Minnesota Session Laws - 2023, Regular Session

CHAPTER 70--S.F.No. 2995

An act

relating to state government; modifying provisions governing health care, health insurance, health policy, the Department of Health, medical education and research costs, health care workforce, health-related licensing boards, background studies, human services licensing, behavioral health, economic assistance, housing and homelessness, children and families, child care workforce, child support, child safety, child permanency, health care affordability and delivery, human services policy, and certified community behavioral health clinics; establishing the Department of Children, Youth, and Families; making technical and conforming changes; requiring reports; making forecast adjustments; appropriating money;

amending Minnesota Statutes 2022, sections 4.045; 10.65, subdivision 2; 12A.08, subdivision 3; 13.10, subdivision 5; 13.46, subdivision 4; 13.465, subdivision 8; 15.01; 15.06, subdivision 1; 15A.0815, subdivision 2; 16A.151, subdivision 2; 43A.08, subdivision 1a; 62A.045; 62A.30, by adding subdivisions; 62A.673, subdivision 2; 62J.03, by adding a subdivision; 62J.17, subdivision 5a; 62J.692, subdivisions 1, 3, 4, 5, 8; 62J.824; 62J.84, subdivisions 2, 3, 4, 6, 7, 8, 9, by adding subdivisions; 62K.10, subdivision 4; 62K.15; 62Q.01, by adding a subdivision; 62Q.021, by adding a subdivision; 62Q.55, subdivision 5; 62Q.556; 62Q.56, subdivision 2; 62Q.675; 62Q.73, subdivisions 1, 7; 62U.01, by adding a subdivision; 62U.04, subdivisions 4, 5, 5a, 11, by adding subdivisions; 62V.05, subdivision 4a; 103I.005, subdivisions 17a, 20a, by adding a subdivision; 103I.208, subdivision 2, by adding a subdivision; 119B.011, subdivisions 2, 3, 5, 13, 15, 19a; 119B.02, subdivision 4; 119B.025, subdivision 4; 119B.03, subdivisions 3, 4a; 119B.05, subdivision 1; 119B.09, subdivision 7; 119B.095, subdivisions 2, 3; 119B.10, subdivisions 1, 3; 119B.105, subdivision 2; 119B.125, subdivisions 1, 1a, 1b, 2, 3, 4, 6, 7; 119B.13, subdivisions 1, 4, 6; 119B.16, subdivisions 1a, 1c, 3; 119B.161, subdivisions 2, 3; 119B.19, subdivision 7; 121A.335; 122A.18, subdivision 8; 144.122; 144.1481, subdivision 1; 144.1501, subdivision 2; 144.1505; 144.1506, subdivision 4; 144.2151; 144.218, subdivisions 1, 2; 144.222; 144.225, subdivision 2; 144.2252; 144.226, subdivisions 3, 4; 144.382, by adding subdivisions; 144.55, subdivision 3; 144.615, subdivision 7; 144.651, by adding a subdivision; 144.6535, subdivisions 1, 2, 4; 144.69; 144.9501, subdivisions 9, 17, 26a, 26b, by adding subdivisions; 144.9505, subdivisions 1, 1g, 1h; 144.9508, subdivision 2; 144A.06, subdivision 2; 144A.071, subdivision 2; 144A.073, subdivision 3b; 144A.474, subdivisions 3, 9, 12; 144A.4791, subdivision 10; 144E.001, subdivision 1, by adding a subdivision; 144E.101, subdivisions 6, 7, 12; 144E.103, subdivision 1; 144E.35; 144G.16, subdivision 7; 144G.18; 144G.57, subdivision 8; 145.411, subdivisions 1, 5; 145.4131, subdivisions 1, 2; 145.4134; 145.423, subdivision 1; 145.4716, subdivision 3; 145.87, subdivision 4; 145.924; 145.925; 145A.131, subdivisions 1, 2, 5; 145A.14, by adding a subdivision; 147.02, subdivision 1; 147.03, subdivision 1; 147.037, subdivision 1; 147.141; 147A.16; 147B.02, subdivisions 4, 7; 148.261, subdivision 1; 148.512, subdivisions 10a, 10b, by adding subdivisions; 148.513, by adding a subdivision; 148.515, subdivision 6; 148.5175; 148.5195, subdivision 3; 148.5196, subdivision 1; 148.5197; 148.5198; 148B.392, subdivision 2; 150A.08, subdivisions 1, 5; 150A.091, by adding a subdivision; 150A.13, subdivision 10; 151.065, subdivisions 1, 2, 3, 4, 6; 151.37, subdivision 12; 151.555; 151.74, subdivisions 3, 4; 152.126, subdivisions 4, 5, 6; 152.28, subdivision 1; 152.29, subdivision 3a; 153A.13, subdivisions 3, 4, 5, 6, 7, 9, 10, 11, by adding subdivisions; 153A.14, subdivisions 1, 2, 2h, 2i, 2j, 4, 4a, 4b, 4c, 4e, 6, 9, 11, by adding a subdivision; 153A.15, subdivisions 1, 2, 4; 153A.17; 153A.175; 153A.18; 153A.20; 168B.07, subdivision 3; 245.095; 245.462, subdivision 17; 245.4661, subdivision 9; 245.4663, subdivisions 1, 4; 245.469, subdivision 3; 245.4889, subdivision 1; 245.4901, subdivision 4, by adding a subdivision; 245.735, subdivisions 3, 5, 6, by adding subdivisions; 245A.02, subdivisions 2c, 5a, 6b, 10b, by adding a subdivision; 245A.03, subdivision 2; 245A.04, subdivisions 1, 4, 7, 7a; 245A.041, by adding a subdivision; 245A.05; 245A.055, subdivision 2; 245A.06, subdivisions 1, 2, 4; 245A.07, subdivisions 1, 2a, 3; 245A.10, subdivisions 3, 4; 245A.11, by adding a subdivision; 245A.14, subdivision 4; 245A.1435; 245A.146, subdivision 3; 245A.16, subdivisions 1, 9, by adding subdivisions; 245A.18, subdivision 2; 245A.50, subdivisions 3, 4, 5, 6, 9; 245A.52, subdivisions 1, 3, 5, by adding a subdivision; 245A.66, by adding a subdivision; 245C.02, subdivisions 6a, 11c, 13e, by adding subdivisions; 245C.03, subdivisions 1, 1a, 4, 5, 5a; 245C.031, subdivisions 1, 4; 245C.04, subdivision 1; 245C.05, subdivisions 1, 2c, 4, by adding a subdivision; 245C.07; 245C.08, subdivision 1; 245C.10, subdivisions 1d, 2, 2a, 3, 4, 5, 6, 8, 9, 9a, 10, 11, 12, 13, 14, 15, 16, 17, 20, 21; 245C.15, subdivision 2, by adding a subdivision; 245C.17, subdivisions 2, 3, 6; 245C.21, subdivisions 1a, 2; 245C.22, subdivision 7; 245C.23, subdivisions 1, 2; 245C.30, subdivision 2; 245C.31, subdivision 1; 245C.32, subdivision 2; 245C.33, subdivision 4; 245D.261, subdivision 3, as added if enacted; 245E.06, subdivision 3; 245G.01, by adding a subdivision; 245G.03, subdivision 1; 245G.11, subdivision 10; 245G.13, subdivision 2; 245H.01, subdivisions 3, 5, by adding a subdivision; 245H.02; 245H.03, subdivisions 2, 4, by adding a subdivision; 245H.05; 245H.06, subdivisions 1, 2; 245H.07, subdivisions 1, 2; 245H.08, subdivisions 4, 5; 245H.13, subdivisions 3, 7, 9; 245I.011, subdivision 3; 245I.04, subdivisions 14, 16; 245I.05, subdivision 3; 245I.08, subdivisions 2, 3, 4; 245I.10, subdivisions 2, 3, 5, 6, 7, 8; 245I.11, subdivisions 3, 4; 245I.20, subdivisions 5, 6, 10, 13, 14, 16; 246.54, subdivision 1a, as amended if enacted; 254B.02, subdivision 5; 254B.05, subdivisions 1, 1a; 256.01, by adding a subdivision; 256.014, subdivisions 1, 2; 256.046, subdivisions 1, 3; 256.0471, subdivision 1; 256.478, subdivisions 1, 2, by adding subdivisions; 256.962, subdivision 5; 256.9655, by adding a subdivision; 256.9685, subdivisions 1a, 1b; 256.9686, by adding a subdivision; 256.969, subdivisions 2b, 9, 25, by adding a subdivision; 256.98, subdivision 8; 256.983, subdivision 5; 256.987, subdivision 4; 256B.04, subdivisions 14, 15, by adding a subdivision; 256B.051, subdivision 5; 256B.055, subdivision 17; 256B.056, subdivision 7, by adding a subdivision; 256B.0622, subdivisions 7b, 7c, 8; 256B.0623, subdivision 4; 256B.0624, subdivisions 5, 8; 256B.0625, subdivisions 3a, 5m, 9, 13, 13c, 13e, 13f, 13g, 16, 28b, 30, 31, 34, by adding subdivisions; 256B.0631, subdivisions 1, 3, by adding a subdivision; 256B.064; 256B.0652, subdivision 5; 256B.0757, subdivision 4c; 256B.0941, subdivisions 2a, 3, by adding subdivisions; 256B.0946, subdivisions 4, 6; 256B.0947, subdivisions 7, 7a; 256B.27, subdivision 3; 256B.434, subdivision 4f; 256B.69, subdivision 5a, by adding subdivisions; 256B.692, subdivision 2; 256B.75; 256B.758; 256B.76, subdivision 1, as amended; 256B.761; 256B.763; 256B.764; 256D.01, subdivision 1a; 256D.02, by adding a subdivision; 256D.024, subdivision 1; 256D.03, by adding a subdivision; 256D.06, subdivision 5; 256D.07; 256D.44, subdivision 5; 256D.63, subdivision 2; 256E.34, subdivision 4; 256E.35, subdivisions 1, 2, 3, 4a, 6, 7; 256I.03, subdivisions 7, 13, 15, by adding a subdivision; 256I.04, subdivisions 1, 2, 3; 256I.05, subdivisions 1a, 2; 256I.06, subdivisions 3, 6, 8, by adding a subdivision; 256I.09; 256J.01, subdivision 1; 256J.02, subdivision 2; 256J.08, subdivisions 21, 65, 71, 79; 256J.09, subdivisions 3, 10; 256J.11, subdivision 1; 256J.21, subdivisions 3, 4; 256J.26, subdivision 1; 256J.33, subdivisions 1, 2; 256J.35; 256J.37, subdivisions 3, 3a; 256J.40; 256J.42, subdivision 5; 256J.425, subdivisions 1, 4, 5, 7; 256J.46, subdivisions 1, 2, 2a; 256J.49, subdivision 9; 256J.50, subdivision 1; 256J.521, subdivision 1; 256J.621, subdivision 1; 256J.626, subdivisions 2, 3; 256J.751, subdivision 2; 256J.95, subdivision 5; 256K.45, subdivisions 3, 7, by adding a subdivision; 256L.03, subdivisions 1, 5; 256L.04, subdivision 10; 256N.24, subdivision 12; 256P.01, by adding subdivisions; 256P.02, subdivisions 1a, 2, by adding subdivisions; 256P.04, subdivisions 4, 8, by adding a subdivision; 256P.06, subdivision 3, by adding subdivisions; 256P.07, subdivisions 1, 2, 3, 4, 6, 7, by adding subdivisions; 259.83, subdivisions 1, 1a, 1b, by adding a subdivision; 260.761, subdivision 2, as amended; 260C.007, subdivisions 14, 26d; 260C.221, subdivision 1; 260C.317, subdivisions 3, 4; 260C.80, subdivision 1; 260E.01; 260E.02, subdivision 1; 260E.03, subdivision 22, by adding subdivisions; 260E.09; 260E.14, subdivisions 2, 5; 260E.17, subdivision 1; 260E.18; 260E.20, subdivision 2; 260E.24, subdivisions 2, 7; 260E.33, subdivision 1; 260E.35, subdivision 6; 261.063; 270B.14, subdivision 1, by adding a subdivision; 297F.10, subdivision 1; 403.161, subdivisions 1, 3, 5, 6, 7; 403.162, subdivisions 1, 2, 5; 514.972, subdivision 5; 518A.31; 518A.32, subdivisions 3, 4; 518A.34; 518A.39, subdivision 2; 518A.41; 518A.42, subdivisions 1, 3; 518A.43, subdivision 1b; 518A.65; 518A.77; 524.5-118; 609B.425, subdivision 2; 609B.435, subdivision 2; Laws 2017, First Special Session chapter 6, article 5, section 11, as amended; Laws 2021, First Special Session chapter 7, article 1, section 36, as amended; article 2, section 84; article 6, section 26; article 14, section 23; article 16, sections 2, subdivision 32, as amended; 3, subdivision 2, as amended; 28, as amended; article 17, sections 5, subdivision 1; 6, as amended; 12, as amended; Laws 2022, chapter 99, article 1, section 46; article 3, section 9; Laws 2023, chapter 52, article 5, section 27; article 7, sections 12; 16; 2023 H.F. No. 2292, section 20, subdivision 13, if enacted; 2023 S.F. No. 2934, article 9, section 2, subdivision 16, if enacted; proposing coding for new law in Minnesota Statutes, chapters 4; 62J; 62Q; 62V; 103I; 115; 119B; 144; 144E; 145; 145A; 148; 245; 245A; 245C; 256; 256B; 256D; 256E; 256K; 256P; 260; 290; proposing coding for new law as Minnesota Statutes, chapter 143; repealing Minnesota Statutes 2022, sections 62J.692, subdivisions 4a, 7, 7a; 62J.84, subdivision 5; 62Q.145; 62U.10, subdivisions 6, 7, 8; 119B.011, subdivision 10a; 119B.03, subdivision 4; 137.38, subdivision 1; 144.059, subdivision 10; 144.212, subdivision 11; 144.9505, subdivision 3; 145.411, subdivisions 2, 4; 145.412; 145.413, subdivisions 2, 3; 145.4132; 145.4133; 145.4135; 145.4136; 145.415; 145.416; 145.423, subdivisions 2, 3, 4, 5, 6, 7, 8, 9; 145.4235; 145.4241; 145.4242; 145.4243; 145.4244; 145.4245; 145.4246; 145.4247; 145.4248; 145.4249; 153A.14, subdivision 5; 245A.22; 245C.02, subdivisions 9, 14b; 245C.031, subdivisions 5, 6, 7; 245C.032; 245C.11, subdivision 3; 245C.30, subdivision 1a; 245C.301; 256.8799; 256.9685, subdivisions 1c, 1d; 256.9864; 256B.011; 256B.0631, subdivisions 1, 2, 3; 256B.40; 256B.69, subdivision 5c; 256B.763; 256D.63, subdivision 1; 256I.03, subdivision 6; 256J.08, subdivisions 10, 24b, 53, 61, 62, 81, 83; 256J.30, subdivisions 5, 7, 8; 256J.33, subdivisions 3, 4, 5; 256J.34, subdivisions 1, 2, 3, 4; 256J.37, subdivision 10; 256J.425, subdivision 6; 256J.95, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19; 256P.07, subdivision 5; 259.83, subdivision 3; 259.89; 260C.637; 261.28; 393.07, subdivision 11; 518A.59; Minnesota Rules, parts 4615.3600; 4640.1500; 4640.1600; 4640.1700; 4640.1800; 4640.1900; 4640.2000; 4640.2100; 4640.2200; 4640.2300; 4640.2400; 4640.2500; 4640.2600; 4640.2700; 4640.2800; 4640.2900; 4640.3000; 4640.3100; 4640.3200; 4640.3300; 4640.3400; 4640.3500; 4640.3600; 4640.3700; 4640.3800; 4640.3900; 4640.4000; 4640.4100; 4640.4200; 4640.4300; 4640.6100; 4640.6200; 4640.6300; 4640.6400; 4645.0300; 4645.0400; 4645.0500; 4645.0600; 4645.0700; 4645.0800; 4645.0900; 4645.1000; 4645.1100; 4645.1200; 4645.1300; 4645.1400; 4645.1500; 4645.1600; 4645.1700; 4645.1800; 4645.1900; 4645.2000; 4645.2100; 4645.2200; 4645.2300; 4645.2400; 4645.2500; 4645.2600; 4645.2700; 4645.2800; 4645.2900; 4645.3000; 4645.3100; 4645.3200; 4645.3300; 4645.3400; 4645.3500; 4645.3600; 4645.3700; 4645.3800; 4645.3805; 4645.3900; 4645.4000; 4645.4100; 4645.4200; 4645.4300; 4645.4400; 4645.4500; 4645.4600; 4645.4700; 4645.4800; 4645.4900; 4645.5100; 4645.5200; 4700.1900; 4700.2000; 4700.2100; 4700.2210; 4700.2300, subparts 1, 3, 4, 4a, 5; 4700.2410; 4700.2420; 4700.2500; 5610.0100; 5610.0200; 5610.0300; 9505.0235; 9505.0505, subpart 18; 9505.0520, subpart 9b.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1

HEALTH CARE

Section 1.

Minnesota Statutes 2022, section 256.01, is amended by adding a subdivision to read:

new text begin Subd. 43. new text end

new text begin Education on contraceptive options. new text end

new text begin The commissioner shall require hospitals and primary care providers serving medical assistance and MinnesotaCare enrollees to develop and implement protocols to provide enrollees, when appropriate, with comprehensive and scientifically accurate information on the full range of contraceptive options, in a medically ethical, culturally competent, and noncoercive manner. The information provided must be designed to assist enrollees in identifying the contraceptive method that best meets their needs and the needs of their families. The protocol must specify the enrollee categories to which this requirement will be applied, the process to be used, and the information and resources to be provided. Hospitals and providers must make this protocol available to the commissioner upon request. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 2.

Minnesota Statutes 2022, section 256.0471, subdivision 1, is amended to read:

Subdivision 1.

Qualifying overpayment.

Any overpayment for assistance granted under deleted text begin chapter 119B, deleted text end the MFIP program formerly codified under sections 256.031 to 256.0361 deleted text begin , deleted text end and the AFDC program formerly codified under sections 256.72 to 256.871; new text begin for assistance granted under new text end chapters deleted text begin 256B for state-funded medical assistance deleted text end new text begin 119B new text end , 256D, 256I, 256J, new text begin and new text end 256K deleted text begin , and 256L deleted text end new text begin ; new text end for new text begin assistance granted pursuant to section 256.045, subdivision 10, for state-funded medical assistance and new text end state-funded MinnesotaCare new text begin under chapters 256B and 256L new text end ; and new text begin for assistance granted under new text end the Supplemental Nutrition Assistance Program (SNAP), except agency error claims, become a judgment by operation of law 90 days after the notice of overpayment is personally served upon the recipient in a manner that is sufficient under rule 4.03(a) of the Rules of Civil Procedure for district courts, or by certified mail, return receipt requested. This judgment shall be entitled to full faith and credit in this and any other state.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023. new text end

Sec. 3.

Minnesota Statutes 2022, section 256.9655, is amended by adding a subdivision to read:

new text begin Subd. 3. new text end

new text begin Prompt payment required. new text end

new text begin (a) In paying claims under medical assistance, the commissioner shall comply with Code of Federal Regulations, title 42, section 447.45. new text end

new text begin (b) If the commissioner does not pay or deny a clean claim within the period provided in paragraph (a), the commissioner must pay interest on the claim for the period beginning on the day after the required payment date specified in paragraph (a) and ending on the date on which the commissioner makes the payment or denies the claim. new text end

new text begin (c) The rate of interest paid by the commissioner under this subdivision must be 1.5 percent per month or any part of a month. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 4.

Minnesota Statutes 2022, section 256.969, subdivision 2b, is amended to read:

Subd. 2b.

Hospital payment rates.

(a) For discharges occurring on or after November 1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according to the following:

(1) critical access hospitals as defined by Medicare shall be paid using a cost-based methodology;

(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology under subdivision 25;

(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation distinct parts as defined by Medicare shall be paid according to the methodology under subdivision 12; and

(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.

(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not be rebased, except that a Minnesota long-term hospital shall be rebased effective January 1, 2011, based on its most recent Medicare cost report ending on or before September 1, 2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on December 31, 2010. For rate setting periods after November 1, 2014, in which the base years are updated, a Minnesota long-term hospital's base year shall remain within the same period as other hospitals.

(c) Effective for discharges occurring on and after November 1, 2014, payment rates for hospital inpatient services provided by hospitals located in Minnesota or the local trade area, except for the hospitals paid under the methodologies described in paragraph (a), clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a manner similar to Medicare. The base year or years for the rates effective November 1, 2014, shall be calendar year 2012. The rebasing under this paragraph shall be budget neutral, ensuring that the total aggregate payments under the rebased system are equal to the total aggregate payments that were made for the same number and types of services in the base year. Separate budget neutrality calculations shall be determined for payments made to critical access hospitals and payments made to hospitals paid under the DRG system. Only the rate increases or decreases under subdivision 3a or 3c that applied to the hospitals being rebased during the entire base period shall be incorporated into the budget neutrality calculation.

(d) For discharges occurring on or after November 1, 2014, through the next rebasing that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph (a), clause (4), shall include adjustments to the projected rates that result in no greater than a five percent increase or decrease from the base year payments for any hospital. Any adjustments to the rates made by the commissioner under this paragraph and paragraph (e) shall maintain budget neutrality as described in paragraph (c).

(e) For discharges occurring on or after November 1, 2014, the commissioner may make additional adjustments to the rebased rates, and when evaluating whether additional adjustments should be made, the commissioner shall consider the impact of the rates on the following:

(1) pediatric services;

(2) behavioral health services;

(3) trauma services as defined by the National Uniform Billing Committee;

(4) transplant services;

(5) obstetric services, newborn services, and behavioral health services provided by hospitals outside the seven-county metropolitan area;

(6) outlier admissions;

(7) low-volume providers; and

(8) services provided by small rural hospitals that are not critical access hospitals.

(f) Hospital payment rates established under paragraph (c) must incorporate the following:

(1) for hospitals paid under the DRG methodology, the base year payment rate per admission is standardized by the applicable Medicare wage index and adjusted by the hospital's disproportionate population adjustment;

(2) for critical access hospitals, payment rates for discharges between November 1, 2014, and June 30, 2015, shall be set to the same rate of payment that applied for discharges on October 31, 2014;

(3) the cost and charge data used to establish hospital payment rates must only reflect inpatient services covered by medical assistance; and

(4) in determining hospital payment rates for discharges occurring on or after the rate year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per discharge shall be based on the cost-finding methods and allowable costs of the Medicare program in effect during the base year or years. In determining hospital payment rates for discharges in subsequent base years, the per discharge rates shall be based on the cost-finding methods and allowable costs of the Medicare program in effect during the base year or years.

(g) The commissioner shall validate the rates effective November 1, 2014, by applying the rates established under paragraph (c), and any adjustments made to the rates under paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the total aggregate payments for the same number and types of services under the rebased rates are equal to the total aggregate payments made during calendar year 2013.

(h) Effective for discharges occurring on or after July 1, 2017, and every two years thereafter, payment rates under this section shall be rebased to reflect only those changes in hospital costs between the existing base year or years and the next base year or years. In any year that inpatient claims volume falls below the threshold required to ensure a statistically valid sample of claims, the commissioner may combine claims data from two consecutive years to serve as the base year. Years in which inpatient claims volume is reduced or altered due to a pandemic or other public health emergency shall not be used as a base year or part of a base year if the base year includes more than one year. Changes in costs between base years shall be measured using the lower of the hospital cost index defined in subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per claim. The commissioner shall establish the base year for each rebasing period considering the most recent year or years for which filed Medicare cost reports are available new text begin , except that the base years for the rebasing effective July 1, 2023, are calendar years 2018 and 2019 new text end . The estimated change in the average payment per hospital discharge resulting from a scheduled rebasing must be calculated and made available to the legislature by January 15 of each year in which rebasing is scheduled to occur, and must include by hospital the differential in payment rates compared to the individual hospital's costs.

(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates for critical access hospitals located in Minnesota or the local trade area shall be determined using a new cost-based methodology. The commissioner shall establish within the methodology tiers of payment designed to promote efficiency and cost-effectiveness. Payment rates for hospitals under this paragraph shall be set at a level that does not exceed the total cost for critical access hospitals as reflected in base year cost reports. Until the next rebasing that occurs, the new methodology shall result in no greater than a five percent decrease from the base year payments for any hospital, except a hospital that had payments that were greater than 100 percent of the hospital's costs in the base year shall have their rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and after July 1, 2016, covered under this paragraph shall be increased by the inflation factor in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the following criteria:

(1) hospitals that had payments at or below 80 percent of their costs in the base year shall have a rate set that equals 85 percent of their base year costs;

(2) hospitals that had payments that were above 80 percent, up to and including 90 percent of their costs in the base year shall have a rate set that equals 95 percent of their base year costs; and

(3) hospitals that had payments that were above 90 percent of their costs in the base year shall have a rate set that equals 100 percent of their base year costs.

(j) The commissioner may refine the payment tiers and criteria for critical access hospitals to coincide with the next rebasing under paragraph (h). The factors used to develop the new methodology may include, but are not limited to:

(1) the ratio between the hospital's costs for treating medical assistance patients and the hospital's charges to the medical assistance program;

(2) the ratio between the hospital's costs for treating medical assistance patients and the hospital's payments received from the medical assistance program for the care of medical assistance patients;

(3) the ratio between the hospital's charges to the medical assistance program and the hospital's payments received from the medical assistance program for the care of medical assistance patients;

(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);

(5) the proportion of that hospital's costs that are administrative and trends in administrative costs; and

(6) geographic location.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023. new text end

Sec. 5.

Minnesota Statutes 2022, section 256.969, subdivision 9, is amended to read:

Subd. 9.

