal care. Home care
services are provided to the recipient at the recipient's
residence that is a place other than a hospital or long-term
care facility or as specified in section 256B.0625.
(g) "Instrumental activities of daily living" includes meal
planning and preparation, managing finances, shopping for food,
clothing, and other essential items, performing essential
household chores, communication by telephone and other media,
and getting around and participating in the community.
(d) (h) "Medically necessary" has the meaning given in
Minnesota Rules, parts 9505.0170 to 9505.0475.
(e) (i) "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 assistant services according to the recipient's care plan,
responds appropriately to recipient needs, and reports changes
in the recipient's condition to the supervising qualified
professional or physician;
(5) is not a consumer of personal care assistant services;
and
(6) is subject to criminal background checks and procedures
specified in section 245A.04.
(f) (j) "Personal care provider organization" means an
organization enrolled to provide personal care assistant
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) (k) "Responsible party" means an individual residing
with a recipient of personal care assistant 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 assistant
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) (l) "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) (m) "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.
(n) "Telehomecare" means the use of telecommunications
technology by a home health care professional to deliver home
health care services, within the professional's scope of
practice, to a patient located at a site other than the site
where the practitioner is located.
Sec. 30. Minnesota Statutes 2000, 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 assistant services under section
256B.0625, subdivision 19a;
(5) supervision of personal care assistant services
provided by a qualified professional under section 256B.0625,
subdivision 19a;
(6) consulting qualified professional of personal care
assistant services under the fiscal agent intermediary 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. 31. Minnesota Statutes 2000, section 256B.0627,
subdivision 4, is amended to read:
Subd. 4. [PERSONAL CARE ASSISTANT SERVICES.] (a) The
personal care assistant services that are eligible for payment
are the following: services and supports furnished to an
individual, as needed, to assist in accomplishing activities of
daily living; instrumental activities of daily living;
health-related functions through hands-on assistance,
supervision, and cuing; and redirection and intervention for
behavior including observation and monitoring.
(b) Payment for services will be made within the limits
approved using the prior authorized process established in
subdivision 5.
(c) The amount and type of services authorized shall be
based on an assessment of the recipient's needs in these areas:
(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 assistant 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) (d) The personal care assistant services that are not
eligible for payment are the following:
(1) services not ordered by the physician;
(2) assessments by personal care assistant 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 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 assistant 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.
(e) The recipient or responsible party may choose to
supervise the personal care assistant or to have a qualified
professional, as defined in section 256B.0625, subdivision 19c,
provide the supervision. As required under section 256B.0625,
subdivision 19c, the county public health nurse, as a part of
the assessment, will assist the recipient or responsible party
to identify the most appropriate person to provide supervision
of the personal care assistant. Health-related delegated tasks
performed by the personal care assistant will be under the
supervision of a qualified professional or the direction of the
recipient's physician. If the recipient has a qualified
professional, Minnesota Rules, part 9505.0335, subpart 4,
applies.
Sec. 32. Minnesota Statutes 2000, 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) up to two face-to-face assessments to determine a
recipient's need for personal care assistant services;
(2) one service update done to determine a recipient's need
for personal care assistant services; and
(3) up to five nine 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. Notwithstanding the provisions of section
256B.0627, subdivision 12, the commissioner shall maximize
federal financial participation to pay for public health nurse
assessments for personal care services. For personal care
assistant 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 assistant 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.
(e) [PRIOR AUTHORIZATION.] The commissioner, or the
commissioner's designee, shall review the assessment, 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. The commissioner, or the commissioner's
designee, may authorize up to two skilled nurse visits per day.
(2) [PERSONAL CARE ASSISTANT SERVICES.] (i) All personal
care assistant services and supervision by a qualified
professional, if requested by the recipient, 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 assistant 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
supervision by a qualified professional of personal
care assistant services, if a qualified professional is
requested by the recipient or responsible party.
(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 assistant 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 9505.0501 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;
(2) personal care assistant 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 assistant 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; or
(4) personal care assistant and private duty nursing
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 personal care assistant and private duty nursing
services be provided, and case management is provided as
required in section 256B.0625, subdivision 19a.
Sec. 33. Minnesota Statutes 2000, section 256B.0627,
subdivision 7, is amended to read:
Subd. 7. [NONCOVERED HOME CARE SERVICES.] The following
home care services are not eligible for payment under medical
assistance:
(1) skilled nurse visits for the sole purpose of
supervision of the home health aide;
(2) a skilled nursing visit:
(i) only for the purpose of monitoring medication
compliance with an established medication program for a
recipient; or
(ii) to administer or assist with medication
administration, including injections, prefilling syringes for
injections, or oral medication set-up of an adult recipient,
when as determined and documented by the registered nurse, the
need can be met by an available pharmacy or the recipient is
physically and mentally able to self-administer or prefill a
medication;
(3) home care services to a recipient who is eligible for
covered services including hospice, if elected by the recipient,
under the Medicare program or any other insurance held by the
recipient;
(4) services to other members of the recipient's household;
(5) a visit made by a skilled nurse solely to train other
home health agency workers;
(6) any home care service included in the daily rate of the
community-based residential facility where the recipient is
residing;
(7) nursing and rehabilitation therapy services that are
reasonably accessible to a recipient outside the recipient's
place of residence, excluding the assessment, counseling and
education, and personal assistant care;
(8) any home health agency service, excluding personal care
assistant services and private duty nursing services, which are
performed in a place other than the recipient's residence; and
(9) Medicare evaluation or administrative nursing visits on
dual-eligible recipients that do not qualify for Medicare visit
billing.
Sec. 34. Minnesota Statutes 2000, section 256B.0627,
subdivision 8, is amended to read:
Subd. 8. [SHARED PERSONAL CARE ASSISTANT SERVICES.] (a)
Medical assistance payments for shared personal care assistance
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 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 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 services on the date
for which the service is billed. No more than three persons may
receive shared services from a personal care assistant in a
single setting.
(c) Shared service is the provision of personal
care assistant 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; or
(3) outside the home or foster care home of one of the
recipients when normal life activities take the recipients
outside the home.
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 personal care assistant services is an
appropriate option based on the individual needs and preferences
of the recipient; and
(2) the amount of shared services allocated as part of the
overall authorization of personal care assistant services.
The recipient or the responsible party, in conjunction with
the supervising qualified professional, if a qualified
professional is requested by any one of the recipients or
responsible parties, shall arrange the setting and grouping of
shared services 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.
(e) The following items must be considered by the recipient
or the responsible party and the supervising qualified
professional, if a qualified professional has been requested by
any one of the recipients or responsible parties, and documented
in the recipient's 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 qualified professional within
the first 14 days of shared services, and monthly thereafter, if
supervision by a qualified provider has been requested by any
one of the recipients or responsible parties;
(3) the setting in which the shared 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 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 one-on-one personal
care assistant services. The recipient or the responsible party
can withdraw from participating in a shared 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 services:
(1) permission by the recipient or the recipient's
responsible party, if any, for the maximum number of shared
services hours per week chosen by the recipient;
(2) permission by the recipient or the recipient's
responsible party, if any, for personal care assistant services
provided outside the recipient's residence;
(3) permission by the recipient or the recipient's
responsible party, if any, for others to receive shared services
in the recipient's residence;
(4) revocation by the recipient or the recipient's
responsible party, if any, of the shared service authorization,
or the shared service to be provided to others in the
recipient's residence, or the shared service to be provided
outside the recipient's residence;
(5) supervision of the shared personal care assistant
services by the qualified professional, if a qualified
professional is requested by one of the recipients or
responsible parties, including the date, time of day, number of
hours spent supervising the provision of shared services,
whether the supervision was face-to-face or another method of
supervision, changes in the recipient's condition, shared
services scheduling issues and recommendations;
(6) documentation by the qualified professional, if a
qualified professional is requested by one of the recipients or
responsible parties, of telephone calls or other discussions
with the personal care assistant regarding services being
provided to the recipient who has requested the supervision; and
(7) daily documentation of the shared services provided by
each identified personal care assistant including:
(i) the names of each recipient receiving shared services
together;
(ii) the setting for the shared services, including the
starting and ending times that the recipient received shared
services; and
(iii) notes by the personal care assistant regarding
changes in the recipient's condition, problems that may arise
from the sharing of services, scheduling issues, care issues,
and other notes as required by the qualified professional, if a
qualified professional is requested by one of the recipients or
responsible parties.
(h) Unless otherwise provided in this subdivision, all
other statutory and regulatory provisions relating to personal
care assistant services apply to shared services.
(i) In the event that supervision by a qualified
professional has been requested by one or more recipients, but
not by all of the recipients, the supervision duties of the
qualified professional shall be limited to only those recipients
who have requested the supervision.
Nothing in this subdivision shall be construed to reduce
the total number of hours authorized for an individual recipient.
Sec. 35. Minnesota Statutes 2000, section 256B.0627,
subdivision 10, is amended to read:
Subd. 10. [FISCAL AGENT INTERMEDIARY 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 intermediary 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
assistant services apply to a recipient using the fiscal agent
intermediary option.
(b) The recipient or responsible party shall:
(1) hire, and terminate the personal care assistant and
consulting professional, with the fiscal agent recruit, hire,
and terminate a qualified professional, if a qualified
professional is requested by the recipient or responsible party;
(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 verify and document the
credentials of the qualified professional, if a qualified
professional is requested by the recipient or responsible party;
(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 develop a service plan
based on physician orders and public health nurse assessment
with the assistance of a qualified professional and implement
recommendations pertaining to the health and safety of the
recipient, if a qualified professional is requested by the
recipient or responsible party, that addresses the health and
safety of the recipient;
(5) hire a qualified professional to train and supervise
the performance of delegated tasks done by (4) recruit, hire,
and terminate the personal care assistant;
(6) monitor services and verify in writing the hours worked
by the personal care assistant and the consulting (5) orient and
train the personal care assistant with assistance as needed from
the qualified professional;
(7) develop and revise a care plan with assistance from a
consulting (6) supervise and evaluate the personal care
assistant with assistance as needed from the recipient's
physician or the qualified professional;
(8) verify and document the credentials of the consulting
(7) monitor and verify in writing and report to the fiscal
intermediary the number of hours worked by the personal care
assistant and the qualified professional; and
(9) (8) enter into a written agreement, as specified in
paragraph (f).
(c) The duties of the fiscal agent intermediary shall be to:
(1) bill the medical assistance program for personal care
assistant and consulting qualified professional services;
(2) request and secure background checks on personal care
assistants and consulting qualified professionals according to
section 245A.04;
(3) pay the personal care assistant and consulting
qualified professional based on actual hours of services
provided;
(4) withhold and pay all applicable federal and state
taxes;
(5) verify and document keep records of hours worked by the
personal care assistant and consulting qualified 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 intermediary; and
(8) enter into a written agreement as specified in
paragraph (f) before services are provided.
(d) The fiscal agent intermediary:
(1) may not be related to the recipient, consulting
qualified 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 qualified professional to the
extent specified in this section.
The fiscal agent intermediary or owners of the entity that
provides fiscal agent intermediary services under this
subdivision must pass a criminal background check as required in
section 256B.0627, subdivision 1, paragraph (e).
(e) If the recipient or responsible party requests a
qualified professional, the consulting qualified professional
providing assistance to the recipient shall meet the
qualifications specified in section 256B.0625, subdivision 19c.
The consulting qualified 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 as
assessed by the public health nurse. In performing this
function, the consulting qualified professional must visit the
recipient in the recipient's home at least once annually.
The consulting qualified 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 intermediary, recipient or responsible
party, personal care assistant, and consulting qualified
professional shall enter into a written agreement before
services are started. The agreement shall include:
(1) the duties of the recipient, qualified 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 the qualified
professional;
(3) the administrative fee of the fiscal agent intermediary
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 the
qualified professional.
(g) The rates paid for personal care assistant services,
qualified professional assistance services, and fiscal agency
intermediary services under this subdivision shall be the same
rates paid for personal care assistant services and qualified
professional services under subdivision 2 respectively. Except
for the administrative fee of the fiscal agent intermediary
specified in paragraph (f), the remainder of the rates paid to
the fiscal agent intermediary must be used to pay for the salary
and benefits for the personal care assistant or those providing
professional consultation the qualified professional.
(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 intermediary:
(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 intermediary option if:
(1) it has been determined by the consulting qualified
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 intermediary
option shall not affect the recipient's authorized level of
personal care assistant services as determined in subdivision 5.
Sec. 36. Minnesota Statutes 2000, section 256B.0627,
subdivision 11, is amended 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 regular 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;
or
(4) outside the home or foster care home of one of the
recipients when normal life activities take the recipients
outside the home.
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 two 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. 37. Minnesota Statutes 2000, section 256B.0627, is
amended by adding a subdivision to read:
Subd. 13. [CONSUMER-DIRECTED HOME CARE DEMONSTRATION
PROJECT.] (a) Upon the receipt of federal waiver authority, the
commissioner shall implement a consumer-directed home care
demonstration project. The consumer-directed home care
demonstration project must demonstrate and evaluate the outcomes
of a consumer-directed service delivery alternative to improve
access, increase consumer control and accountability over
available resources, and enable the use of supports that are
more individualized and cost-effective for eligible medical
assistance recipients receiving certain medical assistance home
care services. The consumer-directed home care demonstration
project will be administered locally by county agencies, tribal
governments, or administrative entities under contract with the
state in regions where counties choose not to provide this
service.
(b) Grant awards for persons who have been receiving
medical assistance covered personal care, home health aide, or
private duty nursing services for a period of 12 consecutive
months or more prior to enrollment in the consumer-directed home
care demonstration project will be established on a case-by-case
basis using historical service expenditure data. An average
monthly expenditure for each continuing enrollee will be
calculated based on historical expenditures made on behalf of
the enrollee for personal care, home health aide, or private
duty nursing services during the 12 month period directly prior
to enrollment in the project. The grant award will equal 90
percent of the average monthly expenditure.
(c) Grant awards for project enrollees who have been
receiving medical assistance covered personal care, home health
aide, or private duty nursing services for a period of less than
12 consecutive months prior to project enrollment will be
calculated on a case-by-case basis using the service
authorization in place at the time of enrollment. The total
number of units of personal care, home health aide, or private
duty nursing services the enrollee has been authorized to
receive will be converted to the total cost of the authorized
services in a given month using the statewide average service
payment rates. To determine an estimated monthly expenditure,
the total authorized monthly personal care, home health aide or
private duty nursing service costs will be reduced by a
percentage rate equivalent to the difference between the
statewide average service authorization and the statewide
average utilization rate for each of the services by medical
assistance eligibles during the most recent fiscal year for
which 12 months of data is available. The grant award will
equal 90 percent of the estimated monthly expenditure.
(d) The state of Minnesota, county agencies, tribal
governments, or administrative entities under contract with the
state that participate in the implementation and administration
of the consumer-directed home care demonstration project, shall
not be liable for damages, injuries, or liabilities sustained
through the purchase of support by the individual, the
individual's family, legal representative, or the authorized
representative under this section with funds received through
the consumer-directed home care demonstration project.
Liabilities include but are not limited to: workers'
compensation liability, the Federal Insurance Contributions Act
(FICA), or the Federal Unemployment Tax Act (FUTA).
(e) With federal approval, the commissioner may adjust
methodologies in paragraphs (b) and (c) to simplify program
administration, improve consistency between state and federal
programs, and maximize federal financial participation.
Sec. 38. Minnesota Statutes 2000, section 256B.0627, is
amended by adding a subdivision to read:
Subd. 14. [TELEHOMECARE; SKILLED NURSE VISITS.] Medical
assistance covers skilled nurse visits according to section
256B.0625, subdivision 6a, provided via telehomecare, for
services which do not require hands-on care between the home
care nurse and recipient. The provision of telehomecare must be
made via live, two-way interactive audiovisual technology and
may be augmented by utilizing store-and-forward technologies.
Store-and-forward technology includes telehomecare services that
do not occur in real time via synchronous transmissions, and
that do not require a face-to-face encounter with the recipient
for all or any part of any such telehomecare visit.
Individually identifiable patient data obtained through
real-time or store-and-forward technology must be maintained as
health records according to section 144.335. If the video is
used for research, training, or other purposes unrelated to the
care of the patient, the identity of the patient must be
concealed. A communication between the home care nurse and
recipient that consists solely of a telephone conversation,
facsimile, electronic mail, or a consultation between two health
care practitioners, is not to be considered a telehomecare visit.
Multiple daily skilled nurse visits provided via telehomecare
are allowed. Coverage of telehomecare is limited to two visits
per day. All skilled nurse visits provided via telehomecare
must be prior authorized by the commissioner or the
commissioner's designee and will be covered at the same
allowable rate as skilled nurse visits provided in-person.
Sec. 39. Minnesota Statutes 2000, section 256B.0627, is
amended by adding a subdivision to read:
Subd. 15. [THERAPIES THROUGH HOME HEALTH AGENCIES.] (a)
[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.
Direction of the physical therapy assistant must be provided by
the physical therapist as described in Minnesota Rules, part
9505.0390, subpart 1, item B. The physical therapist and
physical therapist assistant may not both bill for services
provided to a recipient on the same day.
(b) [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 under the direction of an occupational therapist who
is not on the premises shall be reimbursed at 65 percent of the
occupational therapist rate. Direction of the occupational
therapy assistant must be provided by the occupational therapist
as described in Minnesota Rules, part 9505.0390, subpart 1, item
B. The occupational therapist and occupational therapist
assistant may not both bill for services provided to a recipient
on the same day.
Sec. 40. Minnesota Statutes 2000, section 256B.0627, is
amended by adding a subdivision to read:
Subd. 16. [HARDSHIP CRITERIA; PRIVATE DUTY NURSING.] (a)
Payment is allowed for extraordinary services that require
specialized nursing skills and are provided by parents of minor
children, spouses, and legal guardians who are providing private
duty nursing care under the following conditions:
(1) the provision of these services is not legally required
of the parents, spouses, or legal guardians;
(2) the services are necessary to prevent hospitalization
of the recipient; and
(3) the recipient is eligible for state plan home care or a
home and community-based waiver and one of the following
hardship criteria are met:
(i) the parent, spouse, or legal guardian resigns from a
part-time or full-time job to provide nursing care for the
recipient; or
(ii) the parent, spouse, or legal guardian goes from a
full-time to a part-time job with less compensation to provide
nursing care for the recipient; or
(iii) the parent, spouse, or legal guardian takes a leave
of absence without pay to provide nursing care for the
recipient; or
(iv) because of labor conditions, special language needs,
or intermittent hours of care needed, the parent, spouse, or
legal guardian is needed in order to provide adequate private
duty nursing services to meet the medical needs of the recipient.
(b) Private duty nursing may be provided by a parent,
spouse, or legal guardian who is a nurse licensed in Minnesota.
Private duty nursing services provided by a parent, spouse, or
legal guardian cannot be used in lieu of nursing services
covered and available under liable third-party payors, including
Medicare. The private duty nursing provided by a parent,
spouse, or legal guardian must be included in the service plan.
Authorized skilled nursing services provided by the parent,
spouse, or legal guardian may not exceed 50 percent of the total
approved nursing hours, or eight hours per day, whichever is
less, up to a maximum of 40 hours per week. Nothing in this
subdivision precludes the parent's, spouse's, or legal
guardian's obligation of assuming the nonreimbursed family
responsibilities of emergency backup caregiver and primary
caregiver.
(c) A parent or a spouse may not be paid to provide private
duty nursing care if the parent or spouse fails to pass a
criminal background check according to section 245A.04, or if it
has been determined by the home health agency, the case manager,
or the physician that the private duty nursing care provided by
the parent, spouse, or legal guardian is unsafe.
Sec. 41. Minnesota Statutes 2000, section 256B.0627, is
amended by adding a subdivision to read:
Subd. 17. [QUALITY ASSURANCE PLAN FOR PERSONAL CARE
ASSISTANT SERVICES.] The commissioner shall establish a quality
assurance plan for personal care assistant services that
includes:
(1) performance-based provider agreements;
(2) meaningful consumer input, which may include consumer
surveys, that measure the extent to which participants receive
the services and supports described in the individual plan and
participant satisfaction with such services and supports;
(3) ongoing monitoring of the health and well-being of
consumers; and
(4) an ongoing public process for development,
implementation, and review of the quality assurance plan.
Sec. 42. Minnesota Statutes 2000, section 256B.0911, is
amended by adding a subdivision to read:
Subd. 4d. [PREADMISSION SCREENING OF INDIVIDUALS UNDER 65
YEARS OF AGE.] (a) It is the policy of the state of Minnesota to
ensure that individuals with disabilities or chronic illness are
served in the most integrated setting appropriate to their needs
and have the necessary information to make informed choices
about home and community-based service options.
(b) Individuals under 65 years of age who are admitted to a
nursing facility from a hospital must be screened prior to
admission as outlined in subdivisions 4a through 4c.
(c) Individuals under 65 years of age who are admitted to
nursing facilities with only a telephone screening must receive
a face-to-face assessment from the long-term care consultation
team member of the county in which the facility is located or
from the recipient's county case manager within 20 working days
of admission.
(d) At the face-to-face assessment, the long-term care
consultation team member or county case manager must perform the
activities required under subdivision 3b.
(e) For individuals under 21 years of age, a screening
interview which recommends nursing facility admission must be
face-to-face and approved by the commissioner before the
individual is admitted to the nursing facility.
(f) In the event that an individual under 65 years of age
is admitted to a nursing facility on an emergency basis, the
county must be notified of the admission on the next working
day, and a face-to-face assessment as described in paragraph (c)
must be conducted within 20 working days of admission.
(g) At the face-to-face assessment, the long-term care
consultation team member or the case manager must present
information about home and community-based options so the
individual can make informed choices. If the individual chooses
home and community-based services, the long-term care
consultation team member or case manager must complete a written
relocation plan within 20 working days of the visit. The plan
shall describe the services needed to move out of the facility
and a time line for the move which is designed to ensure a
smooth transition to the individual's home and community.
(h) An individual under 65 years of age residing in a
nursing facility shall receive a face-to-face assessment at
least every 12 months to review the person's service choices and
available alternatives unless the individual indicates, in
writing, that annual visits are not desired. In this case, the
individual must receive a face-to-face assessment at least once
every 36 months for the same purposes.
(i) Notwithstanding the provisions of subdivision 6, the
commissioner may pay county agencies directly for face-to-face
assessments for individuals under 65 years of age who are being
considered for placement or residing in a nursing facility.
Sec. 43. Minnesota Statutes 2000, section 256B.0916, is
amended by adding a subdivision to read:
Subd. 6a. [STATEWIDE AVAILABILITY OF CONSUMER-DIRECTED
COMMUNITY SUPPORT SERVICES.] (a) The commissioner shall submit
to the federal Health Care Financing Administration by August 1,
2001, an amendment to the home and community-based waiver for
persons with mental retardation or related conditions to make
consumer-directed community support services available in every
county of the state by January 1, 2002.
(b) If a county declines to meet the requirements for
provision of consumer-directed community supports, the
commissioner shall contract with another county, a group of
counties, or a private agency to plan for and administer
consumer-directed community supports in that county.
(c) The state of Minnesota, county agencies, tribal
governments, or administrative entities under contract to
participate in the implementation and administration of the home
and community-based waiver for persons with mental retardation
or a related condition, shall not be liable for damages,
injuries, or liabilities sustained through the purchase of
support by the individual, the individual's family, legal
representative, or the authorized representative with funds
received through the consumer-directed community support service
under this section. Liabilities include but are not limited
to: workers' compensation liability, the Federal Insurance
Contributions Act (FICA), or the Federal Unemployment Tax Act
(FUTA).
Sec. 44. Minnesota Statutes 2000, section 256B.0916,
subdivision 7, is amended to read:
Subd. 7. [ANNUAL REPORT BY COMMISSIONER.] Beginning
October 1, 1999, and each October 1 November 1, 2001, and each
November 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.
Sec. 45. Minnesota Statutes 2000, section 256B.0916,
subdivision 9, is amended to read:
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, the home and community-based waiver for persons
with mental retardation or related conditions or the consumer
support grant program pursuant to section 256B.092, subdivision
7 256.476, 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 August
1, 2001, the commissioner shall submit, for federal approval,
amendments to allow legal representatives to provide support and
receive reimbursement under the consumer-directed community
support services section of the home and community-based waiver
plan.
Sec. 46. Minnesota Statutes 2000, section 256B.092,
subdivision 5, is amended to read:
Subd. 5. [FEDERAL WAIVERS.] (a) The commissioner shall
apply for any federal waivers necessary to secure, to the extent
allowed by law, federal financial participation under United
States Code, title 42, sections 1396 et seq., as amended, for
the provision of services to persons who, in the absence of the
services, would need the level of care provided in a regional
treatment center or a community intermediate care facility for
persons with mental retardation or related conditions. The
commissioner may seek amendments to the waivers or apply for
additional waivers under United States Code, title 42, sections
1396 et seq., as amended, to contain costs. The commissioner
shall ensure that payment for the cost of providing home and
community-based alternative services under the federal waiver
plan shall not exceed the cost of intermediate care services
including day training and habilitation services that would have
been provided without the waivered services.
(b) The commissioner, in administering home and
community-based waivers for persons with mental retardation and
related conditions, shall ensure that day services for eligible
persons are not provided by the person's residential service
provider, unless the person or the person's legal representative
is offered a choice of providers and agrees in writing to
provision of day services by the residential service provider.
The individual service plan for individuals who choose to have
their residential service provider provide their day services
must describe how health, safety, and protection needs will be
met by frequent and regular contact with persons other than the
residential service provider.
Sec. 47. Minnesota Statutes 2000, section 256B.093,
subdivision 3, is amended to read:
Subd. 3. [TRAUMATIC BRAIN INJURY PROGRAM DUTIES.] The
department shall fund administrative case management under this
subdivision using medical assistance administrative funds. The
traumatic brain injury program duties include:
(1) recommending to the commissioner in consultation with
the medical review agent according to Minnesota Rules, parts
9505.0500 to 9505.0540, the approval or denial of medical
assistance funds to pay for out-of-state placements for
traumatic brain injury services and in-state traumatic brain
injury services provided by designated Medicare long-term care
hospitals;
(2) coordinating the traumatic brain injury home and
community-based waiver;
(3) approving traumatic brain injury waiver eligibility or
care plans or both;
(4) providing ongoing technical assistance and consultation
to county and facility case managers to facilitate care plan
development for appropriate, accessible, and cost-effective
medical assistance services;
(5) (4) providing technical assistance to promote statewide
development of appropriate, accessible, and cost-effective
medical assistance services and related policy;
(6) (5) providing training and outreach to facilitate
access to appropriate home and community-based services to
prevent institutionalization;
(7) (6) facilitating appropriate admissions, continued stay
review, discharges, and utilization review for neurobehavioral
hospitals and other specialized institutions;
(8) (7) providing technical assistance on the use of prior
authorization of home care services and coordination of these
services with other medical assistance services;
(9) (8) developing a system for identification of nursing
facility and hospital residents with traumatic brain injury to
assist in long-term planning for medical assistance services.
Factors will include, but are not limited to, number of
individuals served, length of stay, services received, and
barriers to community placement; and
(10) (9) providing information, referral, and case
consultation to access medical assistance services for
recipients without a county or facility case manager. Direct
access to this assistance may be limited due to the structure of
the program.
Sec. 48. Minnesota Statutes 2000, section 256B.095, is
amended to read:
256B.095 [THREE-YEAR QUALITY ASSURANCE PILOT PROJECT
ESTABLISHED.]
Effective July 1, 1998, an alternative quality assurance
licensing system pilot project for programs for persons with
developmental disabilities is established in Dodge, Fillmore,
Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele,
Wabasha, and Winona counties for the purpose of improving the
quality of services provided to persons with developmental
disabilities. A county, at its option, may choose to have all
programs for persons with developmental disabilities located
within the county licensed under chapter 245A using standards
determined under the alternative quality assurance licensing
system pilot project or may continue regulation of these
programs under the licensing system operated by the
commissioner. The pilot project expires on June 30, 2001 2005.
Sec. 49. Minnesota Statutes 2000, 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 14 but not more than 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; 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 2005.
Sec. 50. Minnesota Statutes 2000, 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.
(f) The commissioner, in consultation with the commission,
shall examine the feasibility of expanding the project to other
populations or geographic areas and identify barriers to
expansion. The commissioner shall report findings and
recommendations to the legislature by December 15, 2004.
Sec. 51. Minnesota Statutes 2000, section 256B.0951,
subdivision 4, is amended to read:
Subd. 4. [COMMISSION'S AUTHORITY TO RECOMMEND VARIANCES OF
LICENSING STANDARDS.] The commission may recommend to the
commissioners of human services and health variances from the
standards governing licensure of programs for persons with
developmental disabilities in order to improve the quality of
services by implementing an alternative developmental
disabilities licensing system if the commission determines that
the alternative licensing system does not adversely affect the
health or safety of persons being served by the licensed program
nor compromise the qualifications of staff to provide services.
Sec. 52. Minnesota Statutes 2000, section 256B.0951,
subdivision 5, is amended to read:
Subd. 5. [VARIANCE OF CERTAIN STANDARDS PROHIBITED.] The
safety standards, rights, or procedural protections under
sections 245.825; 245.91 to 245.97; 245A.04, subdivisions 3, 3a,
3b, and 3c; 245A.09, subdivision 2, paragraph (c), clauses (2)
and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092,
subdivisions 1b, clause (7), and 10; 626.556; 626.557, and
procedures for the monitoring of psychotropic medications shall
not be varied under the alternative licensing system pilot
project. The commission may make recommendations to the
commissioners of human services and health or to the legislature
regarding alternatives to or modifications of the rules and
procedures referenced in this subdivision.
Sec. 53. Minnesota Statutes 2000, section 256B.0951,
subdivision 7, is amended to read:
Subd. 7. [WAIVER OF RULES.] The commissioner of health may
exempt residents of intermediate care facilities for persons
with mental retardation (ICFs/MR) who participate in the
three-year quality assurance pilot project established in
section 256B.095 from the requirements of Minnesota Rules,
chapter 4665, upon approval by the federal government of a
waiver of federal certification requirements for ICFs/MR. The
commissioners of health and human services shall apply for any
necessary waivers as soon as practicable and shall submit the
concept paper to the federal government by June 1, 1998.
Sec. 54. Minnesota Statutes 2000, section 256B.0951, is
amended by adding a subdivision to read:
Subd. 8. [FEDERAL WAIVER.] The commissioner of human
services shall seek federal authority to waive provisions of
intermediate care facilities for persons with mental retardation
(ICFs/MR) regulations to enable the demonstration and evaluation
of the alternative quality assurance system for ICFs/MR under
the project. The commissioner of human services shall apply for
any necessary waivers as soon as practicable.
Sec. 55. Minnesota Statutes 2000, section 256B.0951, is
amended by adding a subdivision to read:
Subd. 9. [EVALUATION.] The commission, in consultation
with the commissioner of human services, shall conduct an
evaluation of the alternative quality assurance system, and
present a report to the commissioner by June 30, 2004.
Sec. 56. Minnesota Statutes 2000, section 256B.0952,
subdivision 1, is amended to read:
Subdivision 1. [NOTIFICATION.] By January 15, 1998, each
affected county shall notify the commission and the
commissioners of human services and health as to whether it
chooses to implement on July 1, 1998, the alternative licensing
system for the pilot project. A county that does not implement
the alternative licensing system on July 1, 1998, may give
notice to the commission and the commissioners by January 15,
1999, or January 15, 2000, that it will implement the
alternative licensing system on the following July 1. A county
that implements the alternative licensing system commits to
participate until June 30, 2001. For each year of the project,
region 10 counties shall give notice to the commission and
commissioners of human services and health by March 15 of intent
to join the quality assurance alternative licensing system,
effective July 1 of that year. A county choosing to participate
in the alternative licensing system commits to participate until
June 30, 2005. Counties participating in the quality assurance
alternative licensing system as of January 1, 2001, shall notify
the commission and the commissioners of human services and
health by March 15, 2001, of intent to continue participation.