Disproportionate numbers of low-income patients served.

(a) For admissions occurring on or after July 1, 1993, the medical assistance disproportionate population adjustment shall comply with federal law and shall be paid to a hospital, excluding regional treatment centers and facilities of the federal Indian Health Service, with a medical assistance inpatient utilization rate in excess of the arithmetic mean. The adjustment must be determined as follows:

(1) for a hospital with a medical assistance inpatient utilization rate above the arithmetic mean for all hospitals excluding regional treatment centers and facilities of the federal Indian Health Service but less than or equal to one standard deviation above the mean, the adjustment must be determined by multiplying the total of the operating and property payment rates by the difference between the hospital's actual medical assistance inpatient utilization rate and the arithmetic mean for all hospitals excluding regional treatment centers and facilities of the federal Indian Health Service; and

(2) for a hospital with a medical assistance inpatient utilization rate above one standard deviation above the mean, the adjustment must be determined by multiplying the adjustment that would be determined under clause (1) for that hospital by 1.1. The commissioner shall report annually on the number of hospitals likely to receive the adjustment authorized by this paragraph. The commissioner shall specifically report on the adjustments received by public hospitals and public hospital corporations located in cities of the first class.

(b) Certified public expenditures made by Hennepin County Medical Center shall be considered Medicaid disproportionate share hospital payments. Hennepin County and Hennepin County Medical Center shall report by June 15, 2007, on payments made beginning July 1, 2005, or another date specified by the commissioner, that may qualify for reimbursement under federal law. Based on these reports, the commissioner shall apply for federal matching funds.

(c) Upon federal approval of the related state plan amendment, paragraph (b) is effective retroactively from July 1, 2005, or the earliest effective date approved by the Centers for Medicare and Medicaid Services.

(d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall be paid in accordance with a new methodology using 2012 as the base year. Annual payments made under this paragraph shall equal the total amount of payments made for 2012. A licensed children's hospital shall receive only a single DSH factor for children's hospitals. Other DSH factors may be combined to arrive at a single factor for each hospital that is eligible for DSH payments. The new methodology shall make payments only to hospitals located in Minnesota and include the following factors:

(1) a licensed children's hospital with at least 1,000 fee-for-service discharges in the base year shall receive a factor of 0.868. A licensed children's hospital with less than 1,000 fee-for-service discharges in the base year shall receive a factor of 0.7880;

(2) a hospital that has in effect for the initial rate year a contract with the commissioner to provide extended psychiatric inpatient services under section 256.9693 shall receive a factor of 0.0160;

(3) a hospital that has received medical assistance payment for at least 20 transplant services in the base year shall receive a factor of 0.0435;

(4) a hospital that has a medical assistance utilization rate in the base year between 20 percent up to one standard deviation above the statewide mean utilization rate shall receive a factor of 0.0468;

(5) a hospital that has a medical assistance utilization rate in the base year that is at least one standard deviation above the statewide mean utilization rate but is less than two and one-half standard deviations above the mean shall receive a factor of 0.2300; and

(6) a hospital that is a level one trauma center and that has a medical assistance utilization rate in the base year that is at least two and deleted text begin one-half deleted text end new text begin one-quarter new text end standard deviations above the statewide mean utilization rate shall receive a factor of 0.3711.

(e) For the purposes of determining eligibility for the disproportionate share hospital factors in paragraph (d), clauses (1) to (6), the medical assistance utilization rate and discharge thresholds shall be measured using only one year when a two-year base period is used.

(f) Any payments or portion of payments made to a hospital under this subdivision that are subsequently returned to the commissioner because the payments are found to exceed the hospital-specific DSH limit for that hospital shall be redistributed, proportionate to the number of fee-for-service discharges, to other DSH-eligible non-children's hospitals that have a medical assistance utilization rate that is at least one standard deviation above the mean.

(g) An additional payment adjustment shall be established by the commissioner under this subdivision for a hospital that provides high levels of administering high-cost drugs to enrollees in fee-for-service medical assistance. The commissioner shall consider factors including fee-for-service medical assistance utilization rates and payments made for drugs purchased through the 340B drug purchasing program and administered to fee-for-service enrollees. If any part of this adjustment exceeds a hospital's hospital-specific disproportionate share hospital limit, the commissioner shall make a payment to the hospital that equals the nonfederal share of the amount that exceeds the limit. The total nonfederal share of the amount of the payment adjustment under this paragraph shall not exceed $1,500,000.

Sec. 6.

Minnesota Statutes 2022, section 256.969, subdivision 25, is amended to read:

Subd. 25.

Long-term hospital rates.

(a) Long-term hospitals shall be paid on a per diem basis.

(b) For admissions occurring on or after April 1, 1995, a long-term hospital as designated by Medicare that does not have admissions in the base year shall have inpatient rates established at the average of other hospitals with the same designation. For subsequent rate-setting periods in which base years are updated, the hospital's base year shall be the first Medicare cost report filed with the long-term hospital designation and shall remain in effect until it falls within the same period as other hospitals.

new text begin (c) For admissions occurring on or after July 1, 2023, long-term hospitals must be paid the higher of a per diem amount computed using the methodology described in subdivision 2b, paragraph (i), or the per diem rate as of July 1, 2021. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023. new text end

Sec. 7.

Minnesota Statutes 2022, section 256.969, is amended by adding a subdivision to read:

new text begin Subd. 31. new text end

new text begin Long-acting reversible contraceptives. new text end

new text begin (a) The commissioner must provide separate reimbursement to hospitals for long-acting reversible contraceptives provided immediately postpartum in the inpatient hospital setting. This payment must be in addition to the diagnostic related group reimbursement for labor and delivery and shall be made consistent with section 256B.0625, subdivision 13e, paragraph (e). new text end

new text begin (b) The commissioner must require managed care and county-based purchasing plans to comply with this subdivision when providing services to medical assistance enrollees. If, for any contract year, federal approval is not received for this paragraph, the commissioner must adjust the capitation rates paid to managed care plans and county-based purchasing plans for that contract year to reflect the removal of this provision. Contracts between managed care plans and county-based purchasing plans and providers to whom this paragraph applies must allow recovery of payments from those providers if capitation rates are adjusted in accordance with this paragraph. Payment recoveries must not exceed the amount equal to any increase in rates that results from this provision. This paragraph expires if federal approval is not received for this paragraph at any time. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 8.

Minnesota Statutes 2022, section 256B.04, subdivision 14, is amended to read:

Subd. 14.

Competitive bidding.

(a) When determined to be effective, economical, and feasible, the commissioner may utilize volume purchase through competitive bidding and negotiation under the provisions of chapter 16C, to provide items under the medical assistance program including but not limited to the following:

(1) eyeglasses;

(2) oxygen. The commissioner shall provide for oxygen needed in an emergency situation on a short-term basis, until the vendor can obtain the necessary supply from the contract dealer;

(3) hearing aids and supplies;

(4) durable medical equipment, including but not limited to:

(i) hospital beds;

(ii) commodes;

(iii) glide-about chairs;

(iv) patient lift apparatus;

(v) wheelchairs and accessories;

(vi) oxygen administration equipment;

(vii) respiratory therapy equipment;

(viii) electronic diagnostic, therapeutic and life-support systems; and

(ix) allergen-reducing products as described in section 256B.0625, subdivision 67, paragraph (c) or (d);

(5) nonemergency medical transportation level of need determinations, disbursement of public transportation passes and tokens, and volunteer and recipient mileage and parking reimbursements; deleted text begin and deleted text end

(6) drugs deleted text begin . deleted text end new text begin ; and new text end

new text begin (7) quitline services as described in section 256B.0625, subdivision 68, paragraph (c). new text end

(b) Rate changes and recipient cost-sharing under this chapter and chapter 256L do not affect contract payments under this subdivision unless specifically identified.

(c) The commissioner may not utilize volume purchase through competitive bidding and negotiation under the provisions of chapter 16C for special transportation services or incontinence products and related supplies.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 9.

Minnesota Statutes 2022, section 256B.055, subdivision 17, is amended to read:

Subd. 17.

Adults who were in foster care at the age of 18.

new text begin (a) new text end Medical assistance may be paid for a person under 26 years of age who was in foster care under the commissioner's responsibility on the date of attaining 18 new text begin , 19, or 20 new text end years of age, and who was enrolled in medical assistance under the state plan or a waiver of the plan while in foster care, in accordance with section 2004 of the Affordable Care Act.

new text begin (b) Medical assistance may be paid for a person under 26 years of age who was in foster care and enrolled in any state's Medicaid program as provided by Public Law 115-271, section 1002. new text end

new text begin (c) The commissioner shall seek federal waiver approval under United States Code, title 42, section 1315, to include youth who were in a state's foster care program and who turned age 18 prior to January 1, 2023, without regard to potential eligibility under a Medicaid mandatory group. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 10.

Minnesota Statutes 2022, section 256B.0622, subdivision 8, is amended to read:

Subd. 8.

Medical assistance payment for assertive community treatment and intensive residential treatment services.

(a) Payment for intensive residential treatment services and assertive community treatment in this section shall be based on one daily rate per provider inclusive of the following services received by an eligible client in a given calendar day: all rehabilitative services under this section, staff travel time to provide rehabilitative services under this section, and nonresidential crisis stabilization services under section 256B.0624.

(b) Except as indicated in paragraph (c), payment will not be made to more than one entity for each client for services provided under this section on a given day. If services under this section are provided by a team that includes staff from more than one entity, the team must determine how to distribute the payment among the members.

(c) The commissioner shall determine one rate for each provider that will bill medical assistance for residential services under this section and one rate for each assertive community treatment provider. If a single entity provides both services, one rate is established for the entity's residential services and another rate for the entity's nonresidential services under this section. A provider is not eligible for payment under this section without authorization from the commissioner. The commissioner shall develop rates using the following criteria:

(1) the provider's cost for services shall include direct services costs, other program costs, and other costs determined as follows:

(i) the direct services costs must be determined using actual costs of salaries, benefits, payroll taxes, and training of direct service staff and service-related transportation;

(ii) other program costs not included in item (i) must be determined as a specified percentage of the direct services costs as determined by item (i). The percentage used shall be determined by the commissioner based upon the average of percentages that represent the relationship of other program costs to direct services costs among the entities that provide similar services;

(iii) physical plant costs calculated based on the percentage of space within the program that is entirely devoted to treatment and programming. This does not include administrative or residential space;

(iv) assertive community treatment physical plant costs must be reimbursed as part of the costs described in item (ii); and

(v) subject to federal approval, up to an additional five percent of the total rate may be added to the program rate as a quality incentive based upon the entity meeting performance criteria specified by the commissioner;

(2) actual cost is defined as costs which are allowable, allocable, and reasonable, and consistent with federal reimbursement requirements under Code of Federal Regulations, title 48, chapter 1, part 31, relating to for-profit entities, and Office of Management and Budget Circular Number A-122, relating to nonprofit entities;

(3) the number of service units;

(4) the degree to which clients will receive services other than services under this section; and

(5) the costs of other services that will be separately reimbursed.

(d) The rate for intensive residential treatment services and assertive community treatment must exclude room and board, as defined in section 256I.03, subdivision 6, and services not covered under this section, such as partial hospitalization, home care, and inpatient services.

(e) Physician services that are not separately billed may be included in the rate to the extent that a psychiatrist, or other health care professional providing physician services within their scope of practice, is a member of the intensive residential treatment services treatment team. Physician services, whether billed separately or included in the rate, may be delivered by telehealth. For purposes of this paragraph, "telehealth" has the meaning given to "mental health telehealth" in section 256B.0625, subdivision 46, when telehealth is used to provide intensive residential treatment services.

(f) When services under this section are provided by an assertive community treatment provider, case management functions must be an integral part of the team.

(g) The rate for a provider must not exceed the rate charged by that provider for the same service to other payors.

(h) The rates for existing programs must be established prospectively based upon the expenditures and utilization over a prior 12-month period using the criteria established in paragraph (c). The rates for new programs must be established based upon estimated expenditures and estimated utilization using the criteria established in paragraph (c).

new text begin (i) Effective for the rate years beginning on and after January 1, 2024, rates for assertive community treatment, adult residential crisis stabilization services, and intensive residential treatment services must be annually adjusted for inflation using the Centers for Medicare and Medicaid Services Medicare Economic Index, as forecasted in the fourth quarter of the calendar year before 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. new text end

deleted text begin (i) deleted text end new text begin (j) new text end Entities who discontinue providing services must be subject to a settle-up process whereby actual costs and reimbursement for the previous 12 months are compared. In the event that the entity was paid more than the entity's actual costs plus any applicable performance-related funding due the provider, the excess payment must be reimbursed to the department. If a provider's revenue is less than actual allowed costs due to lower utilization than projected, the commissioner may reimburse the provider to recover its actual allowable costs. The resulting adjustments by the commissioner must be proportional to the percent of total units of service reimbursed by the commissioner and must reflect a difference of greater than five percent.

deleted text begin (j) deleted text end new text begin (k) new text end A provider may request of the commissioner a review of any rate-setting decision made under this subdivision.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. new text end

Sec. 11.

Minnesota Statutes 2022, section 256B.0625, subdivision 9, is amended to read:

Subd. 9.

Dental services.

(a) Medical assistance covers new text begin medically necessary new text end dental services.

deleted text begin (b) Medical assistance dental coverage for nonpregnant adults is limited to the following services: deleted text end

deleted text begin (1) comprehensive exams, limited to once every five years; deleted text end

deleted text begin (2) periodic exams, limited to one per year; deleted text end

deleted text begin (3) limited exams; deleted text end

deleted text begin (4) bitewing x-rays, limited to one per year; deleted text end

deleted text begin (5) periapical x-rays; deleted text end

deleted text begin (6) panoramic x-rays, limited to one every five years except (1) when medically necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once every two years for patients who cannot cooperate for intraoral film due to a developmental disability or medical condition that does not allow for intraoral film placement; deleted text end

deleted text begin (7) prophylaxis, limited to one per year; deleted text end

deleted text begin (8) application of fluoride varnish, limited to one per year; deleted text end

deleted text begin (9) posterior fillings, all at the amalgam rate; deleted text end

deleted text begin (10) anterior fillings; deleted text end

deleted text begin (11) endodontics, limited to root canals on the anterior and premolars only; deleted text end

deleted text begin (12) removable prostheses, each dental arch limited to one every six years; deleted text end

deleted text begin (13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses; deleted text end

deleted text begin (14) palliative treatment and sedative fillings for relief of pain; deleted text end

deleted text begin (15) full-mouth debridement, limited to one every five years; and deleted text end

deleted text begin (16) nonsurgical treatment for periodontal disease, including scaling and root planing once every two years for each quadrant, and routine periodontal maintenance procedures. deleted text end

deleted text begin (c) In addition to the services specified in paragraph (b), medical assistance covers the following services for adults, if provided in an outpatient hospital setting or freestanding ambulatory surgical center as part of outpatient dental surgery: deleted text end

deleted text begin (1) periodontics, limited to periodontal scaling and root planing once every two years; deleted text end

deleted text begin (2) general anesthesia; and deleted text end

deleted text begin (3) full-mouth survey once every five years. deleted text end

deleted text begin (d) Medical assistance covers medically necessary dental services for children and pregnant women. deleted text end new text begin (b) new text end The following guidelines apply new text begin to dental services new text end :

(1) posterior fillings are paid at the amalgam rate;

(2) application of sealants are covered once every five years per permanent molar deleted text begin for children only deleted text end ; new text begin and new text end

(3) application of fluoride varnish is covered once every six months deleted text begin ; and deleted text end new text begin . new text end

deleted text begin (4) orthodontia is eligible for coverage for children only. deleted text end

deleted text begin (e) deleted text end new text begin (c) new text end In addition to the services specified in deleted text begin paragraphs deleted text end new text begin paragraph new text end (b) deleted text begin and (c) deleted text end , medical assistance covers the following services deleted text begin for adults deleted text end :

(1) house calls or extended care facility calls for on-site delivery of covered services;

(2) behavioral management when additional staff time is required to accommodate behavioral challenges and sedation is not used;

(3) oral or IV sedation, if the covered dental service cannot be performed safely without it or would otherwise require the service to be performed under general anesthesia in a hospital or surgical center; and

(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but no more than four times per year.

deleted text begin (f) deleted text end new text begin (d) new text end The commissioner shall not require prior authorization for the services included in paragraph deleted text begin (e) deleted text end new text begin (c) new text end , clauses (1) to (3), and shall prohibit managed care and county-based purchasing plans from requiring prior authorization for the services included in paragraph deleted text begin (e) deleted text end new text begin (c) new text end , clauses (1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. new text end

Sec. 12.

Minnesota Statutes 2022, 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, a physician assistant, or an advanced practice registered nurse 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.

(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply deleted text begin , deleted text end unless authorized by the commissioner new text begin or as provided in paragraph (h) new text end or the drug appears on the 90-day supply list published by the commissioner. The 90-day supply list shall be published by the commissioner on the department's website. The commissioner may add to, delete from, and otherwise modify the 90-day supply list after providing public notice and the opportunity for a 15-day public comment period. The 90-day supply list may include cost-effective generic drugs and shall not include controlled substances.

(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical ingredient" is defined as a substance that is represented for use in a drug and when used in the manufacturing, processing, or packaging of a drug becomes an active ingredient of the drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and excipients which are included in the medical assistance formulary. Medical assistance covers selected active pharmaceutical ingredients and excipients used in compounded prescriptions when the compounded combination is specifically approved by the commissioner or when a commercially available product:

(1) is not a therapeutic option for the patient;

(2) does not exist in the same combination of active ingredients in the same strengths as the compounded prescription; and

(3) cannot be used in place of the active pharmaceutical ingredient in the compounded prescription.

(d) Medical assistance covers the following over-the-counter drugs when prescribed by a licensed practitioner or by a licensed pharmacist who meets standards established by the commissioner, in consultation with the board of pharmacy: 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 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. A pharmacist may prescribe over-the-counter medications as provided under this paragraph for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter drugs under this paragraph, licensed pharmacists must consult with the recipient to determine necessity, provide drug counseling, review drug therapy for potential adverse interactions, and make referrals as needed to other health care professionals.

(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible for drug coverage as defined in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these individuals, medical assistance may cover drugs from the drug classes listed in United States Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to 13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall not be covered.

(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing Program and dispensed by 340B covered entities and ambulatory pharmacies under common ownership of the 340B covered entity. Medical assistance does not cover drugs acquired through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.

(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section 151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed pharmacist in accordance with section 151.37, subdivision 16.

new text begin (h) Medical assistance coverage for a prescription contraceptive must provide a 12-month supply for any prescription contraceptive if a 12-month supply is prescribed by the prescribing health care provider. The prescribing health care provider must determine the appropriate duration for which to prescribe the prescription contraceptives, up to 12 months. For purposes of this paragraph, "prescription contraceptive" means any drug or device that requires a prescription and is approved by the Food and Drug Administration to prevent pregnancy. Prescription contraceptive does not include an emergency contraceptive drug approved to prevent pregnancy when administered after sexual contact. For purposes of this paragraph, "health plan" has the meaning provided in section 62Q.01, subdivision 3. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 13.

Minnesota Statutes 2022, section 256B.0625, subdivision 13c, is amended to read:

Subd. 13c.

Formulary Committee.

The commissioner, after receiving recommendations from professional medical associations and professional pharmacy associations, and consumer groups shall designate a Formulary Committee to carry out duties as described in subdivisions 13 to 13g. The Formulary Committee shall be comprised of deleted text begin four deleted text end new text begin at least five new text end licensed physicians actively engaged in the practice of medicine in Minnesota, one of whom deleted text begin must be actively engaged in the treatment of persons with mental illness deleted text end new text begin is an actively practicing psychiatrist, one of whom specializes in the diagnosis and treatment of rare diseases, one of whom specializes in pediatrics, and one of whom actively treats persons with disabilities new text end ; at least three licensed pharmacists actively engaged in the practice of pharmacy in Minnesota new text begin , one of whom practices outside the metropolitan counties listed in section 473.121, subdivision 4, one of whom practices in the metropolitan counties listed in section 473.121, subdivision 4, and one of whom is a practicing hospital pharmacist new text end ; deleted text begin and one deleted text end new text begin at least two new text end consumer deleted text begin representative deleted text end new text begin representatives, all of whom must have a personal or professional connection to medical assistance new text end ; new text begin and one representative designated by the Minnesota Rare Disease Advisory Council established under section 256.4835; new text end 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. Members of the Formulary Committee shall not be employed by the Department of Human Services new text begin or have a personal interest in a pharmaceutical company, pharmacy benefits manager, health plan company, or their affiliate organizations new text end , but the committee shall be staffed by an employee of the department who shall serve as an ex officio, nonvoting member of the committee. new text begin For the purposes of this subdivision, "personal interest" means that a person owns at least five percent of the voting interest or equity interest in the entity, the equity interest owned by a person represents at least five percent of that person's net worth, or more than five percent of a person's gross income for the preceding year was derived from the entity. A committee member must notify the committee of any potential conflict of interest and recuse themselves from any communications, discussion, or vote on any matter where a conflict of interest exists. A conflict of interest alone, without a personal interest, does not preclude an applicant from serving as a member of the Formulary Committee. Members may be removed from the committee for cause after a recommendation for removal by a majority of the committee membership. For the purposes of this subdivision, "cause" does not include offering a differing or dissenting clinical opinion on a drug or drug class. new text end The department's medical director shall also serve as an ex officio, nonvoting member for the committee. Committee members shall serve three-year terms and may be reappointed new text begin twice new text end by the commissioner. new text begin The committee members shall vote on a chair and vice chair from among their membership. The chair shall preside over all committee meetings, and the vice chair shall preside over the meetings if the chair is not present. new text end The Formulary Committee shall meet at least deleted text begin twice deleted text end new text begin three times new text end per year. The commissioner may require more frequent Formulary Committee meetings as needed. An honorarium of $100 per meeting and reimbursement for mileage shall be paid to each committee member in attendance. The Formulary Committee expires June 30, deleted text begin 2023 deleted text end new text begin 2027 new text end . new text begin The Formulary Committee is subject to the Open Meeting Law under chapter 13D. For purposes of establishing a quorum to transact business, vacant committee member positions do not count in the calculation as long as at least 60 percent of the committee member positions are filled. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 14.

Minnesota Statutes 2022, section 256B.0625, subdivision 13e, is amended to read:

Subd. 13e.

Payment rates.

(a) The basis for determining the amount of payment shall be the lower of the ingredient costs of the drugs plus the professional dispensing fee; or the usual and customary price charged to the public. The usual and customary price means the lowest price charged by the provider to a patient who pays for the prescription by cash, check, or charge account and includes prices the pharmacy charges to a patient enrolled in a prescription savings club or prescription discount club administered by the pharmacy or pharmacy chain. The amount of payment basis must be reduced to reflect all discount amounts applied to the charge by any third-party provider/insurer agreement or contract for submitted charges to medical assistance programs. The net submitted charge may not be greater than the patient liability for the service. The professional dispensing fee shall be $10.77 for prescriptions filled with legend drugs meeting the definition of "covered outpatient drugs" according to United States Code, title 42, section 1396r-8(k)(2). The dispensing fee for intravenous solutions that must be compounded by the pharmacist shall be $10.77 per claim. The professional dispensing fee for prescriptions filled with over-the-counter drugs meeting the definition of covered outpatient drugs shall be $10.77 for dispensed quantities equal to or greater than the number of units contained in the manufacturer's original package. The professional dispensing fee shall be prorated based on the percentage of the package dispensed when the pharmacy dispenses a quantity less than the number of units contained in the manufacturer's original package. The pharmacy dispensing fee for prescribed over-the-counter drugs not meeting the definition of covered outpatient drugs shall be $3.65 for quantities equal to or greater than the number of units contained in the manufacturer's original package and shall be prorated based on the percentage of the package dispensed when the pharmacy dispenses a quantity less than the number of units contained in the manufacturer's original package. The National Average Drug Acquisition Cost (NADAC) shall be used to determine the ingredient cost of a drug. For drugs for which a NADAC is not reported, the commissioner shall estimate the ingredient cost at the wholesale acquisition cost minus two percent. The ingredient cost of a drug for a provider participating in the federal 340B Drug Pricing Program shall be either the 340B Drug Pricing Program ceiling price established by the Health Resources and Services Administration or NADAC, whichever is lower. Wholesale acquisition cost is defined as the manufacturer's list price for a drug or biological to wholesalers or direct purchasers in the United States, not including prompt pay or other discounts, rebates, or reductions in price, for the most recent month for which information is available, as reported in wholesale price guides or other publications of drug or biological pricing data. The maximum allowable cost of a multisource drug may be set by the commissioner and it shall be comparable to the actual acquisition cost of the drug product and no higher than the NADAC of the generic product. Establishment of the amount of payment for drugs shall not be subject to the requirements of the Administrative Procedure Act.

(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using an automated drug distribution system meeting the requirements of section 151.58, or a packaging system meeting the packaging standards set forth in Minnesota Rules, part 6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ retrospective billing for prescription drugs dispensed to long-term care facility residents. A retrospectively billing pharmacy must submit a claim only for the quantity of medication used by the enrolled recipient during the defined billing period. A retrospectively billing pharmacy must use a billing period not less than one calendar month or 30 days.

(c) A pharmacy provider using packaging that meets the standards set forth in Minnesota Rules, part 6800.2700, is required to credit the department for the actual acquisition cost of all unused drugs that are eligible for reuse, unless the pharmacy is using retrospective billing. The commissioner may permit the drug clozapine to be dispensed in a quantity that is less than a 30-day supply.

(d) If a pharmacy dispenses a multisource drug, the ingredient cost shall be the NADAC of the generic product or the maximum allowable cost established by the commissioner unless prior authorization for the brand name product has been granted according to the criteria established by the Drug Formulary Committee as required by subdivision 13f, paragraph (a), and the prescriber has indicated "dispense as written" on the prescription in a manner consistent with section 151.21, subdivision 2.