Counties that elect to continue participation must participate
in the alternative licensing system until June 30, 2005.
Sec. 57. Minnesota Statutes 2000, section 256B.0952,
subdivision 4, is amended to read:
Subd. 4. [APPOINTMENT OF QUALITY ASSURANCE MANAGER.] (a) A
county or group of counties that chooses to participate in the
alternative licensing system shall designate a quality assurance
manager and shall establish quality assurance teams in
accordance with subdivision 5. The manager shall recruit,
train, and assign duties to the quality assurance team members.
In assigning team members to conduct the quality assurance
process at a facility, program, or service, the manager shall
take into account the size of the service provider, the number
of services to be reviewed, the skills necessary for team
members to complete the process, and other relevant factors.
The manager shall ensure that no team member has a financial,
personal, or family relationship with the facility, program, or
service being reviewed or with any clients of the facility,
program, or service.
(b) Quality assurance teams shall report the findings of
their quality assurance reviews to the quality assurance manager.
The quality assurance manager shall provide the report from the
quality assurance team to the county and, upon request, to the
commissioners of human services and health, and shall provide a
summary of the report to the quality assurance review council.
Sec. 58. Minnesota Statutes 2000, section 256B.49, is
amended by adding a subdivision to read:
Subd. 11. [AUTHORITY.] (a) The commissioner is authorized
to apply for home and community-based service waivers, as
authorized under section 1915(c) of the Social Security Act to
serve persons under the age of 65 who are determined to require
the level of care provided in a nursing home and persons who
require the level of care provided in a hospital. The
commissioner shall apply for the home and community-based
waivers in order to: (i) promote the support of persons with
disabilities in the most integrated settings; (ii) expand the
availability of services for persons who are eligible for
medical assistance; (iii) promote cost-effective options to
institutional care; and (iv) obtain federal financial
participation.
(b) The provision of waivered services to medical
assistance recipients with disabilities shall comply with the
requirements outlined in the federally approved applications for
home and community-based services and subsequent amendments,
including provision of services according to a service plan
designed to meet the needs of the individual. For purposes of
this section, the approved home and community-based application
is considered the necessary federal requirement.
(c) The commissioner shall provide interested persons
serving on agency advisory committees and task forces, and
others upon request, with notice of, and an opportunity to
comment on, any changes or amendments to the federally approved
applications for home and community-based waivers, prior to
their submission to the federal health care financing
administration.
(d) The commissioner shall seek approval, as authorized
under section 1915(c) of the Social Security Act, to allow
medical assistance eligibility under this section for children
under age 21 without deeming of parental income or assets.
(e) The commissioner shall seek approval, as authorized
under section 1915(c) of the Social Act, to allow medical
assistance eligibility under this section for individuals under
age 65 without deeming the spouse's income or assets.
Sec. 59. Minnesota Statutes 2000, section 256B.49, is
amended by adding a subdivision to read:
Subd. 12. [INFORMED CHOICE.] Persons who are determined
likely to require the level of care provided in a nursing
facility or hospital shall be informed of the home and
community-based support alternatives to the provision of
inpatient hospital services or nursing facility services. Each
person must be given the choice of either institutional or home
and community-based services using the provisions described in
section 256B.77, subdivision 2, paragraph (p).
Sec. 60. Minnesota Statutes 2000, section 256B.49, is
amended by adding a subdivision to read:
Subd. 13. [CASE MANAGEMENT.] (a) Each recipient of a home
and community-based waiver shall be provided case management
services by qualified vendors as described in the federally
approved waiver application. The case management service
activities provided will include:
(1) assessing the needs of the individual within 20 working
days of a recipient's request;
(2) developing the written individual service plan within
ten working days after the assessment is completed;
(3) informing the recipient or the recipient's legal
guardian or conservator of service options;
(4) assisting the recipient in the identification of
potential service providers;
(5) assisting the recipient to access services;
(6) coordinating, evaluating, and monitoring of the
services identified in the service plan;
(7) completing the annual reviews of the service plan; and
(8) informing the recipient or legal representative of the
right to have assessments completed and service plans developed
within specified time periods, and to appeal county action or
inaction under section 256.045, subdivision 3.
(b) The case manager may delegate certain aspects of the
case management service activities to another individual
provided there is oversight by the case manager. The case
manager may not delegate those aspects which require
professional judgment including assessments, reassessments, and
care plan development.
Sec. 61. Minnesota Statutes 2000, section 256B.49, is
amended by adding a subdivision to read:
Subd. 14. [ASSESSMENT AND REASSESSMENT.] (a) Assessments
of each recipient's strengths, informal support systems, and
need for services shall be completed within 20 working days of
the recipient's request. Reassessment of each recipient's
strengths, support systems, and need for services shall be
conducted at least every 12 months and at other times when there
has been a significant change in the recipient's functioning.
(b) Persons with mental retardation or a related condition
who apply for services under the nursing facility level waiver
programs shall be screened for the appropriate level of care
according to section 256B.092.
(c) Recipients who are found eligible for home and
community-based services under this section before their 65th
birthday may remain eligible for these services after their 65th
birthday if they continue to meet all other eligibility factors.
Sec. 62. Minnesota Statutes 2000, section 256B.49, is
amended by adding a subdivision to read:
Subd. 15. [INDIVIDUALIZED SERVICE PLAN.] Each recipient of
home and community-based waivered services shall be provided a
copy of the written service plan which:
(1) is developed and signed by the recipient within ten
working days of the completion of the assessment;
(2) meets the assessed needs of the recipient;
(3) reasonably ensures the health and safety of the
recipient;
(4) promotes independence;
(5) allows for services to be provided in the most
integrated settings; and
(6) provides for an informed choice, as defined in section
256B.77, subdivision 2, paragraph (p), of service and support
providers.
Sec. 63. Minnesota Statutes 2000, section 256B.49, is
amended by adding a subdivision to read:
Subd. 16. [SERVICES AND SUPPORTS.] (a) Services and
supports included in the home and community-based waivers for
persons with disabilities shall meet the requirements set out in
United States Code, title 42, section 1396n. The services and
supports, which are offered as alternatives to institutional
care, shall promote consumer choice, community inclusion,
self-sufficiency, and self-determination.
(b) Beginning January 1, 2003, the commissioner shall
simplify and improve access to home and community-based waivered
services, to the extent possible, through the establishment of a
common service menu that is available to eligible recipients
regardless of age, disability type, or waiver program.
(c) Consumer directed community support services shall be
offered as an option to all persons eligible for services under
subdivision 11, by January 1, 2002.
(d) Services and supports shall be arranged and provided
consistent with individualized written plans of care for
eligible waiver recipients.
(e) The state of Minnesota and county agencies that
administer home and community-based waivered services for
persons with disabilities, shall not be liable for damages,
injuries, or liabilities sustained through the purchase of
supports by the individual, the individual's family, legal
representative, or the authorized representative with funds
received through the consumer-directed community support service
under this section. Liabilities include but are not limited
to: workers' compensation liability, the Federal Insurance
Contributions Act (FICA), or the Federal Unemployment Tax Act
(FUTA).
Sec. 64. Minnesota Statutes 2000, section 256B.49, is
amended by adding a subdivision to read:
Subd. 17. [COST OF SERVICES AND SUPPORTS.] (a) The
commissioner shall ensure that the average per capita
expenditures estimated in any fiscal year for home and
community-based waiver recipients does not exceed the average
per capita expenditures that would have been made to provide
institutional services for recipients in the absence of the
waiver.
(b) The commissioner shall implement on January 1, 2002,
one or more aggregate, need-based methods for allocating to
local agencies the home and community-based waivered service
resources available to support recipients with disabilities in
need of the level of care provided in a nursing facility or a
hospital. The commissioner shall allocate resources to single
counties and county partnerships in a manner that reflects
consideration of:
(1) an incentive-based payment process for achieving
outcomes;
(2) the need for a state-level risk pool;
(3) the need for retention of management responsibility at
the state agency level; and
(4) a phase-in strategy as appropriate.
(c) Until the allocation methods described in paragraph (b)
are implemented, the annual allowable reimbursement level of
home and community-based waiver services shall be the greater of:
(1) the statewide average payment amount which the
recipient is assigned under the waiver reimbursement system in
place on June 30, 2001, modified by the percentage of any
provider rate increase appropriated for home and community-based
services; or
(2) an amount approved by the commissioner based on the
recipient's extraordinary needs that cannot be met within the
current allowable reimbursement level. The increased
reimbursement level must be necessary to allow the recipient to
be discharged from an institution or to prevent imminent
placement in an institution. The additional reimbursement may
be used to secure environmental modifications; assistive
technology and equipment; and increased costs for supervision,
training, and support services necessary to address the
recipient's extraordinary needs. The commissioner may approve
an increased reimbursement level for up to one year of the
recipient's relocation from an institution or up to six months
of a determination that a current waiver recipient is at
imminent risk of being placed in an institution.
(d) Beginning July 1, 2001, medically necessary private
duty nursing services will be authorized under this section as
complex and regular care according to section 256B.0627. The
rate established by the commissioner for registered nurse or
licensed practical nurse services under any home and
community-based waiver as of January 1, 2001, shall not be
reduced.
Sec. 65. Minnesota Statutes 2000, section 256B.49, is
amended by adding a subdivision to read:
Subd. 18. [PAYMENTS.] The commissioner shall reimburse
approved vendors from the medical assistance account for the
costs of providing home and community-based services to eligible
recipients using the invoice processing procedures of the
Medicaid management information system (MMIS). Recipients will
be screened and authorized for services according to the
federally approved waiver application and its subsequent
amendments.
Sec. 66. Minnesota Statutes 2000, section 256B.49, is
amended by adding a subdivision to read:
Subd. 19. [HEALTH AND WELFARE.] The commissioner of human
services shall take the necessary safeguards to protect the
health and welfare of individuals provided services under the
waiver.
Sec. 67. Minnesota Statutes 2000, section 256B.49, is
amended by adding a subdivision to read:
Subd. 20. [TRAUMATIC BRAIN INJURY AND RELATED CONDITIONS.]
The commissioner shall seek to amend the traumatic brain injury
waiver to include, as eligible persons, individuals with an
acquired or degenerative disease diagnosis where cognitive
impairment is present, such as multiple sclerosis.
Sec. 68. Minnesota Statutes 2000, section 256D.35, is
amended by adding a subdivision to read:
Subd. 11a. [INSTITUTION.] "Institution" means a hospital,
consistent with Code of Federal Regulations, title 42, section
440.10; regional treatment center inpatient services, consistent
with section 245.474; a nursing facility; and an intermediate
care facility for persons with mental retardation.
Sec. 69. Minnesota Statutes 2000, section 256D.35, is
amended by adding a subdivision to read:
Subd. 18a. [SHELTER COSTS.] "Shelter costs" means rent,
manufactured home lot rentals; monthly principal, interest,
insurance premiums, and property taxes due for mortgages or
contract for deed costs; costs for utilities, including heating,
cooling, electricity, water, and sewerage; garbage collection
fees; and the basic service fee for one telephone.
Sec. 70. Minnesota Statutes 2000, section 256D.44,
subdivision 5, is amended to read:
Subd. 5. [SPECIAL NEEDS.] In addition to the state
standards of assistance established in subdivisions 1 to 4,
payments are allowed for the following special needs of
recipients of Minnesota supplemental aid who are not residents
of a nursing home, a regional treatment center, or a group
residential housing facility.
(a) The county agency shall pay a monthly allowance for
medically prescribed diets payable under the Minnesota family
investment program if the cost of those additional dietary needs
cannot be met through some other maintenance benefit.
(b) Payment for nonrecurring special needs must be allowed
for necessary home repairs or necessary repairs or replacement
of household furniture and appliances using the payment standard
of the AFDC program in effect on July 16, 1996, for these
expenses, as long as other funding sources are not available.
(c) A fee for guardian or conservator service is allowed at
a reasonable rate negotiated by the county or approved by the
court. This rate shall not exceed five percent of the
assistance unit's gross monthly income up to a maximum of $100
per month. If the guardian or conservator is a member of the
county agency staff, no fee is allowed.
(d) The county agency shall continue to pay a monthly
allowance of $68 for restaurant meals for a person who was
receiving a restaurant meal allowance on June 1, 1990, and who
eats two or more meals in a restaurant daily. The allowance
must continue until the person has not received Minnesota
supplemental aid for one full calendar month or until the
person's living arrangement changes and the person no longer
meets the criteria for the restaurant meal allowance, whichever
occurs first.
(e) A fee of ten percent of the recipient's gross income or
$25, whichever is less, is allowed for representative payee
services provided by an agency that meets the requirements under
SSI regulations to charge a fee for representative payee
services. This special need is available to all recipients of
Minnesota supplemental aid regardless of their living
arrangement.
(f) Notwithstanding the language in this subdivision, an
amount equal to the maximum allotment authorized by the federal
Food Stamp Program for a single individual which is in effect on
the first day of January of the previous year will be added to
the standards of assistance established in subdivisions 1 to 4
for individuals under the age of 65 who are relocating from an
institution and who are shelter needy. An eligible individual
who receives this benefit prior to age 65 may continue to
receive the benefit after the age of 65.
"Shelter needy" means that the assistance unit incurs
monthly shelter costs that exceed 40 percent of the assistance
unit's gross income before the application of this special needs
standard. "Gross income" for the purposes of this section is
the applicant's or recipient's income as defined in section
256D.35, subdivision 10, or the standard specified in
subdivision 3, whichever is greater. A recipient of a federal
or state housing subsidy, that limits shelter costs to a
percentage of gross income, shall not be considered shelter
needy for purposes of this paragraph.
Sec. 71. [256I.07] [RESPITE CARE PILOT PROJECT FOR FAMILY
ADULT FOSTER CARE PROVIDERS.]
Subdivision 1. [PROGRAM ESTABLISHED.] The state recognizes
the importance of developing and maintaining quality family
foster care resources. In order to accomplish that goal, the
commissioner shall establish a two-year respite care pilot
project for family adult foster care providers in three
counties. This pilot project is intended to provide support to
caregivers of family adult foster care residents. The
commissioner shall establish a state-funded pilot project to
accomplish the provisions in subdivisions 2 to 4.
Subd. 2. [ELIGIBILITY.] A family adult foster care home
provider as defined under section 144D.01, subdivision 7, who
has been licensed for six months is eligible for up to 30 days
of respite care per calendar year. In cases of emergency, a
county social services agency may waive the six-month licensing
requirement. In order to be eligible to receive respite
payment, a provider must take time off away from their foster
care residents.
Subd. 3. [PAYMENT STRUCTURE.] (a) The rate of payment for
respite care for an adult foster care resident eligible for only
group residential housing shall be based on the current monthly
group residential housing base room and board rate and the
current maximum monthly group residential housing difficulty of
care rate.
(b) The rate of payment for respite care for an adult
foster care resident eligible for alternative care funds shall
be based on the resident's alternative care foster care rate.
(c) The rate of payment for respite care for an adult
foster care resident eligible for Medicaid home and
community-based services waiver funds shall be based on the
group residential housing base room and board rate.
(d) The total amount available to pay for respite care for
a family adult foster care provider shall be based on the number
of residents currently served in the foster care home. Respite
care must be paid for on a per diem basis and for a full day.
Subd. 4. [PRIVATE PAY RESIDENTS.] Payment for respite care
for private pay foster care residents must be arranged between
the provider and the resident or the resident's family.
Sec. 72. Laws 1999, chapter 152, section 1, is amended to
read:
Section 1. [TASK FORCE.]
A day training and habilitation task force is established.
Task force membership shall consist of representatives of the
commissioner of human services, counties, service consumers, and
vendors of day training and habilitation as defined in Minnesota
Statutes, section 252.41, subdivision 9, including at least one
representative from each association representing day training
and habilitation vendors. Appointments to the task force shall
be made by the commissioner of human services and technical
assistance shall be provided by the department of human services.
Sec. 73. [SEMI-INDEPENDENT LIVING SERVICES (SILS) STUDY.]
The commissioner of human services, in consultation with
county representatives and other interested persons, shall
develop recommendations revising the funding methodology for
SILS as defined in Minnesota Statutes, section 252.275,
subdivisions 3, 4, 4b, and 4c, and report by January 15, 2002,
to the chair of the house of representatives health and human
services finance committee and the chair of the senate health,
human services and corrections budget division.
Sec. 74. [WAIVER REQUEST REGARDING SPOUSAL INCOME.]
By September 1, 2001, the commissioner of human services
shall seek federal approval to allow recipients of home and
community-based waivers authorized under Minnesota Statutes,
section 256B.49, to choose either a waiver of deeming of spousal
income or the spousal impoverishment protections authorized
under United States Code, title 42, section 1396r-5, with the
addition of a recipient's maintenance needs in an amount equal
to the Minnesota supplemental aid equivalent rate as defined in
Minnesota Statutes, section 256I.03, subdivision 5, plus the
personal needs allowance as defined in Minnesota Statutes,
section 256B.35, subdivision 1, paragraph (a). Recipient
maintenance needs shall be adjusted under this provision each
July 1.
Sec. 75. [FEDERAL WAIVER REQUESTS.]
The commissioner of human services shall submit to the
federal Health Care Financing Administration by September 1,
2001, a request for a home and community-based services waiver
for day services, including: community inclusion, supported
employment, and day training and habilitation services defined
in Minnesota Statutes, section 252.41, subdivision 3, clause
(1), for persons eligible for the waiver under Minnesota
Statutes, section 256B.092.
Sec. 76. [REPEALER.]
(a) Minnesota Statutes 2000, section 256B.0951, subdivision
6, is repealed.
(b) Minnesota Statutes 2000, sections 145.9245; 256.476,
subdivision 7; 256B.0912; 256B.0915, subdivisions 3a, 3b, and
3c; and 256B.49, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10,
are repealed.
(c) Laws 1995, chapter 178, article 2, section 48,
subdivision 6, is repealed.
(d) Minnesota Rules, parts 9505.2455; 9505.2458; 9505.2460;
9505.2465; 9505.2470; 9505.2473; 9505.2475; 9505.2480;
9505.2485; 9505.2486; 9505.2490; 9505.2495; 9505.2496;
9505.2500; 9505.3010; 9505.3015; 9505.3020; 9505.3025;
9505.3030; 9505.3035; 9505.3040; 9505.3065; 9505.3085;
9505.3135; 9505.3500; 9505.3510; 9505.3520; 9505.3530;
9505.3535; 9505.3540; 9505.3545; 9505.3550; 9505.3560;
9505.3570; 9505.3575; 9505.3580; 9505.3585; 9505.3600;
9505.3610; 9505.3620; 9505.3622; 9505.3624; 9505.3626;
9505.3630; 9505.3635; 9505.3640; 9505.3645; 9505.3650;
9505.3660; and 9505.3670, are repealed.
Sec. 77. [EFFECTIVE DATE.]
Section 23 is effective January 1, 2003.
ARTICLE 4
CONSUMER INFORMATION
Section 1. [144A.35] [EXPANSION OF BED DISTRIBUTION
STUDY.]
The commissioner of human services, shall monitor and
analyze the distribution of older adult services, including, but
not limited to, nursing home beds, senior housing, housing with
services units, and home and community-based services in the
different geographic areas of the state. The study shall
include an analysis of the impact of amendments to the nursing
home moratorium law which would allow for transfers of nursing
home beds within the state. The commissioner of human services
shall submit to the legislature, beginning June 1, 2002, and
each January 15 thereafter, an assessment of the distribution of
long-term health care services by geographic area, with
particular attention to service deficits or problems, and
corrective action plans.
Sec. 2. Minnesota Statutes 2000, section 256.975, is
amended by adding a subdivision to read:
Subd. 7. [CONSUMER INFORMATION AND ASSISTANCE; SENIOR
LINKAGE.] (a) The Minnesota board on aging shall operate a
statewide information and assistance service to aid older
Minnesotans and their families in making informed choices about
long-term care options and health care benefits. Language
services to persons with limited English language skills may be
made available. The service, known as Senior LinkAge Line, must
be available during business hours through a statewide toll-free
number and must also be available through the Internet.
(b) The service must assist older adults, caregivers, and
providers in accessing information about choices in long-term
care services that are purchased through private providers or
available through public options. The service must:
(1) develop a comprehensive database that includes detailed
listings in both consumer- and provider-oriented formats;
(2) make the database accessible on the Internet and
through other telecommunication and media-related tools;
(3) link callers to interactive long-term care screening
tools and make these tools available through the Internet by
integrating the tools with the database;
(4) develop community education materials with a focus on
planning for long-term care and evaluating independent living,
housing, and service options;
(5) conduct an outreach campaign to assist older adults and
their caregivers in finding information on the Internet and
through other means of communication;
(6) implement a messaging system for overflow callers and
respond to these callers by the next business day;
(7) link callers with county human services and other
providers to receive more in-depth assistance and consultation
related to long-term care options; and
(8) link callers with quality profiles for nursing
facilities and other providers developed by the commissioner of
health.
(c) The Minnesota board on aging shall conduct an
evaluation of the effectiveness of the statewide information and
assistance, and submit this evaluation to the legislature by
December 1, 2002. The evaluation must include an analysis of
funding adequacy, gaps in service delivery, continuity in
information between the service and identified linkages, and
potential use of private funding to enhance the service.
Sec. 3. [256.9754] [COMMUNITY SERVICES DEVELOPMENT GRANTS
PROGRAM.]
Subdivision 1. [DEFINITIONS.] For purposes of this
section, the following terms have the meanings given.
(a) "Community" means a town, township, city, or targeted
neighborhood within a city, or a consortium of towns, townships,
cities, or targeted neighborhoods within cities.
(b) "Older adult services" means any services available
under the elderly waiver program or alternative care grant
programs; nursing facility services; transportation services;
respite services; and other community-based services identified
as necessary either to maintain lifestyle choices for older
Minnesotans, or to promote independence.
(c) "Older adult" refers to individuals 65 years of age and
older.
Subd. 2. [CREATION.] The community services development
grants program is created under the administration of the
commissioner of human services.
Subd. 3. [PROVISION OF GRANTS.] The commissioner shall
make grants available to communities, providers of older adult
services identified in subdivision 1, or to a consortium of
providers of older adult services, to establish older adult
services. Grants may be provided for capital and other costs
including, but not limited to, start-up and training costs,
equipment, and supplies related to older adult services or other
residential or service alternatives to nursing facility care.
Grants may also be made to renovate current buildings, provide
transportation services, fund programs that would allow older
adults or disabled individuals to stay in their own homes by
sharing a home, fund programs that coordinate and manage formal
and informal services to older adults in their homes to enable
them to live as independently as possible in their own homes as
an alternative to nursing home care, or expand state-funded
programs in the area.
Subd. 4. [ELIGIBILITY.] Grants may be awarded only to
communities and providers or to a consortium of providers that
have a local match of 50 percent of the costs for the project in
the form of donations, local tax dollars, in-kind donations,
fundraising, or other local matches.
Subd. 5. [GRANT PREFERENCE.] The commissioner of human
services shall give preference when awarding grants under this
section to areas where nursing facility closures have occurred
or are occurring. The commissioner may award grants to the
extent grant funds are available and to the extent applications
are approved by the commissioner. Denial of approval of an
application in one year does not preclude submission of an
application in a subsequent year. The maximum grant amount is
limited to $750,000.
Sec. 4. Minnesota Statutes 2000, section 256B.0911,
subdivision 1, is amended to read:
Subdivision 1. [PURPOSE AND GOAL.] (a) The purpose of the
preadmission screening program long-term care consultation
services is to assist persons with long-term or chronic care
needs in making long-term care decisions and selecting options
that meet their needs and reflect their preferences. The
availability of, and access to, information and other types of
assistance is also intended to prevent or delay certified
nursing facility placements by assessing applicants and
residents and offering cost-effective alternatives appropriate
for the person's needs and to provide transition assistance
after admission. Further, the goal of the program these
services is to contain costs associated with unnecessary
certified nursing facility admissions. The commissioners of
human services and health shall seek to maximize use of
available federal and state funds and establish the broadest
program possible within the funding available.
(b) These services must be coordinated with services
provided under sections 256.975, subdivision 7, and 256.9772,
and with services provided by other public and private agencies
in the community to offer a variety of cost-effective
alternatives to persons with disabilities and elderly persons.
The county agency providing long-term care consultation services
shall encourage the use of volunteers from families, religious
organizations, social clubs, and similar civic and service
organizations to provide community-based services.
Sec. 5. Minnesota Statutes 2000, section 256B.0911, is
amended by adding a subdivision to read:
Subd. 1a. [DEFINITIONS.] For purposes of this section, the
following definitions apply:
(a) "Long-term care consultation services" means:
(1) providing information and education to the general
public regarding availability of the services authorized under
this section;
(2) an intake process that provides access to the services
described in this section;
(3) assessment of the health, psychological, and social
needs of referred individuals;
(4) assistance in identifying services needed to maintain
an individual in the least restrictive environment;
(5) providing recommendations on cost-effective community
services that are available to the individual;
(6) development of an individual's community support plan;
(7) providing information regarding eligibility for
Minnesota health care programs;
(8) preadmission screening to determine the need for a
nursing facility level of care;
(9) preliminary determination of Minnesota health care
programs eligibility for individuals who need a nursing facility
level of care, with appropriate referrals for final
determination;
(10) providing recommendations for nursing facility
placement when there are no cost-effective community services
available; and
(11) assistance to transition people back to community
settings after facility admission.
(b) "Minnesota health care programs" means the medical
assistance program under chapter 256B, the alternative care
program under section 256B.0913, and the prescription drug
program under section 256.955.
Sec. 6. Minnesota Statutes 2000, section 256B.0911,
subdivision 3, is amended to read:
Subd. 3. [PERSONS RESPONSIBLE FOR CONDUCTING THE
PREADMISSION SCREENING LONG-TERM CARE CONSULTATION TEAM.] (a) A
local screening long-term care consultation team shall be
established by the county board of commissioners. Each local
screening consultation team shall consist of screeners who are a
at least one social worker and a at least one public health
nurse from their respective county agencies. The board may
designate public health or social services as the lead agency
for long-term care consultation services. If a county does not
have a public health nurse available, it may request approval
from the commissioner to assign a county registered nurse with
at least one year experience in home care to participate on the
team. The screening team members must confer regarding the most
appropriate care for each individual screened. Two or more
counties may collaborate to establish a joint local screening
consultation team or teams.
(b) In assessing a person's needs, screeners shall have a
physician available for consultation and shall consider the
assessment of the individual's attending physician, if any. The
individual's physician shall be included if the physician
chooses to participate. Other personnel may be included on the
team as deemed appropriate by the county agencies. The team is
responsible for providing long-term care consultation services
to all persons located in the county who request the services,
regardless of eligibility for Minnesota health care programs.
Sec. 7. Minnesota Statutes 2000, section 256B.0911, is
amended by adding a subdivision to read:
Subd. 3a. [ASSESSMENT AND SUPPORT PLANNING.] (a) Persons
requesting assessment, services planning, or other assistance
intended to support community-based living must be visited by a
long-term care consultation team within ten working days after
the date on which an assessment was requested or recommended.
Assessments must be conducted according to paragraphs (b) to (g).
(b) The county may utilize a team of either the social
worker or public health nurse, or both, to conduct the
assessment in a face-to-face interview. The consultation team
members must confer regarding the most appropriate care for each
individual screened or assessed.
(c) The long-term care consultation team must assess the
health and social needs of the person, using an assessment form
provided by the commissioner.
(d) The team must conduct the assessment in a face-to-face
interview with the person being assessed and the person's legal
representative, if applicable.
(e) The team must provide the person, or the person's legal
representative, with written recommendations for facility- or
community-based services. The team must document that the most
cost-effective alternatives available were offered to the
individual. For purposes of this requirement, "cost-effective
alternatives" means community services and living arrangements
that cost the same as or less than nursing facility care.
(f) If the person chooses to use community-based services,
the team must provide the person or the person's legal
representative with a written community support plan, regardless
of whether the individual is eligible for Minnesota health care
programs. The person may request assistance in developing a
community support plan without participating in a complete
assessment.
(g) The team must give the person receiving assessment or
support planning, or the person's legal representative,
materials supplied by the commissioner containing the following
information:
(1) the purpose of preadmission screening and assessment;
(2) information about Minnesota health care programs;
(3) the person's freedom to accept or reject the
recommendations of the team;
(4) the person's right to confidentiality under the
Minnesota Government Data Practices Act, chapter 13; and
(5) the person's right to appeal the decision regarding the
need for nursing facility level of care or the county's final
decisions regarding public programs eligibility according to
section 256.045, subdivision 3.
Sec. 8. Minnesota Statutes 2000, section 256B.0911, is
amended by adding a subdivision to read:
Subd. 3b. [TRANSITION ASSISTANCE.] (a) A long-term care
consultation team shall provide assistance to persons residing
in a nursing facility, hospital, regional treatment center, or
intermediate care facility for persons with mental retardation
who request or are referred for assistance. Transition
assistance must include assessment, community support plan
development, referrals to Minnesota health care programs, and
referrals to programs that provide assistance with housing.
(b) The county shall develop transition processes with
institutional social workers and discharge planners to ensure
that:
(1) persons admitted to facilities receive information
about transition assistance that is available;
(2) the assessment is completed for persons within ten
working days of the date of request or recommendation for
assessment; and
(3) there is a plan for transition and follow-up for the
individual's return to the community. The plan must require
notification of other local agencies when a person who may
require assistance is screened by one county for admission to a
facility located in another county.
(c) If a person who is eligible for a Minnesota health care
program is admitted to a nursing facility, the nursing facility
must include a consultation team member or the case manager in
the discharge planning process.
Sec. 9. Minnesota Statutes 2000, section 256B.0911, is
amended by adding a subdivision to read:
Subd. 4a. [PREADMISSION SCREENING ACTIVITIES RELATED TO
NURSING FACILITY ADMISSIONS.] (a) All applicants to Medicaid
certified nursing facilities, including certified boarding care
facilities, must be screened prior to admission regardless of
income, assets, or funding sources for nursing facility care,
except as described in subdivision 4b. The purpose of the
screening is to determine the need for nursing facility level of
care as described in paragraph (d) and to complete activities
required under federal law related to mental illness and mental
retardation as outlined in paragraph (b).
(b) A person who has a diagnosis or possible diagnosis of
mental illness, mental retardation, or a related condition must
receive a preadmission screening before admission regardless of
the exemptions outlined in subdivision 4b, paragraph (b), to
identify the need for further evaluation and specialized
services, unless the admission prior to screening is authorized
by the local mental health authority or the local developmental
disabilities case manager, or unless authorized by the county
agency according to Public Law Number 100-508.
The following criteria apply to the preadmission screening:
(1) the county must use forms and criteria developed by the
commissioner to identify persons who require referral for
further evaluation and determination of the need for specialized
services; and
(2) the evaluation and determination of the need for
specialized services must be done by:
(i) a qualified independent mental health professional, for
persons with a primary or secondary diagnosis of a serious
mental illness; or
(ii) a qualified mental retardation professional, for
persons with a primary or secondary diagnosis of mental
retardation or related conditions. For purposes of this
requirement, a qualified mental retardation professional must
meet the standards for a qualified mental retardation
professional under Code of Federal Regulations, title 42,
section 483.430.
(c) The local county mental health authority or the state
mental retardation authority under Public Law Numbers 100-203
and 101-508 may prohibit admission to a nursing facility if the
individual does not meet the nursing facility level of care
criteria or needs specialized services as defined in Public Law
Numbers 100-203 and 101-508. For purposes of this section,
"specialized services" for a person with mental retardation or a
related condition means active treatment as that term is defined
under Code of Federal Regulations, title 42, section 483.440
(a)(1).
(d) The determination of the need for nursing facility
level of care must be made according to criteria developed by
the commissioner. In assessing a person's needs, consultation
team members shall have a physician available for consultation
and shall consider the assessment of the individual's attending
physician, if any. The individual's physician must be included
if the physician chooses to participate. Other personnel may be
included on the team as deemed appropriate by the county.
Sec. 10. Minnesota Statutes 2000, section 256B.0911, is
amended by adding a subdivision to read:
Subd. 4b. [EXEMPTIONS AND EMERGENCY ADMISSIONS.] (a)
Exemptions from the federal screening requirements outlined in
subdivision 4a, paragraphs (b) and (c), are limited to:
(1) a person who, having entered an acute care facility
from a certified nursing facility, is returning to a certified
nursing facility; and
(2) a person transferring from one certified nursing
facility in Minnesota to another certified nursing facility in
Minnesota.
(b) Persons who are exempt from preadmission screening for
purposes of level of care determination include:
(1) persons described in paragraph (a);
(2) an individual who has a contractual right to have
nursing facility care paid for indefinitely by the veterans'
administration;
(3) an individual enrolled in a demonstration project under
section 256B.69, subdivision 8, at the time of application to a
nursing facility;
(4) an individual currently being served under the
alternative care program or under a home and community-based
services waiver authorized under section 1915(c) of the federal
Social Security Act; and
(5) individuals admitted to a certified nursing facility
for a short-term stay, which is expected to be 14 days or less
in duration based upon a physician's certification, and who have
been assessed and approved for nursing facility admission within
the previous six months. This exemption applies only if the
consultation team member determines at the time of the initial
assessment of the six-month period that it is appropriate to use
the nursing facility for short-term stays and that there is an
adequate plan of care for return to the home or community-based
setting. If a stay exceeds 14 days, the individual must be
referred no later than the first county working day following
the 14th resident day for a screening, which must be completed
within five working days of the referral. The payment
limitations in subdivision 7 apply to an individual found at
screening to not meet the level of care criteria for admission
to a certified nursing facility.
(c) Persons admitted to a Medicaid-certified nursing
facility from the community on an emergency basis as described
in paragraph (d) or from an acute care facility on a nonworking
day must be screened the first working day after admission.
(d) Emergency admission to a nursing facility prior to
screening is permitted when all of the following conditions are
met:
(1) a person is admitted from the community to a certified
nursing or certified boarding care facility during county
nonworking hours;
(2) a physician has determined that delaying admission
until preadmission screening is completed would adversely affect
the person's health and safety;
(3) there is a recent precipitating event that precludes
the client from living safely in the community, such as
sustaining an injury, sudden onset of acute illness, or a
caregiver's inability to continue to provide care;
(4) the attending physician has authorized the emergency
placement and has documented the reason that the emergency
placement is recommended; and
(5) the county is contacted on the first working day
following the emergency admission.
Transfer of a patient from an acute care hospital to a nursing
facility is not considered an emergency except for a person who
has received hospital services in the following situations:
hospital admission for observation, care in an emergency room
without hospital admission, or following hospital 24-hour bed
care.
Sec. 11. Minnesota Statutes 2000, section 256B.0911, is
amended by adding a subdivision to read:
Subd. 4c. [SCREENING REQUIREMENTS.] (a) A person may be
screened for nursing facility admission by telephone or in a
face-to-face screening interview. Consultation team members
shall identify each individual's needs using the following
categories:
(1) the person needs no face-to-face screening interview to
determine the need for nursing facility level of care based on
information obtained from other health care professionals;
(2) the person needs an immediate face-to-face screening
interview to determine the need for nursing facility level of
care and complete activities required under subdivision 4a; or
(3) the person may be exempt from screening requirements as
outlined in subdivision 4b, but will need transitional
assistance after admission or in-person follow-along after a
return home.
(b) Persons admitted on a nonemergency basis to a
Medicaid-certified nursing facility must be screened prior to
admission.
(c) The long-term care consultation team shall recommend a
case mix classification for persons admitted to a certified
nursing facility when sufficient information is received to make
that classification. The nursing facility is authorized to
conduct all case mix assessments for persons who have been
screened prior to admission for whom the county did not
recommend a case mix classification. The nursing facility is
authorized to conduct all case mix assessments for persons
admitted to the facility prior to a preadmission screening. The
county retains the responsibility of distributing appropriate
case mix forms to the nursing facility.
(d) The county screening or intake activity must include
processes to identify persons who may require transition
assistance as described in subdivision 3b.
Sec. 12. Minnesota Statutes 2000, section 256B.0911,
subdivision 5, is amended to read:
Subd. 5. [SIMPLIFICATION OF FORMS ADMINISTRATIVE
ACTIVITY.] The commissioner shall minimize the number of forms
required in the preadmission screening process provision of
long-term care consultation services and shall limit the
screening document to items necessary for care community support
plan approval, reimbursement, program planning, evaluation, and
policy development.
Sec. 13. Minnesota Statutes 2000, section 256B.0911,
subdivision 6, is amended to read:
Subd. 6. [PAYMENT FOR PREADMISSION SCREENING LONG-TERM
CARE CONSULTATION SERVICES.] (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 long-term care
consultation services 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. Payments
to counties in which there is no certified nursing facility must
be made by increasing the payment rate of the two facilities
located nearest to the county seat.
(b) The commissioner shall include the total annual payment
for screening determined under paragraph (a) for each nursing
facility reimbursed under section 256B.431 or 256B.434 according
to section 256B.431, subdivision 2b, paragraph (g), or 256B.435.
(c) In the event of the layaway, delicensure and
decertification, or removal from layaway of 25 percent or more
of the beds in a facility, the commissioner may adjust the per
diem payment amount in paragraph (b) and may adjust the monthly
payment amount in paragraph (a). The effective date of an
adjustment made under this paragraph shall be on or after the
first day of the month following the effective date of the
layaway, delicensure and decertification, or removal from
layaway.
(d) Payments for screening activities long-term care
consultation services are available to the county or counties to
cover staff salaries and expenses to provide the screening
function services described in subdivision 1a. The lead agency
county shall employ, or contract with other agencies to employ,
within the limits of available funding, sufficient personnel
to conduct the preadmission screening activity provide long-term
care consultation services while meeting the state's long-term
care outcomes and objectives as defined in section 256B.0917,
subdivision 1. The local agency county shall be accountable for
meeting local objectives as approved by the commissioner in the
CSSA biennial plan.
(d) (e) Notwithstanding section 256B.0641, overpayments
attributable to payment of the screening costs under the medical
assistance program may not be recovered from a facility.
(e) (f) The commissioner of human services shall amend the
Minnesota medical assistance plan to include reimbursement for
the local screening consultation teams.
(g) The county may bill, as case management services,
assessments, support planning, and follow-along provided to
persons determined to be eligible for case management under
Minnesota health care programs. No individual or family member
shall be charged for an initial assessment or initial support
plan development provided under subdivision 3a or 3b.
Sec. 14. Minnesota Statutes 2000, section 256B.0911,
subdivision 7, is amended to read:
Subd. 7. [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.]
(a) Medical assistance reimbursement for nursing facilities
shall be authorized for a medical assistance recipient only if a
preadmission screening has been conducted prior to admission or
the local county agency has authorized an exemption. Medical
assistance reimbursement for nursing facilities shall not be
provided for any recipient who the local screener has determined
does not meet the level of care criteria for nursing facility
placement or, if indicated, has not had a level II PASARR OBRA
evaluation as required under the federal Omnibus Budget
Reconciliation Act of 1987 completed unless an admission for a
recipient with mental illness is approved by the local mental
health authority or an admission for a recipient with mental
retardation or related condition is approved by the state mental
retardation authority.
(b) The nursing facility must not bill a person who is not
a medical assistance recipient for resident days that preceded
the date of completion of screening activities as required under
subdivisions 4a, 4b, and 4c. The nursing facility must include
unreimbursed resident days in the nursing facility resident day
totals reported to the commissioner.
(c) The commissioner shall make a request to the health
care financing administration for a waiver allowing screening
team approval of Medicaid payments for certified nursing
facility care. An individual has a choice and makes the final
decision between nursing facility placement and community
placement after the screening team's recommendation, except as
provided in paragraphs (b) and (c) subdivision 4a, paragraph (c).
(c) The local county mental health authority or the state
mental retardation authority under Public Law Numbers 100-203
and 101-508 may prohibit admission to a nursing facility, if the
individual does not meet the nursing facility level of care
criteria or needs specialized services as defined in Public Law
Numbers 100-203 and 101-508. For purposes of this section,
"specialized services" for a person with mental retardation or a
related condition means "active treatment" as that term is
defined in Code of Federal Regulations, title 42, section
483.440(a)(1).
(e) Appeals from the screening team's recommendation or the
county agency's final decision shall be made according to
section 256.045, subdivision 3.
Sec. 15. Minnesota Statutes 2000, section 256B.0913,
subdivision 1, is amended to read:
Subdivision 1. [PURPOSE AND GOALS.] The purpose of the
alternative care program is to provide funding for or access to
home and community-based services for frail elderly persons, in
order to limit nursing facility placements. The program is
designed to support frail elderly persons in their desire to
remain in the community as independently and as long as possible
and to support informal caregivers in their efforts to provide
care for frail elderly people. Further, the goals of the
program are:
(1) to contain medical assistance expenditures by providing
funding care in the community at a cost the same or less than
nursing facility costs; and
(2) to maintain the moratorium on new construction of
nursing home beds.
Sec. 16. Minnesota Statutes 2000, section 256B.0913,
subdivision 2, is amended to read:
Subd. 2. [ELIGIBILITY FOR SERVICES.] Alternative care
services are available to all frail older Minnesotans. This
includes:
(1) persons who are receiving medical assistance and served
under the medical assistance program or the Medicaid waiver
program;
(2) persons age 65 or older who are not eligible for
medical assistance without a spenddown or waiver obligation but
who would be eligible for medical assistance within 180 days of
admission to a nursing facility and served under subject to
subdivisions 4 to 13; and
(3) persons who are paying for their services out-of-pocket.
Sec. 17. Minnesota Statutes 2000, section 256B.0913,
subdivision 4, is amended to read:
Subd. 4. [ELIGIBILITY FOR FUNDING FOR SERVICES FOR
NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services
under the alternative care program is available to persons who
meet the following criteria:
(1) the person has been screened by the county screening
team or, if previously screened and served under the alternative
care program, assessed by the local county social worker or
public health nurse determined by a community assessment under
section 256B.0911, to be a person who would require the level of
care provided in a nursing facility, but for the provision of
services under the alternative care program;
(2) the person is age 65 or older;
(3) the person would be financially eligible for medical
assistance within 180 days of admission to a nursing facility;
(4) the person meets the asset transfer requirements of is
not ineligible for the medical assistance program due to an
asset transfer penalty;
(5) the screening team would recommend nursing facility
admission or continued stay for the person if alternative care
services were not available;
(6) the person needs services that are not available at
that time in the county funded through other county, state, or
federal funding sources; and
(7) (6) the monthly cost of the alternative care services
funded by the program for this person does not exceed 75 percent
of the statewide average monthly medical assistance payment for
nursing facility care at the individual's case mix
classification weighted average monthly nursing facility rate of
the case mix resident class to which the individual alternative
care client would be assigned under Minnesota Rules, parts
9549.0050 to 9549.0059, less the recipient's maintenance needs
allowance as described in section 256B.0915, subdivision 1d,
paragraph (a), until the first day of the state fiscal year in
which the resident assessment system, under section 256B.437,
for nursing home rate determination is implemented. Effective
on the first day of the state fiscal year in which a resident
assessment system, under section 256B.437, for nursing home rate
determination is implemented and the first day of each
subsequent state fiscal year, the monthly cost of alternative
care services for this person shall not exceed the alternative
care monthly cap for the case mix resident class to which the
alternative care client would be assigned under Minnesota Rules,
parts 9549.0050 to 9549.0059, which was in effect on the last
day of the previous state fiscal year, and adjusted by the
greater of any legislatively adopted home and community-based
services cost-of-living percentage increase or any legislatively
adopted statewide percent rate increase for nursing facilities.
This monthly limit does not prohibit the alternative care client
from payment for additional services, but in no case may the
cost of additional services purchased under this section exceed
the difference between the client's monthly service limit
defined under section 256B.0915, subdivision 3, and the
alternative care program monthly service limit defined in this
paragraph. If medical supplies and equipment or adaptations
environmental modifications are or will be purchased for an
alternative care services recipient, the costs may be prorated
on a monthly basis throughout the year in which they are
purchased for up to 12 consecutive months beginning with the
month of purchase. If the monthly cost of a recipient's other
alternative care services exceeds the monthly limit established
in this paragraph, the annual cost of the alternative care
services shall be determined. In this event, the annual cost of
alternative care services shall not exceed 12 times the monthly
limit calculated described in this paragraph.
(b) Individuals who meet the criteria in paragraph (a) and
who have been approved for alternative care funding are called
180-day eligible clients.
(c) The statewide average payment for nursing facility care
is the statewide average monthly nursing facility rate in effect
on July 1 of the fiscal year in which the cost is incurred, less
the statewide average monthly income of nursing facility
residents who are age 65 or older and who are medical assistance
recipients in the month of March of the previous fiscal year.
This monthly limit does not prohibit the 180-day eligible client
from paying for additional services needed or desired.
(d) In determining the total costs of alternative care
services for one month, the costs of all services funded by the
alternative care program, including supplies and equipment, must
be included.
(e) Alternative care funding under this subdivision is not
available for a person who is a medical assistance recipient or
who would be eligible for medical assistance without a
spenddown, unless authorized by the commissioner or waiver
obligation. A person whose initial application for medical
assistance is being processed may be served under the
alternative care program for a period up to 60 days. If the
individual is found to be eligible for medical assistance, the
county must bill medical assistance must be billed for services
payable under the federally approved elderly waiver plan and
delivered from the date the individual was found eligible
for services reimbursable under the federally approved elderly
waiver program plan. Notwithstanding this provision, upon
federal approval, alternative care funds may not be used to pay
for any service the cost of which is payable by medical
assistance or which is used by a recipient to meet a medical
assistance income spenddown or waiver obligation.
(f) (c) Alternative care funding is not available for a
person who resides in a licensed nursing home or, certified
boarding care home, hospital, or intermediate care facility,
except for case management services which are being provided in
support of the discharge planning process to a nursing home
resident or certified boarding care home resident who is
ineligible for case management funded by medical assistance.
Sec. 18. Minnesota Statutes 2000, 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;
(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 which includes discretionary
funds and direct cash payments to clients, approved by the
county agency following approval by the commissioner, subject to
the provisions of paragraph (m) (j). 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; and
(20) environmental modifications.
(b) The county agency must ensure that the funds are not
used only to supplement and not to supplant services available
through other public assistance or services programs.
(c) Unless specified in statute, the service definitions
and standards for alternative care services shall be the same as
the service definitions and standards defined specified in the
federally approved elderly waiver plan. Except for the county
agencies' approval of direct cash payments to clients as
described in paragraph (j) or for a provider of supplies and
equipment when the monthly cost of the supplies and equipment is
less than $250, 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. Supplies and equipment may
be purchased from a vendor not certified to participate in the
Medicaid program if the cost for the item is less than that of a
Medicaid vendor.
(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. The alternative
care payment for the foster care service in combination with the
payment for other alternative care services, including case
management, must not exceed the limit specified in subdivision
4, paragraph (a), clause (6).
(e) Personal care services may be provided by a personal
care provider organization. must meet the service standards
defined in the federally approved elderly waiver plan, except
that a county agency may contract with a client's relative of
the client who meets the relative hardship waiver requirement as
defined in section 256B.0627, subdivision 4, paragraph (b),
clause (10), to provide personal care services, but must ensure
nursing if the county agency ensures supervision of this service
by a registered nurse or mental health practitioner. 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 under section 157.17 and are not subject to
registration under chapter 144D. 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
home 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 homemaking services funded under this section.
(h) (g) 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 and are licensed by the department of health as a class A
home care provider or a class E home care provider. 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 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.
Individuals receiving assisted living services shall not
receive both assisted living services and homemaking 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. 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) (h) For establishments registered under chapter 144D,
assisted living services under this section means either the
services described and licensed in paragraph (g) and delivered
by a class E home care provider licensed by the department of
health or the services described under section 144A.4605 and
delivered by an assisted living home care provider or a class A
home care provider licensed by the commissioner of health.
(j) For the purposes of this section, reimbursement (i)
Payment 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 and may not cover direct rent or food costs. The
rate
(1) The individualized monthly negotiated payment for
assisted living services as described in paragraph (g) or (h),
and residential care services as described in paragraph (f),
shall not exceed the nonfederal share in effect on July 1 of the
state fiscal year for which the rate limit is being calculated
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 alternative care eligible client would be assigned
under Minnesota Rules, parts 9549.0050 to 9549.0059, unless the
less the maintenance needs allowance as described in section
256B.0915, subdivision 1d, paragraph (a), until the first day of
the state fiscal year in which a resident assessment system,
under section 256B.437, of nursing home rate determination is
implemented. Effective on the first day of the state fiscal
year in which a resident assessment system, under section
256B.437, of nursing home rate determination is implemented and
the first day of each subsequent state fiscal year, the
individualized monthly negotiated payment for the services
described in this clause shall not exceed the limit described in
this clause which was in effect on the last day of the previous
state fiscal year and which has been adjusted by the greater of
any legislatively adopted home and community-based services
cost-of-living percentage increase or any legislatively adopted
statewide percent rate increase for nursing facilities.
(2) The individualized monthly negotiated payment for
assisted living services are provided by a home care described
under section 144A.4605 and delivered by a provider licensed by
the department of health as a class A home care provider or an
assisted living home care provider and are provided in a
building that is registered as a housing with services
establishment under chapter 144D and that provides 24-hour
supervision in combination with the payment for other
alternative care services, including case management, must not
exceed the limit specified in subdivision 4, paragraph (a),
clause (6).
(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 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) (j) 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 which include use of "discretionary funds" for
services that are not otherwise defined in this section and
direct cash payments to the recipient client 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) (6);
(2) a county may not approve any cash payment for a client
who meets either of the following:
(i) 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. An "authorized representative" means
an individual who is at least 18 years of age and is designated
by the person or the person's legal representative to act on the
person's behalf. This individual may be a family member,
guardian, representative payee, or other individual designated
by the person or the person's legal representative, if any, to
assist in purchasing and arranging for supports; or
(ii) 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 of and are
governed by the procedures and liability protection established
in section 256.476, subdivision 4, paragraphs (b) through (h),
and recipients of cash grants must meet the requirements in
section 256.476, subdivision 10; and cash payments to a person
or a person's family will be provided through a monthly payment
and be in the form of cash, voucher, or direct county payment to
a vendor. Fees or premiums assessed to the person for
eligibility for health and human services are not reimbursable
through this service option. Services and goods purchased
through cash payments must be identified in the person's
individualized care plan and must meet all of the following
criteria:
(i) they must be over and above the normal cost of caring
for the person if the person did not have functional
limitations;
(ii) they must be directly attributable to the person's
functional limitations;
(iii) they must have the potential to be effective at
meeting the goals of the program;
(iv) they must be consistent with the needs identified in
the individualized service plan. The service plan shall specify
the needs of the person and family, the form and amount of
payment, the items and services to be reimbursed, and the
arrangements for management of the individual grant; and
(v) the person, the person's family, or the legal
representative shall be provided sufficient information to
ensure an informed choice of alternatives. The local agency
shall document this information in the person's care plan,
including the type and level of expenditures to be reimbursed;
(4) the county, lead agency under contract, or tribal
government under contract to administer the alternative care
program shall not be liable for damages, injuries, or
liabilities sustained through the purchase of direct supports or
goods by the person, the person's family, or the authorized
representative with funds received through the cash payments
under this section. Liabilities include, but are not limited
to, workers' compensation, the Federal Insurance Contributions
Act (FICA), or the Federal Unemployment Tax Act (FUTA);
(5) persons receiving grants under this section shall have
the following responsibilities:
(i) spend the grant money in a manner consistent with their
individualized service plan with the local agency;
(ii) notify the local agency of any necessary changes in
the grant-expenditures;
(iii) arrange and pay for supports; and
(iv) inform the local agency of areas where they have
experienced difficulty securing or maintaining supports; and
(5) (6) the county shall report client outcomes, services,
and costs under this paragraph in a manner prescribed by the
commissioner.
(k) 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. 19. Minnesota Statutes 2000, section 256B.0913,
subdivision 6, is amended to read:
Subd. 6. [ALTERNATIVE CARE PROGRAM ADMINISTRATION.] The
alternative care program is administered by the county agency.
This agency is the lead agency responsible for the local
administration of the alternative care program as described in
this section. However, it may contract with the public health
nursing service to be the lead agency. The commissioner may
contract with federally recognized Indian tribes with a
reservation in Minnesota to serve as the lead agency responsible
for the local administration of the alternative care program as
described in the contract.
Sec. 20. Minnesota Statutes 2000, section 256B.0913,
subdivision 7, is amended to read:
Subd. 7. [CASE MANAGEMENT.] Providers of case management
services for persons receiving services funded by the
alternative care program must meet the qualification
requirements and standards specified in section 256B.0915,
subdivision 1b. The case manager must ensure the health and
safety of the individual client and not approve alternative care
funding for a client in any setting in which the case manager
cannot reasonably ensure the client's health and safety. The
case manager is responsible for the cost-effectiveness of the
alternative care individual care plan and must not approve any
care plan in which the cost of services funded by alternative
care and client contributions exceeds the limit specified in
section 256B.0915, subdivision 3, paragraph (b). The county may
allow a case manager employed by the county to delegate certain
aspects of the case management activity to another individual
employed by the county provided there is oversight of the
individual by the case manager. The case manager may not
delegate those aspects which require professional judgment
including assessments, reassessments, and care plan development.
Sec. 21. Minnesota Statutes 2000, section 256B.0913,
subdivision 8, is amended to read:
Subd. 8. [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The
case manager shall implement the plan of care for each 180-day
eligible alternative care client and ensure that a client's
service needs and eligibility are reassessed at least every 12
months. The plan shall include any services prescribed by the
individual's attending physician as necessary to allow the
individual to remain in a community setting. In developing the
individual's care plan, the case manager should include the use
of volunteers from families and neighbors, religious
organizations, social clubs, and civic and service organizations
to support the formal home care services. The county shall be
held harmless for damages or injuries sustained through the use
of volunteers under this subdivision including workers'
compensation liability. The lead agency shall provide
documentation to the commissioner verifying that the
individual's alternative care is not available at that time
through any other public assistance or service program. The
lead agency shall provide documentation in each individual's
plan of care and, if requested, to the commissioner that the
most cost-effective alternatives available have been offered to
the individual and that the individual was free to choose among
available qualified providers, both public and private. The
case manager must give the individual a ten-day written notice
of any decrease in or termination of alternative care services.
(b) If the county administering alternative care services
is different than the county of financial responsibility, the
care plan may be implemented without the approval of the county
of financial responsibility.
Sec. 22. Minnesota Statutes 2000, section 256B.0913,
subdivision 9, is amended to read:
Subd. 9. [CONTRACTING PROVISIONS FOR PROVIDERS.] The lead
agency shall document to the commissioner that the agency made
reasonable efforts to inform potential providers of the
anticipated need for services under the alternative care program
or waiver programs under sections 256B.0915 and 256B.49,
including a minimum of 14 days' written advance notice of the
opportunity to be selected as a service provider and an annual
public meeting with providers to explain and review the criteria
for selection. The lead agency shall also document to the
commissioner that the agency allowed potential providers an
opportunity to be selected to contract with the county agency.
Funds reimbursed to counties under this subdivision Alternative
care funds paid to service providers are subject to audit by the
commissioner for fiscal and utilization control.
The lead agency must select providers for contracts or
agreements using the following criteria and other criteria
established by the county:
(1) the need for the particular services offered by the
provider;
(2) the population to be served, including the number of
clients, the length of time services will be provided, and the
medical condition of clients;
(3) the geographic area to be served;
(4) quality assurance methods, including appropriate
licensure, certification, or standards, and supervision of
employees when needed;
(5) rates for each service and unit of service exclusive of
county administrative costs;
(6) evaluation of services previously delivered by the
provider; and
(7) contract or agreement conditions, including billing
requirements, cancellation, and indemnification.
The county must evaluate its own agency services under the
criteria established for other providers. The county shall
provide a written statement of the reasons for not selecting
providers.
Sec. 23. Minnesota Statutes 2000, 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 alternative care eligible clients. 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.
(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. The adjusted base for
each county is the county's current fiscal year base allocation
plus any targeted funds approved during the current fiscal
year. Calculations for paragraphs (c) and (d) are to be made as
follows: for each county, the determination of alternative care
program 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 and paid by June 1 of
that year.
(c) If the county alternative care program expenditures for
180-day eligible clients as defined in paragraph (b) are 95
percent or more of its the county's 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 alternative care program expenditures for
180-day eligible clients as defined in paragraph (b) are less
than 95 percent of its the county's 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 a biennium, 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) paragraphs (c) and (d).
Sec. 24. Minnesota Statutes 2000, section 256B.0913,
subdivision 11, is amended to read:
Subd. 11. [TARGETED FUNDING.] (a) The purpose of targeted
funding is to make additional money available to counties with
the greatest need. Targeted funds are not intended to be
distributed equitably among all counties, but rather, allocated
to those with long-term care strategies that meet state goals.
(b) The funds available for targeted funding shall be the
total appropriation for each fiscal year minus county
allocations determined under subdivision 10 as adjusted for any
inflation increases provided in appropriations for the biennium.
(c) The commissioner shall allocate targeted funds to
counties that demonstrate to the satisfaction of the
commissioner that they have developed feasible plans to increase
alternative care spending. In making targeted funding
allocations, the commissioner shall use the following priorities:
(1) counties that received a lower allocation in fiscal
year 1991 than in fiscal year 1990. Counties remain in this
priority until they have been restored to their fiscal year 1990
level plus inflation;
(2) counties that sustain a base allocation reduction for
failure to spend 95 percent of the allocation if they
demonstrate that the base reduction should be restored;
(3) counties that propose projects to divert community
residents from nursing home placement or convert nursing home
residents to community living; and
(4) counties that can otherwise justify program growth by
demonstrating the existence of waiting lists, demographically
justified needs, or other unmet needs.
(d) Counties that would receive targeted funds according to
paragraph (c) must demonstrate to the commissioner's
satisfaction that the funds would be appropriately spent by
showing how the funds would be used to further the state's
alternative care goals as described in subdivision 1, and that
the county has the administrative and service delivery
capability to use them.
(e) The commissioner shall request applications by June 1
each year, for county agencies to apply for targeted funds by
November 1 of each year. The counties selected for targeted
funds shall be notified of the amount of their additional
funding by August 1 of each year. Targeted funds allocated to a
county agency in one year shall be treated as part of the
county's base allocation for that year in determining
allocations for subsequent years. No reallocations between
counties shall be made.
(f) The allocation for each year after fiscal year 1992
shall be determined using the previous fiscal year's allocation,
including any targeted funds, as the base and then applying the
criteria under subdivision 10, paragraphs (c), (d), and (f), to
the current year's expenditures.
Sec. 25. Minnesota Statutes 2000, section 256B.0913,
subdivision 12, is amended to read:
Subd. 12. [CLIENT PREMIUMS.] (a) A premium is required for
all 180-day alternative care 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 recipient's maintenance needs
allowance as defined in section 256B.0915, subdivision 1d,
paragraph (a), but less than 150 percent of the federal poverty
guideline effective on July 1 of the state fiscal year in which
the premium is being computed, and total assets are less than
$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 effective on July 1 of
the state fiscal year in which the premium is being computed,
and total assets are less than $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 effective on July 1
of the state fiscal year in which the premium is being computed
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 $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) (5) a person's fee under paragraph (a) is less than $25.
(c) The county agency must record in the state's receivable
system the client's assessed premium amount or the reason the
premium has been waived. The commissioner will bill and 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. This paragraph does not apply
to alternative care pilot projects authorized in Laws 1993,
First Special Session chapter 1, article 5, section 133, if a
county operating under the pilot project reports the following
dollar amounts to the commissioner quarterly:
(1) total premiums billed to clients;
(2) total collections of premiums billed; and
(3) balance of premiums owed by clients.
If a county does not adhere to these reporting requirements, the
commissioner may terminate the billing, collecting, and
remitting portions of the pilot project and require the county
involved to operate under the procedures set forth in this
paragraph.
(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. 26. Minnesota Statutes 2000, section 256B.0913,
subdivision 13, is amended to read:
Subd. 13. [COUNTY BIENNIAL PLAN.] The county biennial plan
for the preadmission screening program long-term care
consultation services under section 256B.0911, the alternative
care program under this section, and waivers for the elderly
under section 256B.0915, and waivers for the disabled under
section 256B.49, shall be incorporated into the biennial
Community Social Services Act plan and shall meet the
regulations and timelines of that plan. This county biennial
plan shall include:
(1) information on the administration of the preadmission
screening program;
(2) information on the administration of the home and
community-based services waivers for the elderly under section
256B.0915, and for the disabled under section 256B.49; and
(3) information on the administration of the alternative
care program.
Sec. 27. Minnesota Statutes 2000, section 256B.0913,
subdivision 14, is amended to read:
Subd. 14. [REIMBURSEMENT PAYMENT AND RATE ADJUSTMENTS.] (a)
Reimbursement Payment for expenditures for the provided
alternative care services as approved by the client's case
manager shall be through the invoice processing procedures of
the department's Medicaid Management Information System (MMIS).
To receive reimbursement payment, the county or vendor must
submit invoices within 12 months following the date of service.
The county agency and its vendors under contract shall not be
reimbursed for services which exceed the county allocation.
(b) If a county collects less than 50 percent of the client
premiums due under subdivision 12, the commissioner may withhold
up to three percent of the county's final alternative care
program allocation determined under subdivisions 10 and 11.
(c) The county shall negotiate individual rates with
vendors and may be reimbursed authorize service payment for
actual costs up to the greater of the county's current approved
rate or 60 percent of the maximum rate in fiscal year 1994 and
65 percent of the maximum rate in fiscal year 1995 for each
alternative care service. Notwithstanding any other rule or
statutory provision to the contrary, the commissioner shall not
be authorized to increase rates by an annual inflation factor,
unless so authorized by the legislature.
(d) On July 1, 1993, the commissioner shall increase the
maximum rate for home delivered meals to $4.50 per meal. To
improve access to community services and eliminate payment
disparities between the alternative care program and the elderly
waiver program, the commissioner shall establish statewide
maximum service rate limits and eliminate county-specific
service rate limits.
(1) Effective July 1, 2001, for service rate limits, except
those in subdivision 5, paragraphs (d) and (i), the rate limit
for each service shall be the greater of the alternative care
statewide maximum rate or the elderly waiver statewide maximum
rate.
(2) Counties may negotiate individual service rates with
vendors for actual costs up to the statewide maximum service
rate limit.
Sec. 28. Minnesota Statutes 2000, section 256B.0915,
subdivision 1d, is amended to read:
Subd. 1d. [POSTELIGIBILITY TREATMENT OF INCOME AND
RESOURCES FOR ELDERLY WAIVER.] (a) Notwithstanding the
provisions of section 256B.056, the commissioner shall make the
following amendment to the medical assistance elderly waiver
program effective July 1, 1999, or upon federal approval,
whichever is later.
A recipient's maintenance needs will be an amount equal to
the Minnesota supplemental aid equivalent rate as defined in
section 256I.03, subdivision 5, plus the medical assistance
personal needs allowance as defined in section 256B.35,
subdivision 1, paragraph (a), when applying posteligibility
treatment of income rules to the gross income of elderly waiver
recipients, except for individuals whose income is in excess of
the special income standard according to Code of Federal
Regulations, title 42, section 435.236. Recipient maintenance
needs shall be adjusted under this provision each July 1.