(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, 106 percent of the average sales price as determined by the United States Department of Health and Human Services pursuant to title XVIII, section 1847a of the federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner. If average sales price is unavailable, the amount of payment must be lower of the usual and customary cost submitted by the provider, the wholesale acquisition cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner. The commissioner shall discount the payment rate for drugs obtained through the federal 340B Drug Pricing Program by 28.6 percent. The payment for drugs administered in an outpatient setting shall be made to the administering facility or practitioner. A retail or specialty pharmacy dispensing a drug for administration in an outpatient setting is not eligible for direct reimbursement.

(f) The commissioner may establish maximum allowable cost rates for specialty pharmacy products that are lower than the ingredient cost formulas specified in paragraph (a). The commissioner may require individuals enrolled in the health care programs administered by the department to obtain specialty pharmacy products from providers with whom the commissioner has negotiated lower reimbursement rates. Specialty pharmacy products are defined as those used by a small number of recipients or recipients with complex and chronic diseases that require expensive and challenging drug regimens. Examples of these conditions include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms of cancer. Specialty pharmaceutical products include injectable and infusion therapies, biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies that require complex care. The commissioner shall consult with the Formulary Committee to develop a list of specialty pharmacy products subject to maximum allowable cost reimbursement. In consulting with the Formulary Committee in developing this list, the commissioner shall take into consideration the population served by specialty pharmacy products, the current delivery system and standard of care in the state, and access to care issues. The commissioner shall have the discretion to adjust the maximum allowable cost to prevent access to care issues.

(g) Home infusion therapy services provided by home infusion therapy pharmacies must be paid at rates according to subdivision 8d.

(h) The commissioner shall contract with a vendor to conduct a cost of dispensing survey for all pharmacies that are physically located in the state of Minnesota that dispense outpatient drugs under medical assistance. The commissioner shall ensure that the vendor has prior experience in conducting cost of dispensing surveys. Each pharmacy enrolled with the department to dispense outpatient prescription drugs to fee-for-service members must respond to the cost of dispensing survey. The commissioner may sanction a pharmacy under section 256B.064 for failure to respond. The commissioner shall require the vendor to measure a single statewide cost of dispensing for specialty prescription drugs and a single statewide cost of dispensing for nonspecialty prescription drugs for all responding pharmacies to measure the mean, mean weighted by total prescription volume, mean weighted by medical assistance prescription volume, median, median weighted by total prescription volume, and median weighted by total medical assistance prescription volume. The commissioner shall post a copy of the final cost of dispensing survey report on the department's website. The initial survey must be completed no later than January 1, 2021, and repeated every three years. The commissioner shall provide a summary of the results of each cost of dispensing survey and provide recommendations for any changes to the dispensing fee to the chairs and ranking members of the legislative committees with jurisdiction over medical assistance pharmacy reimbursement. new text begin Notwithstanding section 256.01, subdivision 42, this paragraph does not expire. new text end

(i) The commissioner shall increase the ingredient cost reimbursement calculated in paragraphs (a) and (f) by 1.8 percent for prescription and nonprescription drugs subject to the wholesale drug distributor tax under section 295.52.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 15.

Minnesota Statutes 2022, section 256B.0625, subdivision 13f, is amended to read:

Subd. 13f.

Prior authorization.

(a) The Formulary Committee shall review and recommend drugs which require prior authorization. The Formulary Committee shall establish general criteria to be used for the prior authorization of brand-name drugs for which generically equivalent drugs are available, but the committee is not required to review each brand-name drug for which a generically equivalent drug is available.

(b) Prior authorization may be required by the commissioner before certain formulary drugs are eligible for payment. The Formulary Committee may recommend drugs for prior authorization directly to the commissioner. The commissioner may also request that the Formulary Committee review a drug for prior authorization. Before the commissioner may require prior authorization for a drug:

(1) the commissioner must provide information to the Formulary Committee on the impact that placing the drug on prior authorization may have on the quality of patient care and on program costs, information regarding whether the drug is subject to clinical abuse or misuse, and relevant data from the state Medicaid program if such data is available;

(2) the Formulary Committee must review the drug, taking into account medical and clinical data and the information provided by the commissioner; and

(3) the Formulary Committee must hold a public forum and receive public comment for an additional 15 days.

The commissioner must provide a 15-day notice period before implementing the prior authorization.

(c) Except as provided in subdivision 13j, prior authorization shall not be required or utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness if:

(1) there is no generically equivalent drug available; and

(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or

(3) the drug is part of the recipient's current course of treatment.

This paragraph applies to any multistate preferred drug list or supplemental drug rebate program established or administered by the commissioner. Prior authorization shall automatically be granted for 60 days for brand name drugs prescribed for treatment of mental illness within 60 days of when a generically equivalent drug becomes available, provided that the brand name drug was part of the recipient's course of treatment at the time the generically equivalent drug became available.

(d) new text begin Prior authorization must not be required for liquid methadone if only one version of liquid methadone is available. If more than one version of liquid methadone is available, the commissioner shall ensure that at least one version of liquid methadone is available without prior authorization. new text end

new text begin (e) Prior authorization may be required for an oral liquid form of a drug, except as described in paragraph (d). A prior authorization request under this paragraph must be automatically approved within 24 hours if the drug is being prescribed for a Food and Drug Administration-approved condition for a patient who utilizes an enteral tube for feedings or medication administration, even if the patient has current or prior claims for pills for that condition. If more than one version of the oral liquid form of a drug is available, the commissioner may select the version that is able to be approved for a Food and Drug Administration-approved condition for a patient who utilizes an enteral tube for feedings or medication administration. This paragraph applies to any multistate preferred drug list or supplemental drug rebate program established or administered by the commissioner. The commissioner shall design and implement a streamlined prior authorization form for patients who utilize an enteral tube for feedings or medication administration and are prescribed an oral liquid form of a drug. new text end The commissioner may require prior authorization for brand name drugs whenever a generically equivalent product is available, even if the prescriber specifically indicates "dispense as written-brand necessary" on the prescription as required by section 151.21, subdivision 2.

deleted text begin (e) deleted text end new text begin (f) new text end Notwithstanding this subdivision, the commissioner may automatically require prior authorization, for a period not to exceed 180 days, for any drug that is approved by the United States Food and Drug Administration on or after July 1, 2005. The 180-day period begins no later than the first day that a drug is available for shipment to pharmacies within the state. The Formulary Committee shall recommend to the commissioner general criteria to be used for the prior authorization of the drugs, but the committee is not required to review each individual drug. In order to continue prior authorizations for a drug after the 180-day period has expired, the commissioner must follow the provisions of this subdivision.

deleted text begin (f) deleted text end new text begin (g) new text end Prior authorization under this subdivision shall comply with section 62Q.184.

deleted text begin (g) deleted text end new text begin (h) new text end Any step therapy protocol requirements established by the commissioner must comply with section 62Q.1841.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 16.

Minnesota Statutes 2022, section 256B.0625, subdivision 13g, is amended to read:

Subd. 13g.

Preferred drug list.

(a) The commissioner shall adopt and implement a preferred drug list by January 1, 2004. The commissioner may enter into a contract with a vendor for the purpose of participating in a preferred drug list and supplemental rebate program. new text begin The terms of the contract with the vendor must be publicly disclosed on the website of the Department of Human Services. new text end The commissioner shall ensure that any contract meets all federal requirements and maximizes federal financial participation. The commissioner shall publish the preferred drug list annually in the State Register and shall maintain an accurate and up-to-date list on the agency website. new text begin The commissioner shall implement and maintain an accurate archive of previous versions of the preferred drug list, and make this archive available to the public on the website of the Department of Human Services beginning January 1, 2024. new text end

(b) The commissioner may add to, delete from, and otherwise modify the preferred drug list, after consulting with the Formulary Committee and appropriate medical specialists deleted text begin and deleted text end new text begin , new text end providing public notice and the opportunity for public comment new text begin , and complying with the requirements of paragraph (f) new text end .

(c) The commissioner shall adopt and administer the preferred drug list as part of the administration of the supplemental drug rebate program. Reimbursement for prescription drugs not on the preferred drug list may be subject to prior authorization.

(d) For purposes of this subdivision, new text begin the following terms have the meanings given: new text end

new text begin (1) "appropriate medical specialist" means a medical professional who prescribes the relevant class of drug as part of their practice; and new text end

new text begin (2) new text end "preferred drug list" means a list of prescription drugs within designated therapeutic classes selected by the commissioner, for which prior authorization based on the identity of the drug or class is not required.

(e) The commissioner shall seek any federal waivers or approvals necessary to implement this subdivision.

(f) deleted text begin Notwithstanding paragraph (b), deleted text end Before the commissioner may delete a drug from the preferred drug list or modify the inclusion of a drug on the preferred drug list, the commissioner shall consider any implications that the deletion or modification may have on state public health policies or initiatives and any impact that the deletion or modification may have on increasing health disparities in the state. Prior to deleting a drug or modifying the inclusion of a drug, the commissioner shall also conduct a public hearing. The commissioner shall provide adequate notice to the public and the commissioner of health prior to the hearing that specifies the drug that the commissioner is proposing to delete or modify, new text begin and shall disclose new text end any public medical or clinical analysis that the commissioner has relied on in proposing the deletion or modification deleted text begin , deleted text end and evidence that the commissioner has evaluated the impact of the proposed deletion or modification on public health and health disparities. new text begin Notwithstanding section 331A.05, a public notice of a Formulary Committee meeting must be published at least 30 days in advance of the meeting. The list of drugs to be discussed at the meeting must be announced at least 30 days before the meeting and must include the name and class of drug, the proposed action, and the proposed prior authorization requirements, if applicable. new text end

Sec. 17.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision to read:

new text begin Subd. 13k. new text end

new text begin Value-based purchasing arrangements. new text end

new text begin (a) The commissioner may enter into a value-based purchasing arrangement under medical assistance or MinnesotaCare, by written arrangement with a drug manufacturer based on agreed-upon metrics. The commissioner may contract with a vendor to implement and administer the value-based purchasing arrangement. A value-based purchasing arrangement may include but is not limited to rebates, discounts, price reductions, risk sharing, reimbursements, guarantees, shared savings payments, withholds, or bonuses. A value-based purchasing arrangement must provide at least the same value or discount in the aggregate as would claiming the mandatory federal drug rebate under the Federal Social Security Act, section 1927. new text end

new text begin (b) Nothing in this section shall be interpreted as requiring a drug manufacturer or the commissioner to enter into an arrangement as described in paragraph (a). new text end

new text begin (c) Nothing in this section shall be interpreted as altering or modifying medical assistance coverage requirements under the federal Social Security Act, section 1927. new text end

new text begin (d) If the commissioner determines that a state plan amendment is necessary before implementing a value-based purchasing arrangement, the commissioner shall request the amendment and may delay implementing this provision until the amendment is approved. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023. new text end

Sec. 18.

Minnesota Statutes 2022, section 256B.0625, subdivision 16, is amended to read:

Subd. 16.

Abortion services.

Medical assistance covers abortion services deleted text begin , but only if one of the following conditions is met: deleted text end new text begin determined to be medically necessary by the treating provider and delivered in accordance with all applicable Minnesota laws. new text end

deleted text begin (a) The abortion is a medical necessity. "Medical necessity" means (1) the signed written statement of two physicians indicating the abortion is medically necessary to prevent the death of the mother, and (2) the patient has given her consent to the abortion in writing unless the patient is physically or legally incapable of providing informed consent to the procedure, in which case consent will be given as otherwise provided by law; deleted text end

deleted text begin (b) The pregnancy is the result of criminal sexual conduct as defined in section 609.342, subdivision 1, clauses (a), (b), (c)(i) and (ii), and (e), and subdivision 1a, clauses (a), (b), (c)(i) and (ii), and (d), and the incident is reported within 48 hours after the incident occurs to a valid law enforcement agency for investigation, unless the victim is physically unable to report the criminal sexual conduct, in which case the report shall be made within 48 hours after the victim becomes physically able to report the criminal sexual conduct; or deleted text end

deleted text begin (c) The pregnancy is the result of incest, but only if the incident and relative are reported to a valid law enforcement agency for investigation prior to the abortion. deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 19.

Minnesota Statutes 2022, section 256B.0625, subdivision 28b, is amended to read:

Subd. 28b.

Doula services.

Medical assistance covers doula services provided by a certified doula as defined in section 148.995, subdivision 2, of the mother's choice. For purposes of this section, "doula services" means childbirth education and support services, including emotional and physical support provided during pregnancy, labor, birth, and postpartum. new text begin The commissioner shall enroll doula agencies and individual treating doulas to provide direct reimbursement. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. new text end

Sec. 20.

Minnesota Statutes 2022, 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, and public health clinic services. 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 (FQHC) 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. An FQHC 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, an FQHC 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. FQHCs 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), an FQHC 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 FQHCs 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 FQHCs 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 FQHCs or rural health clinics.

(d) Effective July 1, 1999, the provisions of paragraph (c) requiring an FQHC 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, through December 31, 2020, each FQHC 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 Centers for Medicare and Medicaid Services. The alternative payment methodology shall be 100 percent of cost as determined according to Medicare cost principles.

(g) Effective for services provided on or after January 1, 2021, all claims for payment of clinic services provided by FQHCs and rural health clinics shall be paid by the commissioner, according to an annual election by the FQHC or rural health clinic, under the current prospective payment system described in paragraph (f) or the alternative payment methodology described in paragraph (l) new text begin , or, upon federal approval, for FQHCs that are also urban Indian organizations under Title V of the federal Indian Health Improvement Act, as provided under paragraph (k) new text end .

(h) For purposes of this section, "nonprofit community clinic" is a clinic that:

(1) has nonprofit status as specified in chapter 317A;

(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);

(3) is established to provide health services to low-income population groups, uninsured, high-risk and special needs populations, underserved and other special needs populations;

(4) employs professional staff at least one-half of which are familiar with the cultural background of their clients;

(5) charges for services on a sliding fee scale designed to provide assistance to low-income clients based on current poverty income guidelines and family size; and

(6) does not restrict access or services because of a client's financial limitations or public assistance status and provides no-cost care as needed.

(i) Effective for services provided on or after January 1, 2015, all claims for payment of clinic services provided by FQHCs and rural health clinics shall be paid by the commissioner. the commissioner shall determine the most feasible method for paying claims from the following options:

(1) FQHCs and rural health clinics submit claims directly to the commissioner for payment, and the commissioner provides claims information for recipients enrolled in a managed care or county-based purchasing plan to the plan, on a regular basis; or

(2) FQHCs and rural health clinics submit claims for recipients enrolled in a managed care or county-based purchasing plan to the plan, and those claims are submitted by the plan to the commissioner for payment to the clinic.

(j) For clinic services provided prior to January 1, 2015, the commissioner shall calculate and pay monthly the proposed managed care supplemental payments to clinics, and clinics shall conduct a timely review of the payment calculation data in order to finalize all supplemental payments in accordance with federal law. Any issues arising from a clinic's review must be reported to the commissioner by January 1, 2017. Upon final agreement between the commissioner and a clinic on issues identified under this subdivision, and in accordance with United States Code, title 42, section 1396a(bb), no supplemental payments for managed care plan or county-based purchasing plan claims for services provided prior to January 1, 2015, shall be made after June 30, 2017. If the commissioner and clinics are unable to resolve issues under this subdivision, the parties shall submit the dispute to the arbitration process under section 14.57.

deleted text begin (k) The commissioner deleted text end deleted text begin shall deleted text end deleted text begin seek deleted text end deleted text begin a deleted text end deleted text begin federal deleted text end deleted text begin waiver, authorized under section 1115 of the Social Security Act, to obtain federal financial deleted text end deleted text begin participation at the 100 percent federal matching percentage available to facilities of the deleted text end deleted text begin Indian Health Service or tribal organization in accordance with section 1905(b) of the Social deleted text end deleted text begin Security Act for expenditures made to organizations dually certified under Title V of the deleted text end deleted text begin Indian Health Care Improvement Act, Public Law 94-437, and as a federally qualified health deleted text end deleted text begin center under paragraph (a) that deleted text end

deleted text begin provides services to American Indian and deleted text end deleted text begin Alaskan deleted text end deleted text begin Native individuals eligible deleted text end deleted text begin for services under this subdivision deleted text end deleted text begin . deleted text end

new text begin (k) The commissioner shall establish an encounter payment rate that is equivalent to the all inclusive rate (AIR) payment established by the Indian Health Service and published in the Federal Register. The encounter rate must be updated annually and must reflect the changes in the AIR established by the Indian Health Service each calendar year. FQHCs that are also urban Indian organizations under Title V of the federal Indian Health Improvement Act may elect to be paid: (1) at the encounter rate established under this paragraph; (2) under the alternative payment methodology described in paragraph (l); or (3) under the federally required prospective payment system described in paragraph (f). FQHCs that elect to be paid at the encounter rate established under this paragraph must continue to meet all state and federal requirements related to FQHCs and urban Indian organizations, and must maintain their statuses as FQHCs and urban Indian organizations. new text end

(l) All claims for payment of clinic services provided by FQHCs and rural health clinics, that have elected to be paid under this paragraph, shall be paid by the commissioner according to the following requirements:

(1) the commissioner shall establish a single medical and single dental organization encounter rate for each FQHC and rural health clinic when applicable;

(2) each FQHC and rural health clinic is eligible for same day reimbursement of one medical and one dental organization encounter rate if eligible medical and dental visits are provided on the same day;

(3) the commissioner shall reimburse FQHCs and rural health clinics, in accordance with current applicable Medicare cost principles, their allowable costs, including direct patient care costs and patient-related support services. Nonallowable costs include, but are not limited to:

(i) general social services and administrative costs;

(ii) retail pharmacy;

(iii) patient incentives, food, housing assistance, and utility assistance;

(iv) external lab and x-ray;

(v) navigation services;

(vi) health care taxes;

(vii) advertising, public relations, and marketing;

(viii) office entertainment costs, food, alcohol, and gifts;

(ix) contributions and donations;

(x) bad debts or losses on awards or contracts;

(xi) fines, penalties, damages, or other settlements;

(xii) fundraising, investment management, and associated administrative costs;

(xiii) research and associated administrative costs;

(xiv) nonpaid workers;

(xv) lobbying;

(xvi) scholarships and student aid; and

(xvii) nonmedical assistance covered services;

(4) the commissioner shall review the list of nonallowable costs in the years between the rebasing process established in clause (5), in consultation with the Minnesota Association of Community Health Centers, FQHCs, and rural health clinics. The commissioner shall publish the list and any updates in the Minnesota health care programs provider manual;

(5) the initial applicable base year organization encounter rates for FQHCs and rural health clinics shall be computed for services delivered on or after January 1, 2021, and:

(i) must be determined using each FQHC's and rural health clinic's Medicare cost reports from 2017 and 2018;

(ii) must be according to current applicable Medicare cost principles as applicable to FQHCs and rural health clinics without the application of productivity screens and upper payment limits or the Medicare prospective payment system FQHC aggregate mean upper payment limit;

(iii) must be subsequently rebased every two years thereafter using the Medicare cost reports that are three and four years prior to the rebasing year. Years in which organizational cost or claims volume is reduced or altered due to a pandemic, disease, or other public health emergency shall not be used as part of a base year when the base year includes more than one year. The commissioner may use the Medicare cost reports of a year unaffected by a pandemic, disease, or other public health emergency, or previous two consecutive years, inflated to the base year as established under item (iv);

(iv) must be inflated to the base year using the inflation factor described in clause (6); and

(v) the commissioner must provide for a 60-day appeals process under section 14.57;

(6) the commissioner shall annually inflate the applicable organization encounter rates for FQHCs and rural health clinics from the base year payment rate to the effective date by using the CMS FQHC Market Basket inflator established under United States Code, title 42, section 1395m(o), less productivity;

(7) FQHCs and rural health clinics that have elected the alternative payment methodology under this paragraph shall submit all necessary documentation required by the commissioner to compute the rebased organization encounter rates no later than six months following the date the applicable Medicare cost reports are due to the Centers for Medicare and Medicaid Services;

(8) the commissioner shall reimburse FQHCs and rural health clinics an additional amount relative to their medical and dental organization encounter rates that is attributable to the tax required to be paid according to section 295.52, if applicable;

(9) FQHCs and rural health clinics may submit change of scope requests to the commissioner if the change of scope would result in an increase or decrease of 2.5 percent or higher in the medical or dental organization encounter rate currently received by the FQHC or rural health clinic;

(10) for FQHCs and rural health clinics seeking a change in scope with the commissioner under clause (9) that requires the approval of the scope change by the federal Health Resources Services Administration:

(i) FQHCs and rural health clinics shall submit the change of scope request, including the start date of services, to the commissioner within seven business days of submission of the scope change to the federal Health Resources Services Administration;

(ii) the commissioner shall establish the effective date of the payment change as the federal Health Resources Services Administration date of approval of the FQHC's or rural health clinic's scope change request, or the effective start date of services, whichever is later; and

(iii) within 45 days of one year after the effective date established in item (ii), the commissioner shall conduct a retroactive review to determine if the actual costs established under clause (3) or encounters result in an increase or decrease of 2.5 percent or higher in the medical or dental organization encounter rate, and if this is the case, the commissioner shall revise the rate accordingly and shall adjust payments retrospectively to the effective date established in item (ii);

(11) for change of scope requests that do not require federal Health Resources Services Administration approval, the FQHC and rural health clinic shall submit the request to the commissioner before implementing the change, and the effective date of the change is the date the commissioner received the FQHC's or rural health clinic's request, or the effective start date of the service, whichever is later. The commissioner shall provide a response to the FQHC's or rural health clinic's request within 45 days of submission and provide a final approval within 120 days of submission. This timeline may be waived at the mutual agreement of the commissioner and the FQHC or rural health clinic if more information is needed to evaluate the request;

(12) the commissioner, when establishing organization encounter rates for new FQHCs and rural health clinics, shall consider the patient caseload of existing FQHCs and rural health clinics in a 60-mile radius for organizations established outside of the seven-county metropolitan area, and in a 30-mile radius for organizations in the seven-county metropolitan area. If this information is not available, the commissioner may use Medicare cost reports or audited financial statements to establish base rates;

(13) the commissioner shall establish a quality measures workgroup that includes representatives from the Minnesota Association of Community Health Centers, FQHCs, and rural health clinics, to evaluate clinical and nonclinical measures; and

(14) the commissioner shall not disallow or reduce costs that are related to an FQHC's or rural health clinic's participation in health care educational programs to the extent that the costs are not accounted for in the alternative payment methodology encounter rate established in this paragraph.

new text begin (m) Effective July 1, 2023, an enrolled Indian health service facility or a Tribal health center operating under a 638 contract or compact may elect to also enroll as a Tribal FQHC. Requirements that otherwise apply to an FQHC covered in this subdivision do not apply to a Tribal FQHC enrolled under this paragraph, except that any requirements necessary to comply with federal regulations do apply to a Tribal FQHC. The commissioner shall establish an alternative payment method for a Tribal FQHC enrolled under this paragraph that uses the same method and rates applicable to a Tribal facility or health center that does not enroll as a Tribal FQHC. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026, or upon federal approval, whichever is later, except that paragraph (m) is effective July 1, 2023, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. new text end

Sec. 21.

Minnesota Statutes 2022, section 256B.0625, subdivision 31, is amended to read:

Subd. 31.

Medical supplies and equipment.

(a) Medical assistance covers medical supplies and equipment. Separate payment outside of the facility's payment rate shall be made for wheelchairs and wheelchair accessories for recipients who are residents of intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions and limitations as coverage for recipients who do not reside in institutions. A wheelchair purchased outside of the facility's payment rate is the property of the recipient.

(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies must enroll as a Medicare provider.

(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics, or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment requirement if:

(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic, or medical supply;

(2) the vendor serves ten or fewer medical assistance recipients per year;

(3) the commissioner finds that other vendors are not available to provide same or similar durable medical equipment, prosthetics, orthotics, or medical supplies; and

(4) the vendor complies with all screening requirements in this chapter and Code of Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare and Medicaid Services approved national accreditation organization as complying with the Medicare program's supplier and quality standards and the vendor serves primarily pediatric patients.

(d) Durable medical equipment means a device or equipment that:

(1) can withstand repeated use;

(2) is generally not useful in the absence of an illness, injury, or disability; and

(3) is provided to correct or accommodate a physiological disorder or physical condition or is generally used primarily for a medical purpose.

(e) Electronic tablets may be considered durable medical equipment if the electronic tablet will be used as an augmentative and alternative communication system as defined under subdivision 31a, paragraph (a). To be covered by medical assistance, the device must be locked in order to prevent use not related to communication.

(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be locked to prevent use not as an augmentative communication device, a recipient of waiver services may use an electronic tablet for a use not related to communication when the recipient has been authorized under the waiver to receive one or more additional applications that can be loaded onto the electronic tablet, such that allowing the additional use prevents the purchase of a separate electronic tablet with waiver funds.

(g) An order or prescription for medical supplies, equipment, or appliances must meet the requirements in Code of Federal Regulations, title 42, part 440.70.