(b) The commissioner of human services shall secure
approval of additional elderly waiver slots sufficient to serve
persons who will qualify under the revised income standard
described in paragraph (a) before implementing section
256B.0913, subdivision 16.
(c) In implementing this subdivision, the commissioner
shall consider allowing persons who would otherwise be eligible
for the alternative care program but would qualify for the
elderly waiver with a spenddown to remain on the alternative
care program.
Sec. 29. Minnesota Statutes 2000, section 256B.0915,
subdivision 3, is amended to read:
Subd. 3. [LIMITS OF CASES, RATES, REIMBURSEMENT PAYMENTS,
AND FORECASTING.] (a) The number of medical assistance waiver
recipients that a county may serve must be allocated according
to the number of medical assistance waiver cases open on July 1
of each fiscal year. Additional recipients may be served with
the approval of the commissioner.
(b) The monthly limit for the cost of waivered services to
an individual elderly waiver client shall be the statewide
average payment weighted average monthly nursing facility rate
of the case mix resident class to which the elderly waiver
client would be assigned under the medical assistance case mix
reimbursement system. Minnesota Rules, parts 9549.0050 to
9549.0059, less the recipient's maintenance needs allowance as
described in subdivision 1d, paragraph (a), until the first day
of the state fiscal year in which the resident assessment system
as described in section 256B.437 for nursing home rate
determination is implemented. Effective on the first day of the
state fiscal year in which the resident assessment system as
described in section 256B.437 for nursing home rate
determination is implemented and the first day of each
subsequent state fiscal year, the monthly limit for the cost of
waivered services to an individual elderly waiver client shall
be the rate of the case mix resident class to which the waiver
client would be assigned under Minnesota Rules, parts 9549.0050
to 9549.0059, in effect on the last day of the previous state
fiscal year, adjusted by the greater of any legislatively
adopted home and community-based services cost-of-living
percentage increase or any legislatively adopted statewide
percent rate increase for nursing facilities.
(c) If extended medical supplies and equipment or
adaptations environmental modifications are or will be purchased
for an elderly waiver services recipient client, the costs may
be prorated on a monthly basis throughout the year in which they
are purchased for up to 12 consecutive months beginning with the
month of purchase. If the monthly cost of a recipient's other
waivered services exceeds the monthly limit established in this
paragraph (b), the annual cost of the all waivered services
shall be determined. In this event, the annual cost of all
waivered services shall not exceed 12 times the monthly
limit calculated in this paragraph. The statewide average
payment rate is calculated by determining the statewide average
monthly nursing home rate, effective July 1 of the fiscal year
in which the cost is incurred, less the statewide average
monthly income of nursing home residents who are age 65 or
older, and who are medical assistance recipients in the month of
March of the previous state fiscal year. The annual cost
divided by 12 of elderly or disabled waivered services of
waivered services as described in paragraph (b).
(d) For a person who is a nursing facility resident at the
time of requesting a determination of eligibility for elderly or
disabled waivered services shall be the greater of the monthly
payment for: (i), a monthly conversion limit for the cost of
elderly waivered services may be requested. The monthly
conversion limit for the cost of elderly waiver services shall
be the resident class assigned under Minnesota Rules, parts
9549.0050 to 9549.0059, for that resident in the nursing
facility where the resident currently resides; or (ii) the
statewide average payment of the case mix resident class to
which the resident would be assigned under the medical
assistance case mix reimbursement system, provided that until
July 1 of the state fiscal year in which the resident assessment
system as described in section 256B.437 for nursing home rate
determination is implemented. Effective on July 1 of the state
fiscal year in which the resident assessment system as described
in section 256B.437 for nursing home rate determination is
implemented, the monthly conversion limit for the cost of
elderly waiver services shall be the per diem nursing facility
rate as determined by the resident assessment system as
described in section 256B.437 for that resident in the nursing
facility where the resident currently resides multiplied by 365
and divided by 12, less the recipient's maintenance needs
allowance as described in subdivision 1d. The limit under this
clause only applies to persons discharged from a nursing
facility after a minimum 30-day stay and found eligible for
waivered services on or after July 1, 1997. The following costs
must be included in determining the total monthly costs for the
waiver client:
(1) cost of all waivered services, including extended
medical supplies and equipment and environmental modifications;
and
(2) cost of skilled nursing, home health aide, and personal
care services reimbursable by medical assistance.
(c) (e) Medical assistance funding for skilled nursing
services, private duty nursing, home health aide, and personal
care services for waiver recipients must be approved by the case
manager and included in the individual care plan.
(d) For both the elderly waiver and the nursing facility
disabled waiver, a county may purchase extended supplies and
equipment without prior approval from the commissioner when
there is no other funding source and the supplies and equipment
are specified in the individual's care plan as medically
necessary to enable the individual to remain in the community
according to the criteria in Minnesota Rules, part 9505.0210,
items A and B. (f) A county is not required to contract with a
provider of supplies and equipment if the monthly cost of the
supplies and equipment is less than $250.
(e) (g) The adult foster care daily rate for the elderly
and disabled waivers shall be considered a difficulty of care
payment and shall not include room and board. The adult foster
care service rate shall be negotiated between the county agency
and the foster care provider. The rate established under this
section shall not exceed the state average monthly nursing home
payment for the case mix classification to which the individual
receiving foster care is assigned; the rate must allow for other
waiver and medical assistance home care services to be
authorized by the case manager. The elderly waiver payment for
the foster care service in combination with the payment for all
other elderly waiver services, including case management, must
not exceed the limit specified in paragraph (b).
(f) The assisted living and residential care service rates
for elderly and community alternatives for disabled individuals
(CADI) waivers shall be made to the vendor as a monthly rate
negotiated with the county agency 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 elderly or disabled 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. For alternative care assisted living projects
established under Laws 1988, chapter 689, article 2, section
256, monthly rates may not exceed 65 percent of the greater of
either the statewide or any of the geographic groups' weighted
average monthly medical assistance nursing facility payment rate
for the case mix resident class to which the elderly or disabled
client would be assigned under Minnesota Rules, parts 9549.0050
to 9549.0059. The rate may not cover direct rent or food costs.
(h) Payment for assisted living service shall be a monthly
rate negotiated and authorized by the county agency based on an
individualized service plan for each resident and may not cover
direct rent or food costs.
(1) The individualized monthly negotiated payment for
assisted living services as described in section 256B.0913,
subdivision 5, paragraph (g) or (h), and residential care
services as described in section 256B.0913, subdivision 5,
paragraph (f), shall not exceed the nonfederal share, in effect
on July 1 of the state fiscal year for which the rate limit is
being calculated, of the greater of either the statewide or any
of the geographic groups' weighted average monthly nursing
facility rate of the case mix resident class to which the
elderly waiver eligible client would be assigned under Minnesota
Rules, parts 9549.0050 to 9549.0059, less the maintenance needs
allowance as described in subdivision 1d, paragraph (a), until
the July 1 of the state fiscal year in which the resident
assessment system as described in section 256B.437 for nursing
home rate determination is implemented. Effective on July 1 of
the state fiscal year in which the resident assessment system as
described in section 256B.437 for nursing home rate
determination is implemented and July 1 of each subsequent state
fiscal year, the individualized monthly negotiated payment for
the services described in this clause shall not exceed the limit
described in this clause which was in effect on June 30 of the
previous state fiscal year and which has been adjusted by the
greater of any legislatively adopted home and community-based
services cost-of-living percentage increase or any legislatively
adopted statewide percent rate increase for nursing facilities.
(2) The individualized monthly negotiated payment for
assisted living services described in section 144A.4605 and
delivered by a provider licensed by the department of health as
a class A home care provider or an assisted living home care
provider and provided in a building that is registered as a
housing with services establishment under chapter 144D and that
provides 24-hour supervision in combination with the payment for
other elderly waiver services, including case management, must
not exceed the limit specified in paragraph (b).
(g) (i) The county shall negotiate individual service rates
with vendors and may be reimbursed authorize payment for actual
costs up to the greater of the county's current approved rate or
60 percent of the maximum rate in fiscal year 1994 and 65
percent of the maximum rate in fiscal year 1995 for each service
within each program. 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 elderly waiver program, except as a provider
of supplies and equipment when the monthly cost of the supplies
and equipment is less than $250.
(h) On July 1, 1993, the commissioner shall increase the
maximum rate for home-delivered meals to $4.50 per meal.
(i) (j) Reimbursement for the medical assistance recipients
under the approved waiver shall be made from the medical
assistance account through the invoice processing procedures of
the department's Medicaid Management Information System (MMIS),
only with the approval of the client's case manager. The budget
for the state share of the Medicaid expenditures shall be
forecasted with the medical assistance budget, and shall be
consistent with the approved waiver.
(k) To improve access to community services and eliminate
payment disparities between the alternative care program and the
elderly waiver, the commissioner shall establish statewide
maximum service rate limits and eliminate county-specific
service rate limits.
(1) Effective July 1, 2001, for service rate limits, except
those described or defined in paragraphs (g) and (h), the rate
limit for each service shall be the greater of the alternative
care statewide maximum rate or the elderly waiver statewide
maximum rate.
(2) Counties may negotiate individual service rates with
vendors for actual costs up to the statewide maximum service
rate limit.
(j) (l) Beginning July 1, 1991, the state shall reimburse
counties according to the payment schedule in section 256.025
for the county share of costs incurred under this subdivision on
or after January 1, 1991, for individuals who are receiving
medical assistance.
(k) For the community alternatives for disabled individuals
waiver, and nursing facility disabled waivers, county may use
waiver funds for the cost of minor adaptations to a client's
residence or vehicle without prior approval from the
commissioner if there is no other source of funding and the
adaptation:
(1) is necessary to avoid institutionalization;
(2) has no utility apart from the needs of the client; and
(3) meets the criteria in Minnesota Rules, part 9505.0210,
items A and B.
For purposes of this subdivision, "residence" means the client's
own home, the client's family residence, or a family foster
home. For purposes of this subdivision, "vehicle" means the
client's vehicle, the client's family vehicle, or the client's
family foster home vehicle.
(l) The commissioner shall establish a maximum rate unit
for baths provided by an adult day care provider that are not
included in the provider's contractual daily or hourly rate.
This maximum rate must equal the home health aide extended rate
and shall be paid for baths provided to clients served under the
elderly and disabled waivers.
Sec. 30. Minnesota Statutes 2000, section 256B.0915,
subdivision 5, is amended to read:
Subd. 5. [REASSESSMENTS FOR WAIVER CLIENTS.] A
reassessment of a client served under the elderly or disabled
waiver must be conducted at least every 12 months and at other
times when the case manager determines that there has been
significant change in the client's functioning. This may
include instances where the client is discharged from the
hospital.
Sec. 31. Minnesota Statutes 2000, section 256B.0917,
subdivision 7, is amended to read:
Subd. 7. [CONTRACT.] (a) The commissioner of human
services shall execute a contract with Living at Home/Block
Nurse Program, Inc. (LAH/BN, Inc.). The contract shall require
LAH/BN, Inc. to:
(1) develop criteria for and award grants to establish
community-based organizations that will implement
living-at-home/block nurse programs throughout the state;
(2) award grants to enable current living-at-home/block
nurse programs to continue to implement the combined
living-at-home/block nurse program model;
(3) serve as a state technical assistance center to assist
and coordinate the living-at-home/block nurse programs
established; and
(4) manage contracts with individual living-at-home/block
nurse programs.
(b) The contract shall be effective July 1, 1997, and
section 16B.17 shall not apply.
Sec. 32. Minnesota Statutes 2000, section 256B.0917, is
amended by adding a subdivision to read:
Subd. 13. [COMMUNITY SERVICE GRANTS.] The commissioner
shall award contracts for grants to public and private nonprofit
agencies to establish services that strengthen a community's
ability to provide a system of home and community-based services
for elderly persons. The commissioner shall use a request for
proposal process. The commissioner shall give preference when
awarding grants under this section to areas where nursing
facility closures have occurred or are occurring. The
commissioner shall consider grants for:
(1) caregiver support and respite care projects under
subdivision 6;
(2) on-site coordination under section 256.9731;
(3) the living-at-home/block nurse grant under subdivisions
7 to 10; and
(4) services identified as needed for community transition.
Sec. 33. [RESPITE CARE.]
The Minnesota board on aging shall report to the
legislature by February 1, 2002, on the provision of in-home and
out-of-home respite care services on a sliding scale basis under
the federal Older Americans Act.
Sec. 34. [REPEALER.]
(a) Minnesota Statutes 2000, sections 256B.0911,
subdivisions 2, 2a, 4, and 9; 256B.0913, subdivisions 3, 15a,
15b, 15c, and 16; and 256B.0915, subdivisions 3a, 3b, and 3c,
are repealed.
(b) Minnesota Rules, parts 9505.2390; 9505.2395; 9505.2396;
9505.2400; 9505.2405; 9505.2410; 9505.2413; 9505.2415;
9505.2420; 9505.2425; 9505.2426; 9505.2430; 9505.2435;
9505.2440; 9505.2445; 9505.2450; 9505.2455; 9505.2458;
9505.2460; 9505.2465; 9505.2470; 9505.2473; 9505.2475;
9505.2480; 9505.2485; 9505.2486; 9505.2490; 9505.2495;
9505.2496; and 9505.2500, are repealed.
ARTICLE 5
LONG-TERM CARE SYSTEM REFORM AND REIMBURSEMENT
Section 1. Minnesota Statutes 2000, section 144.0721,
subdivision 1, is amended to read:
Subdivision 1. [APPROPRIATENESS AND QUALITY.] Until the
date of implementation of the revised case mix system based on
the minimum data set, the commissioner of health shall assess
the appropriateness and quality of care and services furnished
to private paying residents in nursing homes and boarding care
homes that are certified for participation in the medical
assistance program under United States Code, title 42, sections
1396-1396p. These assessments shall be conducted until the date
of implementation of the revised case mix system based on the
minimum data set, in accordance with section 144.072, with the
exception of provisions requiring recommendations for changes in
the level of care provided to the private paying residents.
Sec. 2. [144.0724] [RESIDENT REIMBURSEMENT
CLASSIFICATION.]
Subdivision 1. [RESIDENT REIMBURSEMENT
CLASSIFICATIONS.] The commissioner of health shall establish
resident reimbursement classifications based upon the
assessments of residents of nursing homes and boarding care
homes conducted under this section and according to section
256B.438. The reimbursement classifications established under
this section shall be implemented after June 30, 2002, but no
later than January 1, 2003.
Subd. 2. [DEFINITIONS.] For purposes of this section, the
following terms have the meanings given.
(a) [ASSESSMENT REFERENCE DATE.] "Assessment reference
date" means the last day of the minimum data set observation
period. The date sets the designated endpoint of the common
observation period, and all minimum data set items refer back in
time from that point.
(b) [CASE MIX INDEX.] "Case mix index" means the weighting
factors assigned to the RUG-III classifications.
(c) [INDEX MAXIMIZATION.] "Index maximization" means
classifying a resident who could be assigned to more than one
category, to the category with the highest case mix index.
(d) [MINIMUM DATA SET.] "Minimum data set" means the
assessment instrument specified by the Health Care Financing
Administration and designated by the Minnesota department of
health.
(e) [REPRESENTATIVE.] "Representative" means a person who
is the resident's guardian or conservator, the person authorized
to pay the nursing home expenses of the resident, a
representative of the nursing home ombudsman's office whose
assistance has been requested, or any other individual
designated by the resident.
(f) [RESOURCE UTILIZATION GROUPS OR RUG.] "Resource
utilization groups" or "RUG" means the system for grouping a
nursing facility's residents according to their clinical and
functional status identified in data supplied by the facility's
minimum data set.
Subd. 3. [RESIDENT REIMBURSEMENT CLASSIFICATIONS.] (a)
Resident reimbursement classifications shall be based on the
minimum data set, version 2.0 assessment instrument, or its
successor version mandated by the Health Care Financing
Administration that nursing facilities are required to complete
for all residents. The commissioner of health shall establish
resident classes according to the 34 group, resource utilization
groups, version III or RUG-III model. Resident classes must be
established based on the individual items on the minimum data
set and must be completed according to the facility manual for
case mix classification issued by the Minnesota department of
health. The facility manual for case mix classification shall
be drafted by the Minnesota department of health and presented
to the chairs of health and human services legislative
committees by December 31, 2001.
(b) Each resident must be classified based on the
information from the minimum data set according to general
domains in clauses (1) to (7):
(1) extensive services where a resident requires
intravenous feeding or medications, suctioning, tracheostomy
care, or is on a ventilator or respirator;
(2) rehabilitation where a resident requires physical,
occupational, or speech therapy;
(3) special care where a resident has cerebral palsy;
quadriplegia; multiple sclerosis; pressure ulcers; fever with
vomiting, weight loss, or dehydration; tube feeding and aphasia;
or is receiving radiation therapy;
(4) clinically complex status where a resident has burns,
coma, septicemia, pneumonia, internal bleeding, chemotherapy,
wounds, kidney failure, urinary tract infections, oxygen, or
transfusions;
(5) impaired cognition where a resident has poor cognitive
performance;
(6) behavior problems where a resident exhibits wandering,
has hallucinations, or is physically or verbally abusive toward
others, unless the resident's other condition would place the
resident in other categories; and
(7) reduced physical functioning where a resident has no
special clinical conditions.
(c) The commissioner of health shall establish resident
classification according to a 34 group model based on the
information on the minimum data set and within the general
domains listed in paragraph (b), clauses (1) to (7). Detailed
descriptions of each resource utilization group shall be defined
in the facility manual for case mix classification issued by the
Minnesota department of health. The 34 groups are described as
follows:
(1) SE3: requires four or five extensive services;
(2) SE2: requires two or three extensive services;
(3) SE1: requires one extensive service;
(4) RAD: requires rehabilitation services and is dependent
in activity of daily living (ADL) at a count of 17 or 18;
(5) RAC: requires rehabilitation services and ADL count is
14 to 16;
(6) RAB: requires rehabilitation services and ADL count is
ten to 13;
(7) RAA: requires rehabilitation services and ADL count is
four to nine;
(8) SSC: requires special care and ADL count is 17 or 18;
(9) SSB: requires special care and ADL count is 15 or 16;
(10) SSA: requires special care and ADL count is seven to
14;
(11) CC2: clinically complex with depression and ADL count
is 17 or 18;
(12) CC1: clinically complex with no depression and ADL
count is 17 or 18;
(13) CB2: clinically complex with depression and ADL count
is 12 to 16;
(14) CB1: clinically complex with no depression and ADL
count is 12 to 16;
(15) CA2: clinically complex with depression and ADL count
is four to 11;
(16) CA1: clinically complex with no depression and ADL
count is four to 11;
(17) IB2: impaired cognition with nursing rehabilitation
and ADL count is six to ten;
(18) IB1: impaired cognition with no nursing
rehabilitation and ADL count is six to ten;
(19) IA2: impaired cognition with nursing rehabilitation
and ADL count is four or five;
(20) IA1: impaired cognition with no nursing
rehabilitation and ADL count is four or five;
(21) BB2: behavior problems with nursing rehabilitation
and ADL count is six to ten;
(22) BB1: behavior problems with no nursing rehabilitation
and ADL count is six to ten;
(23) BA2: behavior problems with nursing rehabilitation
and ADL count is four to five;
(24) BA1: behavior problems with no nursing rehabilitation
and ADL count is four to five;
(25) PE2: reduced physical functioning with nursing
rehabilitation and ADL count is 16 to 18;
(26) PE1: reduced physical functioning with no nursing
rehabilitation and ADL count is 16 to 18;
(27) PD2: reduced physical functioning with nursing
rehabilitation and ADL count is 11 to 15;
(28) PD1: reduced physical functioning with no nursing
rehabilitation and ADL count is 11 to 15;
(29) PC2: reduced physical functioning with nursing
rehabilitation and ADL count is nine or ten;
(30) PC1: reduced physical functioning with no nursing
rehabilitation and ADL count is nine or ten;
(31) PB2: reduced physical functioning with nursing
rehabilitation and ADL count is six to eight;
(32) PB1: reduced physical functioning with no nursing
rehabilitation and ADL count is six to eight;
(33) PA2: reduced physical functioning with nursing
rehabilitation and ADL count is four or five; and
(34) PA1: reduced physical functioning with no nursing
rehabilitation and ADL count is four or five.
Subd. 4. [RESIDENT ASSESSMENT SCHEDULE.] (a) A facility
must conduct and electronically submit to the commissioner of
health case mix assessments that conform with the assessment
schedule defined by the Code of Federal Regulations, title 42,
section 483.20, and published by the United States Department of
Health and Human Services, Health Care Financing Administration,
in the Long Term Care Assessment Instrument User's Manual,
version 2.0, October 1995, and subsequent clarifications made in
the Long-Term Care Assessment Instrument Questions and Answers,
version 2.0, August 1996. The commissioner of health may
substitute successor manuals or question and answer documents
published by the United States Department of Health and Human
Services, Health Care Financing Administration, to replace or
supplement the current version of the manual or document.
(b) The assessments used to determine a case mix
classification for reimbursement include the following:
(1) a new admission assessment must be completed by day 14
following admission;
(2) an annual assessment must be completed within 366 days
of the last comprehensive assessment;
(3) a significant change assessment must be completed
within 14 days of the identification of a significant change;
and
(4) the second quarterly assessment following either a new
admission assessment, an annual assessment, or a significant
change assessment. Each quarterly assessment must be completed
within 92 days of the previous assessment.
Subd. 5. [SHORT STAYS.] (a) A facility must submit to the
commissioner of health an initial admission assessment for all
residents who stay in the facility less than 14 days.
(b) Notwithstanding the admission assessment requirements
of paragraph (a), a facility may elect to accept a default rate
with a case mix index of 1.0 for all facility residents who stay
less than 14 days in lieu of submitting an initial assessment.
Facilities may make this election to be effective on the day of
implementation of the revised case mix system.
(c) After implementation of the revised case mix system,
nursing facilities must elect one of the options described in
paragraphs (a) and (b) on the annual report to the commissioner
of human services filed for each report year ending September
30. The election shall be effective on the following July 1.
(d) For residents who are admitted or readmitted and leave
the facility on a frequent basis and for whom readmission is
expected, the resident may be discharged on an extended leave
status. This status does not require reassessment each time the
resident returns to the facility unless a significant change in
the resident's status has occurred since the last assessment.
The case mix classification for these residents is determined by
the facility election made in paragraphs (a) and (b).
Subd. 6. [PENALTIES FOR LATE OR NONSUBMISSION.] A facility
that fails to complete or submit an assessment for a RUG-III
classification within seven days of the time requirements in
subdivisions 4 and 5 is subject to a reduced rate for that
resident. The reduced rate shall be the lowest rate for that
facility. The reduced rate is effective on the day of admission
for new admission assessments or on the day that the assessment
was due for all other assessments and continues in effect until
the first day of the month following the date of submission of
the resident's assessment.
Subd. 7. [NOTICE OF RESIDENT REIMBURSEMENT
CLASSIFICATION.] (a) A facility must elect between the options
in clauses (1) and (2) to provide notice to a resident of the
resident's case mix classification.
(1) The commissioner of health shall provide to a nursing
facility a notice for each resident of the reimbursement
classification established under subdivision 1. The notice must
inform the resident of the classification that was assigned, the
opportunity to review the documentation supporting the
classification, the opportunity to obtain clarification from the
commissioner, and the opportunity to request a reconsideration
of the classification. The commissioner must send notice of
resident classification by first class mail. A nursing facility
is responsible for the distribution of the notice to each
resident, to the person responsible for the payment of the
resident's nursing home expenses, or to another person
designated by the resident. This notice must be distributed
within three working days after the facility's receipt of the
notice from the commissioner of health.
(2) A facility may choose to provide a classification
notice, as prescribed by the commissioner of health, to a
resident upon receipt of the confirmation of the case mix
classification calculated by a facility or a corrected case mix
classification as indicated on the final validation report from
the commissioner. A nursing facility is responsible for the
distribution of the notice to each resident, to the person
responsible for the payment of the resident's nursing home
expenses, or to another person designated by the resident. This
notice must be distributed within three working days after the
facility's receipt of the validation report from the
commissioner. If a facility elects this option, the
commissioner of health shall provide the facility with a list of
residents and their case mix classifications as determined by
the commissioner. A nursing facility may make this election to
be effective on the day of implementation of the revised case
mix system.
(3) After implementation of the revised case mix system, a
nursing facility shall elect a notice of resident reimbursement
classification procedure as described in clause (1) or (2) on
the annual report to the commissioner of human services filed
for each report year ending September 30. The election will be
effective the following July 1.
(b) If a facility submits a correction to an assessment
conducted under subdivision 3 that results in a change in case
mix classification, the facility shall give written notice to
the resident or the resident's representative about the item
that was corrected and the reason for the correction. The
notice of corrected assessment may be provided at the same time
that the resident or resident's representative is provided the
resident's corrected notice of classification.
Subd. 8. [REQUEST FOR RECONSIDERATION OF RESIDENT
CLASSIFICATIONS.] (a) The resident, or resident's
representative, or the nursing facility or boarding care home
may request that the commissioner of health reconsider the
assigned reimbursement classification. The request for
reconsideration must be submitted in writing to the commissioner
within 30 days of the day the resident or the resident's
representative receives the resident classification notice. The
request for reconsideration must include the name of the
resident, the name and address of the facility in which the
resident resides, the reasons for the reconsideration, the
requested classification changes, and documentation supporting
the requested classification. The documentation accompanying
the reconsideration request is limited to documentation which
establishes that the needs of the resident at the time of the
assessment justify a classification which is different than the
classification established by the commissioner of health.
(b) Upon request, the nursing facility must give the
resident or the resident's representative a copy of the
assessment form and the other documentation that was given to
the commissioner of health to support the assessment findings.
The nursing facility shall also provide access to and a copy of
other information from the resident's record that has been
requested by or on behalf of the resident to support a
resident's reconsideration request. A copy of any requested
material must be provided within three working days of receipt
of a written request for the information. If a facility fails
to provide the material within this time, it is subject to the
issuance of a correction order and penalty assessment under
sections 144.653 and 144A.10. Notwithstanding those sections,
any correction order issued under this subdivision must require
that the nursing facility immediately comply with the request
for information and that as of the date of the issuance of the
correction order, the facility shall forfeit to the state a $100
fine for the first day of noncompliance, and an increase in the
$100 fine by $50 increments for each day the noncompliance
continues.
(c) In addition to the information required under
paragraphs (a) and (b), a reconsideration request from a nursing
facility must contain the following information: (i) the date
the reimbursement classification notices were received by the
facility; (ii) the date the classification notices were
distributed to the resident or the resident's representative;
and (iii) a copy of a notice sent to the resident or to the
resident's representative. This notice must inform the resident
or the resident's representative that a reconsideration of the
resident's classification is being requested, the reason for the
request, that the resident's rate will change if the request is
approved by the commissioner, the extent of the change, that
copies of the facility's request and supporting documentation
are available for review, and that the resident also has the
right to request a reconsideration. If the facility fails to
provide the required information with the reconsideration
request, the request must be denied, and the facility may not
make further reconsideration requests on that specific
reimbursement classification.
(d) Reconsideration by the commissioner must be made by
individuals not involved in reviewing the assessment, audit, or
reconsideration that established the disputed classification.
The reconsideration must be based upon the initial assessment
and upon the information provided to the commissioner under
paragraphs (a) and (b). If necessary for evaluating the
reconsideration request, the commissioner may conduct on-site
reviews. Within 15 working days of receiving the request for
reconsideration, the commissioner shall affirm or modify the
original resident classification. The original classification
must be modified if the commissioner determines that the
assessment resulting in the classification did not accurately
reflect the needs or assessment characteristics of the resident
at the time of the assessment. The resident and the nursing
facility or boarding care home shall be notified within five
working days after the decision is made. A decision by the
commissioner under this subdivision is the final administrative
decision of the agency for the party requesting reconsideration.
(e) The resident classification established by the
commissioner shall be the classification that applies to the
resident while the request for reconsideration is pending.
(f) The commissioner may request additional documentation
regarding a reconsideration necessary to make an accurate
reconsideration determination.
Subd. 9. [AUDIT AUTHORITY.] (a) The commissioner shall
audit the accuracy of resident assessments performed under
section 256B.438 through desk audits, on-site review of
residents and their records, and interviews with staff and
families. The commissioner shall reclassify a resident if the
commissioner determines that the resident was incorrectly
classified.
(b) The commissioner is authorized to conduct on-site
audits on an unannounced basis.
(c) A facility must grant the commissioner access to
examine the medical records relating to the resident assessments
selected for audit under this subdivision. The commissioner may
also observe and speak to facility staff and residents.
(d) The commissioner shall consider documentation under the
time frames for coding items on the minimum data set as set out
in the Resident Assessment Instrument Manual published by the
Health Care Financing Administration.
(e) The commissioner shall develop an audit selection
procedure that includes the following factors:
(1) The commissioner may target facilities that demonstrate
an atypical pattern of scoring minimum data set items,
nonsubmission of assessments, late submission of assessments, or
a previous history of audit changes of greater than 35 percent.
The commissioner shall select at least 20 percent of the most
current assessments submitted to the state for audit. Audits of
assessments selected in the targeted facilities must focus on
the factors leading to the audit. If the number of targeted
assessments selected does not meet the threshold of 20 percent
of the facility residents, then a stratified sample of the
remainder of assessments shall be drawn to meet the quota. If
the total change exceeds 35 percent, the commissioner may
conduct an expanded audit up to 100 percent of the remaining
current assessments.
(2) Facilities that are not a part of the targeted group
shall be placed in a general pool from which facilities will be
selected on a random basis for audit. Every facility shall be
audited annually. If a facility has two successive audits in
which the percentage of change is five percent or less and the
facility has not been the subject of a targeted audit in the
past 36 months, the facility may be audited biannually. A
stratified sample of 15 percent of the most current assessments
shall be selected for audit. If more than 20 percent of the
RUGS-III classifications after the audit are changed, the audit
shall be expanded to a second 15 percent sample. If the total
change between the first and second samples exceed 35 percent,
the commissioner may expand the audit to all of the remaining
assessments.
(3) If a facility qualifies for an expanded audit, the
commissioner may audit the facility again within six months. If
a facility has two expanded audits within a 24-month period,
that facility will be audited at least every six months for the
next 18 months.
(4) The commissioner may conduct special audits if the
commissioner determines that circumstances exist that could
alter or affect the validity of case mix classifications of
residents. These circumstances include, but are not limited to,
the following:
(i) frequent changes in the administration or management of
the facility;
(ii) an unusually high percentage of residents in a
specific case mix classification;
(iii) a high frequency in the number of reconsideration
requests received from a facility;
(iv) frequent adjustments of case mix classifications as
the result of reconsiderations or audits;
(v) a criminal indictment alleging provider fraud; or
(vi) other similar factors that relate to a facility's
ability to conduct accurate assessments.
(f) Within 15 working days of completing the audit process,
the commissioner shall mail the written results of the audit to
the facility, along with a written notice for each resident
affected to be forwarded by the facility. The notice must
contain the resident's classification and a statement informing
the resident, the resident's authorized representative, and the
facility of their right to review the commissioner's documents
supporting the classification and to request a reconsideration
of the classification. This notice must also include the
address and telephone number of the area nursing home ombudsman.
Subd. 10. [TRANSITION.] After implementation of this
section, reconsiderations requested for classifications made
under section 144.0722, subdivision 1, shall be determined under
section 144.0722, subdivision 3.