(h) Allergen-reducing products provided according to subdivision 67, paragraph (c) or (d), shall be considered durable medical equipment.

new text begin (i) Seizure detection devices are covered as durable medical equipment under this subdivision if: new text end

new text begin (1) the seizure detection device is medically appropriate based on the recipient's medical condition or status; and new text end

new text begin (2) the recipient's health care provider has identified that a seizure detection device would: new text end

new text begin (i) likely assist in reducing bodily harm to or death of the recipient as a result of the recipient experiencing a seizure; or new text end

new text begin (ii) provide data to the health care provider necessary to appropriately diagnose or treat a health condition of the recipient that causes the seizure activity. new text end

new text begin (j) For purposes of paragraph (i), "seizure detection device" means a United States Food and Drug Administration-approved monitoring device and related service or subscription supporting the prescribed use of the device, including technology that provides ongoing patient monitoring and alert services that detect seizure activity and transmit notification of the seizure activity to a caregiver for appropriate medical response or collects data of the seizure activity of the recipient that can be used by a health care provider to diagnose or appropriately treat a health care condition that causes the seizure activity. The medical assistance reimbursement rate for a subscription supporting the prescribed use of a seizure detection device is 60 percent of the rate for monthly remote monitoring under the medical assistance telemonitoring benefit. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. new text end

Sec. 22.

Minnesota Statutes 2022, section 256B.0625, subdivision 34, is amended to read:

Subd. 34.

Indian health services facilities.

deleted text begin (a) deleted text end 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 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). 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.

deleted text begin (b) Effective upon federal approval deleted text end deleted text begin , the medical assistance payments to a dually certified facility deleted text end deleted text begin as defined in subdivision 30, paragraph deleted text end deleted text begin (j) deleted text end deleted text begin , shall be the encounter rate described in deleted text end deleted text begin paragraph (a) or a rate that is substantially equivalent for services provided to American deleted text end deleted text begin Indians and deleted text end deleted text begin Alaskan deleted text end deleted text begin Native populations deleted text end deleted text begin . The rate established under this paragraph for dually certified facilities deleted text end deleted text begin shall not apply to MinnesotaCare payments. deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 23.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision to read:

new text begin Subd. 68. new text end

new text begin Tobacco and nicotine cessation. new text end

new text begin (a) Medical assistance covers tobacco and nicotine cessation services, drugs to treat tobacco and nicotine addiction or dependence, and drugs to help individuals discontinue use of tobacco and nicotine products. Medical assistance must cover services and drugs as provided in this subdivision consistent with evidence-based or evidence-informed best practices. new text end

new text begin (b) Medical assistance must cover in-person individual and group tobacco and nicotine cessation education and counseling services if provided by a health care practitioner whose scope of practice encompasses tobacco and nicotine cessation education and counseling. Service providers include but are not limited to the following: new text end

new text begin (1) mental health practitioners under section 245.462, subdivision 17; new text end

new text begin (2) mental health professionals under section 245.462, subdivision 18; new text end

new text begin (3) mental health certified peer specialists under section 256B.0615; new text end

new text begin (4) alcohol and drug counselors licensed under chapter 148F; new text end

new text begin (5) recovery peers as defined in section 245F.02, subdivision 21; new text end

new text begin (6) certified tobacco treatment specialists; new text end

new text begin (7) community health workers; new text end

new text begin (8) physicians; new text end

new text begin (9) physician assistants; new text end

new text begin (10) advanced practice registered nurses; or new text end

new text begin (11) other licensed or nonlicensed professionals or paraprofessionals with training in providing tobacco and nicotine cessation education and counseling services. new text end

new text begin (c) Medical assistance covers telephone cessation counseling services provided through a quitline. Notwithstanding section 256B.0625, subdivision 3b, quitline services may be provided through audio-only communications. The commissioner of human services may utilize volume purchasing for quitline services consistent with section 256B.04, subdivision 14. new text end

new text begin (d) Medical assistance must cover all prescription and over-the-counter pharmacotherapy drugs approved by the United States Food and Drug Administration for cessation of tobacco and nicotine use or treatment of tobacco and nicotine dependence, and that are subject to a Medicaid drug rebate agreement. new text end

new text begin (e) Services covered under this subdivision may be provided by telemedicine. new text end

new text begin (f) The commissioner must not: new text end

new text begin (1) restrict or limit the type, duration, or frequency of tobacco and nicotine cessation services; new text end

new text begin (2) prohibit the simultaneous use of multiple cessation services, including but not limited to simultaneous use of counseling and drugs; new text end

new text begin (3) require counseling before receiving drugs or as a condition of receiving drugs; new text end

new text begin (4) limit pharmacotherapy drug dosage amounts for a dosing regimen for treatment of a medically accepted indication as defined in United States Code, title 14, section 1396r-8(K)(6); limit dosing frequency; or impose duration limits; new text end

new text begin (5) prohibit simultaneous use of multiple drugs, including prescription and over-the-counter drugs; new text end

new text begin (6) require or authorize step therapy; or new text end

new text begin (7) require or utilize prior authorization for any tobacco and nicotine cessation services and drugs covered under this subdivision. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 24.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision to read:

new text begin Subd. 69. new text end

new text begin Biomarker testing. new text end

new text begin Medical assistance covers biomarker testing to diagnose, treat, manage, and monitor illness or disease. Medical assistance coverage must meet the requirements that would otherwise apply to a health plan under section 62Q.473. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. new text end

Sec. 25.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision to read:

new text begin Subd. 70. new text end

new text begin Recuperative care services. new text end

new text begin Medical assistance covers recuperative care services according to section 256B.0701. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 26.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision to read:

new text begin Subd. 71. new text end

new text begin Coverage of services for the diagnosis, monitoring, and treatment of rare diseases. new text end

new text begin (a) Medical assistance covers services related to the diagnosis, monitoring, and treatment of a rare disease or condition. Medical assistance coverage for these services must meet the requirements in section 62Q.451, subdivisions 1 to 3 and 6. Providers must still meet all applicable program requirements. new text end

new text begin (b) Coverage for a service must not be denied solely on the basis that it was provided by, referred for, or ordered by an out-of-network provider. new text end

new text begin (c) Any prior authorization requirements for a service that is provided by, referred for, or ordered by an out-of-network provider must be the same as any prior authorization requirements for a service that is provided by, referred for, or ordered by an in-network provider. new text end

new text begin (d) Nothing in this subdivision requires medical assistance to cover additional services. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 27.

new text begin [256B.0701] RECUPERATIVE CARE SERVICES. new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the meanings given. new text end

new text begin (b) "Provider" means a recuperative care provider as defined by the standards established by the National Institute for Medical Respite Care. new text end

new text begin (c) "Recuperative care" means a model of care that prevents hospitalization or that provides postacute medical care and support services for recipients experiencing homelessness who are too ill or frail to recover from a physical illness or injury while living in a shelter or are otherwise unhoused but who are not sick enough to be hospitalized or remain hospitalized, or to need other levels of care. new text end

new text begin Subd. 2. new text end

new text begin Recuperative care settings. new text end

new text begin Recuperative care may be provided in any setting, including but not limited to homeless shelters, congregate care settings, single room occupancy settings, or supportive housing, so long as the provider of recuperative care or provider of housing is able to provide to the recipient within the designated setting, at a minimum: new text end

new text begin (1) 24-hour access to a bed and bathroom; new text end

new text begin (2) access to three meals a day; new text end

new text begin (3) availability to environmental services; new text end

new text begin (4) access to a telephone; new text end

new text begin (5) a secure place to store belongings; and new text end

new text begin (6) staff available within the setting to provide a wellness check as needed, but at a minimum, at least once every 24 hours. new text end

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin To be eligible for recuperative care service, a recipient must: new text end

new text begin (1) not be a child; new text end

new text begin (2) be experiencing homelessness; new text end

new text begin (3) be in need of short-term acute medical care for a period of no more than 60 days; new text end

new text begin (4) meet clinical criteria, as established by the commissioner, that indicates that the recipient needs recuperative care; and new text end

new text begin (5) not have behavioral health needs that are greater than what can be managed by the provider within the setting. new text end

new text begin Subd. 4. new text end

new text begin Total payment rates. new text end

new text begin Total payment rates for recuperative care consist of the recuperative care services rate and the recuperative care facility rate. new text end

new text begin Subd. 5. new text end

new text begin Recuperative care services rate. new text end

new text begin The recuperative care services rate is for the services provided to the recipient and must be a bundled daily per diem payment of at least $300 per day. Services provided within the bundled payment may include but are not limited to: new text end

new text begin (1) basic nursing care, including: new text end

new text begin (i) monitoring a patient's physical health and pain level; new text end

new text begin (ii) providing wound care; new text end

new text begin (iii) medication support; new text end

new text begin (iv) patient education; new text end

new text begin (v) immunization review and update; and new text end

new text begin (vi) establishing clinical goals for the recuperative care period and discharge plan; new text end

new text begin (2) care coordination, including: new text end

new text begin (i) initial assessment of medical, behavioral, and social needs; new text end

new text begin (ii) development of a care plan; new text end

new text begin (iii) support and referral assistance for legal services, housing, community social services, case management, health care benefits, health and other eligible benefits, and transportation needs and services; and new text end

new text begin (iv) monitoring and follow-up to ensure that the care plan is effectively implemented to address the medical, behavioral, and social needs; new text end

new text begin (3) basic behavioral needs, including counseling and peer support, that can be provided in the recuperative care setting; and new text end

new text begin (4) services provided by a community health worker as defined under section 256B.0625, subdivision 49. new text end

new text begin Subd. 6. new text end

new text begin Recuperative care facility rate. new text end

new text begin (a) The recuperative care facility rate is for facility costs and must be paid from state money in an amount equal to the medical assistance room and board rate at the time the recuperative care services were provided. The eligibility standards in chapter 256I do not apply to the recuperative care facility rate. The recuperative care facility rate is only paid when the recuperative care services rate is paid to a provider. Providers may opt to only receive the recuperative care services rate. new text end

new text begin (b) Before a recipient is discharged from a recuperative care setting, the provider must ensure that the recipient's medical condition is stabilized or that the recipient is being discharged to a setting that is able to meet that recipient's needs. new text end

new text begin Subd. 7. new text end

new text begin Extended stay. new text end

new text begin If a recipient requires care exceeding the 60-day limit described in subdivision 3, the provider may request in a format prescribed by the commissioner an extension to continue payments until the recipient is discharged. new text end

new text begin Subd. 8. new text end

new text begin Report. new text end

new text begin (a) The commissioner must submit an initial report on coverage of recuperative care services to the chairs and ranking minority members of the legislative committees having jurisdiction over health and human services finance and policy by February 1, 2025, and a final report by February 1, 2027. The reports must include but are not limited to: new text end

new text begin (1) a list of the recuperative care services in Minnesota and the number of recipients; new text end

new text begin (2) the estimated return on investment, including health care savings due to reduced hospitalizations; new text end

new text begin (3) follow-up information, if available, on whether recipients' hospital visits decreased since recuperative care services were provided compared to before the services were provided; and new text end

new text begin (4) any other information that can be used to determine the effectiveness of the program and its funding, including recommendations for improvements to the program. new text end

new text begin (b) This subdivision expires upon submission of the final report. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 28.

Minnesota Statutes 2022, section 256B.0941, subdivision 3, is amended to read:

Subd. 3.

Per diem rate.

(a) The commissioner must establish one per diem rate per provider for psychiatric residential treatment facility services for individuals 21 years of age or younger. The rate for a provider must not exceed the rate charged by that provider for the same service to other payers. Payment must not be made to more than one entity for each individual for services provided under this section on a given day. The commissioner must set rates prospectively for the annual rate period. The commissioner must require providers to submit annual cost reports on a uniform cost reporting form and must use submitted cost reports to inform the rate-setting process. The cost reporting must be done according to federal requirements for Medicare cost reports.

(b) The following are included in the rate:

(1) costs necessary for licensure and accreditation, meeting all staffing standards for participation, meeting all service standards for participation, meeting all requirements for active treatment, maintaining medical records, conducting utilization review, meeting inspection of care, and discharge planning. The direct services costs must be determined using the actual cost of salaries, benefits, payroll taxes, and training of direct services staff and service-related transportation; and

(2) payment for room and board provided by facilities meeting all accreditation and licensing requirements for participation.

(c) A facility may submit a claim for payment outside of the per diem for professional services arranged by and provided at the facility by an appropriately licensed professional who is enrolled as a provider with Minnesota health care programs. Arranged services may be billed by either the facility or the licensed professional. These services must be included in the individual plan of care and are subject to prior authorization.

(d) Medicaid must reimburse for concurrent services as approved by the commissioner to support continuity of care and successful discharge from the facility. "Concurrent services" means services provided by another entity or provider while the individual is admitted to a psychiatric residential treatment facility. Payment for concurrent services may be limited and these services are subject to prior authorization by the state's medical review agent. Concurrent services may include targeted case management, assertive community treatment, clinical care consultation, team consultation, and treatment planning.

(e) Payment rates under this subdivision must not include the costs of providing the following services:

(1) educational services;

(2) acute medical care or specialty services for other medical conditions;

(3) dental services; and

(4) pharmacy drug costs.

(f) For purposes of this section, "actual cost" means costs that are allowable, allocable, reasonable, and consistent with federal reimbursement requirements in Code of Federal Regulations, title 48, chapter 1, part 31, relating to for-profit entities, and the Office of Management and Budget Circular Number A-122, relating to nonprofit entities.

new text begin (g) The commissioner shall annually adjust psychiatric residential treatment facility services per diem rates to reflect the change in the Centers for Medicare and Medicaid Services Inpatient Psychiatric Facility Market Basket. The commissioner shall use the indices as forecasted for the midpoint of the prior rate year to the midpoint of the current rate year. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. new text end

Sec. 29.

Minnesota Statutes 2022, section 256B.0947, subdivision 7, is amended to read:

Subd. 7.

Medical assistance payment and rate setting.

(a) Payment for services in this section must be based on one daily encounter rate per provider inclusive of the following services received by an eligible client in a given calendar day: all rehabilitative services, supports, and ancillary activities under this section, staff travel time to provide rehabilitative services under this section, and crisis response services under section 256B.0624.

(b) Payment must not be made to more than one entity for each client for services provided under this section on a given day. If services under this section are provided by a team that includes staff from more than one entity, the team shall determine how to distribute the payment among the members.

(c) The commissioner shall establish regional cost-based rates for entities that will bill medical assistance for nonresidential intensive rehabilitative mental health services. In developing these rates, the commissioner shall consider:

(1) the cost for similar services in the health care trade area;

(2) actual costs incurred by entities providing the services;

(3) the intensity and frequency of services to be provided to each client;

(4) the degree to which clients will receive services other than services under this section; and

(5) the costs of other services that will be separately reimbursed.

(d) The rate for a provider must not exceed the rate charged by that provider for the same service to other payers.

new text begin (e) Effective for the rate years beginning on and after January 1, 2024, rates must be annually adjusted for inflation using the Centers for Medicare and Medicaid Services Medicare Economic Index, as forecasted in the fourth quarter of the calendar year before 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. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. new text end

Sec. 30.

Minnesota Statutes 2022, section 256B.69, subdivision 5a, is amended to read:

Subd. 5a.

Managed care contracts.

(a) Managed care contracts under this section and section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner may issue separate contracts with requirements specific to services to medical assistance recipients age 65 and older.

(b) A prepaid health plan providing covered health services for eligible persons pursuant to chapters 256B and 256L is responsible for complying with the terms of its contract with the commissioner. Requirements applicable to managed care programs under chapters 256B and 256L established after the effective date of a contract with the commissioner take effect when the contract is next issued or renewed.

(c) The commissioner shall withhold five percent of managed care plan payments under this section and county-based purchasing plan payments under section 256B.692 for the prepaid medical assistance program pending completion of performance targets. Each performance target must be quantifiable, objective, measurable, and reasonably attainable, except in the case of a performance target based on a federal or state law or rule. Criteria for assessment of each performance target must be outlined in writing prior to the contract effective date. Clinical or utilization performance targets and their related criteria must consider evidence-based research and reasonable interventions when available or applicable to the populations served, and must be developed with input from external clinical experts and stakeholders, including managed care plans, county-based purchasing plans, and providers. The managed care or county-based purchasing plan must demonstrate, to the commissioner's satisfaction, that the data submitted regarding attainment of the performance target is accurate. The commissioner shall periodically change the administrative measures used as performance targets in order to improve plan performance across a broader range of administrative services. The performance targets must include measurement of plan efforts to contain spending on health care services and administrative activities. The commissioner may adopt plan-specific performance targets that take into account factors affecting only one plan, including characteristics of the plan's enrollee population. The withheld funds must be returned no sooner than July of the following year if performance targets in the contract are achieved. The commissioner may exclude special demonstration projects under subdivision 23.

(d) The commissioner shall require that managed care plans:

(1) use the assessment and authorization processes, forms, timelines, standards, documentation, and data reporting requirements, protocols, billing processes, and policies consistent with medical assistance fee-for-service or the Department of Human Services contract requirements for all personal care assistance services under section 256B.0659 and community first services and supports under section 256B.85; and

(2) by January 30 of each year that follows a rate increase for any aspect of services under section 256B.0659 or 256B.85, inform the commissioner and the chairs and ranking minority members of the legislative committees with jurisdiction over rates determined under section 256B.851 of the amount of the rate increase that is paid to each personal care assistance provider agency with which the plan has a contract.

deleted text begin (e) Effective for services rendered on or after January 1, 2012, the commissioner shall include as part of the performance targets described in paragraph (c) a reduction in the health plan's emergency department utilization rate for medical assistance and MinnesotaCare enrollees, as determined by the commissioner. For 2012, the reduction shall be based on the health plan's utilization in 2009. To earn the return of the withhold each subsequent year, the managed care plan or county-based purchasing plan must achieve a qualifying reduction of no less than ten percent of the plan's emergency department utilization rate for medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 28, compared to the previous measurement year until the final performance target is reached. When measuring performance, the commissioner must consider the difference in health risk in a managed care or county-based purchasing plan's membership in the baseline year compared to the measurement year, and work with the managed care or county-based purchasing plan to account for differences that they agree are significant. deleted text end

deleted text begin The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following calendar year if the managed care plan or county-based purchasing plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate was achieved. The commissioner shall structure the withhold so that the commissioner returns a portion of the withheld funds in amounts commensurate with achieved reductions in utilization less than the targeted amount. deleted text end

deleted text begin The withhold described in this paragraph shall continue for each consecutive contract period until the plan's emergency room utilization rate for state health care program enrollees is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the health plans in meeting this performance target and shall accept payment withholds that may be returned to the hospitals if the performance target is achieved. deleted text end

deleted text begin (f) Effective for services rendered on or after January 1, 2012, the commissioner shall include as part of the performance targets described in paragraph (c) a reduction in the plan's hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the withhold each year, the managed care plan or county-based purchasing plan must achieve a qualifying reduction of no less than five percent of the plan's hospital admission rate for medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 28, compared to the previous calendar year until the final performance target is reached. When measuring performance, the commissioner must consider the difference in health risk in a managed care or county-based purchasing plan's membership in the baseline year compared to the measurement year, and work with the managed care or county-based purchasing plan to account for differences that they agree are significant. deleted text end

deleted text begin The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following calendar year if the managed care plan or county-based purchasing plan demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization rate was achieved. The commissioner shall structure the withhold so that the commissioner returns a portion of the withheld funds in amounts commensurate with achieved reductions in utilization less than the targeted amount. deleted text end

deleted text begin The withhold described in this paragraph shall continue until there is a 25 percent reduction in the hospital admission rate compared to the hospital admission rates in calendar year 2011, as determined by the commissioner. The hospital admissions in this performance target do not include the admissions applicable to the subsequent hospital admission performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting this performance target and shall accept payment withholds that may be returned to the hospitals if the performance target is achieved. deleted text end

deleted text begin (g) Effective for services rendered on or after January 1, 2012, the commissioner shall include as part of the performance targets described in paragraph (c) a reduction in the plan's hospitalization admission rates for subsequent hospitalizations within 30 days of a previous hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the withhold each year, the managed care plan or county-based purchasing plan must achieve a qualifying reduction of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 28, of no less than five percent compared to the previous calendar year until the final performance target is reached. deleted text end

deleted text begin The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following calendar year if the managed care plan or county-based purchasing plan demonstrates to the satisfaction of the commissioner that a qualifying reduction in the subsequent hospitalization rate was achieved. The commissioner shall structure the withhold so that the commissioner returns a portion of the withheld funds in amounts commensurate with achieved reductions in utilization less than the targeted amount. deleted text end

deleted text begin The withhold described in this paragraph must continue for each consecutive contract period until the plan's subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year 2011. Hospitals shall cooperate with the plans in meeting this performance target and shall accept payment withholds that must be returned to the hospitals if the performance target is achieved. deleted text end

deleted text begin (h) deleted text end new text begin (e) new text end Effective for services rendered on or after January 1, 2013, through December 31, 2013, the commissioner shall withhold 4.5 percent of managed care plan payments under this section and county-based purchasing plan payments under section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following year. The commissioner may exclude special demonstration projects under subdivision 23.

deleted text begin (i) deleted text end new text begin (f) new text end Effective for services rendered on or after January 1, 2014, the commissioner shall withhold three percent of managed care plan payments under this section and county-based purchasing plan payments under section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following year. The commissioner may exclude special demonstration projects under subdivision 23.

deleted text begin (j) deleted text end new text begin (g) new text end A managed care plan or a county-based purchasing plan under section 256B.692 may include as admitted assets under section 62D.044 any amount withheld under this section that is reasonably expected to be returned.

deleted text begin (k) deleted text end new text begin (h) new text end Contracts between the commissioner and a prepaid health plan are exempt from the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and 7.

deleted text begin (l) deleted text end new text begin (i) new text end The return of the withhold under paragraphs (h) and (i) is not subject to the requirements of paragraph (c).

deleted text begin (m) deleted text end new text begin (j) new text end Managed care plans and county-based purchasing plans shall maintain current and fully executed agreements for all subcontractors, including bargaining groups, for administrative services that are expensed to the state's public health care programs. Subcontractor agreements determined to be material, as defined by the commissioner after taking into account state contracting and relevant statutory requirements, must be in the form of a written instrument or electronic document containing the elements of offer, acceptance, consideration, payment terms, scope, duration of the contract, and how the subcontractor services relate to state public health care programs. Upon request, the commissioner shall have access to all subcontractor documentation under this paragraph. Nothing in this paragraph shall allow release of information that is nonpublic data pursuant to section 13.02.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 31.

Minnesota Statutes 2022, section 256B.69, is amended by adding a subdivision to read:

new text begin Subd. 19a. new text end

new text begin Limitation on reimbursement; rare disease services provided in Minnesota by out-of-network providers. new text end

new text begin (a) If a managed care or county-based purchasing plan has an established contractual payment under medical assistance with an out-of-network provider for a service provided in Minnesota related to the diagnosis, monitoring, and treatment of a rare disease or condition, the provider must accept the established contractual payment for that service as payment in full. new text end

new text begin (b) If a plan does not have an established contractual payment under medical assistance with an out-of-network provider for a service provided in Minnesota related to the diagnosis, monitoring, and treatment of a rare disease or condition, the provider must accept the provider's established rate for uninsured patients for that service as payment in full. If the provider does not have an established rate for uninsured patients for that service, the provider must accept the fee-for-service rate. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 32.

Minnesota Statutes 2022, section 256B.69, is amended by adding a subdivision to read:

new text begin Subd. 19b. new text end

new text begin Limitation on reimbursement; rare disease services provided outside of Minnesota by an out-of-network provider. new text end

new text begin (a) If a managed care or county-based purchasing plan has an established contractual payment under medical assistance with an out-of-network provider for a service provided in another state related to diagnosis, monitoring, and treatment of a rare disease or condition, the plan must pay the established contractual payment for that service. new text end

new text begin (b) If a plan does not have an established contractual payment under medical assistance with an out-of-network provider for a service provided in another state related to diagnosis, monitoring, and treatment of a rare disease or condition, the plan must pay the provider's established rate for uninsured patients for that service. If the provider does not have an established rate for uninsured patients for that service, the plan must pay the provider the fee-for-service rate in that state. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 33.

Minnesota Statutes 2022, section 256B.758, is amended to read:

256B.758 REIMBURSEMENT FOR DOULA SERVICES.

new text begin (a) new text end Effective for services provided on or after July 1, 2019 new text begin , through December 31, 2023 new text end , payments for doula services provided by a certified doula shall be $47 per prenatal or postpartum visit and $488 for attending and providing doula services at a birth.

new text begin (b) Effective for services provided on or after January 1, 2024, payments for doula services provided by a certified doula are $100 per prenatal or postpartum visit and $1,400 for attending and providing doula services at birth. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 34.

Minnesota Statutes 2022, section 256B.76, subdivision 1, as amended by Laws 2023, chapter 25, section 145, is amended to read:

Subdivision 1.

Physician new text begin and professional services new text end 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 Centers for Medicare and Medicaid Services' common procedural coding system codes titled "office and other outpatient services," "preventive medicine new and established patient," "delivery, antepartum, and postpartum care," "critical care," cesarean delivery and pharmacologic management provided to psychiatric patients, and 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;

(2) payments for all other services shall be paid at the lower of (i) submitted charges, or (ii) 15.4 percent above the rate in effect on June 30, 1992; and

(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th percentile of 1989, less the percent in aggregate necessary to equal the above increases except that payment rates for home health agency services shall be the rates in effect on September 30, 1992.

(b) 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. The increases in this paragraph shall be implemented January 1, 2000, for managed care.

(c) Effective for services rendered on or after July 1, 2009, payment rates for physician and professional services shall be reduced by five percent, except that for the period July 1, 2009, through June 30, 2010, payment rates shall be reduced by 6.5 percent for the medical assistance and general assistance medical care programs, over the rates in effect on June 30, 2009. This reduction and the reductions in paragraph (d) do not apply to office or other outpatient visits, preventive medicine visits and family planning visits billed by physicians, advanced practice registered nurses, or physician assistants in a family planning agency or in one of the following primary care practices: general practice, general internal medicine, general pediatrics, general geriatrics, and family medicine. This reduction and the reductions in paragraph (d) do not apply to federally qualified health centers, rural health centers, and Indian health services. Effective October 1, 2009, payments made to managed care plans and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment reduction described in this paragraph.

(d) Effective for services rendered on or after July 1, 2010, payment rates for physician and professional services shall be reduced an additional seven percent over the five percent reduction in rates described in paragraph (c). This additional reduction does not apply to physical therapy services, occupational therapy services, and speech pathology and related services provided on or after July 1, 2010. This additional reduction does not apply to physician services billed by a psychiatrist or an advanced practice registered nurse with a specialty in mental health. Effective October 1, 2010, payments made to managed care plans and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment reduction described in this paragraph.

(e) Effective for services rendered on or after September 1, 2011, through June 30, 2013, payment rates for physician and professional services shall be reduced three percent from the rates in effect on August 31, 2011. This reduction does not apply to physical therapy services, occupational therapy services, and speech pathology and related services.

(f) Effective for services rendered on or after September 1, 2014, payment rates for physician and professional services, including physical therapy, occupational therapy, speech pathology, and mental health services shall be increased by five percent from the rates in effect on August 31, 2014. In calculating this rate increase, the commissioner shall not include in the base rate for August 31, 2014, the rate increase provided under section 256B.76, subdivision 7. This increase does not apply to federally qualified health centers, rural health centers, and Indian health services. Payments made to managed care plans and county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.

(g) Effective for services rendered on or after July 1, 2015, payment rates for physical therapy, occupational therapy, and speech pathology and related services provided by a hospital meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause (4), shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments made to managed care plans and county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.

(h) Any ratables effective before July 1, 2015, do not apply to early intensive developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.

new text begin (i) The commissioner may reimburse physicians and other licensed professionals for costs incurred to pay the fee for testing newborns who are medical assistance enrollees for heritable and congenital disorders under section 144.125, subdivision 1, paragraph (c), when the sample is collected outside of an inpatient hospital or freestanding birth center and the cost is not recognized by another payment source. new text end

Sec. 35.

Minnesota Statutes 2022, section 256B.761, is amended to read:

256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.

(a) Effective for services rendered on or after July 1, 2001, payment for medication management provided to psychiatric patients, outpatient mental health services, day treatment services, home-based mental health services, and family community support services shall be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 50th percentile of 1999 charges.

(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health services provided by an entity that operates: (1) a Medicare-certified comprehensive outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 1993, with at least 33 percent of the clients receiving rehabilitation services in the most recent calendar year who are medical assistance recipients, will be increased by 38 percent, when those services are provided within the comprehensive outpatient rehabilitation facility and provided to residents of nursing facilities owned by the entity.

(c) In addition to rate increases otherwise provided, the commissioner may restructure coverage policy and rates to improve access to adult rehabilitative mental health services under section 256B.0623 and related mental health support services under section 256B.021, subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and 2016, the projected state share of increased costs due to this paragraph is transferred from adult mental health grants under sections 245.4661 and 256E.12. The transfer for fiscal year 2016 is a permanent base adjustment for subsequent fiscal years. Payments made to managed care plans and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the rate changes described in this paragraph.

(d) Any ratables effective before July 1, 2015, do not apply to early intensive developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.

new text begin (e) Effective for services rendered on or after January 1, 2024, payment rates for behavioral health services included in the rate analysis required by Laws 2021, First Special Session chapter 7, article 17, section 18, except for adult day treatment services under section 256B.0671, subdivision 3; early intensive developmental and behavioral intervention services under section 256B.0949; and substance use disorder services under chapter 254B, must be increased by three percent from the rates in effect on December 31, 2023. Effective for services rendered on or after January 1, 2025, payment rates for behavioral health services included in the rate analysis required by Laws 2021, First Special Session chapter 7, article 17, section 18, except for adult day treatment services under section 256B.0671, subdivision 3; early intensive developmental behavioral intervention services under section 256B.0949; and substance use disorder services under chapter 254B, must be annually adjusted according to the change from the midpoint of the previous rate year to the midpoint of the rate year for which the rate is being determined using the Centers for Medicare and Medicaid Services Medicare Economic Index as forecasted in the fourth quarter of the calendar year before the rate year. For payments made in accordance with this paragraph, if and to the extent that the commissioner identifies that the state has received federal financial participation for behavioral health services in excess of the amount allowed under United States Code, title 42, section 447.321, the state shall repay the excess amount to the Centers for Medicare and Medicaid Services with state money and maintain the full payment rate under this paragraph. This paragraph does not apply to federally qualified health centers, rural health centers, Indian health services, certified community behavioral health clinics, cost-based rates, and rates that are negotiated with the county. This paragraph expires upon legislative implementation of the new rate methodology resulting from the rate analysis required by Laws 2021, First Special Session chapter 7, article 17, section 18. new text end

new text begin (f) Effective January 1, 2024, the commissioner shall increase capitation payments made to managed care plans and county-based purchasing plans to reflect the behavioral health service rate increase provided in paragraph (e). Managed care and county-based purchasing plans must use the capitation rate increase provided under this paragraph to increase payment rates to behavioral health services providers. The commissioner must monitor the effect of this rate increase on enrollee access to behavioral health services. If for any contract year federal approval is not received for this paragraph, the commissioner must adjust the capitation rates paid to managed care plans and county-based purchasing plans for that contract year to reflect the removal of this provision. Contracts between managed care plans and county-based purchasing plans and providers to whom this paragraph applies must allow recovery of payments from those providers if capitation rates are adjusted in accordance with this paragraph. Payment recoveries must not exceed the amount equal to any increase in rates that results from this provision. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. new text end

Sec. 36.

Minnesota Statutes 2022, section 256B.763, is amended to read:

256B.763 CRITICAL ACCESS MENTAL HEALTH RATE INCREASE.

new text begin Subdivision 1. new text end

new text begin Rate add-on. new text end

(a) For services defined in paragraph (b) and rendered on or after July 1, 2007, payment rates shall be increased by 23.7 percent over the rates in effect on January 1, 2006, for:

(1) psychiatrists and advanced practice registered nurses with a psychiatric specialty;

(2) community mental health centers under section 256B.0625, subdivision 5; and

(3) mental health clinics certified under section 245I.20, or hospital outpatient psychiatric departments that are designated as essential community providers under section 62Q.19.

(b) This increase applies to group skills training when provided as a component of children's therapeutic services and support, psychotherapy, medication management, evaluation and management, diagnostic assessment, explanation of findings, psychological testing, neuropsychological services, direction of behavioral aides, and inpatient consultation.

(c) This increase does not apply to rates that are governed by section 256B.0625, subdivision 30, or 256B.761, paragraph (b), other cost-based rates, rates that are negotiated with the county, rates that are established by the federal government, or rates that increased between January 1, 2004, and January 1, 2005.

(d) Payment rates shall be increased by 23.7 percent over the rates in effect on December 31, 2007, for:

(1) medication education services provided on or after January 1, 2008, by adult rehabilitative mental health services providers certified under section 256B.0623; and

(2) mental health behavioral aide services provided on or after January 1, 2008, by children's therapeutic services and support providers certified under section 256B.0943.

(e) For services defined in paragraph (b) and rendered on or after January 1, 2008, by children's therapeutic services and support providers certified under section 256B.0943 and not already included in paragraph (a), payment rates shall be increased by 23.7 percent over the rates in effect on December 31, 2007.

(f) Payment rates shall be increased by 2.3 percent over the rates in effect on December 31, 2007, for individual and family skills training provided on or after January 1, 2008, by children's therapeutic services and support providers certified under section 256B.0943.

(g) For services described in paragraphs (b), (d), and (f) and rendered on or after July 1, 2017, payment rates for mental health clinics certified under section 245I.20 that are not designated as essential community providers under section 62Q.19 shall be equal to payment rates for mental health clinics certified under section 245I.20 that are designated as essential community providers under section 62Q.19. In order to receive increased payment rates under this paragraph, a provider must demonstrate a commitment to serve low-income and underserved populations by:

(1) charging for services on a sliding-fee schedule based on current poverty income guidelines; and

(2) not restricting access or services because of a client's financial limitation.

(h) For services identified under this section that are rendered by providers identified under this section, managed care plans and county-based purchasing plans shall reimburse the providers at a rate that is at least equal to the fee-for-service payment rate. The commissioner shall monitor the effect of this requirement on the rate of access to the services delivered by mental health providers.

new text begin Subd. 2. new text end

new text begin Phaseout. new text end

new text begin The critical access mental health rate add-on under this section must be reduced according to the following schedule: new text end

new text begin (1) effective for services provided on or after January 1, 2025, the rate add-on is reduced to 11.85 percent; new text end

new text begin (2) effective for services provided on or after January 1, 2026, the rate add-on is reduced to 5.92 percent; and new text end

new text begin (3) effective for services provided on or after January 1, 2027, the rate add-on is 0 percent. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. new text end

Sec. 37.

Minnesota Statutes 2022, section 256B.764, is amended to read:

256B.764 REIMBURSEMENT FOR FAMILY PLANNING SERVICES.

(a) Effective for services rendered on or after July 1, 2007, payment rates for family planning services shall be increased by 25 percent over the rates in effect June 30, 2007, when these services are provided by a community clinic as defined in section 145.9268, subdivision 1.

(b) Effective for services rendered on or after July 1, 2013, payment rates for family planning services shall be increased by 20 percent over the rates in effect June 30, 2013, when these services are provided by a community clinic as defined in section 145.9268, subdivision 1. The commissioner shall adjust capitation rates to managed care and county-based purchasing plans to reflect this increase, and shall require plans to pass on the full amount of the rate increase to eligible community clinics, in the form of higher payment rates for family planning services.

new text begin (c) Effective for services provided on or after January 1, 2024, payment rates for family planning and abortion services shall be increased by 20 percent. This increase does not apply to federally qualified health centers, rural health centers, or Indian health services. new text end

Sec. 38.

Minnesota Statutes 2022, section 256L.03, subdivision 1, is amended to read:

Subdivision 1.

Covered health services.

(a) "Covered health services" means the health services reimbursed under chapter 256B, with the exception of special education services, home care nursing services, adult dental care services other than services covered under section 256B.0625, subdivision 9, orthodontic services, nonemergency medical transportation services, personal care assistance and case management services, community first services and supports under section 256B.85, behavioral health home services under section 256B.0757, housing stabilization services under section 256B.051, and nursing home or intermediate care facilities services.

deleted text begin (b) No public funds shall be used for coverage of abortion under MinnesotaCare except where the life of the female would be endangered or substantial and irreversible impairment of a major bodily function would result if the fetus were carried to term; or where the pregnancy is the result of rape or incest. deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end Covered health services shall be expanded as provided in this section.

deleted text begin (d) deleted text end new text begin (c) new text end For the purposes of covered health services under this section, "child" means an individual younger than 19 years of age.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 39.

Minnesota Statutes 2022, section 256L.03, subdivision 5, is amended to read:

Subd. 5.

Cost-sharing.

(a) Co-payments, coinsurance, and deductibles do not apply to children under the age of 21 and to American Indians as defined in Code of Federal Regulations, title 42, section 600.5.

(b) The commissioner deleted text begin shall deleted text end new text begin must new text end adjust co-payments, coinsurance, and deductibles for covered services in a manner sufficient to maintain the actuarial value of the benefit to 94 percent. The cost-sharing changes described in this paragraph do not apply to eligible recipients or services exempt from cost-sharing under state law. The cost-sharing changes described in this paragraph shall not be implemented prior to January 1, 2016.

(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations, title 42, sections 600.510 and 600.520.

new text begin (d) Co-payments, coinsurance, and deductibles do not apply to additional diagnostic services or testing that a health care provider determines an enrollee requires after a mammogram, as specified under section 62A.30, subdivision 5. new text end

new text begin (e) Cost-sharing must not apply to drugs used for tobacco and nicotine cessation or to tobacco and nicotine cessation services covered under section 256B.0625, subdivision 68. new text end

new text begin (f) Co-payments, coinsurance, and deductibles do not apply to pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) medications when used for the prevention or treatment of the human immunodeficiency virus (HIV). new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. new text end

Sec. 40.

Laws 2021, First Special Session chapter 7, article 1, section 36, as amended by Laws 2023, chapter 22, section 2, is amended to read:

Sec. 36.

RESPONSE TO COVID-19 PUBLIC HEALTH EMERGENCY.

(a) Notwithstanding Minnesota Statutes, section 256B.057, subdivision 9, or any other provision to the contrary, the commissioner shall not collect any unpaid premium for a coverage month that occurred during the COVID-19 public health emergency declared by the United States Secretary of Health and Human Services and through the month prior to an enrollee's first renewal following the resumption of medical assistance renewals after March 31, 2023.

(b) Notwithstanding any provision to the contrary, periodic data matching under Minnesota Statutes, section 256B.0561, subdivision 2, may be suspended for up to 12 months following the resumption of medical assistance and MinnesotaCare renewals after March 31, 2023.

(c) Notwithstanding any provision to the contrary, the requirement for the commissioner of human services to issue an annual report on periodic data matching under Minnesota Statutes, section 256B.0561, is suspended for one year following the last day of the COVID-19 public health emergency declared by the United States Secretary of Health and Human Services.

(d) For individuals enrolled in deleted text begin medical assistance deleted text end new text begin Minnesota health care programs new text end as of March 31, 2023, who are subject to the asset limits established by Minnesota Statutes, deleted text begin section deleted text end new text begin sections new text end 256B.056, subdivision 3, paragraph (a), new text begin and 256B.057, new text end assets in excess of the limits deleted text begin established by Minnesota Statutes, section 256B.056, subdivision 3, paragraph (a), deleted text end new text begin therein new text end must be disregarded until the individual's second annual renewal deleted text begin occurring deleted text end following the resumption of renewals after March 31, 2023.

(e) The commissioner may temporarily adjust medical assistance eligibility verification requirements as needed to comply with federal guidance and ensure a timely renewal process for the period during which enrollees are subject to their first annual renewal following March 31, 2023. The commissioner must implement sufficient controls to monitor the effectiveness of verification adjustments and ensure program integrity.

(f) Notwithstanding any provision to the contrary, the commissioner of human services may temporarily extend the time frame permitted to take final administrative action on fair hearing requests from medical assistance and MinnesotaCare recipients under Minnesota Statutes, section 256.045, until the end of the 23rd month after the end of the month in which the public health emergency for COVID-19, as declared by the United States Secretary of Health and Human Services, ends. During this period, the commissioner must:

(1) not delay resolving expedited fair hearings described in Code of Federal Regulations, title 42, chapter IV, subchapter C, part 431, subpart E, section 431.224, paragraph (a);

(2) provide medical assistance benefits, pending the outcome of a fair hearing decision, to any medical assistance recipient, and provide MinnesotaCare benefits, pending the outcome of a fair hearing decision, to any MinnesotaCare recipient, who requests a fair hearing within the time provided under Minnesota Statutes, section 256.045, subdivision 3, paragraph (i), and regardless of whether the recipient has requested benefits pending the outcome of the recipient's fair hearing;

(3) reinstate medical assistance or MinnesotaCare benefits back to the date of action, if the recipient requests a fair hearing after the date of action and within the time provided under Minnesota Statutes, section 256.045, subdivision 3, paragraph (i);

(4) take final administrative action within the maximum 90 days permitted under Code of Federal Regulations, title 42, chapter IV, subchapter C, part 431, subpart E, section 431.244, paragraph (f)(1), for fair hearing requests where medical assistance or MinnesotaCare benefits cannot be provided pending the outcome of the fair hearing, such as a fair hearing challenging a denial of eligibility for an applicant;

(5) not recoup or recover from the recipient the cost of medical assistance or MinnesotaCare benefits provided pending final administrative action, even if the agency's action is sustained by the hearing decision; and

(6) not use this authority as justification to delay taking final action, and only exceed the 90 days permitted for taking final agency action under Code of Federal Regulations, title 42, section 431.244, paragraph (f)(1), to the extent to which the commissioner is unable to take timely final agency action on a given fair hearing request.

(g) Notwithstanding Minnesota Statutes, section 256L.06, subdivision 3; 256L.15, subdivision 2, or any other provision to the contrary, the commissioner must not collect any unpaid premium for a coverage month that occurred during the COVID-19 public health emergency declared by the United States Secretary of Health and Human Services.

(h) Notwithstanding Minnesota Statutes, sections 256L.06 and 256L.15, or any other provision to the contrary, the commissioner must waive MinnesotaCare premiums for all enrollees beginning May 1, 2023, through June 30, 2024.

(i) Notwithstanding any other law to the contrary, the commissioner shall, as required by the Centers for Medicare & Medicaid Services, suspend certain procedural terminations for medical assistance enrollees.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 41.

Laws 2021, First Special Session chapter 7, article 6, section 26, is amended to read:

Sec. 26.

COMMISSIONER OF HUMAN SERVICES; EXTENSION OF COVID-19 HUMAN SERVICES PROGRAM MODIFICATIONS.

Notwithstanding Laws 2020, First Special Session chapter 7, section 1, subdivision 2, as amended by Laws 2020, Third Special Session chapter 1, section 3, when the peacetime emergency declared by the governor in response to the COVID-19 outbreak expires, is terminated, or is rescinded by the proper authority, the following modifications issued by the commissioner of human services pursuant to Executive Orders 20-11 and 20-12, and including any amendments to the modification issued before the peacetime emergency expires, shall remain in effect until July 1, deleted text begin 2023 deleted text end new text begin 2025 new text end :

(1) CV16: expanding access to telemedicine services for Children's Health Insurance Program, Medical Assistance, and MinnesotaCare enrollees; and

(2) CV21: allowing telemedicine alternative for school-linked mental health services and intermediate school district mental health services.

Sec. 42.

new text begin ELIGIBILITY FOR DEFERRED ACTION FOR CHILDHOOD ARRIVAL ENROLLEES. new text end

new text begin (a) The commissioner of human services shall make federally funded medical assistance and federally funded MinnesotaCare available to Minnesotans who are Deferred Action for Childhood Arrival recipients considered lawfully present noncitizens in accordance with regulations finalized by the Centers for Medicare and Medicaid Services and who meet all other medical assistance and MinnesotaCare eligibility criteria. new text end

new text begin (b) This section expires June 30, 2025. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon the effective date of final regulations published by the Centers for Medicare and Medicaid Services. The commissioner of human services shall notify the revisor of statutes when the final regulations published by the Centers for Medicare and Medicaid Services are effective. new text end

Sec. 43.

new text begin REPEALER. new text end

new text begin (a) new text end new text begin Minnesota Statutes 2022, section 256B.763, new text end new text begin is repealed. new text end

new text begin (b) new text end new text begin Minnesota Rules, part 9505.0235, new text end new text begin is repealed. new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (a) is effective January 1, 2027. Paragraph (b) is effective the day following final enactment. new text end

ARTICLE 2

HEALTH INSURANCE

Section 1.

Minnesota Statutes 2022, section 62A.045, is amended to read:

62A.045 PAYMENTS ON BEHALF OF ENROLLEES IN GOVERNMENT HEALTH PROGRAMS.

(a) As a condition of doing business in Minnesota or providing coverage to residents of Minnesota covered by this section, each health insurer shall comply with the requirements deleted text begin of deleted text end new text begin for health insurers under new text end the federal Deficit Reduction Act of 2005, Public Law 109-171 new text begin and the federal Consolidated Appropriations Act of 2022, Public Law 117-103 new text end , including any federal regulations adopted under deleted text begin that act deleted text end new text begin those acts new text end , to the extent that deleted text begin it imposes deleted text end new text begin they impose new text end a requirement that applies in this state and that is not also required by the laws of this state. This section does not require compliance with any provision of the federal deleted text begin act deleted text end new text begin acts new text end prior to the effective deleted text begin date deleted text end new text begin dates new text end provided for deleted text begin that provision deleted text end new text begin those provisions new text end in the federal deleted text begin act deleted text end new text begin acts new text end . The commissioner shall enforce this section.

For the purpose of this section, "health insurer" includes self-insured plans, group health plans (as defined in section 607(1) of the Employee Retirement Income Security Act of 1974), service benefit plans, managed care organizations, pharmacy benefit managers, or other parties that are by contract legally responsible to pay a claim for a health-care item or service for an individual receiving benefits under paragraph (b).

(b) No plan offered by a health insurer issued or renewed to provide coverage to a Minnesota resident shall contain any provision denying or reducing benefits because services are rendered to a person who is eligible for or receiving medical benefits pursuant to title XIX of the Social Security Act (Medicaid) in this or any other state; chapter 256 or 256B; or services pursuant to section 252.27; 256L.01 to 256L.10; 260B.331, subdivision 2; 260C.331, subdivision 2; or 393.07, subdivision 1 or 2. No health insurer providing benefits under plans covered by this section shall use eligibility for medical programs named in this section as an underwriting guideline or reason for nonacceptance of the risk.

(c) If payment for covered expenses has been made under state medical programs for health care items or services provided to an individual, and a third party has a legal liability to make payments, the rights of payment and appeal of an adverse coverage decision for the individual, or in the case of a child their responsible relative or caretaker, will be subrogated to the state agency. The state agency may assert its rights under this section within three years of the date the service was rendered. For purposes of this section, "state agency" includes prepaid health plans under contract with the commissioner according to sections 256B.69 and 256L.12; children's mental health collaboratives under section 245.493; demonstration projects for persons with disabilities under section 256B.77; nursing homes under the alternative payment demonstration project under section 256B.434; and county-based purchasing entities under section 256B.692.

(d) Notwithstanding any law to the contrary, when a person covered by a plan offered by a health insurer receives medical benefits according to any statute listed in this section, payment for covered services or notice of denial for services billed by the provider must be issued directly to the provider. If a person was receiving medical benefits through the Department of Human Services at the time a service was provided, the provider must indicate this benefit coverage on any claim forms submitted by the provider to the health insurer for those services. If the commissioner of human services notifies the health insurer that the commissioner has made payments to the provider, payment for benefits or notices of denials issued by the health insurer must be issued directly to the commissioner. Submission by the department to the health insurer of the claim on a Department of Human Services claim form is proper notice and shall be considered proof of payment of the claim to the provider and supersedes any contract requirements of the health insurer relating to the form of submission. Liability to the insured for coverage is satisfied to the extent that payments for those benefits are made by the health insurer to the provider or the commissioner as required by this section.

(e) When a state agency has acquired the rights of an individual eligible for medical programs named in this section and has health benefits coverage through a health insurer, the health insurer shall not impose requirements that are different from requirements applicable to an agent or assignee of any other individual covered.

(f) A health insurer must process a clean claim made by a state agency for covered expenses paid under state medical programs within 90 business days of the claim's submission. A health insurer must process all other claims made by a state agency for covered expenses paid under a state medical program within the timeline set forth in Code of Federal Regulations, title 42, section 447.45(d)(4).

(g) A health insurer may request a refund of a claim paid in error to the Department of Human Services within two years of the date the payment was made to the department. A request for a refund shall not be honored by the department if the health insurer makes the request after the time period has lapsed.

Sec. 2.

Minnesota Statutes 2022, section 62A.30, is amended by adding a subdivision to read:

new text begin Subd. 5. new text end

new text begin Mammogram; diagnostic services and testing. new text end

new text begin If a health care provider determines an enrollee requires additional diagnostic services or testing after a mammogram, a health plan must provide coverage for the additional diagnostic services or testing with no cost-sharing, including co-pay, deductible, or coinsurance. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, and applies to health plans offered, issued, or sold on or after that date. new text end

Sec. 3.

Minnesota Statutes 2022, section 62A.30, is amended by adding a subdivision to read:

new text begin Subd. 6. new text end

new text begin Application. new text end

new text begin If the application of subdivision 5 before an enrollee has met their health plan's deductible would result in: (1) health savings account ineligibility under United States Code, title 26, section 223; or (2) catastrophic health plan ineligibility under United States Code, title 42, section 18022(e), then subdivision 5 shall apply to diagnostic services or testing only after the enrollee has met their health plan's deductible. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, and applies to health plans offered, issued, or sold on or after that date. new text end

Sec. 4.

Minnesota Statutes 2022, section 62A.673, subdivision 2, is amended to read:

Subd. 2.

Definitions.

(a) For purposes of this section, the terms defined in this subdivision have the meanings given.

(b) "Distant site" means a site at which a health care provider is located while providing health care services or consultations by means of telehealth.

(c) "Health care provider" means a health care professional who is licensed or registered by the state to perform health care services within the provider's scope of practice and in accordance with state law. A health care provider includes a mental health professional under section 245I.04, subdivision 2; a mental health practitioner under section 245I.04, subdivision 4; a clinical trainee under section 245I.04, subdivision 6; a treatment coordinator under section 245G.11, subdivision 7; an alcohol and drug counselor under section 245G.11, subdivision 5; and a recovery peer under section 245G.11, subdivision 8.

(d) "Health carrier" has the meaning given in section 62A.011, subdivision 2.

(e) "Health plan" has the meaning given in section 62A.011, subdivision 3. Health plan includes dental plans as defined in section 62Q.76, subdivision 3, but does not include dental plans that provide indemnity-based benefits, regardless of expenses incurred, and are designed to pay benefits directly to the policy holder.

(f) "Originating site" means a site at which a patient is located at the time health care services are provided to the patient by means of telehealth. For purposes of store-and-forward technology, the originating site also means the location at which a health care provider transfers or transmits information to the distant site.

(g) "Store-and-forward technology" means the asynchronous electronic transfer or transmission of a patient's medical information or data from an originating site to a distant site for the purposes of diagnostic and therapeutic assistance in the care of a patient.

(h) "Telehealth" means the delivery of health care services or consultations through the use of real time two-way interactive audio and visual communications to provide or support health care delivery and facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient's health care. Telehealth includes the application of secure video conferencing, store-and-forward technology, and synchronous interactions between a patient located at an originating site and a health care provider located at a distant site. Until July 1, deleted text begin 2023 deleted text end new text begin 2025 new text end , telehealth also includes audio-only communication between a health care provider and a patient in accordance with subdivision 6, paragraph (b). Telehealth does not include communication between health care providers that consists solely of a telephone conversation, email, or facsimile transmission. Telehealth does not include communication between a health care provider and a patient that consists solely of an email or facsimile transmission. Telehealth does not include telemonitoring services as defined in paragraph (i).