Sec. 3. Minnesota Statutes 2000, section 144A.071,
subdivision 1, is amended to read:
Subdivision 1. [FINDINGS.] The legislature declares that a
moratorium on the licensure and medical assistance certification
of new nursing home beds and construction projects that
exceed $750,000 $1,000,000 is necessary to control nursing home
expenditure growth and enable the state to meet the needs of its
elderly by providing high quality services in the most
appropriate manner along a continuum of care.
Sec. 4. Minnesota Statutes 2000, section 144A.071,
subdivision 1a, is amended to read:
Subd. 1a. [DEFINITIONS.] For purposes of sections 144A.071
to 144A.073, the following terms have the meanings given them:
(a) "attached fixtures" has the meaning given in Minnesota
Rules, part 9549.0020, subpart 6.
(b) "buildings" has the meaning given in Minnesota Rules,
part 9549.0020, subpart 7.
(c) "capital assets" has the meaning given in section
256B.421, subdivision 16.
(d) "commenced construction" means that all of the
following conditions were met: the final working drawings and
specifications were approved by the commissioner of health; the
construction contracts were let; a timely construction schedule
was developed, stipulating dates for beginning, achieving
various stages, and completing construction; and all zoning and
building permits were applied for.
(e) "completion date" means the date on which a certificate
of occupancy is issued for a construction project, or if a
certificate of occupancy is not required, the date on which the
construction project is available for facility use.
(f) "construction" means any erection, building,
alteration, reconstruction, modernization, or improvement
necessary to comply with the nursing home licensure rules.
(g) "construction project" means:
(1) a capital asset addition to, or replacement of a
nursing home or certified boarding care home that results in new
space or the remodeling of or renovations to existing facility
space;
(2) the remodeling or renovation of existing facility space
the use of which is modified as a result of the project
described in clause (1). This existing space and the project
described in clause (1) must be used for the functions as
designated on the construction plans on completion of the
project described in clause (1) for a period of not less than 24
months; or
(3) capital asset additions or replacements that are
completed within 12 months before or after the completion date
of the project described in clause (1).
(h) "new licensed" or "new certified beds" means:
(1) newly constructed beds in a facility or the
construction of a new facility that would increase the total
number of licensed nursing home beds or certified boarding care
or nursing home beds in the state; or
(2) newly licensed nursing home beds or newly certified
boarding care or nursing home beds that result from remodeling
of the facility that involves relocation of beds but does not
result in an increase in the total number of beds, except when
the project involves the upgrade of boarding care beds to
nursing home beds, as defined in section 144A.073, subdivision
1. "Remodeling" includes any of the type of conversion,
renovation, replacement, or upgrading projects as defined in
section 144A.073, subdivision 1.
(i) "project construction costs" means the cost of the
facility capital asset additions, replacements, renovations, or
remodeling projects, construction site preparation costs, and
related soft costs. Project construction costs also include the
cost of any remodeling or renovation of existing facility space
which is modified as a result of the construction
project. Project construction costs also includes the cost of
new technology implemented as part of the construction project.
(j) "technology" means information systems or devices that
make documentation, charting, and staff time more efficient or
encourage and allow for care through alternative settings
including, but not limited to, touch screens, monitors,
hand-helds, swipe cards, motion detectors, pagers, telemedicine,
medication dispensers, and equipment to monitor vital signs and
self-injections, and to observe skin and other conditions.
Sec. 5. Minnesota Statutes 2000, section 144A.071,
subdivision 2, is amended to read:
Subd. 2. [MORATORIUM.] The commissioner of health, in
coordination with the commissioner of human services, shall deny
each request for new licensed or certified nursing home or
certified boarding care beds except as provided in subdivision 3
or 4a, or section 144A.073. "Certified bed" means a nursing
home bed or a boarding care bed certified by the commissioner of
health for the purposes of the medical assistance program, under
United States Code, title 42, sections 1396 et seq.
The commissioner of human services, in coordination with
the commissioner of health, shall deny any request to issue a
license under section 252.28 and chapter 245A to a nursing home
or boarding care home, if that license would result in an
increase in the medical assistance reimbursement amount.
In addition, the commissioner of health must not approve
any construction project whose cost exceeds $750,000 $1,000,000,
unless:
(a) any construction costs exceeding $750,000 $1,000,000
are not added to the facility's appraised value and are not
included in the facility's payment rate for reimbursement under
the medical assistance program; or
(b) the project:
(1) has been approved through the process described in
section 144A.073;
(2) meets an exception in subdivision 3 or 4a;
(3) is necessary to correct violations of state or federal
law issued by the commissioner of health;
(4) is necessary to repair or replace a portion of the
facility that was damaged by fire, lightning, groundshifts, or
other such hazards, including environmental hazards, provided
that the provisions of subdivision 4a, clause (a), are met;
(5) as of May 1, 1992, the facility has submitted to the
commissioner of health written documentation evidencing that the
facility meets the "commenced construction" definition as
specified in subdivision 1a, clause (d), or that substantial
steps have been taken prior to April 1, 1992, relating to the
construction project. "Substantial steps" require that the
facility has made arrangements with outside parties relating to
the construction project and include the hiring of an architect
or construction firm, submission of preliminary plans to the
department of health or documentation from a financial
institution that financing arrangements for the construction
project have been made; or
(6) is being proposed by a licensed nursing facility that
is not certified to participate in the medical assistance
program and will not result in new licensed or certified beds.
Prior to the final plan approval of any construction
project, the commissioner of health shall be provided with an
itemized cost estimate for the project construction costs. If a
construction project is anticipated to be completed in phases,
the total estimated cost of all phases of the project shall be
submitted to the commissioner and shall be considered as one
construction project. Once the construction project is
completed and prior to the final clearance by the commissioner,
the total project construction costs for the construction
project shall be submitted to the commissioner. If the final
project construction cost exceeds the dollar threshold in this
subdivision, the commissioner of human services shall not
recognize any of the project construction costs or the related
financing costs in excess of this threshold in establishing the
facility's property-related payment rate.
The dollar thresholds for construction projects are as
follows: for construction projects other than those authorized
in clauses (1) to (6), the dollar threshold
is $750,000 $1,000,000. For projects authorized after July 1,
1993, under clause (1), the dollar threshold is the cost
estimate submitted with a proposal for an exception under
section 144A.073, plus inflation as calculated according to
section 256B.431, subdivision 3f, paragraph (a). For projects
authorized under clauses (2) to (4), the dollar threshold is the
itemized estimate project construction costs submitted to the
commissioner of health at the time of final plan approval, plus
inflation as calculated according to section 256B.431,
subdivision 3f, paragraph (a).
The commissioner of health shall adopt rules to implement
this section or to amend the emergency rules for granting
exceptions to the moratorium on nursing homes under section
144A.073.
Sec. 6. Minnesota Statutes 2000, section 144A.071,
subdivision 4a, is amended to read:
Subd. 4a. [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the
best interest of the state to ensure that nursing homes and
boarding care homes continue to meet the physical plant
licensing and certification requirements by permitting certain
construction projects. Facilities should be maintained in
condition to satisfy the physical and emotional needs of
residents while allowing the state to maintain control over
nursing home expenditure growth.
The commissioner of health in coordination with the
commissioner of human services, may approve the renovation,
replacement, upgrading, or relocation of a nursing home or
boarding care home, under the following conditions:
(a) to license or certify beds in a new facility
constructed to replace a facility or to make repairs in an
existing facility that was destroyed or damaged after June 30,
1987, by fire, lightning, or other hazard provided:
(i) destruction was not caused by the intentional act of or
at the direction of a controlling person of the facility;
(ii) at the time the facility was destroyed or damaged the
controlling persons of the facility maintained insurance
coverage for the type of hazard that occurred in an amount that
a reasonable person would conclude was adequate;
(iii) the net proceeds from an insurance settlement for the
damages caused by the hazard are applied to the cost of the new
facility or repairs;
(iv) the new facility is constructed on the same site as
the destroyed facility or on another site subject to the
restrictions in section 144A.073, subdivision 5;
(v) the number of licensed and certified beds in the new
facility does not exceed the number of licensed and certified
beds in the destroyed facility; and
(vi) the commissioner determines that the replacement beds
are needed to prevent an inadequate supply of beds.
Project construction costs incurred for repairs authorized under
this clause shall not be considered in the dollar threshold
amount defined in subdivision 2;
(b) to license or certify beds that are moved from one
location to another within a nursing home facility, provided the
total costs of remodeling performed in conjunction with the
relocation of beds does not exceed $750,000 $1,000,000;
(c) to license or certify beds in a project recommended for
approval under section 144A.073;
(d) to license or certify beds that are moved from an
existing state nursing home to a different state facility,
provided there is no net increase in the number of state nursing
home beds;
(e) to certify and license as nursing home beds boarding
care beds in a certified boarding care facility if the beds meet
the standards for nursing home licensure, or in a facility that
was granted an exception to the moratorium under section
144A.073, and if the cost of any remodeling of the facility does
not exceed $750,000 $1,000,000. If boarding care beds are
licensed as nursing home beds, the number of boarding care beds
in the facility must not increase beyond the number remaining at
the time of the upgrade in licensure. The provisions contained
in section 144A.073 regarding the upgrading of the facilities do
not apply to facilities that satisfy these requirements;
(f) to license and certify up to 40 beds transferred from
an existing facility owned and operated by the Amherst H. Wilder
Foundation in the city of St. Paul to a new unit at the same
location as the existing facility that will serve persons with
Alzheimer's disease and other related disorders. The transfer
of beds may occur gradually or in stages, provided the total
number of beds transferred does not exceed 40. At the time of
licensure and certification of a bed or beds in the new unit,
the commissioner of health shall delicense and decertify the
same number of beds in the existing facility. As a condition of
receiving a license or certification under this clause, the
facility must make a written commitment to the commissioner of
human services that it will not seek to receive an increase in
its property-related payment rate as a result of the transfers
allowed under this paragraph;
(g) to license and certify nursing home beds to replace
currently licensed and certified boarding care beds which may be
located either in a remodeled or renovated boarding care or
nursing home facility or in a remodeled, renovated, newly
constructed, or replacement nursing home facility within the
identifiable complex of health care facilities in which the
currently licensed boarding care beds are presently located,
provided that the number of boarding care beds in the facility
or complex are decreased by the number to be licensed as nursing
home beds and further provided that, if the total costs of new
construction, replacement, remodeling, or renovation exceed ten
percent of the appraised value of the facility or $200,000,
whichever is less, the facility makes a written commitment to
the commissioner of human services that it will not seek to
receive an increase in its property-related payment rate by
reason of the new construction, replacement, remodeling, or
renovation. The provisions contained in section 144A.073
regarding the upgrading of facilities do not apply to facilities
that satisfy these requirements;
(h) to license as a nursing home and certify as a nursing
facility a facility that is licensed as a boarding care facility
but not certified under the medical assistance program, but only
if the commissioner of human services certifies to the
commissioner of health that licensing the facility as a nursing
home and certifying the facility as a nursing facility will
result in a net annual savings to the state general fund of
$200,000 or more;
(i) to certify, after September 30, 1992, and prior to July
1, 1993, existing nursing home beds in a facility that was
licensed and in operation prior to January 1, 1992;
(j) to license and certify new nursing home beds to replace
beds in a facility acquired by the Minneapolis community
development agency as part of redevelopment activities in a city
of the first class, provided the new facility is located within
three miles of the site of the old facility. Operating and
property costs for the new facility must be determined and
allowed under section 256B.431 or 256B.434;
(k) to license and certify up to 20 new nursing home beds
in a community-operated hospital and attached convalescent and
nursing care facility with 40 beds on April 21, 1991, that
suspended operation of the hospital in April 1986. The
commissioner of human services shall provide the facility with
the same per diem property-related payment rate for each
additional licensed and certified bed as it will receive for its
existing 40 beds;
(l) to license or certify beds in renovation, replacement,
or upgrading projects as defined in section 144A.073,
subdivision 1, so long as the cumulative total costs of the
facility's remodeling projects do not
exceed $750,000 $1,000,000;
(m) to license and certify beds that are moved from one
location to another for the purposes of converting up to five
four-bed wards to single or double occupancy rooms in a nursing
home that, as of January 1, 1993, was county-owned and had a
licensed capacity of 115 beds;
(n) to allow a facility that on April 16, 1993, was a
106-bed licensed and certified nursing facility located in
Minneapolis to layaway all of its licensed and certified nursing
home beds. These beds may be relicensed and recertified in a
newly-constructed teaching nursing home facility affiliated with
a teaching hospital upon approval by the legislature. The
proposal must be developed in consultation with the interagency
committee on long-term care planning. The beds on layaway
status shall have the same status as voluntarily delicensed and
decertified beds, except that beds on layaway status remain
subject to the surcharge in section 256.9657. This layaway
provision expires July 1, 1998;
(o) to allow a project which will be completed in
conjunction with an approved moratorium exception project for a
nursing home in southern Cass county and which is directly
related to that portion of the facility that must be repaired,
renovated, or replaced, to correct an emergency plumbing problem
for which a state correction order has been issued and which
must be corrected by August 31, 1993;
(p) to allow a facility that on April 16, 1993, was a
368-bed licensed and certified nursing facility located in
Minneapolis to layaway, upon 30 days prior written notice to the
commissioner, up to 30 of the facility's licensed and certified
beds by converting three-bed wards to single or double
occupancy. Beds on layaway status shall have the same status as
voluntarily delicensed and decertified beds except that beds on
layaway status remain subject to the surcharge in section
256.9657, remain subject to the license application and renewal
fees under section 144A.07 and shall be subject to a $100 per
bed reactivation fee. In addition, at any time within three
years of the effective date of the layaway, the beds on layaway
status may be:
(1) relicensed and recertified upon relocation and
reactivation of some or all of the beds to an existing licensed
and certified facility or facilities located in Pine River,
Brainerd, or International Falls; provided that the total
project construction costs related to the relocation of beds
from layaway status for any facility receiving relocated beds
may not exceed the dollar threshold provided in subdivision 2
unless the construction project has been approved through the
moratorium exception process under section 144A.073;
(2) relicensed and recertified, upon reactivation of some
or all of the beds within the facility which placed the beds in
layaway status, if the commissioner has determined a need for
the reactivation of the beds on layaway status.
The property-related payment rate of a facility placing
beds on layaway status must be adjusted by the incremental
change in its rental per diem after recalculating the rental per
diem as provided in section 256B.431, subdivision 3a, paragraph
(c). The property-related payment rate for a facility
relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after
recalculating its rental per diem using the number of beds after
the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month
following the month in which the relicensing and recertification
became effective. Any beds remaining on layaway status more
than three years after the date the layaway status became
effective must be removed from layaway status and immediately
delicensed and decertified;
(q) to license and certify beds in a renovation and
remodeling project to convert 12 four-bed wards into 24 two-bed
rooms, expand space, and add improvements in a nursing home
that, as of January 1, 1994, met the following conditions: the
nursing home was located in Ramsey county; had a licensed
capacity of 154 beds; and had been ranked among the top 15
applicants by the 1993 moratorium exceptions advisory review
panel. The total project construction cost estimate for this
project must not exceed the cost estimate submitted in
connection with the 1993 moratorium exception process;
(r) to license and certify up to 117 beds that are
relocated from a licensed and certified 138-bed nursing facility
located in St. Paul to a hospital with 130 licensed hospital
beds located in South St. Paul, provided that the nursing
facility and hospital are owned by the same or a related
organization and that prior to the date the relocation is
completed the hospital ceases operation of its inpatient
hospital services at that hospital. After relocation, the
nursing facility's status under section 256B.431, subdivision
2j, shall be the same as it was prior to relocation. The
nursing facility's property-related payment rate resulting from
the project authorized in this paragraph shall become effective
no earlier than April 1, 1996. For purposes of calculating the
incremental change in the facility's rental per diem resulting
from this project, the allowable appraised value of the nursing
facility portion of the existing health care facility physical
plant prior to the renovation and relocation may not exceed
$2,490,000;
(s) to license and certify two beds in a facility to
replace beds that were voluntarily delicensed and decertified on
June 28, 1991;
(t) to allow 16 licensed and certified beds located on July
1, 1994, in a 142-bed nursing home and 21-bed boarding care home
facility in Minneapolis, notwithstanding the licensure and
certification after July 1, 1995, of the Minneapolis facility as
a 147-bed nursing home facility after completion of a
construction project approved in 1993 under section 144A.073, to
be laid away upon 30 days' prior written notice to the
commissioner. Beds on layaway status shall have the same status
as voluntarily delicensed or decertified beds except that they
shall remain subject to the surcharge in section 256.9657. The
16 beds on layaway status may be relicensed as nursing home beds
and recertified at any time within five years of the effective
date of the layaway upon relocation of some or all of the beds
to a licensed and certified facility located in Watertown,
provided that the total project construction costs related to
the relocation of beds from layaway status for the Watertown
facility may not exceed the dollar threshold provided in
subdivision 2 unless the construction project has been approved
through the moratorium exception process under section 144A.073.
The property-related payment rate of the facility placing
beds on layaway status must be adjusted by the incremental
change in its rental per diem after recalculating the rental per
diem as provided in section 256B.431, subdivision 3a, paragraph
(c). The property-related payment rate for the facility
relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after
recalculating its rental per diem using the number of beds after
the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month
following the month in which the relicensing and recertification
became effective. Any beds remaining on layaway status more
than five years after the date the layaway status became
effective must be removed from layaway status and immediately
delicensed and decertified;
(u) to license and certify beds that are moved within an
existing area of a facility or to a newly constructed addition
which is built for the purpose of eliminating three- and
four-bed rooms and adding space for dining, lounge areas,
bathing rooms, and ancillary service areas in a nursing home
that, as of January 1, 1995, was located in Fridley and had a
licensed capacity of 129 beds;
(v) to relocate 36 beds in Crow Wing county and four beds
from Hennepin county to a 160-bed facility in Crow Wing county,
provided all the affected beds are under common ownership;
(w) to license and certify a total replacement project of
up to 49 beds located in Norman county that are relocated from a
nursing home destroyed by flood and whose residents were
relocated to other nursing homes. The operating cost payment
rates for the new nursing facility shall be determined based on
the interim and settle-up payment provisions of Minnesota Rules,
part 9549.0057, and the reimbursement provisions of section
256B.431, except that subdivision 26, paragraphs (a) and (b),
shall not apply until the second rate year after the settle-up
cost report is filed. Property-related reimbursement rates
shall be determined under section 256B.431, taking into account
any federal or state flood-related loans or grants provided to
the facility;
(x) to license and certify a total replacement project of
up to 129 beds located in Polk county that are relocated from a
nursing home destroyed by flood and whose residents were
relocated to other nursing homes. The operating cost payment
rates for the new nursing facility shall be determined based on
the interim and settle-up payment provisions of Minnesota Rules,
part 9549.0057, and the reimbursement provisions of section
256B.431, except that subdivision 26, paragraphs (a) and (b),
shall not apply until the second rate year after the settle-up
cost report is filed. Property-related reimbursement rates
shall be determined under section 256B.431, taking into account
any federal or state flood-related loans or grants provided to
the facility;
(y) to license and certify beds in a renovation and
remodeling project to convert 13 three-bed wards into 13 two-bed
rooms and 13 single-bed rooms, expand space, and add
improvements in a nursing home that, as of January 1, 1994, met
the following conditions: the nursing home was located in
Ramsey county, was not owned by a hospital corporation, had a
licensed capacity of 64 beds, and had been ranked among the top
15 applicants by the 1993 moratorium exceptions advisory review
panel. The total project construction cost estimate for this
project must not exceed the cost estimate submitted in
connection with the 1993 moratorium exception process;
(z) to license and certify up to 150 nursing home beds to
replace an existing 285 bed nursing facility located in St.
Paul. The replacement project shall include both the renovation
of existing buildings and the construction of new facilities at
the existing site. The reduction in the licensed capacity of
the existing facility shall occur during the construction
project as beds are taken out of service due to the construction
process. Prior to the start of the construction process, the
facility shall provide written information to the commissioner
of health describing the process for bed reduction, plans for
the relocation of residents, and the estimated construction
schedule. The relocation of residents shall be in accordance
with the provisions of law and rule;
(aa) to allow the commissioner of human services to license
an additional 36 beds to provide residential services for the
physically handicapped under Minnesota Rules, parts 9570.2000 to
9570.3400, in a 198-bed nursing home located in Red Wing,
provided that the total number of licensed and certified beds at
the facility does not increase;
(bb) to license and certify a new facility in St. Louis
county with 44 beds constructed to replace an existing facility
in St. Louis county with 31 beds, which has resident rooms on
two separate floors and an antiquated elevator that creates
safety concerns for residents and prevents nonambulatory
residents from residing on the second floor. The project shall
include the elimination of three- and four-bed rooms;
(cc) to license and certify four beds in a 16-bed certified
boarding care home in Minneapolis to replace beds that were
voluntarily delicensed and decertified on or before March 31,
1992. The licensure and certification is conditional upon the
facility periodically assessing and adjusting its resident mix
and other factors which may contribute to a potential
institution for mental disease declaration. The commissioner of
human services shall retain the authority to audit the facility
at any time and shall require the facility to comply with any
requirements necessary to prevent an institution for mental
disease declaration, including delicensure and decertification
of beds, if necessary; or
(dd) to license and certify 72 beds in an existing facility
in Mille Lacs county with 80 beds as part of a renovation
project. The renovation must include construction of an
addition to accommodate ten residents with beginning and
midstage dementia in a self-contained living unit; creation of
three resident households where dining, activities, and support
spaces are located near resident living quarters; designation of
four beds for rehabilitation in a self-contained area;
designation of 30 private rooms; and other improvements.;
(ee) to license and certify beds in a facility that has
undergone replacement or remodeling as part of a planned closure
under section 256B.437;
(ff) to license and certify a total replacement project of
up to 124 beds located in Wilkin county that are in need of
relocation from a nursing home significantly damaged by flood.
The operating cost payment rates for the new nursing facility
shall be determined based on the interim and settle-up payment
provisions of Minnesota Rules, part 9549.0057, and the
reimbursement provisions of section 256B.431, except that
section 256B.431, subdivision 26, paragraphs (a) and (b), shall
not apply until the second rate year after the settle-up cost
report is filed. Property-related reimbursement rates shall be
determined under section 256B.431, taking into account any
federal or state flood-related loans or grants provided to the
facility;
(gg) to allow the commissioner of human services to license
an additional nine beds to provide residential services for the
physically handicapped under Minnesota Rules, parts 9570.2000 to
9570.3400, in a 240-bed nursing home located in Duluth, provided
that the total number of licensed and certified beds at the
facility does not increase;
(hh) to license and certify up to 120 new nursing facility
beds to replace beds in a facility in Anoka county, which was
licensed for 98 beds as of July 1, 2000, provided the new
facility is located within four miles of the existing facility
and is in Anoka county. Operating and property rates shall be
determined and allowed under section 256B.431 and Minnesota
Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or
256B.435. The provisions of section 256B.431, subdivision 26,
paragraphs (a) and (b), do not apply until the second rate year
following settle-up; or
(ii) to transfer up to 98 beds of a 129-licensed bed
facility located in Anoka county that, as of March 25, 2001, is
in the active process of closing, to a 122-licensed bed
nonprofit nursing facility located in the city of Columbia
Heights or its affiliate. The transfer is effective when the
receiving facility notifies the commissioner in writing of the
number of beds accepted. The commissioner shall place all
transferred beds on layaway status held in the name of the
receiving facility. The layaway adjustment provisions of
section 256B.431, subdivision 30, do not apply to this layaway.
The receiving facility may only remove the beds from layaway for
recertification and relicensure at the receiving facility's
current site, or at a newly constructed facility located in
Anoka county. The receiving facility must receive statutory
authorization before removing these beds from layaway status.
Sec. 7. Minnesota Statutes 2000, section 144A.073,
subdivision 2, as amended by Laws 2001, chapter 161, section 22,
is amended to read:
Subd. 2. [REQUEST FOR PROPOSALS.] At the authorization by
the legislature of additional medical assistance expenditures
for exceptions to the moratorium on nursing homes, the
commissioner shall publish in the State Register a request for
proposals for nursing home projects to be licensed or certified
under section 144A.071, subdivision 4a, clause (c). The public
notice of this funding and the request for proposals must
specify how the approval criteria will be prioritized by the
commissioner. The notice must describe the information that
must accompany a request and state that proposals must be
submitted to the commissioner within 90 days of the date of
publication. The notice must include the amount of the
legislative appropriation available for the additional costs to
the medical assistance program of projects approved under this
section. If no money is appropriated for a year, the
commissioner shall publish a notice to that effect, and no
proposals shall be requested. If money is appropriated, the
commissioner shall initiate the application and review process
described in this section at least twice each biennium and up to
four times each biennium, according to dates established by
rule. Authorized funds shall be allocated proportionally to the
number of processes. Funds not encumbered by an earlier process
within a biennium shall carry forward to subsequent iterations
of the process. Authorization for expenditures does not carry
forward into the following biennium. To be considered for
approval, a proposal must include the following information:
(1) whether the request is for renovation, replacement,
upgrading, conversion, or relocation;
(2) a description of the problem the project is designed to
address;
(3) a description of the proposed project;
(4) an analysis of projected costs of the nursing facility
proposal, which are not required to exceed the cost threshold
referred to in section 144A.071, subdivision 1, to be considered
under this section, including initial construction and
remodeling costs; site preparation costs; technology costs;
financing costs, including the current estimated long-term
financing costs of the proposal, which consists of estimates of
the amount and sources of money, reserves if required under the
proposed funding mechanism, annual payments schedule, interest
rates, length of term, closing costs and fees, insurance costs,
and any completed marketing study or underwriting review; and
estimated operating costs during the first two years after
completion of the project;
(5) for proposals involving replacement of all or part of a
facility, the proposed location of the replacement facility and
an estimate of the cost of addressing the problem through
renovation;
(6) for proposals involving renovation, an estimate of the
cost of addressing the problem through replacement;
(7) the proposed timetable for commencing construction and
completing the project;
(8) a statement of any licensure or certification issues,
such as certification survey deficiencies;
(9) the proposed relocation plan for current residents if
beds are to be closed so that the department of human services
can estimate the total costs of a proposal; and
(10) other information required by permanent rule of the
commissioner of health in accordance with subdivisions 4 and 8.
Sec. 8. Minnesota Statutes 2000, section 144A.073,
subdivision 4, is amended to read:
Subd. 4. [CRITERIA FOR REVIEW.] The following criteria
shall be used in a consistent manner to compare, evaluate, and
rank all proposals submitted. Except for the criteria specified
in clause (3), the application of criteria listed under this
subdivision shall not reflect any distinction based on the
geographic location of the proposed project:
(1) the extent to which the proposal furthers state
long-term care goals, including the goals stated in section
144A.31, and including the goal of enhancing the availability
and use of alternative care services and the goal of reducing
the number of long-term care resident rooms with more than two
beds;
(2) the proposal's long-term effects on state costs
including the cost estimate of the project according to section
144A.071, subdivision 5a;
(3) the extent to which the proposal promotes equitable
access to long-term care services in nursing homes through
redistribution of the nursing home bed supply, as measured by
the number of beds relative to the population 85 or older,
projected to the year 2000 by the state demographer, and
according to items (i) to (iv):
(i) reduce beds in counties where the supply is high,
relative to the statewide mean, and increase beds in counties
where the supply is low, relative to the statewide mean;
(ii) adjust the bed supply so as to create the greatest
benefits in improving the distribution of beds;
(iii) adjust the existing bed supply in counties so that
the bed supply in a county moves toward the statewide mean; and
(iv) adjust the existing bed supply so that the
distribution of beds as projected for the year 2020 would be
consistent with projected need, based on the methodology
outlined in the interagency long-term care committee's 1993
nursing home bed distribution study;
(4) the extent to which the project improves conditions
that affect the health or safety of residents, such as narrow
corridors, narrow door frames, unenclosed fire exits, and wood
frame construction, and similar provisions contained in fire and
life safety codes and licensure and certification rules;
(5) the extent to which the project improves conditions
that affect the comfort or quality of life of residents in a
facility or the ability of the facility to provide efficient
care, such as a relatively high number of residents in a room;
inadequate lighting or ventilation; poor access to bathing or
toilet facilities; a lack of available ancillary space for
dining rooms, day rooms, or rooms used for other activities;
problems relating to heating, cooling, or energy efficiency;
inefficient location of nursing stations; narrow corridors; or
other provisions contained in the licensure and certification
rules;
(6) the extent to which the applicant demonstrates the
delivery of quality care, as defined in state and federal
statutes and rules, to residents as evidenced by the two most
recent state agency certification surveys and the applicants'
response to those surveys;
(7) the extent to which the project removes the need for
waivers or variances previously granted by either the licensing
agency, certifying agency, fire marshal, or local government
entity; and
(8) the extent to which the project increases the number of
private or single bed rooms; and
(9) other factors that may be developed in permanent rule
by the commissioner of health that evaluate and assess how the
proposed project will further promote or protect the health,
safety, comfort, treatment, or well-being of the facility's
residents.
Sec. 9. [144A.161] [NURSING FACILITY RESIDENT RELOCATION.]
Subdivision 1. [DEFINITIONS.] The definitions in this
subdivision apply to subdivisions 2 to 10.
(a) "Closure" means the cessation of operations of a
facility and the delicensure and decertification of all beds
within the facility.
(b) "Curtailment," "reduction," or "change" refers to any
change in operations which would result in or encourage the
relocation of residents.
(c) "Facility" means a nursing home licensed pursuant to
this chapter, or a certified boarding care home licensed
pursuant to sections 144.50 to 144.56.
(d) "Licensee" means the owner of the facility or the
owner's designee or the commissioner of health for a facility in
receivership.
(e) "Local agency" means the county or multicounty social
service agency authorized under sections 393.01 and 393.07, as
the agency responsible for providing social services for the
county in which the nursing home is located.
(f) "Plan" means a process developed under subdivision 3,
paragraph (b), for the closure, curtailment, reduction, or
change in operations in a facility and the subsequent relocation
of residents.
(g) "Relocation" means the discharge of a resident and
movement of the resident to another facility or living
arrangement as a result of the closing, curtailment, reduction,
or change in operations of a nursing home or boarding care home.
Subd. 2. [INITIAL NOTICE FROM LICENSEE.] (a) A licensee
shall notify the following parties in writing when there is an
intent to close or curtail, reduce, or change operations which
would result in or encourage the relocation of residents:
(1) the commissioner of health;
(2) the commissioner of human services;
(3) the local agency;
(4) the office of the ombudsman for older Minnesotans; and
(5) the office of the ombudsman for mental health and
mental retardation.
(b) The written notice shall include the names, telephone
numbers, facsimile numbers, and e-mail addresses of the persons
in the facility responsible for coordinating the licensee's
efforts in the planning process, and the number of residents
potentially affected by the closure or curtailment, reduction,
or change in operations.
Subd. 3. [PLANNING PROCESS.] (a) The local agency shall,
within five working days of receiving initial notice of the
licensee's intent to close or curtail, reduce, or change
operations, provide the licensee and all parties identified in
subdivision 2, paragraph (a), with the names, telephone numbers,
facsimile numbers, and e-mail addresses of those persons
responsible for coordinating local agency efforts in the
planning process.
(b) Within ten working days of receipt of the notice under
paragraph (a), the local agency and licensee shall meet to
develop the relocation plan. The local agency shall inform the
departments of health and human services, the office of the
ombudsman for older Minnesotans, and the office of the ombudsman
for mental health and mental retardation of the date, time, and
location of the meeting so that their representatives may
attend. The relocation plan must be completed within 45 days of
receipt of the initial notice. However, the plan may be
finalized on an earlier schedule agreed to by all parties. To
the extent practicable, consistent with requirements to protect
the safety and health of residents, the commissioner may
authorize the planning process under this subdivision to occur
concurrent with the 60-day notice required under subdivision
5a. The plan shall:
(1) identify the expected date of closure, curtailment,
reduction, or change in operations;
(2) outline the process for public notification of the
closure, curtailment, reduction, or change in operations;
(3) identify efforts that will be made to include other
stakeholders in the relocation process;
(4) outline the process to ensure 60-day advance written
notice to residents, family members, and designated
representatives;
(5) present an aggregate description of the resident
population remaining to be relocated and the population's needs;
(6) outline the individual resident assessment process to
be utilized;
(7) identify an inventory of available relocation options,
including home and community-based services;
(8) identify a timeline for submission of the list
identified in subdivision 5c, paragraph (b); and
(9) identify a schedule for the timely completion of each
element of the plan.