(i) "Telemonitoring services" means the remote monitoring of clinical data related to the enrollee's vital signs or biometric data by a monitoring device or equipment that transmits the data electronically to a health care provider for analysis. Telemonitoring is intended to collect an enrollee's health-related data for the purpose of assisting a health care provider in assessing and monitoring the enrollee's medical condition or status.

Sec. 5.

new text begin [62J.811] PROVIDER BALANCE BILLING REQUIREMENTS. new text end

new text begin Subdivision 1. new text end

new text begin Billing requirements. new text end

new text begin (a) Each health care provider and health facility shall comply with the federal Consolidated Appropriations Act, 2021, Division BB also known as the "No Surprises Act," including any federal regulations adopted under that act. new text end

new text begin (b) For the purposes of this section, "provider" or "facility" means any health care provider or facility pursuant to section 62A.63, subdivision 2, or 62J.03, subdivision 8, that is subject to relevant provisions of the No Surprises Act. new text end

new text begin Subd. 2. new text end

new text begin Investigations and compliance. new text end

new text begin (a) The commissioner shall, to the extent practicable, seek the cooperation of health care providers and facilities, and may provide any support and assistance as available, in obtaining compliance with this section. new text end

new text begin (b) The commissioner shall determine the manner and processes for fulfilling any responsibilities and taking any of the actions in paragraphs (c) to (f). new text end

new text begin (c) A person who believes a health care provider or facility has not complied with the requirements of the No Surprises Act or this section may file a complaint with the commissioner in the manner determined by the commissioner. new text end

new text begin (d) The commissioner shall conduct compliance reviews and investigate complaints filed under this section in the manner determined by the commissioner to ascertain whether health care providers and facilities are complying with this section. new text end

new text begin (e) The commissioner may report violations under this section to other relevant federal and state departments and jurisdictions as appropriate, including the attorney general and relevant licensing boards, and may also coordinate on investigations and enforcement of this section with other relevant federal and state departments and jurisdictions as appropriate, including the attorney general and relevant licensing boards. new text end

new text begin (f) A health care provider or facility may contest whether the finding of facts constitute a violation of this section according to the contested case proceeding in sections 14.57 to 14.62, subject to appeal according to sections 14.63 to 14.68. new text end

new text begin (g) Any data collected by the commissioner as part of an active investigation or active compliance review under this section are classified (1) if the data is not on individuals, it is classified as protected nonpublic data pursuant to section 13.02 subdivision 13; or (2) if the data is on individuals, it is classified as confidential pursuant to section 13.02, subdivision 3. Data describing the final disposition of an investigative or compliance review are classified as public. new text end

new text begin Subd. 3. new text end

new text begin Civil penalty. new text end

new text begin (a) The commissioner, in monitoring and enforcing this section, may levy a civil monetary penalty against each health care provider or facility found to be in violation of up to $100 for each violation, but may not exceed $25,000 for identical violations during a calendar year. new text end

new text begin (b) No civil monetary penalty shall be imposed under this section for violations that occur prior to January 1, 2024. new text end

Sec. 6.

Minnesota Statutes 2022, section 62J.824, is amended to read:

62J.824 FACILITY FEE DISCLOSURE.

(a) Prior to the delivery of nonemergency services, a provider-based clinic that charges a facility fee shall provide notice to any patient new text begin , including patients served by telehealth as defined in section 62A.673, subdivision 2, paragraph (h), new text end stating that the clinic is part of a hospital and the patient may receive a separate charge or billing for the facility component, which may result in a higher out-of-pocket expense.

(b) Each health care facility must post prominently in locations easily accessible to and visible by patients, including on its website, a statement that the provider-based clinic is part of a hospital and the patient may receive a separate charge or billing for the facility, which may result in a higher out-of-pocket expense.

(c) This section does not apply to laboratory services, imaging services, or other ancillary health services that are provided by staff who are not employed by the health care facility or clinic.

(d) For purposes of this section:

(1) "facility fee" means any separate charge or billing by a provider-based clinic in addition to a professional fee for physicians' services that is intended to cover building, electronic medical records systems, billing, and other administrative and operational expenses; and

(2) "provider-based clinic" means the site of an off-campus clinic or provider office, located at least 250 yards from the main hospital buildings or as determined by the Centers for Medicare and Medicaid Services, that is owned by a hospital licensed under chapter 144 or a health system that operates one or more hospitals licensed under chapter 144, and is primarily engaged in providing diagnostic and therapeutic care, including medical history, physical examinations, assessment of health status, and treatment monitoring. This definition does not include clinics that are exclusively providing laboratory, x-ray, testing, therapy, pharmacy, or educational services and does not include facilities designated as rural health clinics.

Sec. 7.

new text begin [62J.826] MEDICAL AND DENTAL PRACTICES; CURRENT STANDARD CHARGES. new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The definitions in this subdivision apply to this section. new text end

new text begin (b) "CDT code" means a code value drawn from the Code on Dental Procedures and Nomenclature published by the American Dental Association. new text end

new text begin (c) "Chargemaster" means the list of all individual items and services maintained by a medical or dental practice for which the medical or dental practice has established a charge. new text end

new text begin (d) "Commissioner" means the commissioner of health. new text end

new text begin (e) "CPT code" means a code value drawn from the Current Procedural Terminology published by the American Medical Association. new text end

new text begin (f) "Dental service" means a service charged using a CDT code. new text end

new text begin (g) "Diagnostic laboratory testing" means a service charged using a CPT code within the CPT code range of 80047 to 89398. new text end

new text begin (h) "Diagnostic radiology service" means a service charged using a CPT code within the CPT code range of 70010 to 79999 and includes the provision of x-rays, computed tomography scans, positron emission tomography scans, magnetic resonance imaging scans, and mammographies. new text end

new text begin (i) "Hospital" means an acute care institution licensed under sections 144.50 to 144.58, but does not include a health care institution conducted for those who rely primarily upon treatment by prayer or spiritual means in accordance with the creed or tenets of any church or denomination. new text end

new text begin (j) "Medical or dental practice" means a business that: new text end

new text begin (1) earns revenue by providing medical care or dental services to the public; new text end

new text begin (2) issues payment claims to health plan companies and other payers; and new text end

new text begin (3) may be identified by its federal tax identification number. new text end

new text begin (k) "Outpatient surgical center" means a health care facility other than a hospital offering elective outpatient surgery under a license issued under sections 144.50 to 144.58. new text end

new text begin (l) "Standard charge" means the regular rate established by the medical or dental practice for an item or service provided to a specific group of paying patients. This includes all of the following: new text end

new text begin (1) the charge for an individual item or service that is reflected on a medical or dental practice's chargemaster, absent any discounts; new text end

new text begin (2) the charge that a medical or dental practice has negotiated with a third-party payer for an item or service; new text end

new text begin (3) the lowest charge that a medical or dental practice has negotiated with all third-party payers for an item or service; new text end

new text begin (4) the highest charge that a medical or dental practice has negotiated with all third-party payers for an item or service; and new text end

new text begin (5) the charge that applies to an individual who pays cash, or cash equivalent, for an item or service. new text end

new text begin Subd. 2. new text end

new text begin Requirement; current standard charges. new text end

new text begin The following medical or dental practices must make available to the public a list of their current standard charges for all items and services, as reflected in the medical or dental practice's chargemaster, provided by the medical or dental practice: new text end

new text begin (1) hospitals; new text end

new text begin (2) outpatient surgical centers; and new text end

new text begin (3) any other medical or dental practice that has revenue of greater than $50,000,000 per year and that derives the majority of its revenue by providing one or more of the following services: new text end

new text begin (i) diagnostic radiology services; new text end

new text begin (ii) diagnostic laboratory testing; new text end

new text begin (iii) orthopedic surgical procedures, including joint arthroplasty procedures within the CPT code range of 26990 to 27899; new text end

new text begin (iv) ophthalmologic surgical procedures, including cataract surgery coded using CPT code 66982 or 66984, or refractive correction surgery to improve visual acuity; new text end

new text begin (v) anesthesia services commonly provided as an ancillary to services provided at a hospital, outpatient surgical center, or medical practice that provides orthopedic surgical procedures or ophthalmologic surgical procedures; new text end

new text begin (vi) oncology services, including radiation oncology treatments within the CPT code range of 77261 to 77799 and drug infusions; or new text end

new text begin (vii) dental services. new text end

new text begin Subd. 3. new text end

new text begin Required file format and content. new text end

new text begin (a) A medical or dental practice that is subject to this section must make available to the public current standard charges using the format and data elements specified in the currently effective version of the Hospital Price Transparency Sample Format (Tall) (CSV) and related data dictionary recommended for hospitals by the Centers for Medicare and Medicaid Services (CMS). If CMS modifies or replaces the specifications for this format, the form of this file must be modified or replaced to conform with the new CMS specifications by the date specified by CMS for compliance with its new specifications. All prices included in the file must be expressed as dollar amounts. The data must be in the form of a comma separated values file which can be directly imported, without further editing or remediation, into a relational database table which has been designed to receive these files. The medical or dental practice must make the file available to the public in a manner specified by the commissioner. new text end

new text begin (b) A medical or dental practice must test its file for compliance with paragraph (a) before making the file available to the public. new text end

new text begin (c) A hospital must comply with this section no later than January 1, 2024. A medical or dental practice that meets the requirements in subdivision 2, clause (3), or an outpatient surgical center must comply with this section no later than January 1, 2025. new text end

Sec. 8.

Minnesota Statutes 2022, section 62J.84, subdivision 2, is amended to read:

Subd. 2.

Definitions.

(a) For purposes of this section, the terms defined in this subdivision have the meanings given.

(b) "Biosimilar" means a drug that is produced or distributed pursuant to a biologics license application approved under United States Code, title 42, section 262(K)(3).

(c) "Brand name drug" means a drug that is produced or distributed pursuant to:

(1) deleted text begin an original, deleted text end new text begin a new text end new drug application approved under United States Code, title 21, section 355(c), except for a generic drug as defined under Code of Federal Regulations, title 42, section 447.502; or

(2) a biologics license application approved under United States Code, title deleted text begin 45 deleted text end new text begin 42 new text end , section 262(a)(c).

(d) "Commissioner" means the commissioner of health.

(e) "Generic drug" means a drug that is marketed or distributed pursuant to:

(1) an abbreviated new drug application approved under United States Code, title 21, section 355(j);

(2) an authorized generic as defined under Code of Federal Regulations, title deleted text begin 45 deleted text end new text begin 42 new text end , section 447.502; or

(3) a drug that entered the market the year before 1962 and was not originally marketed under a new drug application.

(f) "Manufacturer" means a drug manufacturer licensed under section 151.252.

(g) "New prescription drug" or "new drug" means a prescription drug approved for marketing by the United States Food and Drug Administration new text begin (FDA) new text end for which no previous wholesale acquisition cost has been established for comparison.

(h) "Patient assistance program" means a program that a manufacturer offers to the public in which a consumer may reduce the consumer's out-of-pocket costs for prescription drugs by using coupons, discount cards, prepaid gift cards, manufacturer debit cards, or by other means.

(i) "Prescription drug" or "drug" has the meaning provided in section 151.441, subdivision 8.

(j) "Price" means the wholesale acquisition cost as defined in United States Code, title 42, section 1395w-3a(c)(6)(B).

new text begin (k) "30-day supply" means the total daily dosage units of a prescription drug recommended by the prescribing label approved by the FDA for 30 days. If the FDA-approved prescribing label includes more than one recommended daily dosage, the 30-day supply is based on the maximum recommended daily dosage on the FDA-approved prescribing label. new text end

new text begin (l) "Course of treatment" means the total dosage of a single prescription for a prescription drug recommended by the FDA-approved prescribing label. If the FDA-approved prescribing label includes more than one recommended dosage for a single course of treatment, the course of treatment is the maximum recommended dosage on the FDA-approved prescribing label. new text end

new text begin (m) "Drug product family" means a group of one or more prescription drugs that share a unique generic drug description or nontrade name and dosage form. new text end

new text begin (n) "Individual salable unit" means the smallest container of product introduced into commerce by the manufacturer or repackager that is intended by the manufacturer or repackager for individual sale to a dispenser. new text end

new text begin (o) "National drug code" means the three-segment code maintained by the federal Food and Drug Administration that includes a labeler code, a product code, and a package code for a drug product and that has been converted to an 11-digit format consisting of five digits in the first segment, four digits in the second segment, and two digits in the third segment. A three-segment code shall be considered converted to an 11-digit format when, as necessary, at least one "0" has been added to the front of each segment containing less than the specified number of digits such that each segment contains the specified number of digits. new text end

new text begin (p) "Pharmacy" or "pharmacy provider" means a community/outpatient pharmacy as defined in Minnesota Rules, part 6800.0100, subpart 2, that is also licensed as a pharmacy by the Board of Pharmacy under section 151.19. new text end

new text begin (q) "Pharmacy benefit manager" or "PBM" means an entity licensed to act as a pharmacy benefit manager under section 62W.03. new text end

new text begin (r) "Pricing unit" means the smallest dispensable amount of a prescription drug product that could be dispensed. new text end

new text begin (s) "Rebate" means a discount, chargeback, or other price concession that affects the price of a prescription drug product, regardless of whether conferred through regular aggregate payments, on a claim-by-claim basis at the point of sale, as part of retrospective financial reconciliations, including reconciliations that also reflect other contractual arrangements, or by any other method. "Rebate" does not mean a bona fide service fee as defined in Code of Federal Regulations, title 42, section 447.502. new text end

new text begin (t) "Reporting entity" means any manufacturer, pharmacy, pharmacy benefit manager, wholesale drug distributor, or any other entity required to submit data under this section. new text end

new text begin (u) "Wholesale drug distributor" or "wholesaler" means an entity that: new text end

new text begin (1) is licensed to act as a wholesale drug distributor under section 151.47; and new text end

new text begin (2) distributes prescription drugs, for which it is not the manufacturer, to persons or entities, or both, other than a consumer or patient in the state. new text end

Sec. 9.

Minnesota Statutes 2022, section 62J.84, subdivision 3, is amended to read:

Subd. 3.

Prescription drug price increases reporting.

(a) Beginning January 1, 2022, a drug manufacturer must submit to the commissioner the information described in paragraph (b) for each prescription drug for which the price was $100 or greater for a 30-day supply or for a course of treatment lasting less than 30 days and:

(1) for brand name drugs where there is an increase of ten percent or greater in the price over the previous 12-month period or an increase of 16 percent or greater in the price over the previous 24-month period; and

(2) for generic new text begin or biosimilar new text end drugs where there is an increase of 50 percent or greater in the price over the previous 12-month period.

(b) For each of the drugs described in paragraph (a), the manufacturer shall submit to the commissioner no later than 60 days after the price increase goes into effect, in the form and manner prescribed by the commissioner, the following information, if applicable:

(1) the deleted text begin name deleted text end new text begin description new text end and price of the drug and the net increase, expressed as a percentage deleted text begin ; deleted text end new text begin , with the following listed separately: new text end

new text begin (i) the national drug code; new text end

new text begin (ii) the product name; new text end

new text begin (iii) the dosage form; new text end

new text begin (iv) the strength; and new text end

new text begin (v) the package size; new text end

(2) the factors that contributed to the price increase;

(3) the name of any generic version of the prescription drug available on the market;

(4) the introductory price of the prescription drug when it was deleted text begin approved for marketing by the Food and Drug Administration and the net yearly increase, by calendar year, in the price of the prescription drug during the previous five years deleted text end new text begin introduced for sale in the United States and the price of the drug on the last day of each of the five calendar years preceding the price increase new text end ;

(5) the direct costs incurred new text begin during the previous 12-month period new text end by the manufacturer that are associated with the prescription drug, listed separately:

(i) to manufacture the prescription drug;

(ii) to market the prescription drug, including advertising costs; and

(iii) to distribute the prescription drug;

(6) the total sales revenue for the prescription drug during the previous 12-month period;

(7) the manufacturer's net profit attributable to the prescription drug during the previous 12-month period;

(8) the total amount of financial assistance the manufacturer has provided through patient prescription assistance programs new text begin during the previous 12-month period new text end , if applicable;

(9) any agreement between a manufacturer and another entity contingent upon any delay in offering to market a generic version of the prescription drug;

(10) the patent expiration date of the prescription drug if it is under patent;

(11) the name and location of the company that manufactured the drug; deleted text begin and deleted text end

(12) if a brand name prescription drug, the deleted text begin ten deleted text end highest deleted text begin prices deleted text end new text begin price new text end paid for the prescription drug during the previous calendar year in deleted text begin any country other than deleted text end new text begin the ten countries, excluding new text end the United States deleted text begin . deleted text end new text begin , that charged the highest single price for the prescription drug; and new text end

new text begin (13) if the prescription drug was acquired by the manufacturer during the previous 12-month period, all of the following information: new text end

new text begin (i) price at acquisition; new text end

new text begin (ii) price in the calendar year prior to acquisition; new text end

new text begin (iii) name of the company from which the drug was acquired; new text end

new text begin (iv) date of acquisition; and new text end

new text begin (v) acquisition price. new text end

(c) The manufacturer may submit any documentation necessary to support the information reported under this subdivision.

Sec. 10.

Minnesota Statutes 2022, section 62J.84, subdivision 4, is amended to read:

Subd. 4.

New prescription drug price reporting.

(a) Beginning January 1, 2022, no later than 60 days after a manufacturer introduces a new prescription drug for sale in the United States that is a new brand name drug with a price that is greater than the tier threshold established by the Centers for Medicare and Medicaid Services for specialty drugs in the Medicare Part D program for a 30-day supply new text begin or for a course of treatment lasting fewer than 30 days new text end or a new generic or biosimilar drug with a price that is greater than the tier threshold established by the Centers for Medicare and Medicaid Services for specialty drugs in the Medicare Part D program for a 30-day supply new text begin or for a course of treatment lasting fewer than 30 days new text end and is not at least 15 percent lower than the referenced brand name drug when the generic or biosimilar drug is launched, the manufacturer must submit to the commissioner, in the form and manner prescribed by the commissioner, the following information, if applicable:

new text begin (1) the description of the drug, with the following listed separately: new text end

new text begin (i) the national drug code; new text end

new text begin (ii) the product name; new text end

new text begin (iii) the dosage form; new text end

new text begin (iv) the strength; and new text end

new text begin (v) the package size; new text end

deleted text begin (1) deleted text end new text begin (2) new text end the price of the prescription drug;

deleted text begin (2) deleted text end new text begin (3) new text end whether the Food and Drug Administration granted the new prescription drug a breakthrough therapy designation or a priority review;

deleted text begin (3) deleted text end new text begin (4) new text end the direct costs incurred by the manufacturer that are associated with the prescription drug, listed separately:

(i) to manufacture the prescription drug;

(ii) to market the prescription drug, including advertising costs; and

(iii) to distribute the prescription drug; and

deleted text begin (4) deleted text end new text begin (5) new text end the patent expiration date of the drug if it is under patent.

(b) The manufacturer may submit documentation necessary to support the information reported under this subdivision.

Sec. 11.

Minnesota Statutes 2022, section 62J.84, subdivision 6, is amended to read:

Subd. 6.

Public posting of prescription drug price information.

(a) The commissioner shall post on the department's website, or may contract with a private entity or consortium that satisfies the standards of section 62U.04, subdivision 6, to meet this requirement, the following information:

(1) a list of the prescription drugs reported under subdivisions 3, 4, and deleted text begin 5, deleted text end new text begin 11 to 14 new text end and the manufacturers of those prescription drugs; and

(2) information reported to the commissioner under subdivisions 3, 4, and deleted text begin 5 deleted text end new text begin 11 to 14 new text end .

(b) The information must be published in an easy-to-read format and in a manner that identifies the information that is disclosed on a per-drug basis and must not be aggregated in a manner that prevents the identification of the prescription drug.

(c) The commissioner shall not post to the department's website or a private entity contracting with the commissioner shall not post any information described in this section if the information is not public data under section 13.02, subdivision 8a; or is trade secret information under section 13.37, subdivision 1, paragraph (b); or is trade secret information pursuant to the Defend Trade Secrets Act of 2016, United States Code, title 18, section 1836, as amended. If a deleted text begin manufacturer deleted text end new text begin reporting entity new text end believes information should be withheld from public disclosure pursuant to this paragraph, the deleted text begin manufacturer deleted text end new text begin reporting entity new text end must clearly and specifically identify that information and describe the legal basis in writing when the deleted text begin manufacturer deleted text end new text begin reporting entity new text end submits the information under this section. If the commissioner disagrees with the deleted text begin manufacturer's deleted text end new text begin reporting entity's new text end request to withhold information from public disclosure, the commissioner shall provide the deleted text begin manufacturer deleted text end new text begin reporting entity new text end written notice that the information will be publicly posted 30 days after the date of the notice.

(d) If the commissioner withholds any information from public disclosure pursuant to this subdivision, the commissioner shall post to the department's website a report describing the nature of the information and the commissioner's basis for withholding the information from disclosure.

(e) To the extent the information required to be posted under this subdivision is collected and made available to the public by another state, by the University of Minnesota, or through an online drug pricing reference and analytical tool, the commissioner may reference the availability of this drug price data from another source including, within existing appropriations, creating the ability of the public to access the data from the source for purposes of meeting the reporting requirements of this subdivision.

Sec. 12.

Minnesota Statutes 2022, section 62J.84, subdivision 7, is amended to read:

Subd. 7.

Consultation.

(a) The commissioner may consult with a private entity or consortium that satisfies the standards of section 62U.04, subdivision 6, the University of Minnesota, or the commissioner of commerce, as appropriate, in issuing the form and format of the information reported under this section; in posting information pursuant to subdivision 6; and in taking any other action for the purpose of implementing this section.

(b) The commissioner may consult with representatives of the deleted text begin manufacturers deleted text end new text begin reporting entities new text end to establish a standard format for reporting information under this section and may use existing reporting methodologies to establish a standard format to minimize administrative burdens to the state and deleted text begin manufacturers deleted text end new text begin reporting entities new text end .

Sec. 13.

Minnesota Statutes 2022, section 62J.84, subdivision 8, is amended to read:

Subd. 8.

Enforcement and penalties.

(a) A deleted text begin manufacturer deleted text end new text begin reporting entity new text end may be subject to a civil penalty, as provided in paragraph (b), for:

new text begin (1) failing to register under subdivision 15; new text end

deleted text begin (1) deleted text end new text begin (2) new text end failing to submit timely reports or notices as required by this section;

deleted text begin (2) deleted text end new text begin (3) new text end failing to provide information required under this section; or

deleted text begin (3) deleted text end new text begin (4) new text end providing inaccurate or incomplete information under this section.

(b) The commissioner shall adopt a schedule of civil penalties, not to exceed $10,000 per day of violation, based on the severity of each violation.

(c) The commissioner shall impose civil penalties under this section as provided in section 144.99, subdivision 4.

(d) The commissioner may remit or mitigate civil penalties under this section upon terms and conditions the commissioner considers proper and consistent with public health and safety.

(e) Civil penalties collected under this section shall be deposited in the health care access fund.

Sec. 14.

Minnesota Statutes 2022, section 62J.84, subdivision 9, is amended to read:

Subd. 9.

Legislative report.

(a) No later than May 15, 2022, and by January 15 of each year thereafter, the commissioner shall report to the chairs and ranking minority members of the legislative committees with jurisdiction over commerce and health and human services policy and finance on the implementation of this section, including but not limited to the effectiveness in addressing the following goals:

(1) promoting transparency in pharmaceutical pricing for the state and other payers;

(2) enhancing the understanding on pharmaceutical spending trends; and

(3) assisting the state and other payers in the management of pharmaceutical costs.

(b) The report must include a summary of the information submitted to the commissioner under subdivisions 3, 4, and deleted text begin 5 deleted text end new text begin 11 to 14 new text end .

Sec. 15.

Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:

new text begin Subd. 10. new text end

new text begin Notice of prescription drugs of substantial public interest. new text end

new text begin (a) No later than January 31, 2024, and quarterly thereafter, the commissioner shall produce and post on the department's website a list of prescription drugs that the commissioner determines to represent a substantial public interest and for which the commissioner intends to request data under subdivisions 11 to 14, subject to paragraph (c). The commissioner shall base its inclusion of prescription drugs on any information the commissioner determines is relevant to providing greater consumer awareness of the factors contributing to the cost of prescription drugs in the state, and the commissioner shall consider drug product families that include prescription drugs: new text end

new text begin (1) that triggered reporting under subdivision 3 or 4 during the previous calendar quarter; new text end

new text begin (2) for which average claims paid amounts exceeded 125 percent of the price as of the claim incurred date during the most recent calendar quarter for which claims paid amounts are available; or new text end

new text begin (3) that are identified by members of the public during a public comment process. new text end

new text begin (b) Not sooner than 30 days after publicly posting the list of prescription drugs under paragraph (a), the department shall notify, via email, reporting entities registered with the department of the requirement to report under subdivisions 11 to 14. new text end

new text begin (c) The commissioner must not designate more than 500 prescription drugs as having a substantial public interest in any one notice. new text end

Sec. 16.

Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:

new text begin Subd. 11. new text end

new text begin Manufacturer prescription drug substantial public interest reporting. new text end

new text begin (a) Beginning January 1, 2024, a manufacturer must submit to the commissioner the information described in paragraph (b) for any prescription drug: new text end

new text begin (1) included in a notification to report issued to the manufacturer by the department under subdivision 10; new text end

new text begin (2) which the manufacturer manufactures or repackages; new text end

new text begin (3) for which the manufacturer sets the wholesale acquisition cost; and new text end

new text begin (4) for which the manufacturer has not submitted data under subdivision 3 during the 120-day period prior to the date of the notification to report. new text end

new text begin (b) For each of the drugs described in paragraph (a), the manufacturer shall submit to the commissioner no later than 60 days after the date of the notification to report, in the form and manner prescribed by the commissioner, the following information, if applicable: new text end

new text begin (1) a description of the drug with the following listed separately: new text end

new text begin (i) the national drug code; new text end

new text begin (ii) the product name; new text end

new text begin (iii) the dosage form; new text end

new text begin (iv) the strength; and new text end

new text begin (v) the package size; new text end

new text begin (2) the price of the drug product on the later of: new text end

new text begin (i) the day one year prior to the date of the notification to report; new text end

new text begin (ii) the introduced to market date; or new text end

new text begin (iii) the acquisition date; new text end

new text begin (3) the price of the drug product on the date of the notification to report; new text end

new text begin (4) the introductory price of the prescription drug when it was introduced for sale in the United States and the price of the drug on the last day of each of the five calendar years preceding the date of the notification to report; new text end

new text begin (5) the direct costs incurred during the 12-month period prior to the date of the notification to report by the manufacturers that are associated with the prescription drug, listed separately: new text end

new text begin (i) to manufacture the prescription drug; new text end

new text begin (ii) to market the prescription drug, including advertising costs; and new text end

new text begin (iii) to distribute the prescription drug; new text end

new text begin (6) the number of units of the prescription drug sold during the 12-month period prior to the date of the notification to report; new text end

new text begin (7) the total sales revenue for the prescription drug during the 12-month period prior to the date of the notification to report; new text end

new text begin (8) the total rebate payable amount accrued for the prescription drug during the 12-month period prior to the date of the notification to report; new text end

new text begin (9) the manufacturer's net profit attributable to the prescription drug during the 12-month period prior to the date of the notification to report; new text end

new text begin (10) the total amount of financial assistance the manufacturer has provided through patient prescription assistance programs during the 12-month period prior to the date of the notification to report, if applicable; new text end

new text begin (11) any agreement between a manufacturer and another entity contingent upon any delay in offering to market a generic version of the prescription drug; new text end

new text begin (12) the patent expiration date of the prescription drug if the prescription drug is under patent; new text end

new text begin (13) the name and location of the company that manufactured the drug; new text end

new text begin (14) if the prescription drug is a brand name prescription drug, the ten countries other than the United States that paid the highest prices for the prescription drug during the previous calendar year and their prices; and new text end

new text begin (15) if the prescription drug was acquired by the manufacturer within a 12-month period prior to the date of the notification to report, all of the following information: new text end

new text begin (i) the price at acquisition; new text end

new text begin (ii) the price in the calendar year prior to acquisition; new text end

new text begin (iii) the name of the company from which the drug was acquired; new text end

new text begin (iv) the date of acquisition; and new text end

new text begin (v) the acquisition price. new text end

new text begin (c) The manufacturer may submit any documentation necessary to support the information reported under this subdivision. new text end

Sec. 17.

Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:

new text begin Subd. 12. new text end

new text begin Pharmacy prescription drug substantial public interest reporting. new text end

new text begin (a) Beginning January 1, 2024, a pharmacy must submit to the commissioner the information described in paragraph (b) for any prescription drug included in a notification to report issued to the pharmacy by the department under subdivision 10. new text end

new text begin (b) For each of the drugs described in paragraph (a), the pharmacy shall submit to the commissioner no later than 60 days after the date of the notification to report, in the form and manner prescribed by the commissioner, the following information, if applicable: new text end

new text begin (1) a description of the drug with the following listed separately: new text end

new text begin (i) the national drug code; new text end

new text begin (ii) the product name; new text end

new text begin (iii) the dosage form; new text end

new text begin (iv) the strength; and new text end

new text begin (v) the package size; new text end

new text begin (2) the number of units of the drug acquired during the 12-month period prior to the date of the notification to report; new text end

new text begin (3) the total spent before rebates by the pharmacy to acquire the drug during the 12-month period prior to the date of the notification to report; new text end

new text begin (4) the total rebate receivable amount accrued by the pharmacy for the drug during the 12-month period prior to the date of the notification to report; new text end

new text begin (5) the number of pricing units of the drug dispensed by the pharmacy during the 12-month period prior to the date of the notification to report; new text end

new text begin (6) the total payment receivable by the pharmacy for dispensing the drug including ingredient cost, dispensing fee, and administrative fees during the 12-month period prior to the date of the notification to report; new text end

new text begin (7) the total rebate payable amount accrued by the pharmacy for the drug during the 12-month period prior to the date of the notification to report; and new text end

new text begin (8) the average cash price paid by consumers per pricing unit for prescriptions dispensed where no claim was submitted to a health care service plan or health insurer during the 12-month period prior to the date of the notification to report. new text end

new text begin (c) The pharmacy may submit any documentation necessary to support the information reported under this subdivision. new text end

new text begin (d) The commissioner may grant extensions, exemptions, or both to compliance with the requirements of paragraphs (a) and (b) by small or independent pharmacies, if compliance with paragraphs (a) and (b) would represent a hardship or undue burden to the pharmacy. The commissioner may establish procedures for small or independent pharmacies to request extensions or exemptions under this paragraph. new text end

Sec. 18.

Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:

new text begin Subd. 13. new text end

new text begin PBM prescription drug substantial public interest reporting. new text end

new text begin (a) Beginning January 1, 2024, a PBM must submit to the commissioner the information described in paragraph (b) for any prescription drug included in a notification to report issued to the PBM by the department under subdivision 10. new text end

new text begin (b) For each of the drugs described in paragraph (a), the PBM shall submit to the commissioner no later than 60 days after the date of the notification to report, in the form and manner prescribed by the commissioner, the following information, if applicable: new text end

new text begin (1) a description of the drug with the following listed separately: new text end

new text begin (i) the national drug code; new text end

new text begin (ii) the product name; new text end

new text begin (iii) the dosage form; new text end

new text begin (iv) the strength; and new text end

new text begin (v) the package size; new text end

new text begin (2) the number of pricing units of the drug product filled for which the PBM administered claims during the 12-month period prior to the date of the notification to report; new text end

new text begin (3) the total reimbursement amount accrued and payable to pharmacies for pricing units of the drug product filled for which the PBM administered claims during the 12-month period prior to the date of the notification to report; new text end

new text begin (4) the total reimbursement or administrative fee amount, or both, accrued and receivable from payers for pricing units of the drug product filled for which the PBM administered claims during the 12-month period prior to the date of the notification to report; new text end

new text begin (5) the total rebate receivable amount accrued by the PBM for the drug product during the 12-month period prior to the date of the notification to report; and new text end

new text begin (6) the total rebate payable amount accrued by the PBM for the drug product during the 12-month period prior to the date of the notification to report. new text end

new text begin (c) The PBM may submit any documentation necessary to support the information reported under this subdivision. new text end

Sec. 19.

Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:

new text begin Subd. 14. new text end

new text begin Wholesale drug distributor prescription drug substantial public interest reporting. new text end

new text begin (a) Beginning January 1, 2024, a wholesale drug distributor must submit to the commissioner the information described in paragraph (b) for any prescription drug included in a notification to report issued to the wholesale drug distributor by the department under subdivision 10. new text end

new text begin (b) For each of the drugs described in paragraph (a), the wholesale drug distributor shall submit to the commissioner no later than 60 days after the date of the notification to report, in the form and manner prescribed by the commissioner, the following information, if applicable: new text end

new text begin (1) a description of the drug with the following listed separately: new text end

new text begin (i) the national drug code; new text end

new text begin (ii) the product name; new text end

new text begin (iii) the dosage form; new text end

new text begin (iv) the strength; and new text end

new text begin (v) the package size; new text end

new text begin (2) the number of units of the drug product acquired by the wholesale drug distributor during the 12-month period prior to the date of the notification to report; new text end

new text begin (3) the total spent before rebates by the wholesale drug distributor to acquire the drug product during the 12-month period prior to the date of the notification to report; new text end

new text begin (4) the total rebate receivable amount accrued by the wholesale drug distributor for the drug product during the 12-month period prior to the date of the notification to report; new text end

new text begin (5) the number of units of the drug product sold by the wholesale drug distributor during the 12-month period prior to the date of the notification to report; new text end

new text begin (6) gross revenue from sales in the United States generated by the wholesale drug distributor for this drug product during the 12-month period prior to the date of the notification to report; and new text end

new text begin (7) total rebate payable amount accrued by the wholesale drug distributor for the drug product during the 12-month period prior to the date of the notification to report. new text end

new text begin (c) The wholesale drug distributor may submit any documentation necessary to support the information reported under this subdivision. new text end

Sec. 20.

Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:

new text begin Subd. 15. new text end

new text begin Registration requirements. new text end

new text begin Beginning January 1, 2024, a reporting entity subject to this chapter shall register with the department in a form and manner prescribed by the commissioner. new text end

Sec. 21.

Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to read:

new text begin Subd. 16. new text end

new text begin Rulemaking. new text end

new text begin For the purposes of this section, the commissioner may use the expedited rulemaking process under section 14.389. new text end

Sec. 22.

Minnesota Statutes 2022, section 62K.10, subdivision 4, is amended to read:

Subd. 4.

Network adequacy.

new text begin (a) new text end Each designated provider network must include a sufficient number and type of providers, including providers that specialize in mental health and substance use disorder services, to ensure that covered services are available to all enrollees without unreasonable delay. In determining network adequacy, the commissioner of health shall consider availability of services, including the following:

(1) primary care physician services are available and accessible 24 hours per day, seven days per week, within the network area;

(2) a sufficient number of primary care physicians have hospital admitting privileges at one or more participating hospitals within the network area so that necessary admissions are made on a timely basis consistent with generally accepted practice parameters;

(3) specialty physician service is available through the network or contract arrangement;

(4) mental health and substance use disorder treatment providers new text begin , including but not limited to psychiatric residential treatment facilities, new text end are available and accessible through the network or contract arrangement;

(5) to the extent that primary care services are provided through primary care providers other than physicians, and to the extent permitted under applicable scope of practice in state law for a given provider, these services shall be available and accessible; and

(6) the network has available, either directly or through arrangements, appropriate and sufficient personnel, physical resources, and equipment to meet the projected needs of enrollees for covered health care services.

new text begin (b) The commissioner may establish sufficiency by referencing any reasonable criteria, which include but are not limited to: new text end

new text begin (1) ratios of providers to enrollees by specialty; new text end

new text begin (2) ratios of primary care professionals to enrollees; new text end

new text begin (3) geographic accessibility of providers; new text end

new text begin (4) waiting times for an appointment with participating providers; new text end

new text begin (5) hours of operation; new text end

new text begin (6) the ability of the network to meet the needs of enrollees that are: new text end

new text begin (i) low-income persons; new text end

new text begin (ii) children and adults with serious, chronic, or complex health conditions, physical disabilities, or mental illness; or new text end

new text begin (iii) persons with limited English proficiency and persons from underserved communities; new text end

new text begin (7) other health care service delivery system options, including telemedicine or telehealth, mobile clinics, centers of excellence, and other ways of delivering care; and new text end

new text begin (8) the volume of technological and specialty care services available to serve the needs of enrollees that need technologically advanced or specialty care services. new text end

new text begin EFFECTIVE DATE; APPLICATION. new text end

new text begin Paragraph (a) is effective July 1, 2023. Paragraph (b) is effective January 1, 2025, and applies to health plans offered, issued, or renewed on or after that date. This section supercedes S.F. No. 2744, article 2, section 39, if enacted in the 2023 legislative session. new text end

Sec. 23.

Minnesota Statutes 2022, section 62Q.01, is amended by adding a subdivision to read:

new text begin Subd. 6b. new text end

new text begin No Surprises Act. new text end

new text begin "No Surprises Act" means Division BB of the Consolidated Appropriations Act, 2021, which amended Title XXVII of the Public Health Service Act, Public Law 116-260, and any amendments to and any federal guidance or regulations issued under this act. new text end

Sec. 24.

Minnesota Statutes 2022, section 62Q.021, is amended by adding a subdivision to read:

new text begin Subd. 3. new text end

new text begin Compliance with 2021 federal law. new text end

new text begin Each health plan company, health provider, and health facility shall comply with the No Surprises Act, including any federal regulations adopted under the act, to the extent that the act imposes requirements that apply in this state but are not required under the laws of this state. This subdivision does not require compliance with any provision of the No Surprises Act before the effective date provided for that provision in the No Surprises Act. The commissioner shall enforce this subdivision. new text end

Sec. 25.

new text begin [62Q.451] UNRESTRICTED ACCESS TO SERVICES FOR THE DIAGNOSIS, MONITORING, AND TREATMENT OF RARE DISEASES. new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the meanings given. new text end

new text begin (b) "Rare disease or condition" means any disease or condition: new text end

new text begin (1) that affects fewer than 200,000 persons in the United States and is chronic, serious, life-altering, or life-threatening; new text end

new text begin (2) that affects more than 200,000 persons in the United States and a drug for treatment has been designated as a drug for a rare disease or condition pursuant to United States Code, title 21, section 360bb; new text end

new text begin (3) that is labeled as a rare disease or condition on the Genetic and Rare Diseases Information Center list created by the National Institutes of Health; or new text end

new text begin (4) for which an enrollee: new text end

new text begin (i) has received two or more clinical consultations from a primary care provider or specialty provider that are specific to the presenting complaint; new text end

new text begin (ii) has documentation in the enrollee's medical record of a developmental delay through standardized assessment, developmental regression, failure to thrive, or progressive multisystemic involvement; and new text end

new text begin (iii) had laboratory or clinical testing that failed to provide a definitive diagnosis or resulted in conflicting diagnoses. new text end

new text begin A rare disease or condition does not include an infectious disease that has widely available and known protocols for diagnosis and treatment and that is commonly treated in a primary care setting, even if it affects less than 200,000 persons in the United States. new text end

new text begin Subd. 2. new text end

new text begin Unrestricted access. new text end

new text begin (a) No health plan company may restrict the choice of an enrollee as to where the enrollee receives services from a licensed health care provider related to the diagnosis, monitoring, and treatment of a rare disease or condition, including but not limited to additional restrictions through any prior authorization, preauthorization, prior approval, precertification process, increased fees, or other methods. new text end

new text begin (b) Any services provided by, referred for, or ordered by an out-of-network provider for an enrollee who, before receiving and being notified of a definitive diagnosis, satisfied the requirements in subdivision 1, paragraph (b), clause (4), are governed by paragraph (c), even if the subsequent definitive diagnosis does not meet the definition of rare disease or condition in subdivision 1, paragraph (b), clause (1), (2), or (3). Once the enrollee is definitively diagnosed with a disease or condition that does not meet the definition of rare disease or condition in subdivision 1, paragraph (b), clause (1), (2), or (3), and notification of the diagnosis has been provided to both the health plan and the enrollee, or a parent or guardian of a minor enrollee, any services provided by, referred for, or ordered by an out-of-network provider related to the diagnosis are governed by paragraph (c) for up to 60 days, providing time for care to be transferred to a qualified in-network provider and to schedule needed in-network appointments. After this 60-day period, subsequent services provided by, referred for, or ordered by an out-of-network provider related to the diagnosis are no longer governed by paragraph (c). new text end

new text begin (c) Cost-sharing requirements and benefit or services limitations for the diagnosis and treatment of a rare disease or condition must not place a greater financial burden on the enrollee or be more restrictive than those requirements for in-network medical treatment. new text end

new text begin (d) A health plan company must provide enrollees with written information on the content and application of this section and must train customer service representatives on the content and application of this section. new text end

new text begin Subd. 3. new text end

new text begin Coverage; prior authorization. new text end

new text begin (a) Nothing in this section requires a health plan company to provide coverage for a medication, procedure or treatment, or laboratory or clinical testing, that is not covered under the enrollee's health plan. new text end

new text begin (b) Coverage for a service must not be denied solely on the basis that it was provided by, referred for, or ordered by an out-of-network provider. new text end

new text begin (c) Any prior authorization requirements for a service that is provided by, referred for, or ordered by an out-of-network provider must be the same as any prior authorization requirements for a service that is provided by, referred for, or ordered by an in-network provider. new text end

new text begin (d) Subject to the requirements of this section and chapter 62W, a health plan may require use of a specialty pharmacy, as defined in section 62W.02, subdivision 20. new text end

new text begin Subd. 4. new text end

new text begin Payments to out-of-network providers for services provided in this state. new text end

new text begin (a) If a health plan company has an established contractual payment under a health plan in the commercial insurance market with an out-of-network provider for a service provided in Minnesota related to the diagnosis, monitoring, and treatment of a rare disease or condition, across any of the health plan's networks, then the provider shall accept the established contractual payment for that service as payment in full. new text end

new text begin (b) If a health plan company does not have an established contractual payment under a health plan in the commercial insurance market with an out-of-network provider for a service provided in Minnesota related to the diagnosis, monitoring, and treatment of a rare disease or condition, across any of the health plan's networks, then the provider shall accept: new text end

new text begin (1) the provider's established rate for uninsured patients for that service as payment in full; or new text end

new text begin (2) if the provider does not have an established rate for uninsured patients for that service, then the average commercial insurance rate the health plan company has paid for that service in this state over the past 12 months as payment in full. new text end

new text begin (d) If the payment amount is determined under paragraph (b), clause (2), and the health plan company has not paid for that service in this state within the past 12 months, then the health plan company shall pay the lesser of the following: new text end

new text begin (1) the average rate in the commercial insurance market the health plan company paid for that service across all states over the past 12 months; or new text end

new text begin (2) the provider's standard charge. new text end

new text begin (e) This subdivision does not apply to managed care organizations or county-based purchasing plans when the plan provides coverage to public health care program enrollees under chapters 256B or 256L. new text end

new text begin Subd. 5. new text end

new text begin Payments to out-of-network providers when services are provided outside of the state. new text end

new text begin (a) If a health plan company has an established contractual payment under a health plan in the commercial insurance market with an out-of-network provider for a service provided in another state related to the diagnosis, monitoring, and treatment of a rare disease or condition, across any of the health plan's networks in the state where the service is provided, then the health plan company shall pay the established contractual payment for that service. new text end

new text begin (b) If a health plan company does not have an established contractual payment under a health plan in the commercial insurance market with an out-of-network provider for a service provided in another state related to the diagnosis, monitoring, and treatment of a rare disease or condition, across any of the health plan's networks in the state where the service is provided, then the health plan company shall pay: new text end

new text begin (1) the provider's established rate for uninsured patients for that service; or new text end

new text begin (2) if the provider does not have an established rate for uninsured patients for that service, then the average commercial insurance rate the health plan company has paid for that service in the state where the service is provided over the past 12 months. new text end

new text begin (c) If the payment amount is determined under paragraph (b), clause (2), and the health plan company has not paid for that service in the state where the service is provided within the past 12 months, then the health plan company shall pay the lesser of the following: new text end

new text begin (1) the average commercial insurance rate the health plan company has paid for that service across all states over the last 12 months; or new text end

new text begin (2) the provider's standard charge. new text end

new text begin (d) This subdivision does not apply to managed care organizations or county-based purchasing plans when the plan provides coverage to public health care program enrollees under chapter 256B or 256L. new text end

new text begin Subd. 6. new text end

new text begin Exclusion. new text end

new text begin This section does not apply to medications obtained from a retail pharmacy as defined in section 62W.02, subdivision 18. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, and applies to health plans offered, issued, or renewed on or after that date. new text end

Sec. 26.

new text begin [62Q.473] BIOMARKER TESTING. new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the terms defined in this subdivision have the meanings given. new text end

new text begin (b) "Biomarker" means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention, including but not limited to known gene-drug interactions for medications being considered for use or already being administered. Biomarkers include but are not limited to gene mutations, characteristics of genes, or protein expression. new text end

new text begin (c) "Biomarker testing" means the analysis of an individual's tissue, blood, or other biospecimen for the presence of a biomarker. Biomarker testing includes but is not limited to single-analyst tests; multiplex panel tests; protein expression; and whole exome, whole genome, and whole transcriptome sequencing. new text end

new text begin (d) "Clinical utility" means a test provides information that is used to formulate a treatment or monitoring strategy that informs a patient's outcome and impacts the clinical decision. The most appropriate test may include information that is actionable and some information that cannot be immediately used to formulate a clinical decision. new text end

new text begin (e) "Consensus statement" means a statement that: (1) describes optimal clinical care outcomes, based on the best available evidence, for a specific clinical circumstance; and (2) is developed by an independent, multidisciplinary panel of experts that: (i) uses a rigorous and validated development process that includes a transparent methodology and reporting structure; and (ii) strictly adheres to the panel's conflict of interest policy. new text end

new text begin (f) "Nationally recognized clinical practice guideline" means an evidence-based clinical practice guideline that: (1) establishes a standard of care informed by (i) a systematic review of evidence, and (ii) an assessment of the risks and benefits of alternative care options; and (2) is developed by an independent organization or medical professional society that: (i) uses a transparent methodology and reporting structure; and (ii) adheres to a conflict of interest policy. Nationally recognized clinical practice guideline includes recommendations to optimize patient care. new text end

new text begin Subd. 2. new text end

new text begin Biomarker testing; coverage required. new text end

new text begin (a) A health plan must provide coverage for biomarker testing to diagnose, treat, manage, and monitor illness or disease if the test provides clinical utility. For purposes of this section, a test's clinical utility may be demonstrated by medical and scientific evidence, including but not limited to: new text end

new text begin (1) nationally recognized clinical practice guidelines as defined in this section; new text end

new text begin (2) consensus statements as defined in this section; new text end

new text begin (3) labeled indications for a United States Food and Drug Administration (FDA) approved or FDA-cleared test, indicated tests for an FDA-approved drug, or adherence to warnings and precautions on FDA-approved drug labels; or new text end

new text begin (4) Centers for Medicare and Medicaid Services national coverage determinations or Medicare Administrative Contractor local coverage determinations. new text end

new text begin (b) Coverage under this section must be provided in a manner that limits disruption of care, including the need for multiple biopsies or biospecimen samples. new text end

new text begin (c) Nothing in this section prohibits a health plan company from requiring a prior authorization or imposing other utilization controls when approving coverage for biomarker testing. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, and applies to health plans offered, issued, or renewed on or after that date. new text end

Sec. 27.