(c) All parties to the plan shall refrain from any public
notification of the intent to close or curtail, reduce, or
change operations until a relocation plan has been established.
If the planning process occurs concurrently with the 60-day
notice period, this requirement does not apply once 60-day
notice is given.
Subd. 4. [RESPONSIBILITIES OF LICENSEE FOR RESIDENT
RELOCATIONS.] The licensee shall provide for the safe, orderly,
and appropriate relocation of residents. The licensee and
facility staff shall cooperate with representatives from the
local agency, the department of health, the department of human
services, the office of ombudsman for older Minnesotans, and
ombudsman for mental health and mental retardation in planning
for and implementing the relocation of residents.
Subd. 5. [LICENSEE RESPONSIBILITIES PRIOR TO
RELOCATION.] (a) The licensee shall establish an
interdisciplinary team responsible for coordinating and
implementing the plan. The interdisciplinary team shall include
representatives from the local agency, the office of ombudsman
for older Minnesotans, facility staff that provide direct care
services to the residents, and facility administration.
(b) The licensee shall provide a list to the local agency
that includes the following information on each resident to be
relocated:
(1) name;
(2) date of birth;
(3) social security number;
(4) medical assistance identification number;
(5) all diagnoses; and
(6) the name and contact information for the resident's
family or other designated representative.
(c) The licensee shall consult with the local agency on the
availability and development of available resources and on the
resident relocation process.
Subd. 5a. [LICENSEE RESPONSIBILITIES TO PROVIDE
NOTICE.] At least 60 days before the proposed date of closing,
curtailment, reduction, or change in operations as agreed to in
the plan, the licensee shall send a written notice of closure or
curtailment, reduction, or change in operations to each resident
being relocated, the resident's family member or designated
representative, and the resident's attending physician. The
notice must include the following:
(1) the date of the proposed closure, curtailment,
reduction, or change in operations;
(2) the name, address, telephone number, facsimile number,
and e-mail address of the individual or individuals in the
facility responsible for providing assistance and information;
(3) notification of upcoming meetings for residents,
families and designated representatives, and resident and family
councils to discuss the relocation of residents;
(4) the name, address, and telephone number of the local
agency contact person; and
(5) the name, address, and telephone number of the office
of ombudsman for older Minnesotans and the ombudsman for mental
health and mental retardation.
The notice must comply with all applicable state and
federal requirements for notice of transfer or discharge of
nursing home residents.
Subd. 5b. [LICENSEE RESPONSIBILITY REGARDING MEDICAL
INFORMATION.] The licensee shall request the attending physician
provide or arrange for the release of medical information needed
to update resident medical records and prepare all required
forms and discharge summaries.
Subd. 5c. [LICENSEE RESPONSIBILITY REGARDING PLACEMENT
INFORMATION.] (a) The licensee shall provide sufficient
preparation to residents to ensure safe, orderly, and
appropriate discharge and relocation. The licensee shall assist
residents in finding placements that respond to personal
preferences, such as desired geographic location.
(b) The licensee shall prepare a resource list with several
relocation options for each resident. The list must contain the
following information for each relocation option, when
applicable:
(1) the name, address, and telephone and facsimile numbers
of each facility with appropriate, available beds or services;
(2) the certification level of the available beds;
(3) the types of services available; and
(4) the name, address, and telephone and facsimile numbers
of appropriate available home and community-based placements,
services, and settings or other options for individuals with
special needs.
The list shall be made available to residents and their families
or designated representatives, and upon request to the office of
ombudsman for older Minnesotans, the ombudsman for mental health
and mental retardation, and the local agency.
(c) The Senior LinkAge line may make available via a Web
site the name, address, and telephone and facsimile numbers of
each facility with available beds, the certification level of
the available beds, the types of services available, and the
number of beds that are available as updated daily by the listed
facilities. The licensee must provide residents, their families
or designated representatives, the office of the ombudsman for
older Minnesotans, the office of the ombudsman for mental health
and mental retardation, and the local agency with the toll-free
number and Web site address for the Senior LinkAge line.
Subd. 5d. [LICENSEE RESPONSIBILITY TO MEET WITH RESIDENTS
AND FAMILIES.] Following the establishment of the plan, the
licensee shall conduct meetings with residents, families and
designated representatives, and resident and family councils to
notify them of the process for resident relocation.
Representatives from the local county social services agency,
the office of ombudsman for older Minnesotans, the ombudsman for
mental health and mental retardation, the commissioner of
health, and the commissioner of human services shall receive
advance notice of the meetings.
Subd. 5e. [LICENSEE RESPONSIBILITY FOR SITE VISITS.] The
licensee shall assist residents desiring to make site visits to
facilities with available beds or other appropriate living
options to which the resident may relocate, unless it is
medically inadvisable, as documented by the attending physician
in the resident's care record. The licensee shall provide or
arrange transportation for site visits to facilities or other
living options within a 50-mile radius to which the resident may
relocate, or within a larger radius if no suitable options are
available within 50 miles. The licensee shall provide available
written materials to residents on a potential new facility or
living option.
Subd. 5f. [LICENSEE RESPONSIBILITY FOR PERSONAL PROPERTY,
PERSONAL FUNDS, AND TELEPHONE SERVICE.] (a) The licensee shall
complete an inventory of resident personal possessions and
provide a copy of the final inventory to the resident and the
resident's designated representative prior to relocation. The
licensee shall be responsible for the transfer of the resident's
possessions for all relocations within a 50-mile radius of the
facility, or within a larger radius if no suitable options are
available within 50 miles. The licensee shall complete the
transfer of resident possessions in a timely manner, but no
later than the date of the actual physical relocation of the
resident.
(b) The licensee shall complete a final accounting of
personal funds held in trust by the facility and provide a copy
of this accounting to the resident and the resident's family or
the resident's designated representative. The licensee shall be
responsible for the transfer of all personal funds held in trust
by the facility. The licensee shall complete the transfer of
all personal funds in a timely manner.
(c) The licensee shall assist residents with the transfer
and reconnection of service for telephones or, for residents who
are deaf or blind, other personal communication devices or
services. The licensee shall pay the costs associated with
reestablishing service for telephones or other personal
communication devices or services, such as connection fees or
other one-time charges. The transfer or reconnection of
personal communication devices or services shall be completed in
a timely manner.
Subd. 5g. [LICENSEE RESPONSIBILITIES FOR FINAL NOTICE AND
RECORDS TRANSFER.] (a) The licensee shall provide the resident,
the resident's family or designated representative, and the
resident's attending physician final written notice prior to the
relocation of the resident. The notice must:
(1) be provided seven days prior to the actual relocation,
unless the resident agrees to waive the right to advance notice;
and
(2) identify the date of the anticipated relocation and the
destination to which the resident is being relocated.
(b) The licensee shall provide the receiving facility or
other health, housing, or care entity with complete and accurate
resident records including information on family members,
designated representatives, guardians, social service
caseworkers, or other contact information. These records must
also include all information necessary to provide appropriate
medical care and social services. This includes, but is not
limited to, information on preadmission screening, Level I and
Level II screening, minimum data set (MDS), and all other
assessments, resident diagnoses, social, behavioral, and
medication information.
(c) For residents with special care needs, the licensee
shall consult with the receiving facility or other placement
entity and provide staff training or other preparation as needed
to assist in providing for the special needs.
Subd. 6. [RESPONSIBILITIES OF THE LICENSEE DURING
RELOCATION.] (a) The licensee shall make arrangements or provide
for the transportation of residents to the new facility or
placement within a 50-mile radius, or within a larger radius if
no suitable options are available within 50 miles. The licensee
shall provide a staff person to accompany the resident during
transportation, upon request of the resident, the resident's
family, or designated representative. The discharge and
relocation of residents must comply with all applicable state
and federal requirements and must be conducted in a safe,
orderly, and appropriate manner. The licensee must ensure that
there is no disruption in providing meals, medications, or
treatments of a resident during the relocation process.
(b) Beginning the week following development of the initial
relocation plan, the licensee shall submit biweekly status
reports to the commissioners of health and human services or
their designees and to the local agency. The initial status
report must identify:
(1) the relocation plan developed;
(2) the interdisciplinary team members; and
(3) the number of residents to be relocated.
(c) Subsequent status reports must identify:
(1) any modifications to the plan;
(2) any change of interdisciplinary team members;
(3) the number of residents relocated;
(4) the destination to which residents have been relocated;
(5) the number of residents remaining to be relocated; and
(6) issues or problems encountered during the process and
resolution of these issues.
Subd. 7. [RESPONSIBILITIES OF THE LICENSEE FOLLOWING
RELOCATION.] The licensee shall retain or make arrangements for
the retention of all remaining resident records for the period
required by law. The licensee shall provide the department of
health access to these records. The licensee shall notify the
department of health of the location of any resident records
that have not been transferred to the new facility or other
health care entity.
Subd. 8. [RESPONSIBILITIES OF THE LOCAL AGENCY.] (a) The
local agency shall participate in the meeting as outlined in
subdivision 3, paragraph (b), to develop a relocation plan.
(b) The local agency shall designate a representative to
the interdisciplinary team established by the licensee
responsible for coordinating the relocation efforts.
(c) The local agency shall serve as a resource in the
relocation process.
(d) Concurrent with the notice sent to residents from the
licensee as provided in subdivision 5a, the local agency shall
provide written notice to residents, family, or designated
representatives describing:
(1) the county's role in the relocation process and in the
follow-up to relocations;
(2) a local agency contact name, address, and telephone
number; and
(3) the name, address, and telephone number of the office
of ombudsman for older Minnesotans and the ombudsman for mental
health and mental retardation.
(e) The local agency designee shall meet with appropriate
facility staff to coordinate any assistance in the relocation
process. This coordination shall include participating in group
meetings with residents, families, and designated
representatives to explain the relocation process.
(f) The local agency shall monitor compliance with all
components of the plan. If the licensee is not in compliance,
the local agency shall notify the commissioners of the
department of health and the department of human services.
(g) Except as requested by the resident, family member, or
designated representative and within the parameters of the
Vulnerable Adults Act, the local agency may halt a relocation
that it deems inappropriate or dangerous to the health or safety
of a resident. The local agency shall pursue remedies to
protect the resident during the relocation process, including,
but not limited to, assisting the resident with filing an appeal
of transfer or discharge, notification of all appropriate
licensing boards and agencies, and other remedies available to
the county under section 626.557, subdivision 10.
(h) A member of the local agency staff shall visit
residents relocated within 100 miles of the county within 30
days after the relocation. Local agency staff shall interview
the resident and family or designated representative, observe
the resident on site, and review and discuss pertinent medical
or social records with appropriate facility staff to:
(1) assess the adjustment of the resident to the new
placement;
(2) recommend services or methods to meet any special needs
of the resident; and
(3) identify residents at risk.
(i) The local agency may conduct subsequent follow-up
visits in cases where the adjustment of the resident to the new
placement is in question.
(j) Within 60 days of the completion of the follow-up
visits, the local agency shall submit a written summary of the
follow-up work to the department of health and the department of
human services in a manner approved by the commissioners.
(k) The local agency shall submit to the department of
health and the department of human services a report of any
issues that may require further review or monitoring.
(l) The local agency shall be responsible for the safe and
orderly relocation of residents in cases where an emergent need
arises or when the licensee has abrogated its responsibilities
under the plan.
Subd. 9. [PENALTIES.] Upon the recommendation of the
commissioner of health, the commissioner of human services may
eliminate a closure rate adjustment under subdivision 10 for
violations of this section.
Subd. 10. [FACILITY CLOSURE RATE ADJUSTMENT.] Upon the
request of a closing facility, the commissioner of human
services must allow the facility a closure rate adjustment equal
to a 50 percent payment rate increase to reimburse relocation
costs or other costs related to facility closure. This rate
increase is effective on the date the facility's occupancy
decreases to 90 percent of capacity days after the written
notice of closure is distributed under subdivision 5 and shall
remain in effect for a period of up to 60 days. The
commissioner shall delay the implementation of rate adjustments
under section 256B.437, subdivisions 3, paragraph (b), and 6,
paragraph (a), to offset the cost of this rate adjustment.
Subd. 11. [COUNTY COSTS.] The commissioner of human
services shall allocate up to $450 in total state and federal
funds per nursing facility bed that is closing, within the
limits of the appropriation specified for this purpose, to be
used for relocation costs incurred by counties for resident
relocation under this section or planned closures under section
256B.437. To be eligible for this allocation, a county in which
a nursing facility closes must provide to the commissioner a
detailed statement in a form provided by the commissioner of
additional costs, not to exceed $450 in total state and federal
funds per bed closed, that are directly incurred related to the
county's role in the relocation process.
Sec. 10. [144A.162] [TRANSFER OF RESIDENTS WITHIN
FACILITIES.]
The licensee shall provide for the safe, orderly, and
appropriate transfer of residents within the facility. In
situations where there is a curtailment, reduction, capital
improvement, or change in operations within a facility, the
licensee shall minimize the number of intra-facility transfers
needed to complete the project or change in operations, consider
individual resident needs and preferences, and provide
reasonable accommodation for individual resident requests
regarding their room transfer. The licensee shall provide
notice to the office of ombudsman for older Minnesotans and,
when appropriate, the office of ombudsman for mental health and
mental retardation, in advance of any notice to residents and
family, when all of the following circumstances apply:
(1) the transfers of residents within the facility are
being proposed due to curtailment, reduction, capital
improvements or change in operations;
(2) the transfers of residents within the facility are not
temporary moves to accommodate physical plan upgrades or
renovation; and
(3) the transfers involve multiple residents being moved
simultaneously.
Sec. 11. [144A.1888] [REUSE OF FACILITIES.]
Notwithstanding any local ordinance related to development,
planning, or zoning to the contrary, the conversion or reuse of
a nursing home that closes or that curtails, reduces, or changes
operations shall be considered a conforming use permitted under
local law, provided that the facility is converted to another
long-term care service approved by a regional planning group
under section 256B.437 that serves a smaller number of persons
than the number of persons served before the closure or
curtailment, reduction, or change in operations.
Sec. 12. [144A.36] [TRANSITION PLANNING GRANTS.]
Subdivision 1. [DEFINITIONS.] "Eligible nursing home"
means any nursing home licensed under sections 144A.01 to
144A.16 and certified by the appropriate authority under United
States Code, title 42, sections 1396-1396p, to participate as a
vendor in the medical assistance program established under
chapter 256B.
Subd. 2. [GRANTS AUTHORIZED.] (a) The commissioner shall
establish a program of transition planning grants to assist
eligible nursing homes in implementing the provisions in
paragraphs (b) and (c).
(b) Transition planning grants may be used by nursing homes
to develop strategic plans which identify the appropriate
institutional and noninstitutional settings necessary to meet
the older adult service needs of the community.
(c) At a minimum, a strategic plan must consist of:
(1) a needs assessment to determine what older adult
services are needed and desired by the community;
(2) an assessment of the appropriate settings in which to
provide needed older adult services;
(3) an assessment identifying currently available services
and their settings in the community; and
(4) a transition plan to achieve the needed outcome
identified by the assessment.
Subd. 3. [ALLOCATION OF GRANTS.] (a) Eligible nursing
homes must apply to the commissioner no later than September 1
of each fiscal year for grants awarded in that fiscal year. A
grant shall be awarded upon signing of a grant contract.
(b) The commissioner must make a final decision on the
funding of each application within 60 days of the deadline for
receiving applications.
Subd. 4. [EVALUATION.] The commissioner shall evaluate the
overall effectiveness of the grant program. The commissioner
may collect, from the nursing homes receiving grants, the
information necessary to evaluate the grant program.
Information related to the financial condition of individual
nursing homes shall be classified as nonpublic data.
Sec. 13. [144A.37] [ALTERNATIVE NURSING HOME SURVEY
PROCESS.]
Subdivision 1. [ALTERNATIVE NURSING HOME SURVEY
SCHEDULES.] (a) The commissioner of health shall implement
alternative procedures for the nursing home survey process as
authorized under this section.
(b) These alternative survey process procedures seek to:
(1) use department resources more effectively and efficiently to
target problem areas; (2) use other existing or new mechanisms
to provide objective assessments of quality and to measure
quality improvement; (3) provide for frequent collaborative
interaction of facility staff and surveyors rather than a
punitive approach; and (4) reward a nursing home that has
performed very well by extending intervals between full surveys.
(c) The commissioner shall pursue changes in federal law
necessary to accomplish this process and shall apply for any
necessary federal waivers or approval. If a federal waiver is
approved, the commissioner shall promptly submit, to the house
and senate committees with jurisdiction over health and human
services policy and finance, fiscal estimates for implementing
the alternative survey process waiver. The commissioner shall
also pursue any necessary federal law changes during the 107th
Congress.
(d) The alternative nursing home survey schedule and
related educational activities shall not be implemented until
funding is appropriated by the legislature.
Subd. 2. [SURVEY INTERVALS.] The commissioner of health
must extend the time period between standard surveys up to 30
months based on the criteria established in subdivision 4. In
using the alternative survey schedule, the requirement for the
statewide average to not exceed 12 months does not apply.
Subd. 3. [COMPLIANCE HISTORY.] The commissioner shall
develop a process for identifying the survey cycles for skilled
nursing facilities based upon the compliance history of the
facility. This process can use a range of months for survey
intervals. At a minimum, the process must be based on
information from the last two survey cycles and shall take into
consideration any deficiencies issued as the result of a survey
or a complaint investigation during the interval. A skilled
nursing facility with a finding of substandard quality of care
or a finding of immediate jeopardy is not entitled to a survey
interval greater than 12 months. The commissioner shall alter
the survey cycle for a specific skilled nursing facility based
on findings identified through the completion of a survey, a
monitoring visit, or a complaint investigation. The
commissioner must also take into consideration information other
than the facility's compliance history.
Subd. 4. [CRITERIA FOR SURVEY INTERVAL
CLASSIFICATION.] (a) The commissioner shall provide public
notice of the classification process and shall identify the
selected survey cycles for each skilled nursing facility. The
classification system must be based on an analysis of the
findings made during the past two standard survey intervals, but
it only takes one survey or complaint finding to modify the
interval.
(b) The commissioner shall also take into consideration
information obtained from residents and family members in each
skilled nursing facility and from other sources such as
employees and ombudsmen in determining the appropriate survey
intervals for facilities.
Subd. 5. [REQUIRED MONITORING.] (a) The commissioner shall
conduct at least one monitoring visit on an annual basis for
every skilled nursing facility which has been selected for a
survey cycle greater than 12 months. The commissioner shall
develop protocols for the monitoring visits which shall be less
extensive than the requirements for a standard survey. The
commissioner shall use the criteria in paragraph (b) to
determine whether additional monitoring visits to a facility
will be required.
(b) The criteria shall include, but not be limited to, the
following:
(1) changes in ownership, administration of the facility,
or direction of the facility's nursing service;
(2) changes in the facility's quality indicators which
might evidence a decline in the facility's quality of care;
(3) reductions in staffing or an increase in the
utilization of temporary nursing personnel; and
(4) complaint information or other information that
identifies potential concerns for the quality of the care and
services provided in the skilled nursing facility.
Subd. 6. [SURVEY REQUIREMENTS FOR FACILITIES NOT APPROVED
FOR EXTENDED SURVEY INTERVALS.] The commissioner shall establish
a process for surveying and monitoring of facilities which
require a survey interval of less than 15 months. This
information shall identify the steps that the commissioner must
take to monitor the facility in addition to the standard survey.
Subd. 7. [IMPACT ON SURVEY AGENCY'S BUDGET.] The
implementation of an alternative survey process for the state
must not result in any reduction of funding that would have been
provided to the state survey agency for survey and enforcement
activity based upon the completion of full standard surveys for
each skilled nursing facility in the state.
Subd. 8. [EDUCATIONAL ACTIVITIES.] The commissioner shall
expand the state survey agency's ability to conduct training and
educational efforts for skilled nursing facilities, residents
and family members, residents and family councils, long-term
care ombudsman programs, and the general public.
Subd. 9. [EVALUATION.] The commissioner shall develop a
process for the evaluation of the effectiveness of an
alternative survey process conducted under this section.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 14. [144A.38] [INNOVATIONS IN QUALITY DEMONSTRATION
GRANTS.]
Subdivision 1. [PROGRAM ESTABLISHED.] The commissioner of
health and the commissioner of human services shall establish a
long-term care grant program that demonstrates best practices
and innovation for long-term care service delivery and housing.
The grants must fund demonstrations that create new means and
models for serving the elderly or demonstrate creativity in
service provision through the scope of their program or service.
Subd. 2. [ELIGIBILITY.] Grants may only be made to those
who provide direct service or housing to the elderly within the
state. Grants may only be made for projects that show
innovations and measurable improvement in resident care, quality
of life, use of technology, or customer satisfaction.
Subd. 3. [AWARDING OF GRANTS.] (a) Applications for grants
must be made to the commissioners on forms prescribed by the
commissioners.
(b) The commissioners shall review applications and award
grants based on the following criteria:
(1) improvement in direct care to residents;
(2) increase in efficiency through the use of technology;
(3) increase in quality of care through the use of
technology;
(4) increase in the access and delivery of service;
(5) enhancement of nursing staff training;
(6) the effectiveness of the project as a demonstration;
and
(7) the immediate transferability of the project to scale.
(c) In reviewing applications and awarding grants, the
commissioners shall consult with long-term care providers,
consumers of long-term care, long-term care researchers, and
staff of other state agencies.
(d) Grants for eligible projects may not exceed $100,000.
Sec. 15. Minnesota Statutes 2000, section 256B.431,
subdivision 2e, is amended to read:
Subd. 2e. [CONTRACTS FOR SERVICES FOR VENTILATOR-DEPENDENT
PERSONS.] The commissioner may contract with a nursing facility
eligible to receive medical assistance payments to provide
services to a ventilator-dependent person identified by the
commissioner according to criteria developed by the
commissioner, including:
(1) nursing facility care has been recommended for the
person by a preadmission screening team;
(2) the person has been assessed at case mix classification
K;
(3) the person has been hospitalized for at least six
months and no longer requires inpatient acute care hospital
services; and
(4) (3) the commissioner has determined that necessary
services for the person cannot be provided under existing
nursing facility rates.
The commissioner may issue a request for proposals to
provide services to a ventilator-dependent person to nursing
facilities eligible to receive medical assistance payments and
shall select nursing facilities from among respondents according
to criteria developed by the commissioner, including:
(1) the cost-effectiveness and appropriateness of services;
(2) the nursing facility's compliance with federal and
state licensing and certification standards; and
(3) the proximity of the nursing facility to a
ventilator-dependent person identified by the commissioner who
requires nursing facility placement.
The commissioner may negotiate an adjustment to the
operating cost payment rate for a nursing facility selected by
the commissioner from among respondents to the request for
proposals. The negotiated adjustment must reflect only the
actual additional cost of meeting the specialized care needs of
a ventilator-dependent person identified by the commissioner for
whom necessary services cannot be provided under existing
nursing facility rates and which are not otherwise covered under
Minnesota Rules, parts 9549.0010 to 9549.0080 or 9505.0170 to
9505.0475. For persons who are initially admitted to a nursing
facility before July 1, 2001, and have their payment rate under
this subdivision negotiated after July 1, 2001, the negotiated
payment rate must not exceed 200 percent of the highest multiple
bedroom payment rate for a Minnesota nursing the facility, as
initially established by the commissioner for the rate year for
case mix classification K. For persons initially admitted to a
nursing facility on or after July 1, 2001, the negotiated
payment rate must not exceed 300 percent of the facility's
multiple bedroom payment rate for case mix classification K.
The negotiated adjustment shall not affect the payment rate
charged to private paying residents under the provisions of
section 256B.48, subdivision 1.
Sec. 16. Minnesota Statutes 2000, 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) 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,
the transfer of the nursing facility's license from one physical
plant location to another, or a new building addition to
relocate beds from three- and four-bed wards. 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 (c), 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.
(g) Notwithstanding Minnesota Rules, part 9549.0060,
subpart 11, item C, subitem (2), for a total replacement, as
defined in paragraph (f), authorized under section 144A.071 or
144A.073 after July 1, 1999, or any building project that is a
relocation, renovation, upgrading, or conversion authorized
under section 144A.073, completed on or after July 1, 2001, 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.
(h) For a total replacement, as defined in paragraph (f),
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.
(i) For a renovation authorized under section 144A.073 for
a 65-bed nursing home in St. Louis county, the incremental
increase in rental rate for purposes of paragraph (d) shall be
$8.16, and the total replacement cost, allowable appraised
value, allowable debt, and allowable interest shall be increased
according to the incremental increase.
(j) For a total replacement, as defined in paragraph (f),
authorized under section 144A.073 involving a new building
addition that relocates beds from three-bed wards for an 80-bed
nursing home in Redwood county, the replacement-costs-new per
bed limit shall be $74,280 per licensed bed for multiple-bed
rooms; $92,850 per licensed bed for semiprivate rooms with a
fixed partition separating the beds; and $111,420 per licensed
bed for single rooms. These amounts shall be adjusted annually,
beginning January 1, 2001. 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. 17. Minnesota Statutes 2000, section 256B.431, is
amended by adding a subdivision to read:
Subd. 31. [NURSING FACILITY RATE INCREASES BEGINNING JULY
1, 2001, AND JULY 1, 2002.] For the rate years beginning July 1,
2001, and July 1, 2002, the commissioner shall provide to each
nursing facility reimbursed under this section or section
256B.434 an adjustment equal to 3.0 percent of the total
operating payment rate. The operating payment rates in effect
on June 30, 2001, shall include the adjustment in subdivision
2i, paragraph (c).
Sec. 18. Minnesota Statutes 2000, section 256B.431, is
amended by adding a subdivision to read:
Subd. 32. [PAYMENT DURING FIRST 90 DAYS.] (a) For rate
years beginning on or after July 1, 2001, the total payment rate
for a facility reimbursed under this section, section 256B.434,
or any other section for the first 90 paid days after admission
shall be:
(1) for the first 30 paid days, the rate shall be 120
percent of the facility's medical assistance rate for each case
mix class; and
(2) for the next 60 paid days after the first 30 paid days,
the rate shall be 110 percent of the facility's medical
assistance rate for each case mix class.
(b) Beginning with the 91st paid day after admission, the
payment rate shall be the rate otherwise determined under this
section, section 256B.434, or any other section.
(c) This subdivision applies to admissions occurring on or
after July 1, 2001.
Sec. 19. Minnesota Statutes 2000, section 256B.431, is
amended by adding a subdivision to read:
Subd. 33. [STAGED REDUCTION IN RATE DISPARITIES.] (a) For
the rate years beginning July 1, 2001, and July 1, 2002, the
commissioner shall adjust the operating payment rates for
low-rate nursing facilities reimbursed under this section or
section 256B.434.
(b) For the rate year beginning July 1, 2001, for each case
mix level, if the amount computed under subdivision 32 is less
than the amount in clause (1), the commissioner shall make
available the lesser of the amount in clause (1) or an increase
of ten percent over the rate in effect on June 30, 2001, as an
adjustment to the operating payment rate. For the rate year
beginning July 1, 2002, for each case mix level, if the amount
computed under subdivision 32 is less than the amount in clause
(2), the commissioner shall make available the lesser of the
amount in clause (2) or an increase of ten percent over the rate
in effect on June 30, 2002, as an adjustment to the operating
payment rate. For purposes of this subdivision, nursing
facilities shall be considered to be metro if they are located
in Anoka, Carver, Dakota, Hennepin, Olmsted, Ramsey, Scott, or
Washington counties; or in the cities of Moorhead or
Breckenridge; or in St. Louis county, north of Toivola and south
of Cook; or in Itasca county, east of a north south line two
miles west of Grand Rapids:
(1) Operating Payment Rate Target Level for July 1, 2001:
Case Mix Classification Metro Nonmetro
A $ 76.00 $ 68.13
B $ 83.40 $ 74.46
C $ 91.67 $ 81.63
D $ 99.51 $ 88.04
E $107.46 $ 94.87
F $107.96 $ 95.29
G $114.67 $100.98
H $126.99 $111.31
I $131.42 $115.06
J $138.34 $120.85
K $152.26 $133.10
(2) Operating Payment Rate Target Level for July 1, 2002:
Case Mix Classification Metro Nonmetro
A $ 78.28 $ 70.51
B $ 85.91 $ 77.16
C $ 94.42 $ 84.62
D $102.50 $ 91.42
E $110.68 $ 98.40
F $111.20 $ 98.84
G $118.11 $104.77
H $130.80 $115.64
I $135.38 $119.50
J $142.49 $125.38
K $156.85 $137.77
Sec. 20. Minnesota Statutes 2000, section 256B.431, is
amended by adding a subdivision to read:
Subd. 34. [NURSING FACILITY RATE INCREASES BEGINNING JULY
1, 2001, AND JULY 1, 2002.] (a) For the rate years beginning
July 1, 2001, and July 1, 2002, two-thirds of the money
resulting from the rate adjustment under subdivision 31 and
one-half of the money resulting from the rate adjustment under
subdivisions 32 and 33 must be used to increase the wages and
benefits and pay associated costs of all employees except
management fees, the administrator, and central office staff.
(b) Money received by a facility as a result of the rate
adjustments provided in subdivisions 31 to 33, which must be
used as provided in paragraph (a), must be used only for wage
and benefit increases implemented on or after July 1, 2001, or
July 1, 2002, respectively, and must not be used for wage
increases implemented prior to those dates.
(c) Nursing facilities may apply for the portions of the
rate adjustments under subdivisions 31 to 33, which must be used
as provided in paragraph (a). The application must be made to
the commissioner and contain a plan by which the nursing
facility will distribute to employees of the nursing facility
the funds, which must be used as provided in paragraph (a). 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. A negotiated agreement may
constitute the plan only if the agreement is finalized after the
date of enactment of all increases for the rate year. The
commissioner shall review the plan to ensure that the rate
adjustments are used as provided in paragraph (a). To be
eligible, a facility must submit its plan for the wage and
benefit distribution by December 31 each year. If a facility's
plan for wage and benefit distribution is effective for its
employees after July 1 of the year that the funds are available,
the portion of the rate adjustments, which must be used as
provided in paragraph (a), are effective the same date as its
plan.
(d) A hospital-attached nursing facility may include costs
in their distribution plan for wages and benefits and associated
costs of employees in the organization's shared services
departments, provided that:
(1) the nursing facility and the hospital share common
ownership; and
(2) adjustments for hospital services using the
diagnostic-related grouping payment rates per admission under
Medicare are less than three percent during the 12 months prior
to the effective date of these rate adjustments.
If a hospital-attached facility meets the qualifications in
this paragraph, the difference between the rate adjustments
approved for nursing facility services and the rate increase
approved for hospital services may be permitted as a
distribution in the hospital-attached facility's plan regardless
of whether the use of those funds is shown as being attributable
to employee hours worked in the nursing facility or employee
hours worked in the hospital.
For the purposes of this paragraph, a hospital-attached
nursing facility is one that meets the definition under
subdivision 2j, or, in the case of a facility reimbursed under
section 256B.434, met this definition at the time their last
payment rate was established under Minnesota Rules, parts
9549.0010 to 9549.0080, and this section.
(e) A copy of the approved distribution plan must be made
available to all employees 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 wage
and benefit adjustment described in the 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 telephone
number provided by the commissioner and included in the approved
plan.
(f) Notwithstanding section 256B.48, subdivision 1, clause
(a), upon the request of a nursing facility, the commissioner
may authorize the facility to raise per diem rates for
private-pay residents on July 1 by the amount anticipated to be
required upon implementation of the rate adjustments allowable
under subdivisions 31 to 33. The commissioner shall require any
amounts collected under this paragraph, which must be used as
provided in paragraph (a), to be placed in an escrow account
established for this purpose with a financial institution that
provides deposit insurance until the medical assistance rate is
finalized. The commissioner shall conduct audits as necessary
to ensure that:
(1) the amounts collected are retained in escrow until
medical assistance rates are increased to reflect the
wage-related adjustment; and
(2) any amounts collected from private-pay residents in
excess of the final medical assistance rate are repaid to the
private-pay residents with interest at the rate used by the
commissioner of revenue for the late payment of taxes and in
effect on the date the distribution plan is approved by the
commissioner of human services.
Sec. 21. Minnesota Statutes 2000, section 256B.431, is
amended by adding a subdivision to read:
Subd. 35. [EXCLUSION OF RAW FOOD COST ADJUSTMENT.] For
rate years beginning on or after July 1, 2001, in calculating a
nursing facility's operating cost per diem for the purposes of
constructing an array, determining a median, or otherwise
performing a statistical measure of nursing facility payment
rates to be used to determine future rate increases under this
section, section 256B.434, or any other section, the
commissioner shall exclude adjustments for raw food costs under
subdivision 2b, paragraph (h), that are related to providing
special diets based on religious beliefs.
Sec. 22. Minnesota Statutes 2000, section 256B.433,
subdivision 3a, is amended to read:
Subd. 3a. [EXEMPTION FROM REQUIREMENT FOR SEPARATE THERAPY
BILLING.] The provisions of subdivision 3 do not apply to
nursing facilities that are reimbursed according to the
provisions of section 256B.431 and are located in a county
participating in the prepaid medical assistance program.
Nursing facilities that are reimbursed according to the
provisions of section 256B.434 and are located in a county
participating in the prepaid medical assistance program are
exempt from the maximum therapy rent revenue provisions of
subdivision 3, paragraph (c).
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 23. Minnesota Statutes 2000, 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, 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.
(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 and, for facilities reimbursed under
this section or section 256B.431, an adjustment to include the
cost of any increase in health department licensing fees for the
facility taking effect on or after July 1, 2001. 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, July 1,
2001, and July 1, 2002, this paragraph shall apply only to the
property-related payment rate, except that adjustments to
include the cost of any increase in health department licensing
fees taking effect on or after July 1, 2001, shall be provided.
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. 24. Minnesota Statutes 2000, section 256B.434, is
amended by adding a subdivision to read:
Subd. 4c. [FACILITY RATE INCREASES EFFECTIVE JANUARY 1,
2002.] For the rate period beginning January 1, 2002, and for
the rate year beginning July 1, 2002, a nursing facility in
Morrison county licensed for 83 beds as of March 1, 2001, shall
receive an increase of $2.54 in each case mix payment rate to
offset property tax payments due as a result of the facility's
conversion from nonprofit to for-profit status. The increase
under this subdivision shall be added following the
determination under this chapter of the payment rate for the
rate year beginning July 1, 2001, and shall be included in the
facility's total payment rates for the purposes of determining
future rates under this section or any other section.
Sec. 25. Minnesota Statutes 2000, section 256B.434, is
amended by adding a subdivision to read:
Subd. 4d. [FACILITY RATE INCREASES EFFECTIVE JULY 1,
2001.] For the rate year beginning July 1, 2001, a nursing
facility in Hennepin county licensed for 302 beds shall receive
an increase of 29 cents in each case mix payment rate to correct
an error in the cost-reporting system that occurred prior to the
date that the facility entered the alternative payment
demonstration project. The increase under this subdivision
shall be added following the determination under this chapter of
the payment rate for the rate year beginning July 1, 2001, and
shall be included in the facility's total payment rates for the
purposes of determining future rates under this section or any
other section.
Sec. 26. Minnesota Statutes 2000, section 256B.434, is
amended by adding a subdivision to read:
Subd. 4e. [RATE INCREASE EFFECTIVE JULY 1, 2001.] A
nursing facility in Anoka county licensed for 98 beds as of July
1, 2000, shall receive a total increase of $10 in each case mix
rate for the rate year beginning July 1, 2001, as a result of
increases provided under this subdivision and section 256B.431,
subdivision 33. The increases under this subdivision shall be
added prior to the determination under section 256B.431,
subdivision 33, of the payment rate for the rate year beginning
July 1, 2001, and shall be included in the facility's total
payment rate for purposes of determining future rates under this
section or any other section through June 30, 2004.
Sec. 27. [256B.437] [NURSING FACILITY VOLUNTARY CLOSURES;
PLANNING AND DEVELOPMENT OF COMMUNITY-BASED ALTERNATIVES.]
Subdivision 1. [DEFINITIONS.] (a) The definitions in this
subdivision apply to subdivisions 2 to 9.
(b) "Closure" means the cessation of operations of a
nursing facility and delicensure and decertification of all beds
within the facility.
(c) "Closure plan" means a plan to close a nursing facility
and reallocate a portion of the resulting savings to provide
planned closure rate adjustments at other facilities.
(d) "Commencement of closure" means the date on which
residents and designated representatives are notified of a
planned closure as provided in section 144A.161, subdivision 5a,
as part of an approved closure plan.
(e) "Completion of closure" means the date on which the
final resident of the nursing facility designated for closure in
an approved closure plan is discharged from the facility.
(f) "Partial closure" means the delicensure and
decertification of a portion of the beds within the facility.
(g) "Planned closure rate adjustment" means an increase in
a nursing facility's operating rates resulting from a planned
closure or a planned partial closure of another facility.
Subd. 2. [PLANNING AND DEVELOPMENT OF COMMUNITY-BASED
SERVICES.] (a) The commissioner of human services shall
establish a process to adjust the capacity and distribution of
long-term care services to equalize the supply and demand for
different types of services. This process must include
community planning, expansion or establishment of needed
services, and analysis of voluntary nursing facility closures.
(b) The purpose of this process is to support the planning
and development of community-based services. This process must
support early intervention, advocacy, and consumer protection
while providing resources and incentives for expanded county
planning and for nursing facilities to transition to meet
community needs.
(c) The process shall support and facilitate expansion of
community-based services under the county-administered
alternative care program under section 256B.0913 and waivers for
elderly under section 256B.0915, including, but not limited to,
the development of supportive services such as housing and
transportation. The process shall utilize community assessments
and planning developed for the community health services plan
and plan update and for the community social services act plan,
and other relevant information.
(d) The commissioners of health and human services as
appropriate shall provide, by July 15, 2001, available data
necessary for the county, including, but not limited to, data on
nursing facility bed distribution, housing with services
options, the closure of nursing facilities that occur outside of
the planned closure process, and approval of planned closures in
the county and contiguous counties.
(e) Each county shall submit to the commissioner of human
services, by October 15, 2001, a gaps analysis that identifies
local service needs, pending development of services, and any
other issues that would contribute to or impede further
development of community-based services. The gaps analysis must
also be sent to the local area agency on aging and, if
applicable, local SAIL projects, for review and comment. The
review and comment must assess needs across county boundaries.
The area agencies on aging and SAIL projects must provide the
commissioner and the counties with their review and analyses by
November 15, 2001.
(f) The addendum to the biennial plan shall be submitted
annually, beginning December 31, 2001, and each December 31
thereafter, and shall include recommendations for development of
community-based services. Both planning and implementation
shall be implemented within the amount of funding made available
to the county board for these purposes.
(g) The plan, within the funding allocated, shall:
(1) include the gaps analysis required by paragraph (e);
(2) involve providers, consumers, cities, townships,
businesses, and area agencies on aging in the planning process;
(3) address the availability of alternative care and
elderly waiver services for eligible recipients;
(4) address the development of other supportive services,
such as transit, housing, and workforce and economic
development; and
(5) estimate the cost and timelines for development.
(h) The biennial plan addendum shall be coordinated with
the county mental health plan for inclusion in the community
health services plan and included as an addendum to the
community social services plan.
(i) The county board having financial responsibility for
persons present in another county shall cooperate with that
county for planning and development of services.
(j) The county board shall cooperate in planning and
development of community-based services with other counties, as
necessary, and coordinate planning for long-term care services
that involve more than one county, within the funding allocated
for these purposes.
(k) The commissioners of health and human services, in
cooperation with county boards, shall report to the legislature
by February 1 of each year, beginning February 1, 2002,
regarding the development of community-based services,
transition or closure of nursing facilities, and specific gaps
in services in identified geographic areas that may require
additional resources or flexibility, as documented by the
process in this subdivision and reported to the commissioners by
December 31 of each year.
Subd. 3. [APPLICATIONS FOR PLANNED CLOSURE OF NURSING
FACILITIES.] (a) By August 15, 2001, the commissioner of human
services shall implement and announce a program for closure or
partial closure of nursing facilities. Names and identifying
information provided in response to the announcement shall
remain private unless approved, according to the timelines
established in the plan. The announcement must specify:
(1) the criteria in subdivision 4 that will be used by the
commissioner to approve or reject applications;
(2) a requirement for the submission of a letter of intent
before the submission of an application;
(3) the information that must accompany an application; and
(4) that applications may combine planned closure rate
adjustments with moratorium exception funding, in which case a
single application may serve both purposes.
Between August 1, 2001, and June 30, 2003, the commissioner may
approve planned closures of up to 5,140 nursing facility beds,
less the number of licensed beds in facilities that close during
the same time period without approved closure plans or that have
notified the commissioner of health of their intent to close
without an approved closure plan.
(b) A facility or facilities reimbursed under section
256B.431 or 256B.434 with a closure plan approved by the
commissioner under subdivision 5 may assign a planned closure
rate adjustment to another facility or facilities that are not
closing or in the case of a partial closure, to the facility
undertaking the partial closure. A facility may also elect to
have a planned closure rate adjustment shared equally by the
five nursing facilities with the lowest total operating payment
rates in the state development region designated under section
462.385, in which the facility that is closing is located. The
planned closure rate adjustment must be calculated under
subdivision 6. Facilities that close without a closure plan, or
whose closure plan is not approved by the commissioner, are not
eligible to assign a planned closure rate adjustment under
subdivision 6. The commissioner shall calculate the amount the
facility would have been eligible to assign under subdivision 6,
and shall use this amount to provide equal rate adjustments to
the five nursing facilities with the lowest total operating
payment rates in the state development region designated under
section 462.385, in which the facility that closed is located.
(c) To be considered for approval, an application must
include:
(1) a description of the proposed closure plan, which must
include identification of the facility or facilities to receive
a planned closure rate adjustment and the amount and timing of a
planned closure rate adjustment proposed for each facility;
(2) the proposed timetable for any proposed closure,
including the proposed dates for announcement to residents,
commencement of closure, and completion of closure;
(3) the proposed relocation plan for current residents of
any facility designated for closure. The proposed relocation
plan must be designed to comply with all applicable state and
federal statutes and regulations, including, but not limited to,
section 144A.161;
(4) a description of the relationship between the nursing
facility that is proposed for closure and the nursing facility
or facilities proposed to receive the planned closure rate
adjustment. If these facilities are not under common ownership,
copies of any contracts, purchase agreements, or other documents
establishing a relationship or proposed relationship must be
provided;
(5) documentation, in a format approved by the
commissioner, that all the nursing facilities receiving a
planned closure rate adjustment under the plan have accepted
joint and several liability for recovery of overpayments under
section 256B.0641, subdivision 2, for the facilities designated
for closure under the plan; and
(6) an explanation of how the application coordinates with
planning efforts under subdivision 2. If the planning group
does not support a level of nursing facility closures that the
commissioner considers to be reasonable, the commissioner may
approve a planned closure proposal without its support.
(d) The application must address the criteria listed in
subdivision 4.
Subd. 4. [CRITERIA FOR REVIEW OF APPLICATION.] In
reviewing and approving closure proposals, the commissioner
shall consider, but not be limited to, the following criteria:
(1) improved quality of care and quality of life for
consumers;
(2) closure of a nursing facility that has a poor physical
plant, which may be evidenced by the conditions referred to in
section 144A.073, subdivision 4, clauses (4) and (5);
(3) the existence of excess nursing facility beds, measured
in terms of beds per thousand persons aged 85 or older. The
excess must be measured in reference to:
(i) the county in which the facility is located;
(ii) the county and all contiguous counties;
(iii) the region in which the facility is located; or
(iv) the facility's service area;
the facility shall indicate in its application the service area
it believes is appropriate for this measurement. A facility in
a county that is in the lowest quartile of counties with
reference to beds per thousand persons aged 85 or older is not
in an area of excess capacity;
(4) low-occupancy rates, provided that the unoccupied beds
are not the result of a personnel shortage. In analyzing
occupancy rates, the commissioner shall examine waiting lists in
the applicant facility and at facilities in the surrounding
area, as determined under clause (3);
(5) evidence of coordination between the community planning
process and the facility application. If the planning group
does not support a level of nursing facility closures that the
commissioner considers to be reasonable, the commissioner may
approve a planned closure proposal without its support;
(6) proposed usage of funds available from a planned
closure rate adjustment for care-related purposes;
(7) innovative use planned for the closed facility's
physical plant;
(8) evidence that the proposal serves the interests of the
state; and
(9) evidence of other factors that affect the viability of
the facility, including excessive nursing pool costs.
Subd. 5. [REVIEW AND APPROVAL OF APPLICATIONS.] (a) The
commissioner of human services, in consultation with the
commissioner of health, shall approve or disapprove an
application within 30 days after receiving it. The commissioner
may appoint an advisory review panel composed of representatives
of counties, SAIL projects, consumers, and providers to review
proposals and provide comments and recommendations to the
committee. The commissioners of human services and health shall
provide staff and technical assistance to the committee for the
review and analysis of proposals.
(b) Approval of a planned closure expires 18 months after
approval by the commissioner of human services, unless
commencement of closure has begun.
(c) The commissioner of human services may change any
provision of the application to which the applicant, the
regional planning group, and the commissioner agree.
Subd. 6. [PLANNED CLOSURE RATE ADJUSTMENT.] (a) The
commissioner of human services shall calculate the amount of the
planned closure rate adjustment available under subdivision 3,
paragraph (b), for up to 5,140 beds according to clauses (1) to
(4):
(1) the amount available is the net reduction of nursing
facility beds multiplied by $2,080;
(2) the total number of beds in the nursing facility or
facilities receiving the planned closure rate adjustment must be
identified;
(3) capacity days are determined by multiplying the number
determined under clause (2) by 365; and
(4) the planned closure rate adjustment is the amount
available in clause (1), divided by capacity days determined
under clause (3).
(b) A planned closure rate adjustment under this section is
effective on the first day of the month following completion of
closure of the facility designated for closure in the
application and becomes part of the nursing facility's total
operating payment rate.
(c) Applicants may use the planned closure rate adjustment
to allow for a property payment for a new nursing facility or an
addition to an existing nursing facility or as an operating
payment rate adjustment. Applications approved under this
subdivision are exempt from other requirements for moratorium
exceptions under section 144A.073, subdivisions 2 and 3.
(d) Upon the request of a closing facility, the
commissioner must allow the facility a closure rate adjustment
as provided under section 144A.161, subdivision 10.
Subd. 7. [OTHER RATE ADJUSTMENTS.] Facilities receiving
planned closure rate adjustments remain eligible for any
applicable rate adjustments provided under section 256B.431,
256B.434, or any other section.
Subd. 8. [COUNTY COSTS.] The commissioner of human
services shall allocate funds for relocation costs incurred by
counties for planned closures under this section as provided
under section 144A.161, subdivision 11.
Sec. 28. [256B.438] [IMPLEMENTATION OF A CASE MIX SYSTEM
FOR NURSING FACILITIES BASED ON THE MINIMUM DATA SET.]
Subdivision 1. [SCOPE.] This section establishes the
method and criteria used to determine resident reimbursement
classifications based upon the assessments of residents of
nursing homes and boarding care homes whose payment rates are
established under section 256B.431, 256B.434, or 256B.435.
Resident reimbursement classifications shall be established
according to the 34 group, resource utilization groups, version
III or RUG-III model as described in section 144.0724.
Reimbursement classifications established under this section
shall be implemented after June 30, 2002, but no later than
January 1, 2003.
Subd. 2. [DEFINITIONS.] For purposes of this section, the
following terms have the meanings given.
(a) [ASSESSMENT REFERENCE DATE.] "Assessment reference
date" has the meaning given in section 144.0724, subdivision 2,
paragraph (a).
(b) [CASE MIX INDEX.] "Case mix index" has the meaning
given in section 144.0724, subdivision 2, paragraph (b).
(c) [INDEX MAXIMIZATION.] "Index maximization" has the
meaning given in section 144.0724, subdivision 2, paragraph (c).
(d) [MINIMUM DATA SET.] "Minimum data set" has the meaning
given in section 144.0724, subdivision 2, paragraph (d).
(e) [REPRESENTATIVE.] "Representative" has the meaning
given in section 144.0724, subdivision 2, paragraph (e).
(f) [RESOURCE UTILIZATION GROUPS OR RUG.] "Resource
utilization groups" or "RUG" has the meaning given in section
144.0724, subdivision 2, paragraph (f).
Subd. 3. [CASE MIX INDICES.] (a) The commissioner of human
services shall assign a case mix index to each resident class
based on the Health Care Financing Administration's staff time
measurement study and adjusted for Minnesota-specific wage
indices. The case mix indices assigned to each resident class
shall be published in the Minnesota State Register at least 120
days prior to the implementation of the 34 group, RUG-III
resident classification system.
(b) An index maximization approach shall be used to
classify residents.
(c) After implementation of the revised case mix system,
the commissioner of human services may annually rebase case mix
indices and base rates using more current data on average wage
rates and staff time measurement studies. This rebasing shall
be calculated under subdivision 7, paragraph (b). The
commissioner shall publish in the Minnesota State Register
adjusted case mix indices at least 45 days prior to the
effective date of the adjusted case mix indices.
Subd. 4. [RESIDENT ASSESSMENT SCHEDULE.] (a) Nursing
facilities shall conduct and submit case mix assessments
according to the schedule established by the commissioner of
health under section 144.0724, subdivisions 4 and 5.
(b) The resident reimbursement classifications established
under section 144.0724, subdivision 3, shall be effective the
day of admission for new admission assessments. The effective
date for significant change assessments shall be the assessment
reference date. The effective date for annual and second
quarterly assessments shall be the first day of the month
following assessment reference date.
Subd. 5. [NOTICE OF RESIDENT REIMBURSEMENT
CLASSIFICATION.] Nursing facilities shall provide notice to a
resident of the resident's case mix classification according to
procedures established by the commissioner of health under
section 144.0724, subdivision 7.
Subd. 6. [RECONSIDERATION OF RESIDENT CLASSIFICATION.] Any
request for reconsideration of a resident classification must be
made under section 144.0724, subdivision 8.
Subd. 7. [RATE DETERMINATION UPON TRANSITION TO RUG-III
PAYMENT RATES.] (a) The commissioner of human services shall
determine payment rates at the time of transition to the RUG
based payment model in a facility-specific, budget-neutral
manner. The case mix indices as defined in subdivision 3 shall
be used to allocate the case mix adjusted component of total
payment across all case mix groups. To transition from the
current calculation methodology to the RUG based methodology,
the commissioner of health shall report to the commissioner of
human services the resident days classified according to the
categories defined in subdivision 3 for the 12-month reporting
period ending September 30, 2001, for each nursing facility.
The commissioner of human services shall use this data to
compute the standardized days for the reporting period under the
RUG system.
(b) The commissioner of human services shall determine the
case mix adjusted component of the rate as follows:
(1) determine the case mix portion of the 11 case mix rates
in effect on June 30, 2002, or the 34 case mix rates in effect
on or after June 30, 2003;
(2) multiply each amount in clause (1) by the number of
resident days assigned to each group for the reporting period
ending September 30, 2001, or the most recent year for which
data is available;
(3) compute the sum of the amounts in clause (2);
(4) determine the total RUG standardized days for the
reporting period ending September 30, 2001, or the most recent
year for which data is available using the new indices
calculated under subdivision 3, paragraph (c);
(5) divide the amount in clause (3) by the amount in clause
(4) which shall be the average case mix adjusted component of
the rate under the RUG method; and
(6) multiply this average rate by the case mix weight in
subdivision 3 for each RUG group.
(c) The noncase mix component will be allocated to each RUG
group as a constant amount to determine the transition payment
rate. Any other rate adjustments that are effective on or after
July 1, 2002, shall be applied to the transition rates
determined under this section.
Sec. 29. [256B.439] [LONG-TERM CARE QUALITY PROFILES.]
Subdivision l. [DEVELOPMENT AND IMPLEMENTATION OF QUALITY
PROFILES.] (a) The commissioner of human services, in
cooperation with the commissioner of health, shall develop and
implement a quality profile system for nursing facilities and,
beginning not later than July 1, 2003, other providers of
long-term care services, except when the quality profile system
would duplicate requirements under section 256B.5011, 256B.5012,
or 256B.5013. The system must be developed and implemented to
the extent possible without the collection of significant
amounts of new data. To the extent possible, the system must
incorporate or be coordinated with information on quality
maintained by area agencies on aging, long-term care trade
associations, and other entities. The system must be designed
to provide information on quality to:
(1) consumers and their families to facilitate informed
choices of service providers;
(2) providers to enable them to measure the results of
their quality improvement efforts and compare quality
achievements with other service providers; and
(3) public and private purchasers of long-term care
services to enable them to purchase high-quality care.
(b) The system must be developed in consultation with the
long-term care task force, area agencies on aging, and
representatives of consumers, providers, and labor unions.
Within the limits of available appropriations, the commissioners
may employ consultants to assist with this project.
Subd. 2. [QUALITY MEASUREMENT TOOLS.] The commissioners
shall identify and apply existing quality measurement tools to:
(1) emphasize quality of care and its relationship to
quality of life; and
(2) address the needs of various users of long-term care
services, including, but not limited to, short-stay residents,
persons with behavioral problems, persons with dementia, and
persons who are members of minority groups.
The tools must be identified and applied, to the extent
possible, without requiring providers to supply information
beyond current state and federal requirements.
Subd. 3. [CONSUMER SURVEYS.] Following identification of
the quality measurement tool, the commissioners shall conduct
surveys of long-term care service consumers to develop quality
profiles of providers. To the extent possible, surveys must be
conducted face-to-face by state employees or contractors. At
the discretion of the commissioners, surveys may be conducted by
telephone or by provider staff. Surveys must be conducted
periodically to update quality profiles of individual service
providers.
Subd. 4. [DISSEMINATION OF QUALITY PROFILES.] By July 1,
2002, the commissioners shall implement a system to disseminate
the quality profiles developed from consumer surveys using the
quality measurement tool. Profiles may be disseminated to the
Senior LinkAge line and to consumers, providers, and purchasers
of long-term care services through all feasible printed and
electronic outlets. The commissioners may conduct a public
awareness campaign to inform potential users regarding profile
contents and potential uses.
Sec. 30. Minnesota Statutes 2000, section 256B.5012, is
amended by adding a subdivision to read:
Subd. 4. [ICF/MR RATE INCREASES BEGINNING JULY 1, 2001,
AND JULY 1, 2002.] (a) For the rate years beginning July 1,
2001, and July 1, 2002, the commissioner shall make available to
each facility reimbursed under this section an adjustment to the
total operating payment rate of 3.5 percent. Of this
adjustment, two-thirds must be used as provided under paragraph
(b) and one-third must be used for operating costs.
(b) The adjustment under this paragraph must be used to
increase the wages and benefits and pay associated costs of all
employees except administrative and central office employees,
provided that this increase must be used only for wage and
benefit increases implemented on or after the first day of the
rate year and must not be used for increases implemented prior
to that date.
(c) For each facility, the commissioner shall make
available an adjustment using the percentage specified in
paragraph (a) multiplied by the total payment rate, excluding
the property-related payment rate, in effect on the preceding
June 30. The total payment rate shall include the adjustment
provided in section 256B.501, subdivision 12.
(d) A facility whose payment rates are governed by closure
agreements, receivership agreements, or Minnesota Rules, part
9553.0075, is not eligible for an adjustment otherwise granted
under this subdivision.
(e) A facility may apply for the payment rate adjustment
provided under paragraph (b). The application must be made to
the commissioner and contain a plan by which the facility will
distribute the adjustment in paragraph (b) to employees of the
facility. For 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. A negotiated
agreement may constitute the plan only if the agreement is
finalized after the date of enactment of all rate increases for
the rate year. The commissioner shall review the plan to ensure
that the payment rate adjustment per diem is used as provided in
this subdivision. To be eligible, a facility must submit its
plan by March 31, 2002, and March 31, 2003, respectively. If a
facility's plan is effective for its employees after the first
day of the applicable rate year that the funds are available,
the payment rate adjustment per diem is effective the same date
as its plan.
(f) A copy of the approved distribution plan must be made
available to all employees by giving each employee a copy or by
posting it in an area of the facility to which all employees
have access. If an employee does not receive the wage and
benefit adjustment described in the 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 telephone number
provided by the commissioner and included in the approved plan.
Sec. 31. Minnesota Statutes 2000, section 626.557,
subdivision 12b, is amended to read:
Subd. 12b. [DATA MANAGEMENT.] (a) [COUNTY DATA.] In
performing any of the duties of this section as a lead agency,
the county social service agency shall maintain appropriate
records. Data collected by the county social service agency
under this section are welfare data under section 13.46.
Notwithstanding section 13.46, subdivision 1, paragraph (a),
data under this paragraph that are inactive investigative data
on an individual who is a vendor of services are private data on
individuals, as defined in section 13.02. The identity of the
reporter may only be disclosed as provided in paragraph (c).
Data maintained by the common entry point are confidential
data on individuals or protected nonpublic data as defined in
section 13.02. Notwithstanding section 138.163, the common
entry point shall destroy data three calendar years after date
of receipt.
(b) [LEAD AGENCY DATA.] The commissioners of health and
human services shall prepare an investigation memorandum for
each report alleging maltreatment investigated under this
section. During an investigation by the commissioner of health
or the commissioner of human services, data collected under this
section are confidential data on individuals or protected
nonpublic data as defined in section 13.02. Upon completion of
the investigation, the data are classified as provided in
clauses (1) to (3) and paragraph (c).
(1) The investigation memorandum must contain the following
data, which are public:
(i) the name of the facility investigated;
(ii) a statement of the nature of the alleged maltreatment;
(iii) pertinent information obtained from medical or other
records reviewed;
(iv) the identity of the investigator;
(v) a summary of the investigation's findings;
(vi) statement of whether the report was found to be
substantiated, inconclusive, false, or that no determination
will be made;
(vii) a statement of any action taken by the facility;
(viii) a statement of any action taken by the lead agency;
and
(ix) when a lead agency's determination has substantiated
maltreatment, a statement of whether an individual, individuals,
or a facility were responsible for the substantiated
maltreatment, if known.
The investigation memorandum must be written in a manner
which protects the identity of the reporter and of the
vulnerable adult and may not contain the names or, to the extent
possible, data on individuals or private data listed in clause
(2).
(2) Data on individuals collected and maintained in the
investigation memorandum are private data, including:
(i) the name of the vulnerable adult;
(ii) the identity of the individual alleged to be the
perpetrator;
(iii) the identity of the individual substantiated as the
perpetrator; and
(iv) the identity of all individuals interviewed as part of
the investigation.
(3) Other data on individuals maintained as part of an
investigation under this section are private data on individuals
upon completion of the investigation.
(c) [IDENTITY OF REPORTER.] The subject of the report may
compel disclosure of the name of the reporter only with the
consent of the reporter or upon a written finding by a court
that the report was false and there is evidence that the report
was made in bad faith. This subdivision does not alter
disclosure responsibilities or obligations under the rules of
criminal procedure, except that where the identity of the
reporter is relevant to a criminal prosecution, the district
court shall do an in-camera review prior to determining whether
to order disclosure of the identity of the reporter.
(d) [DESTRUCTION OF DATA.] Notwithstanding section
138.163, data maintained under this section by the commissioners
of health and human services must be destroyed under the
following schedule:
(1) data from reports determined to be false, two years
after the finding was made;
(2) data from reports determined to be inconclusive, four
years after the finding was made;
(3) data from reports determined to be substantiated, seven
years after the finding was made; and
(4) data from reports which were not investigated by a lead
agency and for which there is no final disposition, two years
from the date of the report.
(e) [SUMMARY OF REPORTS.] The commissioners of health and
human services shall each annually prepare a summary of report
to the legislature and the governor on the number and type of
reports of alleged maltreatment involving licensed facilities
reported under this section, the number of those requiring
investigation under this section, and the resolution of those
investigations. The report shall identify:
(1) whether and where backlogs of cases result in a failure
to conform with statutory time frames;
(2) where adequate coverage requires additional
appropriations and staffing; and
(3) any other trends that affect the safety of vulnerable
adults.
(f) [RECORD RETENTION POLICY.] Each lead agency must have
a record retention policy.
(g) [EXCHANGE OF INFORMATION.] Lead agencies, prosecuting
authorities, and law enforcement agencies may exchange not
public data, as defined in section 13.02, if the agency or
authority requesting the data determines that the data are
pertinent and necessary to the requesting agency in initiating,
furthering, or completing an investigation under this section.
Data collected under this section must be made available to
prosecuting authorities and law enforcement officials, local
county agencies, and licensing agencies investigating the
alleged maltreatment under this section. The lead agency shall
exchange not public data with the vulnerable adult maltreatment
review panel established in section 256.021 if the data are
pertinent and necessary for a review requested under that
section. Upon completion of the review, not public data
received by the review panel must be returned to the lead agency.
(h) [COMPLETION TIME.] Each lead agency shall keep records
of the length of time it takes to complete its investigations.
(i) [NOTIFICATION OF OTHER AFFECTED PARTIES.] A lead
agency may notify other affected parties and their authorized
representative if the agency has reason to believe maltreatment
has occurred and determines the information will safeguard the
well-being of the affected parties or dispel widespread rumor or
unrest in the affected facility.
(j) [FEDERAL REQUIREMENTS.] Under any notification
provision of this section, where federal law specifically
prohibits the disclosure of patient identifying information, a
lead agency may not provide any notice unless the vulnerable
adult has consented to disclosure in a manner which conforms to
federal requirements.
Sec. 32. Laws 1995, chapter 207, article 3, section 21, as
amended by Laws 1999, chapter 245, article 3, section 43, is
amended to read:
Sec. 21. [FACILITY CERTIFICATION.]
(a) 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.
(b) 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.
(c) Effective July 1, 2001, the commissioner of human
services shall fund the entire state share of medical assistance
reimbursement for the residential and day habilitation services
funded by medical assistance and provided to clients for whom
counties are financially responsible from the medical assistance
account, and shall not make any transfer from the community
social service allocations of affected counties.
(d) 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. 33. Laws 1999, chapter 245, article 3, section 45, as
amended by Laws 2000, chapter 312, section 3, is amended to read:
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 unless the resident, if
competent, or a family member or legally appointed conservator,
guardian, or health care agent of a resident who is not
competent, agrees in writing to waive physician involvement in
determining this interval.
(b) This section expires July 1, 2001 2003.
Sec. 34. Laws 2000, chapter 364, section 2, is amended to
read:
Sec. 2. [MORATORIUM EXCEPTION PROCESS.]
For fiscal year the biennium beginning July 1, 2000 2001,
when approving nursing home moratorium exception projects under
Minnesota Statutes, section 144A.073, the commissioner of health
shall give priority to proposals a proposal to build a
replacement facilities facility in the city of Anoka or within
ten miles of the city of Anoka.
Sec. 35. [DEVELOPMENT OF NEW NURSING FACILITY
REIMBURSEMENT SYSTEM.]
(a) The commissioner of human services shall develop and
report to the legislature by January 15, 2003, a system to
replace the current nursing facility reimbursement system
established under Minnesota Statutes, sections 256B.431,
256B.434, and 256B.435.
(b) The system must be developed in consultation with the
long-term care task force and with representatives of consumers,
providers, and labor unions. Within the limits of available
appropriations, the commissioner may employ consultants to
assist with this project.
(c) The new reimbursement system must:
(1) provide incentives to enhance quality of life and
quality of care;
(2) recognize cost differences in the care of different
types of populations, including subacute care and dementia care;
(3) establish rates that are sufficient without being
excessive;
(4) be affordable for the state and for private-pay
residents;
(5) be sensitive to changing conditions in the long-term
care environment;
(6) avoid creating access problems related to insufficient
funding;
(7) allow providers maximum flexibility in their business
operations;
(8) recognize the need for capital investment to improve
physical plants; and
(9) provide incentives for the development and use of
private rooms.
(d) Notwithstanding Minnesota Statutes, section 256B.435,
the commissioner must not implement a performance-based
contracting system for nursing facilities prior to July 1, 2003.
The commissioner shall continue to reimburse nursing facilities
under Minnesota Statutes, section 256B.431 or 256B.434, until
otherwise directed by law.
(e) The commissioner of human services, in consultation
with the commissioner of health, shall conduct or contract for a
time study to determine staff time being spent on various case
mix categories; recommend adjustments to the case mix weights
based on the time study data; and determine whether current
staffing standards are adequate for providing quality care based
on professional best practice and consumer experience. If the
commissioner determines the current standards are inadequate,
the commissioner shall determine an appropriate staffing
standard for the various case mix categories and the financial
implications of phasing into this standard over the next four
years.
Sec. 36. [MINIMUM STAFFING STANDARDS REPORT.]
By January 15, 2002, the commissioner of health and the
commissioner of human services shall report to the legislature
on whether they should translate the minimum nurse staffing
requirement in Minnesota Statutes, section 144A.04, subdivision
7, paragraph (a), upon the transition to the RUG-III
classification system, or whether they should establish
different time-based standards, and how to accomplish either.
Sec. 37. [PROVIDER RATE INCREASES.]
(a) The commissioner of human services shall increase
reimbursement rates by three percent each year of the biennium
for the providers listed in paragraph (b) and 3.5 percent for
the providers listed in paragraph (c). The increases are
effective for services rendered on or after July 1 of each year.
(b) The three percent rate increases described in this
section must be provided to:
(1) home and community-based waivered services for persons
with mental retardation or related conditions under Minnesota
Statutes, section 256B.501;
(2) home and community-based waivered services for the
elderly under Minnesota Statutes, section 256B.0915;
(3) waivered services under community alternatives for
disabled individuals under Minnesota Statutes, section 256B.49;
(4) community alternative care waivered services under
Minnesota Statutes, section 256B.49;
(5) traumatic brain injury waivered services under
Minnesota Statutes, section 256B.49;
(6) nursing services and home health services under
Minnesota Statutes, section 256B.0625, subdivision 6a;
(7) personal care services and nursing supervision of
personal care services under Minnesota Statutes, section
256B.0625, subdivision 19a;
(8) private duty nursing services under Minnesota Statutes,
section 256B.0625, subdivision 7;
(9) day training and habilitation services for adults with
mental retardation or related conditions under Minnesota
Statutes, sections 252.40 to 252.46;
(10) alternative care services under Minnesota Statutes,
section 256B.0913;
(11) adult residential program grants under Minnesota
Rules, parts 9535.2000 to 9535.3000;
(12) adult and family community support grants under
Minnesota Rules, parts 9535.1700 to 9535.1760;
(13) the group residential housing supplementary service
rate under Minnesota Statutes, section 256I.05, subdivision 1a;
(14) adult mental health integrated fund grants under
Minnesota Statutes, section 245.4661;
(15) 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;
(16) 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; and
(17) living skills training programs for persons with
intractable epilepsy who need assistance in the transition to
independent living.
(c) The 3.5 percent rate increases described in this
section must be provided to day training and habilitation
services under Minnesota Statutes, chapter 256B.
(d) Providers that receive a rate increase under this
section shall use one-third of the additional revenue for
operating cost increases and two-thirds of the additional
revenue to increase wages and benefits and pay associated costs
for all employees other than the administrator and central
office staff. For public employees, the portion of this
increase reserved to increase wages and benefits for certain
staff is available and pay rates shall be increased only to the
extent that they comply with laws governing public employees
collective bargaining. Money received by a provider for pay
increases under this section must be used only for increases
implemented on or after the first day of the state fiscal year
in which the increase is available and must not be used for
increases implemented prior to that date.
(e) A copy of the provider's plan for complying with
paragraph (d) must be made available to all employees 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 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.
Sec. 38. [REGULATORY FLEXIBILITY.]
(a) By September 1, 2001, the commissioners of health and
human services shall:
(1) develop a summary of federal nursing facility and
community long-term care regulations that hamper state
flexibility and place burdens on the goal of achieving
high-quality care and optimum outcomes for consumers of
services; and
(2) share this summary with the legislature, other states,
national groups that advocate for state interests with Congress,
and the Minnesota congressional delegation.
(b) The commissioners shall conduct ongoing follow-up with
the entities to which this summary is provided and with the
health care financing administration to achieve maximum
regulatory flexibility, including the possibility of pilot
projects to demonstrate regulatory flexibility on less than a
statewide basis.
Sec. 39. [REPORT.]
By January 15, 2003, the commissioner of health and the
commissioner of human services shall report to the senate health
and family security committee and the house health and human
services policy committee on the number of closures that have
taken place under Minnesota Statutes, section 256B.437, and any
other nursing facility closures that may have taken place,
alternatives to nursing facility care that have been developed,
any problems with access to long-term care services that have
resulted, and any recommendations for continuation of the
regional long-term care planning process and the closure process
after June 30, 2003.
Sec. 40. [INSTRUCTION TO REVISOR.]
The revisor of statutes shall delete any reference to
Minnesota Statutes, section 144A.16, in Minnesota Statutes and
Minnesota Rules.
Sec. 41. [REPEALER.]
(a) Minnesota Statutes 2000, sections 144A.16; and
256B.434, subdivision 5, are repealed.
(b) Minnesota Rules, parts 4655.6810; 4655.6820; 4655.6830;
4658.1600; 4658.1605; 4658.1610; 4658.1690; 9546.0010;
9546.0020; 9546.0030; 9546.0040; 9546.0050; and 9546.0060, are
repealed.
ARTICLE 6
WORKFORCE RECRUITMENT AND RETENTION
Section 1. Minnesota Statutes 2000, section 116L.11,
subdivision 4, is amended to read:
Subd. 4. [QUALIFYING CONSORTIUM.] "Qualifying consortium"
means an entity that may include includes a public or private
institution of higher education, work force center, county, and
one or more eligible employers, but must include a public or
private institution of higher education and one or more eligible
employers employer.
Sec. 2. Minnesota Statutes 2000, section 116L.12,
subdivision 4, is amended to read:
Subd. 4. [GRANTS.] Within the limits of available
appropriations, the board shall make grants not to exceed
$400,000 each to qualifying consortia to operate local,
regional, or statewide training and retention programs. Grants
may be made from TANF funds, general fund appropriations, and
any other funding sources available to the board, provided the
requirements of those funding sources are satisfied. Grant
awards must establish specific, measurable outcomes and
timelines for achieving those outcomes.
Sec. 3. Minnesota Statutes 2000, section 116L.12,
subdivision 5, is amended to read:
Subd. 5. [LOCAL MATCH REQUIREMENTS.] A consortium must
provide at least a 50 percent match from local resources for
money appropriated under this section. The local match
requirement must be satisfied on an overall program basis but
need not be satisfied for each particular client. The local
match requirement may be reduced for consortia that include a
relatively large number of small employers whose financial
contribution has been reduced in accordance with section 116L.15.
In-kind services and expenditures under section 116L.13,
subdivision 2, may be used to meet this local match
requirement. The grant application must specify the financial
contribution from each member of the consortium satisfy the
match requirements established in section 116L.02, paragraph (a).
Sec. 4. Minnesota Statutes 2000, section 116L.13,
subdivision 1, is amended to read:
Subdivision 1. [MARKETING AND RECRUITMENT.] A qualifying
consortium must implement a marketing and outreach strategy to
recruit into the health care and human services fields persons
from one or more of the potential employee target groups.
Recruitment strategies must include:
(1) a screening process to evaluate whether potential
employees may be disqualified as the result of a required
background check or are otherwise unlikely to succeed in the
position for which they are being recruited; and
(2) a process for modifying course work to meet the
training needs of non-English-speaking persons, when appropriate.
Sec. 5. [116L.146] [EXPEDITED GRANT PROCESS.]
(a) The board may authorize grants not to exceed $50,000
each through an expedited grant approval process to:
(1) eligible employers to provide training programs for up
to 50 workers; or
(2) a public or private institution of higher education to:
(i) do predevelopment or curriculum development for
training programs prior to submission for program funding under
section 116L.12;
(ii) convert an existing curriculum for distance learning
through interactive television or other communication methods;
or
(iii) enable a training program to be offered when it would
otherwise be canceled due to an enrollment shortfall of one or
two students when the program is offered in a health-related
field with a documented worker shortage and is part of a
training program not exceeding two years in length.
(b) The board shall develop application procedures and
evaluation policies for grants made under this section.
Sec. 6. Minnesota Statutes 2000, section 256B.431, is
amended by adding a subdivision to read:
Subd. 36. [EMPLOYEE SCHOLARSHIP COSTS AND TRAINING IN
ENGLISH AS A SECOND LANGUAGE.] (a) For the period between July
1, 2001, and June 30, 2003, the commissioner shall provide to
each nursing facility reimbursed under this section, section
256B.434, or any other section, a scholarship per diem of 25
cents to the total operating payment rate to be used:
(1) for employee scholarships that satisfy the following
requirements:
(i) scholarships are available to all employees who work an
average of at least 20 hours per week at the facility except the
administrator, department supervisors, and registered nurses;
and
(ii) the course of study is expected to lead to career
advancement with the facility or in long-term care, including
medical care interpreter services and social work; and
(2) to provide job-related training in English as a second
language.
(b) A facility receiving a rate adjustment under this
subdivision may submit to the commissioner on a schedule
determined by the commissioner and on a form supplied by the
commissioner a calculation of the scholarship per diem,
including: the amount received from this rate adjustment; the
amount used for training in English as a second language; the
number of persons receiving the training; the name of the person
or entity providing the training; and for each scholarship
recipient, the name of the recipient, the amount awarded, the
educational institution attended, the nature of the educational
program, the program completion date, and a determination of the
per diem amount of these costs based on actual resident days.
(c) On July 1, 2003, the commissioner shall remove the 25
cent scholarship per diem from the total operating payment rate
of each facility.
(d) For rate years beginning after June 30, 2003, the
commissioner shall provide to each facility the scholarship per
diem determined in paragraph (b).
Sec. 7. [CHIP WAIVER.]
The commissioner of human services shall seek all waivers
necessary to obtain enhanced matching funds under the state
children's health insurance program established as title XXI of
the Social Security Act, United States Code, title 42, section
1397aa et seq. for a program to develop a long-term care
employee health insurance program. Upon receipt of federal
approval, the commissioner, in consultation with the long-term
care task force, shall report to the legislature with
recommendations on implementing the program.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 8. [REPEALER.]
Minnesota Statutes 2000, section 116L.12, subdivisions 2
and 7, are repealed.
ARTICLE 7
REGULATION OF SUPPLEMENTAL
NURSING SERVICES AGENCIES
Section 1. Minnesota Statutes 2000, section 144.057, is
amended to read:
144.057 [BACKGROUND STUDIES ON LICENSEES AND SUPPLEMENTAL
NURSING SERVICES AGENCY PERSONNEL.]
Subdivision 1. [BACKGROUND STUDIES REQUIRED.] The
commissioner of health shall contract with the commissioner of
human services to conduct background studies of:
(1) individuals providing services which have direct
contact, as defined under section 245A.04, subdivision 3, with
patients and residents in hospitals, boarding care homes,
outpatient surgical centers licensed under sections 144.50 to
144.58; nursing homes and home care agencies licensed under
chapter 144A; residential care homes licensed under chapter
144B, and board and lodging establishments that are registered
to provide supportive or health supervision services under
section 157.17; and
(2) beginning July 1, 1999, all other employees in nursing
homes licensed under chapter 144A, and boarding care homes
licensed under sections 144.50 to 144.58. A disqualification of
an individual in this section shall disqualify the individual
from positions allowing direct contact or access to patients or
residents receiving services;
(3) individuals employed by a supplemental nursing services
agency, as defined under section 144A.70, who are providing
services in health care facilities; and
(4) controlling persons of a supplemental nursing services
agency, as defined under section 144A.70.
If a facility or program is licensed by the department of
human services and subject to the background study provisions of
chapter 245A and is also licensed by the department of health,
the department of human services is solely responsible for the
background studies of individuals in the jointly licensed
programs.
Subd. 2. [RESPONSIBILITIES OF DEPARTMENT OF HUMAN
SERVICES.] The department of human services shall conduct the
background studies required by subdivision 1 in compliance with
the provisions of chapter 245A and Minnesota Rules, parts
9543.3000 to 9543.3090. For the purpose of this section, the
term "residential program" shall include all facilities
described in subdivision 1. The department of human services
shall provide necessary forms and instructions, shall conduct
the necessary background studies of individuals, and shall
provide notification of the results of the studies to the
facilities, supplemental nursing services agencies, individuals,
and the commissioner of health. Individuals shall be
disqualified under the provisions of chapter 245A and Minnesota
Rules, parts 9543.3000 to 9543.3090. If an individual is
disqualified, the department of human services shall notify the
facility, the supplemental nursing services agency, and the
individual and shall inform the individual of the right to
request a reconsideration of the disqualification by submitting
the request to the department of health.
Subd. 3. [RECONSIDERATIONS.] The commissioner of health
shall review and decide reconsideration requests, including the
granting of variances, in accordance with the procedures and
criteria contained in chapter 245A and Minnesota Rules, parts
9543.3000 to 9543.3090. The commissioner's decision shall be
provided to the individual and to the department of human
services. The commissioner's decision to grant or deny a
reconsideration of disqualification is the final administrative
agency action, except for the provisions under section 245A.04,
subdivisions 3b, paragraphs (e) and (f); and 3c, paragraph (a).
[EFFECTIVE DATE.] This subdivision is effective January 1,
2002.
Subd. 4. [RESPONSIBILITIES OF FACILITIES AND AGENCIES.]
Facilities and agencies described in subdivision 1 shall be
responsible for cooperating with the departments in implementing
the provisions of this section. The responsibilities imposed on
applicants and licensees under chapter 245A and Minnesota Rules,
parts 9543.3000 to 9543.3090, shall apply to these
facilities and supplemental nursing services agencies. The
provision of section 245A.04, subdivision 3, paragraph (e),
shall apply to applicants, licensees, registrants, or an
individual's refusal to cooperate with the completion of the
background studies. Supplemental nursing services agencies
subject to the registration requirements in section 144A.71 must
maintain records verifying compliance with the background study
requirements under this section.
Sec. 2. [144A.70] [REGISTRATION OF SUPPLEMENTAL NURSING
SERVICES AGENCIES; DEFINITIONS.]
Subdivision 1. [SCOPE.] As used in sections 144A.70 to
144A.74, the terms defined in this section have the meanings
given them.
Subd. 2. [COMMISSIONER.] "Commissioner" means the
commissioner of health.
Subd. 3. [CONTROLLING PERSON.] "Controlling person" means
a business entity, officer, program administrator, or director
whose responsibilities include the direction of the management
or policies of a supplemental nursing services agency.
Controlling person also means an individual who, directly or
indirectly, beneficially owns an interest in a corporation,
partnership, or other business association that is a controlling
person.
Subd. 4. [HEALTH CARE FACILITY.] "Health care facility"
means a hospital, boarding care home, or outpatient surgical
center licensed under sections 144.50 to 144.58; a nursing home
or home care agency licensed under this chapter; a housing with
services establishment registered under chapter 144D; or a board
and lodging establishment that is registered to provide
supportive or health supervision services under section 157.17.
Subd. 5. [PERSON.] "Person" includes an individual, firm,
corporation, partnership, or association.
Subd. 6. [SUPPLEMENTAL NURSING SERVICES
AGENCY.] "Supplemental nursing services agency" means a person,
firm, corporation, partnership, or association engaged for hire
in the business of providing or procuring temporary employment
in health care facilities for nurses, nursing assistants, nurse
aides, and orderlies. Supplemental nursing services agency does
not include an individual who only engages in providing the
individual's services on a temporary basis to health care
facilities. Supplemental nursing services agency also does not
include any nursing service agency that is limited to providing
temporary nursing personnel solely to one or more health care
facilities owned or operated by the same person, firm,
corporation, or partnership.
Sec. 3. [144A.71] [SUPPLEMENTAL NURSING SERVICES AGENCY
REGISTRATION.]
Subdivision 1. [DUTY TO REGISTER.] A person who operates a
supplemental nursing services agency shall register the agency
with the commissioner. Each separate location of the business
of a supplemental nursing services agency shall register the
agency with the commissioner. Each separate location of the
business of a supplemental nursing services agency shall have a
separate registration.
Subd. 2. [APPLICATION INFORMATION AND FEE.] The
commissioner shall establish forms and procedures for processing
each supplemental nursing services agency registration
application. An application for a supplemental nursing services
agency registration must include at least the following:
(1) the names and addresses of the owner or owners of the
supplemental nursing services agency;
(2) if the owner is a corporation, copies of its articles
of incorporation and current bylaws, together with the names and
addresses of its officers and directors;
(3) any other relevant information that the commissioner
determines is necessary to properly evaluate an application for
registration; and
(4) the annual registration fee for a supplemental nursing
services agency, which is $891.
Subd. 3. [REGISTRATION NOT TRANSFERABLE.] A registration
issued by the commissioner according to this section is
effective for a period of one year from the date of its issuance
unless the registration is revoked or suspended under section
144A.72, subdivision 2, or unless the supplemental nursing
services agency is sold or ownership or management is
transferred. When a supplemental nursing services agency is
sold or ownership or management is transferred, the registration
of the agency must be voided and the new owner or operator may
apply for a new registration.
Sec. 4. [144A.72] [REGISTRATION REQUIREMENTS; PENALTIES.]
Subdivision 1. [MINIMUM CRITERIA.] The commissioner shall
require that, as a condition of registration:
(1) the supplemental nursing services agency shall document
that each temporary employee provided to health care facilities
currently meets the minimum licensing, training, and continuing
education standards for the position in which the employee will
be working;
(2) the supplemental nursing services agency shall comply
with all pertinent requirements relating to the health and other
qualifications of personnel employed in health care facilities;
(3) the supplemental nursing services agency must not
restrict in any manner the employment opportunities of its
employees;
(4) the supplemental nursing services agency, when
supplying temporary employees to a health care facility, and
when requested by the facility to do so, shall agree that at
least 30 percent of the total personnel hours supplied are
during night, holiday, or weekend shifts;
(5) the supplemental nursing services agency shall carry
medical malpractice insurance to insure against the loss,
damage, or expense incident to a claim arising out of the death
or injury of any person as the result of negligence or
malpractice in the provision of health care services by the
supplemental nursing services agency or by any employee of the
agency; and
(6) the supplemental nursing services agency must not, in
any contract with any employee or health care facility, require
the payment of liquidated damages, employment fees, or other
compensation should the employee be hired as a permanent
employee of a health care facility.
Subd. 2. [PENALTIES.] A pattern of failure to comply with
this section shall subject the supplemental nursing services
agency to revocation or nonrenewal of its registration.
Violations of section 144A.74 are subject to a fine equal to 200
percent of the amount billed or received in excess of the
maximum permitted under that section.
Sec. 5. [144A.73] [COMPLAINT SYSTEM.]
The commissioner shall establish a system for reporting
complaints against a supplemental nursing services agency or its
employees. Complaints may be made by any member of the public.
Written complaints must be forwarded to the employer of each
person against whom a complaint is made. The employer shall
promptly report to the commissioner any corrective action taken.
Sec. 6. [144A.74] [MAXIMUM CHARGES.]
A supplemental nursing services agency must not bill or
receive payments from a nursing home licensed under this chapter
at a rate higher than 150 percent of the weighted average wage
rate for the applicable employee classification for the
geographic group to which the nursing home is assigned under
Minnesota Rules, part 9549.0052. The weighted average wage
rates must be determined by the commissioner of human services
and reported to the commissioner of health on an annual basis.
Facilities shall provide information necessary to determine
weighted average wage rates to the commissioner of human
services in a format requested by the commissioner. The maximum
rate must include all charges for administrative fees, contract
fees, or other special charges in addition to the hourly rates
for the temporary nursing pool personnel supplied to a nursing
home.
[EFFECTIVE DATE.] This section is effective August 31, 2001.
Sec. 7. [256B.039] [REPORTING OF SUPPLEMENTAL NURSING
SERVICES AGENCY USE.]
Beginning March 1, 2002, the commissioner shall to report
to the legislature annually on the use of supplemental nursing
services, including the number of hours worked by supplemental
nursing services agency personnel and payments to supplemental
nursing services agencies.
ARTICLE 8
LONG-TERM CARE INSURANCE
Section 1. Minnesota Statutes 2000, section 62A.48,
subdivision 4, is amended to read:
Subd. 4. [LOSS RATIO.] The anticipated loss ratio for
long-term care policies must not be less than 65 percent for
policies issued on a group basis or 60 percent for policies
issued on an individual or mass-market basis. This subdivision
does not apply to policies issued on or after January 1, 2002,
that comply with sections 62S.021 and 62S.081.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 2. Minnesota Statutes 2000, section 62A.48, is
amended by adding a subdivision to read:
Subd. 10. [REGULATION OF PREMIUMS AND PREMIUM
INCREASES.] Policies issued under sections 62A.46 to 62A.56 on
or after January 1, 2002, must comply with sections 62S.021,
62S.081, 62S.265, and 62S.266 to the same extent as policies
issued under chapter 62S.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 3. Minnesota Statutes 2000, section 62A.48, is
amended by adding a subdivision to read:
Subd. 11. [NONFORFEITURE BENEFITS.] Policies issued under
sections 62A.46 to 62A.56 on or after January 1, 2002, must
comply with section 62S.02, subdivision 2, to the same extent as
policies issued under chapter 62S.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 4. Minnesota Statutes 2000, section 62S.01, is
amended by adding a subdivision to read:
Subd. 13a. [EXCEPTIONAL INCREASE.] (a) "Exceptional
increase" means only those premium rate increases filed by an
insurer as exceptional for which the commissioner determines
that the need for the premium rate increase is justified due to
changes in laws or rules applicable to long-term care coverage
in this state, or due to increased and unexpected utilization
that affects the majority of insurers of similar products.
(b) Except as provided in section 62S.265, exceptional
increases are subject to the same requirements as other premium
rate schedule increases. The commissioner may request a review
by an independent actuary or a professional actuarial body of
the basis for a request that an increase be considered an
exceptional increase. The commissioner, in determining that the
necessary basis for an exceptional increase exists, shall also
determine any potential offsets to higher claims costs.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 5. Minnesota Statutes 2000, section 62S.01, is
amended by adding a subdivision to read:
Subd. 17a. [INCIDENTAL.] "Incidental," as used in section
62S.265, subdivision 10, means that the value of the long-term
care benefits provided is less than ten percent of the total
value of the benefits provided over the life of the policy.
These values must be measured as of the date of issue.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 6. Minnesota Statutes 2000, section 62S.01, is
amended by adding a subdivision to read:
Subd. 23a. [QUALIFIED ACTUARY.] "Qualified actuary" means
a member in good standing of the American Academy of Actuaries.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 7. Minnesota Statutes 2000, section 62S.01, is
amended by adding a subdivision to read:
Subd. 25a. [SIMILAR POLICY FORMS.] "Similar policy forms"
means all of the long-term care insurance policies and
certificates issued by an insurer in the same long-term care
benefit classification as the policy form being considered.
Certificates of groups that meet the definition in section
62S.01, subdivision 15, clause (1), are not considered similar
to certificates or policies otherwise issued as long-term care
insurance, but are similar to other comparable certificates with
the same long-term care benefit classifications. For purposes
of determining similar policy forms, long-term care benefit
classifications are defined as follows: institutional long-term
care benefits only, noninstitutional long-term care benefits
only, or comprehensive long-term care benefits.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 8. [62S.021] [LONG-TERM CARE INSURANCE; INITIAL
FILING.]
Subdivision 1. [APPLICABILITY.] This section applies to
any long-term care policy issued in this state on or after
January 1, 2002, under this chapter or sections 62A.46 to 62A.56.
Subd. 2. [REQUIRED SUBMISSION TO COMMISSIONER.] An insurer
shall provide the following information to the commissioner 30
days prior to making a long-term care insurance form available
for sale:
(1) a copy of the disclosure documents required in section
62S.081; and
(2) an actuarial certification consisting of at least the
following:
(i) a statement that the initial premium rate schedule is
sufficient to cover anticipated costs under moderately adverse
experience and that the premium rate schedule is reasonably
expected to be sustainable over the life of the form with no
future premium increases anticipated;
(ii) a statement that the policy design and coverage
provided have been reviewed and taken into consideration;
(iii) a statement that the underwriting and claims
adjudication processes have been reviewed and taken into
consideration; and
(iv) a complete description of the basis for contract
reserves that are anticipated to be held under the form, to
include:
(A) sufficient detail or sample calculations provided so as
to have a complete depiction of the reserve amounts to be held;
(B) a statement that the assumptions used for reserves
contain reasonable margins for adverse experience;
(C) a statement that the net valuation premium for renewal
years does not increase, except for attained age rating where
permitted;
(D) a statement that the difference between the gross
premium and the net valuation premium for renewal years is
sufficient to cover expected renewal expenses, or if such a
statement cannot be made, a complete description of the
situations in which this does not occur. An aggregate
distribution of anticipated issues may be used as long as the
underlying gross premiums maintain a reasonably consistent
relationship. If the gross premiums for certain age groups
appear to be inconsistent with this requirement, the
commissioner may request a demonstration under item (i) based on
a standard age distribution; and
(E) either a statement that the premium rate schedule is
not less than the premium rate schedule for existing similar
policy forms also available from the insurer except for
reasonable differences attributable to benefits, or a comparison
of the premium schedules for similar policy forms that are
currently available from the insurer with an explanation of the
differences.
Subd. 3. [ACTUARIAL DEMONSTRATION.] The commissioner may
request an actuarial demonstration that benefits are reasonable
in relation to premiums. The actuarial demonstration must
include either premium and claim experience on similar policy
forms, adjusted for any premium or benefit differences, relevant
and credible data from other studies, or both. If the
commissioner asks for additional information under this
subdivision, the 30-day time limit in subdivision 2 does not
include the time during which the insurer is preparing the
requested information.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 9. [62S.081] [REQUIRED DISCLOSURE OF RATING PRACTICES
TO CONSUMERS.]
Subdivision 1. [APPLICATION.] This section applies as
follows:
(a) Except as provided in paragraph (b), this section
applies to any long-term care policy or certificate issued in
this state on or after January 1, 2002.
(b) For certificates issued on or after the effective date
of this section under a policy of group long-term care insurance
as defined in section 62S.01, subdivision 15, that was in force
on the effective date of this section, this section applies on
the policy anniversary following June 30, 2002.
Subd. 2. [REQUIRED DISCLOSURES.] Other than policies for
which no applicable premium rate or rate schedule increases can
be made, insurers shall provide all of the information listed in
this subdivision to the applicant at the time of application or
enrollment, unless the method of application does not allow for
delivery at that time; in this case, an insurer shall provide
all of the information listed in this subdivision to the
applicant no later than at the time of delivery of the policy or
certificate:
(1) a statement that the policy may be subject to rate
increases in the future;
(2) an explanation of potential future premium rate
revisions and the policyholder's or certificate holder's option
in the event of a premium rate revision;
(3) the premium rate or rate schedules applicable to the
applicant that will be in effect until a request is made for an
increase;
(4) a general explanation of applying premium rate or rate
schedule adjustments that must include:
(i) a description of when premium rate or rate schedule
adjustments will be effective, for example the next anniversary
date or the next billing date; and
(ii) the right to a revised premium rate or rate schedule
as provided in clause (3) if the premium rate or rate schedule
is changed; and
(5)(i) information regarding each premium rate increase on
this policy form or similar policy forms over the past ten years
for this state or any other state that, at a minimum, identifies:
(A) the policy forms for which premium rates have been
increased;
(B) the calendar years when the form was available for
purchase; and
(C) the amount or percent of each increase. The percentage
may be expressed as a percentage of the premium rate prior to
the increase and may also be expressed as minimum and maximum
percentages if the rate increase is variable by rating
characteristics;
(ii) the insurer may, in a fair manner, provide additional
explanatory information related to the rate increases;
(iii) an insurer has the right to exclude from the
disclosure premium rate increases that apply only to blocks of
business acquired from other nonaffiliated insurers or the
long-term care policies acquired from other nonaffiliated
insurers when those increases occurred prior to the acquisition;
(iv) if an acquiring insurer files for a rate increase on a
long-term care policy form acquired from nonaffiliated insurers
or a block of policy forms acquired from nonaffiliated insurers
on or before the later of the effective date of this section, or
the end of a 24-month period following the acquisition of the
block of policies, the acquiring insurer may exclude that rate
increase from the disclosure. However, the nonaffiliated
selling company must include the disclosure of that rate
increase according to item (i); and
(v) if the acquiring insurer in item (iv) files for a
subsequent rate increase, even within the 24-month period, on
the same policy form acquired from nonaffiliated insurers or
block of policy forms acquired from nonaffiliated insurers
referenced in item (iv), the acquiring insurer shall make all
disclosures required by this subdivision, including disclosure
of the earlier rate increase referenced in item (iv).
Subd. 3. [ACKNOWLEDGMENT.] An applicant shall sign an
acknowledgment at the time of application, unless the method of
application does not allow for signature at that time, that the
insurer made the disclosure required under subdivision 2. If,
due to the method of application, the applicant cannot sign an
acknowledgment at the time of application, the applicant shall
sign no later than at the time of delivery of the policy or
certificate.
Subd. 4. [FORMS.] An insurer shall use the forms in
Appendices B and F of the Long-term Care Insurance Model
Regulation adopted by the National Association of Insurance
Commissioners to comply with the requirements of subdivisions 1
and 2.
Subd. 5. [NOTICE OF INCREASE.] An insurer shall provide
notice of an upcoming premium rate schedule increase, after the
increase has been approved by the commissioner, to all
policyholders or certificate holders, if applicable, at least 45
days prior to the implementation of the premium rate schedule
increase by the insurer. The notice must include the
information required by subdivision 2 when the rate increase is
implemented.
[EFFECTIVE DATE.] This section is effective the day
following final enactment.
Sec. 10. Minnesota Statutes 2000, section 62S.26, is
amended to read:
62S.26 [LOSS RATIO.]
(a) The minimum loss ratio must be at least 60 percent,
calculated in a manner which provides for adequate reserving of
the long-term care insurance risk. In evaluating the expected
loss ratio, the commissioner shall give consideration to all
relevant factors, including:
(1) statistical credibility of incurred claims experience
and earned premiums;
(2) the period for which rates are computed to provide
coverage;
(3) experienced and projected trends;
(4) concentration of experience within early policy
duration;
(5) expected claim fluctuation;
(6) experience refunds, adjustments, or dividends;
(7) renewabi