new text begin [62Q.522] COVERAGE OF CONTRACEPTIVE METHODS AND SERVICES. new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The definitions in this subdivision apply to this section. new text end

new text begin (b) "Closely held for-profit entity" means an entity that: new text end

new text begin (1) is not a nonprofit entity; new text end

new text begin (2) has more than 50 percent of the value of its ownership interest owned directly or indirectly by five or fewer owners; and new text end

new text begin (3) has no publicly traded ownership interest. new text end

new text begin For purposes of this paragraph: new text end

new text begin (i) ownership interests owned by a corporation, partnership, limited liability company, estate, trust, or similar entity are considered owned by that entity's shareholders, partners, members, or beneficiaries in proportion to their interest held in the corporation, partnership, limited liability company, estate, trust, or similar entity; new text end

new text begin (ii) ownership interests owned by a nonprofit entity are considered owned by a single owner; new text end

new text begin (iii) ownership interests owned by all individuals in a family are considered held by a single owner. For purposes of this item, "family" means brothers and sisters, including half-brothers and half-sisters, a spouse, ancestors, and lineal descendants; and new text end

new text begin (iv) if an individual or entity holds an option, warrant, or similar right to purchase an ownership interest, the individual or entity is considered to be the owner of those ownership interests. new text end

new text begin (c) "Contraceptive method" means a drug, device, or other product approved by the Food and Drug Administration to prevent unintended pregnancy. new text end

new text begin (d) "Contraceptive service" means consultation, examination, procedures, and medical services related to the prevention of unintended pregnancy, excluding vasectomies. This includes but is not limited to voluntary sterilization procedures, patient education, counseling on contraceptives, and follow-up services related to contraceptive methods or services, management of side effects, counseling for continued adherence, and device insertion or removal. new text end

new text begin (e) "Eligible organization" means an organization that opposes providing coverage for some or all contraceptive methods or services on account of religious objections and that is: new text end

new text begin (1) organized as a nonprofit entity and holds itself out to be religious; or new text end

new text begin (2) organized and operates as a closely held for-profit entity, and the organization's owners or highest governing body has adopted, under the organization's applicable rules of governance and consistent with state law, a resolution or similar action establishing that the organization objects to covering some or all contraceptive methods or services on account of the owners' sincerely held religious beliefs. new text end

new text begin (f) "Exempt organization" means an organization that is organized and operates as a nonprofit entity and meets the requirements of section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended. new text end

new text begin (g) "Medical necessity" includes but is not limited to considerations such as severity of side effects, difference in permanence and reversibility of a contraceptive method or service, and ability to adhere to the appropriate use of the contraceptive method or service, as determined by the attending provider. new text end

new text begin (h) "Therapeutic equivalent version" means a drug, device, or product that can be expected to have the same clinical effect and safety profile when administered to a patient under the conditions specified in the labeling, and that: new text end

new text begin (1) is approved as safe and effective; new text end

new text begin (2) is a pharmaceutical equivalent: (i) containing identical amounts of the same active drug ingredient in the same dosage form and route of administration; and (ii) meeting compendial or other applicable standards of strength, quality, purity, and identity; new text end

new text begin (3) is bioequivalent in that: new text end

new text begin (i) the drug, device, or product does not present a known or potential bioequivalence problem and meets an acceptable in vitro standard; or new text end

new text begin (ii) if the drug, device, or product does present a known or potential bioequivalence problem, it is shown to meet an appropriate bioequivalence standard; new text end

new text begin (4) is adequately labeled; and new text end

new text begin (5) is manufactured in compliance with current manufacturing practice regulations. new text end

new text begin Subd. 2. new text end

new text begin Required coverage; cost sharing prohibited. new text end

new text begin (a) A health plan must provide coverage for contraceptive methods and services. new text end

new text begin (b) A health plan company must not impose cost-sharing requirements, including co-pays, deductibles, or coinsurance, for contraceptive methods or services. new text end

new text begin (c) A health plan company must not impose any referral requirements, restrictions, or delays for contraceptive methods or services. new text end

new text begin (d) A health plan must include at least one of each type of Food and Drug Administration approved contraceptive method in its formulary. If more than one therapeutic equivalent version of a contraceptive method is approved, a health plan must include at least one therapeutic equivalent version in its formulary, but is not required to include all therapeutic equivalent versions. new text end

new text begin (e) For each health plan, a health plan company must list the contraceptive methods and services that are covered without cost-sharing in a manner that is easily accessible to enrollees, health care providers, and representatives of health care providers. The list for each health plan must be promptly updated to reflect changes to the coverage. new text end

new text begin (f) If an enrollee's attending provider recommends a particular contraceptive method or service based on a determination of medical necessity for that enrollee, the health plan must cover that contraceptive method or service without cost-sharing. The health plan company issuing the health plan must defer to the attending provider's determination that the particular contraceptive method or service is medically necessary for the enrollee. new text end

new text begin Subd. 3. new text end

new text begin Exemption. new text end

new text begin (a) An exempt organization is not required to cover contraceptives or contraceptive services if the exempt organization has religious objections to the coverage. An exempt organization that chooses to not provide coverage for some or all contraceptives and contraceptive services must notify employees as part of the hiring process and to all employees at least 30 days before: new text end

new text begin (1) an employee enrolls in the health plan; or new text end

new text begin (2) the effective date of the health plan, whichever occurs first. new text end

new text begin (b) If the exempt organization provides coverage for some contraceptive methods or services, the notice required under paragraph (a) must provide a list of the contraceptive methods or services the organization refuses to cover. new text end

new text begin Subd. 4. new text end

new text begin Accommodation for eligible organizations. new text end

new text begin (a) A health plan established or maintained by an eligible organization complies with the requirements of subdivision 2 to provide coverage of contraceptive methods and services, with respect to the contraceptive methods or services identified in the notice under this paragraph, if the eligible organization provides notice to any health plan company the eligible organization contracts with that it is an eligible organization and that the eligible organization has a religious objection to coverage for all or a subset of contraceptive methods or services. new text end

new text begin (b) The notice from an eligible organization to a health plan company under paragraph (a) must include: (1) the name of the eligible organization; (2) a statement that it objects to coverage for some or all of contraceptive methods or services, including a list of the contraceptive methods or services the eligible organization objects to, if applicable; and (3) the health plan name. The notice must be executed by a person authorized to provide notice on behalf of the eligible organization. new text end

new text begin (c) An eligible organization must provide a copy of the notice under paragraph (a) to prospective employees as part of the hiring process and to all employees at least 30 days before: new text end

new text begin (1) an employee enrolls in the health plan; or new text end

new text begin (2) the effective date of the health plan, whichever occurs first. new text end

new text begin (d) A health plan company that receives a copy of the notice under paragraph (a) with respect to a health plan established or maintained by an eligible organization must, for all future enrollments in the health plan: new text end

new text begin (1) expressly exclude coverage for those contraceptive methods or services identified in the notice under paragraph (a) from the health plan; and new text end

new text begin (2) provide separate payments for any contraceptive methods or services required to be covered under subdivision 2 for enrollees as long as the enrollee remains enrolled in the health plan. new text end

new text begin (e) The health plan company must not impose any cost-sharing requirements, including co-pays, deductibles, or coinsurance, or directly or indirectly impose any premium, fee, or other charge for contraceptive services or methods on the eligible organization, health plan, or enrollee. new text end

new text begin (f) On January 1, 2024, and every year thereafter a health plan company must notify the commissioner, in a manner determined by the commissioner, of the number of eligible organizations granted an accommodation under this subdivision. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, and applies to coverage offered, sold, issued, or renewed on or after that date. new text end

Sec. 28.

new text begin [62Q.523] COVERAGE FOR PRESCRIPTION CONTRACEPTIVES; SUPPLY REQUIREMENTS. new text end

new text begin Subdivision 1. new text end

new text begin Scope of coverage. new text end

new text begin Except as otherwise provided in section 62Q.522, subdivisions 3 and 4, all health plans that provide prescription coverage must comply with the requirements of this section. new text end

new text begin Subd. 2. new text end

new text begin Definition. new text end

new text begin For purposes of this section, "prescription contraceptive" means any drug or device that requires a prescription and is approved by the Food and Drug Administration to prevent pregnancy. Prescription contraceptive does not include an emergency contraceptive drug that prevents pregnancy when administered after sexual contact. new text end

new text begin Subd. 3. new text end

new text begin Required coverage. new text end

new text begin Health plan coverage for a prescription contraceptive must provide a 12-month supply for any prescription contraceptive if a 12-month supply is prescribed by the prescribing health care provider. The prescribing health care provider must determine the appropriate duration to prescribe the prescription contraceptives for up to 12 months. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, and applies to coverage offered, sold, issued, or renewed on or after that date. new text end

Sec. 29.

Minnesota Statutes 2022, section 62Q.55, subdivision 5, is amended to read:

Subd. 5.

Coverage restrictions or limitations.

If emergency services are provided by a nonparticipating provider, with or without prior authorization, the health plan company shall not impose coverage restrictions or limitations that are more restrictive than apply to emergency services received from a participating provider. Cost-sharing requirements that apply to emergency services received out-of-network must be the same as the cost-sharing requirements that apply to services received in-network new text begin and shall count toward the in-network deductible. All coverage and charges for emergency services must comply with the No Surprises Act new text end .

Sec. 30.

Minnesota Statutes 2022, section 62Q.556, is amended to read:

62Q.556 deleted text begin UNAUTHORIZED PROVIDER SERVICES deleted text end new text begin CONSUMER PROTECTIONS AGAINST BALANCE BILLING new text end .

Subdivision 1.

deleted text begin Unauthorized provider services deleted text end new text begin Nonparticipating provider balance billing prohibition new text end .

(a) Except as provided in paragraph deleted text begin (c), unauthorized provider services occur deleted text end new text begin (b), balance billing is prohibited new text end when an enrollee receives services new text begin from new text end :

(1) deleted text begin from deleted text end a nonparticipating provider at a participating hospital or ambulatory surgical center, deleted text begin when the services are rendered: deleted text end new text begin as described by the No Surprises Act, including any federal regulations adopted under that act; new text end

deleted text begin (i) due to the unavailability of a participating provider; deleted text end

deleted text begin (ii) by a nonparticipating provider without the enrollee's knowledge; or deleted text end

deleted text begin (iii) due to the need for unforeseen services arising at the time the services are being rendered; or deleted text end

(2) deleted text begin from deleted text end a participating provider that sends a specimen taken from the enrollee in the participating provider's practice setting to a nonparticipating laboratory, pathologist, or other medical testing facility deleted text begin . deleted text end new text begin ; or new text end

new text begin (3) a nonparticipating provider or facility providing emergency services as defined in section 62Q.55, subdivision 3, and other services as described in the requirements of the No Surprises Act. new text end

deleted text begin (b) Unauthorized provider services do not include emergency services as defined in section 62Q.55, subdivision 3. deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end The services described in paragraph (a), deleted text begin clause (2) deleted text end new text begin clauses (1), (2), and (3), as defined in the No Surprises Act, and any federal regulations adopted under that act new text end , are deleted text begin not unauthorized provider services deleted text end new text begin subject to balance billing new text end if the enrollee deleted text begin gives advance written deleted text end new text begin provides informed new text end consent deleted text begin to deleted text end new text begin prior to receiving services from new text end the new text begin nonparticipating new text end provider acknowledging that the use of a provider, or the services to be rendered, may result in costs not covered by the health plan. new text begin The informed consent must comply with all requirements of the No Surprises Act, including any federal regulations adopted under that act. new text end

Subd. 2.

deleted text begin Prohibition deleted text end new text begin Cost-sharing requirements and independent dispute resolution new text end .

(a) An enrollee's financial responsibility for the deleted text begin unauthorized deleted text end new text begin nonparticipating new text end provider services new text begin described in subdivision 1, paragraph (a), new text end shall be the same cost-sharing requirements, including co-payments, deductibles, coinsurance, coverage restrictions, and coverage limitations, as those applicable to services received by the enrollee from a participating provider. A health plan company must apply any enrollee cost sharing requirements, including co-payments, deductibles, and coinsurance, for deleted text begin unauthorized deleted text end new text begin nonparticipating new text end provider services to the enrollee's annual out-of-pocket limit to the same extent payments to a participating provider would be applied.

(b) A health plan company must attempt to negotiate the reimbursement, less any applicable enrollee cost sharing under paragraph (a), for the deleted text begin unauthorized deleted text end new text begin nonparticipating new text end provider services with the nonparticipating provider. If deleted text begin a health plan company's and nonparticipating provider's attempts deleted text end new text begin the attempt new text end to negotiate reimbursement for the deleted text begin health care deleted text end new text begin nonparticipating provider new text end services deleted text begin do deleted text end new text begin does new text end not result in a resolution, deleted text begin the health plan company or provider may elect to refer the matter for binding arbitration, chosen in accordance with paragraph (c). A nondisclosure agreement must be executed by both parties prior to engaging an arbitrator in accordance with this section. The cost of arbitration must be shared equally between the parties. deleted text end new text begin either party may initiate the federal independent dispute resolution process pursuant to the No Surprises Act, including any federal regulations adopted under that act. new text end

deleted text begin (c) The commissioner of health, in consultation with the commissioner of the Bureau of Mediation Services, must develop a list of professionals qualified in arbitration, for the purpose of resolving disputes between a health plan company and nonparticipating provider arising from the payment for unauthorized provider services. The commissioner of health shall publish the list on the Department of Health website, and update the list as appropriate. deleted text end

deleted text begin (d) The arbitrator must consider relevant information, including the health plan company's payments to other nonparticipating providers for the same services, the circumstances and complexity of the particular case, and the usual and customary rate for the service based on information available in a database in a national, independent, not-for-profit corporation, and similar fees received by the provider for the same services from other health plans in which the provider is nonparticipating, in reaching a decision. deleted text end

new text begin Subd. 3. new text end

new text begin Annual data reporting. new text end

new text begin (a) Beginning April 1, 2024, a health plan company must report annually to the commissioner of health: new text end

new text begin (1) the total number of claims and total billed and paid amounts for nonparticipating provider services, by service and provider type, submitted to the health plan in the prior calendar year; and new text end

new text begin (2) the total number of enrollee complaints received regarding the rights and protections established by the No Surprises Act in the prior calendar year. new text end

new text begin (b) The commissioners of commerce and health shall develop the form and manner for health plan companies to comply with paragraph (a). new text end

new text begin Subd. 4. new text end

new text begin Enforcement. new text end

new text begin (a) Any provider or facility, including a health care provider or facility pursuant to section 62A.63, subdivision 2, or 62J.03, subdivision 8, that is subject to the relevant provisions of the No Surprises Act is subject to the requirements of this section and section 62J.811. new text end

new text begin (b) The commissioner of commerce or health shall enforce this section. new text end

new text begin (c) If a health-related licensing board has cause to believe that a provider has violated this section, it may further investigate and enforce the provisions of this section pursuant to chapter 214. new text end

Sec. 31.

Minnesota Statutes 2022, section 62Q.56, subdivision 2, is amended to read:

Subd. 2.

Change in health plans.

(a) If an enrollee is subject to a change in health plans, the enrollee's new health plan company must provide, upon request, authorization to receive services that are otherwise covered under the terms of the new health plan through the enrollee's current provider:

(1) for up to 120 days if the enrollee is engaged in a current course of treatment for one or more of the following conditions:

(i) an acute condition;

(ii) a life-threatening mental or physical illness;

(iii) pregnancy deleted text begin beyond the first trimester of pregnancy deleted text end ;

(iv) a physical or mental disability defined as an inability to engage in one or more major life activities, provided that the disability has lasted or can be expected to last for at least one year, or can be expected to result in death; or

(v) a disabling or chronic condition that is in an acute phase; or

(2) for the rest of the enrollee's life if a physician certifies that the enrollee has an expected lifetime of 180 days or less.

For all requests for authorization under this paragraph, the health plan company must grant the request for authorization unless the enrollee does not meet the criteria provided in this paragraph.

(b) The health plan company shall prepare a written plan that provides a process for coverage determinations regarding continuity of care of up to 120 days for new enrollees who request continuity of care with their former provider, if the new enrollee:

(1) is receiving culturally appropriate services and the health plan company does not have a provider in its preferred provider network with special expertise in the delivery of those culturally appropriate services within the time and distance requirements of section 62D.124, subdivision 1; or

(2) does not speak English and the health plan company does not have a provider in its preferred provider network who can communicate with the enrollee, either directly or through an interpreter, within the time and distance requirements of section 62D.124, subdivision 1.

The written plan must explain the criteria that will be used to determine whether a need for continuity of care exists and how it will be provided.

(c) This subdivision applies only to group coverage and continuation and conversion coverage, and applies only to changes in health plans made by the employer.

Sec. 32.

Minnesota Statutes 2022, section 62Q.73, subdivision 1, is amended to read:

Subdivision 1.

Definition.

For purposes of this section, "adverse determination" means:

(1) for individual health plans, a complaint decision relating to a health care service or claim that is partially or wholly adverse to the complainant;

(2) an individual health plan that is grandfathered plan coverage may instead apply the definition of adverse determination for group coverage in clause (3);

(3) for group health plans, a complaint decision relating to a health care service or claim that has been appealed in accordance with section 62Q.70 and the appeal decision is partially or wholly adverse to the complainant;

(4) any adverse determination, as defined in section 62M.02, subdivision 1a, that has been appealed in accordance with section 62M.06 and the appeal did not reverse the adverse determination;

(5) a decision relating to a health care service made by a health plan company licensed under chapter 60A that denies the service on the basis that the service was not medically necessary; deleted text begin or deleted text end

(6) the enrollee has met the requirements of subdivision 6, paragraph (e) deleted text begin . deleted text end new text begin ; or new text end

new text begin (7) a decision relating to a health plan's coverage of nonparticipating provider services as described in and subject to section 62Q.556, subdivision 1, paragraph (a). new text end

An adverse determination does not include complaints relating to fraudulent marketing practices or agent misrepresentation.

Sec. 33.

Minnesota Statutes 2022, section 62Q.73, subdivision 7, is amended to read:

Subd. 7.

Standards of review.

(a) For an external review of any issue in an adverse determination that does not require a medical necessity determination, the external review must be based on whether the adverse determination was in compliance with the enrollee's health benefit plan new text begin or section 62Q.556, subdivision 1, paragraph (a) new text end .

(b) For an external review of any issue in an adverse determination by a health plan company licensed under chapter 62D that requires a medical necessity determination, the external review must determine whether the adverse determination was consistent with the definition of medically necessary care in Minnesota Rules, part 4685.0100, subpart 9b.

(c) For an external review of any issue in an adverse determination by a health plan company, other than a health plan company licensed under chapter 62D, that requires a medical necessity determination, the external review must determine whether the adverse determination was consistent with the definition of medically necessary care in section 62Q.53, subdivision 2.

(d) For an external review of an adverse determination involving experimental or investigational treatment, the external review entity must base its decision on all documents submitted by the health plan company and enrollee, including:

(1) medical records;

(2) the recommendation of the attending physician, advanced practice registered nurse, physician assistant, or health care professional;

(3) consulting reports from health care professionals;

(4) the terms of coverage;

(5) federal Food and Drug Administration approval; and

(6) medical or scientific evidence or evidence-based standards.

Sec. 34.

Minnesota Statutes 2022, section 62U.01, is amended by adding a subdivision to read:

new text begin Subd. 5a. new text end

new text begin Dental organization. new text end

new text begin "Dental organization" has the meaning given in section 62Q.76, subdivision 7. new text end

Sec. 35.

Minnesota Statutes 2022, section 62U.04, subdivision 4, is amended to read:

Subd. 4.

Encounter data.

(a) All health plan companies new text begin , dental organizations, new text end and third-party administrators shall submit encounter data on a monthly basis to a private entity designated by the commissioner of health. The data shall be submitted in a form and manner specified by the commissioner subject to the following requirements:

(1) the data must be de-identified data as described under the Code of Federal Regulations, title 45, section 164.514;

(2) the data for each encounter must include an identifier for the patient's health care home if the patient has selected a health care home new text begin , data on contractual value-based payments, new text end and deleted text begin , for claims incurred on or after January 1, 2019, deleted text end data deemed necessary by the commissioner to uniquely identify claims in the individual health insurance market; deleted text begin and deleted text end

(3) new text begin the data must include enrollee race and ethnicity, to the extent available, for claims incurred on or after January 1, 2023; and new text end

new text begin (4) new text end except for the deleted text begin identifier deleted text end new text begin data new text end described in deleted text begin clause deleted text end new text begin clauses new text end (2) new text begin and (3) new text end , the data must not include information that is not included in a health care claim new text begin , dental care claim, new text end or equivalent encounter information transaction that is required under section 62J.536.

(b) The commissioner or the commissioner's designee shall only use the data submitted under paragraph (a) to carry out the commissioner's responsibilities in this section, including supplying the data to providers so they can verify their results of the peer grouping process consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d), and adopted by the commissioner and, if necessary, submit comments to the commissioner or initiate an appeal.

(c) Data on providers collected under this subdivision are private data on individuals or nonpublic data, as defined in section 13.02. deleted text begin Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary data prepared under this subdivision may be derived from nonpublic data. deleted text end new text begin Notwithstanding the data classifications in this paragraph, data on providers collected under this subdivision may be released or published as authorized in subdivision 11. new text end The commissioner or the commissioner's designee shall establish procedures and safeguards to protect the integrity and confidentiality of any data that it maintains.

(d) The commissioner or the commissioner's designee shall not publish analyses or reports that identify, or could potentially identify, individual patients.

(e) The commissioner shall compile summary information on the data submitted under this subdivision. The commissioner shall work with its vendors to assess the data submitted in terms of compliance with the data submission requirements and the completeness of the data submitted by comparing the data with summary information compiled by the commissioner and with established and emerging data quality standards to ensure data quality.

Sec. 36.

Minnesota Statutes 2022, section 62U.04, subdivision 5, is amended to read:

Subd. 5.

Pricing data.

(a) All health plan companies new text begin , dental organizations, new text end and third-party administrators shall submit, on a monthly basis, data on their contracted prices with health care providers new text begin and dental care providers new text end to a private entity designated by the commissioner of health for the purposes of performing the analyses required under this subdivision. new text begin Data on contracted prices submitted under this paragraph must include data on supplemental contractual value-based payments paid to health care providers. new text end The data shall be submitted in the form and manner specified by the commissioner of health.

(b) The commissioner or the commissioner's designee shall only use the data submitted under this subdivision to carry out the commissioner's responsibilities under this section, including supplying the data to providers so they can verify their results of the peer grouping process consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d), and adopted by the commissioner and, if necessary, submit comments to the commissioner or initiate an appeal.

(c) Data collected under this subdivision are new text begin private data on individuals or new text end nonpublic data as defined in section 13.02. Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary data prepared under this section may be derived from nonpublic data. new text begin Notwithstanding the data classifications in this paragraph, data on providers collected under this subdivision may be released or published as authorized in subdivision 11. new text end The commissioner shall establish procedures and safeguards to protect the integrity and confidentiality of any data that it maintains.

Sec. 37.

Minnesota Statutes 2022, section 62U.04, subdivision 5a, is amended to read:

Subd. 5a.

Self-insurers.

new text begin (a) new text end The commissioner shall not require a self-insurer governed by the federal Employee Retirement Income Security Act of 1974 (ERISA) to comply with this section.

new text begin (b) A third-party administrator must annually notify the self-insurers whose health plans are administered by the third-party administrator that the self-insurer may elect to have the third-party administrator submit encounter data, data on contracted prices, and data on nonclaims-based payments under subdivisions 4, 5, and 5b, from the self-insurer's health plan for the upcoming plan year. This notice must be provided in a form and manner specified by the commissioner. After receiving responses from self-insurers, a third-party administrator must, in a form and manner specified by the commissioner, report to the commissioner: new text end

new text begin (1) the number of self-insured clients that elected to have the third-party administrator submit encounter data, data on contracted prices, and data on nonclaims-based payments from the self-insurer's health plan for the upcoming plan year, along with the number of covered lives, claims volume, and aggregated claim value; new text end

new text begin (2) the number of self-insured clients that declined to have the third-party administrator submit encounter data, data on contracted prices, and data on nonclaims-based payments from the self-insurer's health plan for the upcoming plan year, along with the number of covered lives, claims volume, and aggregated claim value; and new text end

new text begin (3) data deemed necessary by the commissioner to assure the quality of the submitted data. new text end

new text begin (c) Data collected under this subdivision are private data on individuals or nonpublic data as defined in section 13.02. Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary data prepared under this subdivision may be derived from nonpublic data. The commissioner shall establish procedures and safeguards to protect the integrity and confidentiality of any data maintained by the commissioner. new text end

Sec. 38.

Minnesota Statutes 2022, section 62U.04, is amended by adding a subdivision to read:

new text begin Subd. 5b. new text end

new text begin Nonclaims-based payments. new text end

new text begin (a) Beginning January 1, 2025, all health plan companies and third-party administrators shall submit to a private entity designated by the commissioner of health all nonclaims-based payments made to health care providers. The data shall be submitted in a form, manner, and frequency specified by the commissioner. Nonclaims-based payments are payments to health care providers designed to pay for value of health care services over volume of health care services and include alternative payment models or incentives, payments for infrastructure expenditures or investments, and payments for workforce expenditures or investments. Nonclaims-based payments submitted under this subdivision must, to the extent possible, be attributed to a health care provider in the same manner in which claims-based data are attributed to a health care provider and, where appropriate, must be combined with data collected under subdivisions 4 to 5a in analyses of health care spending. new text end

new text begin (b) Data collected under this subdivision are private data on individuals or nonpublic data as defined in section 13.02. Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary data prepared under this subdivision may be derived from nonpublic data. The commissioner shall establish procedures and safeguards to protect the integrity and confidentiality of any data maintained by the commissioner. new text end

new text begin (c) The commissioner shall consult with health plan companies, hospitals, health care providers, and the commissioner of human services in developing the data reported under this subdivision and standardized reporting forms. new text end

Sec. 39.

Minnesota Statutes 2022, section 62U.04, subdivision 11, is amended to read:

Subd. 11.

Restricted uses of the all-payer claims data.

(a) Notwithstanding subdivision 4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's designee shall only use the data submitted under subdivisions 4 deleted text begin and deleted text end new text begin , new text end 5 new text begin , 5a, and 5b new text end for the deleted text begin following deleted text end purposes new text begin authorized in this subdivision and in subdivision 13 new text end :

(1) to evaluate the performance of the health care home program as authorized under section 62U.03, subdivision 7;

(2) to study, in collaboration with the reducing avoidable readmissions effectively (RARE) campaign, hospital readmission trends and rates;

(3) to analyze variations in health care costs, quality, utilization, and illness burden based on geographical areas or populations;

(4) to evaluate the state innovation model (SIM) testing grant received by the Departments of Health and Human Services, including the analysis of health care cost, quality, and utilization baseline and trend information for targeted populations and communities; and

(5) to compile one or more public use files of summary data or tables that must:

(i) be available to the public for no or minimal cost by March 1, 2016, and available by web-based electronic data download by June 30, 2019;

(ii) not identify individual patients deleted text begin , payers, or providers deleted text end new text begin but that may identify the rendering or billing hospital, clinic, or medical practice so long as no individual health professionals are identified and the commissioner finds the data to be accurate, valid, and suitable for publication for such use new text end ;

(iii) be updated by the commissioner, at least annually, with the most current data available; new text begin and new text end

(iv) contain clear and conspicuous explanations of the characteristics of the data, such as the dates of the data contained in the files, the absence of costs of care for uninsured patients or nonresidents, and other disclaimers that provide appropriate context deleted text begin ; and deleted text end new text begin . new text end

deleted text begin (v) not lead to the collection of additional data elements beyond what is authorized under this section as of June 30, 2015. deleted text end

(b) The commissioner may publish the results of the authorized uses identified in paragraph (a) deleted text begin so long as the data released publicly do not contain information or descriptions in which the identity of individual hospitals, clinics, or other providers may be discerned deleted text end . new text begin The data published under this paragraph may identify hospitals, clinics, and medical practices so long as no individual health professionals are identified and the commissioner finds the data to be accurate, valid, and suitable for publication for such use. new text end

deleted text begin (c) Nothing in this subdivision shall be construed to prohibit the commissioner from using the data collected under subdivision 4 to complete the state-based risk adjustment system assessment due to the legislature on October 1, 2015. deleted text end

deleted text begin (d) The commissioner or the commissioner's designee may use the data submitted under subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1, 2023. deleted text end

deleted text begin (e) The commissioner shall consult with the all-payer claims database work group established under subdivision 12 regarding the technical considerations necessary to create the public use files of summary data described in paragraph (a), clause (5). deleted text end

Sec. 40.

Minnesota Statutes 2022, section 62U.04, is amended by adding a subdivision to read:

new text begin Subd. 13. new text end

new text begin Expanded access to and use of the all-payer claims data. new text end

new text begin (a) The commissioner or the commissioner's designee shall make the data submitted under subdivisions 4, 5, 5a, and 5b, including data classified as private or nonpublic, available to individuals and organizations engaged in research on, or efforts to effect transformation in, health care outcomes, access, quality, disparities, or spending, provided the use of the data serves a public benefit. Data made available under this subdivision may not be used to: new text end

new text begin (1) create an unfair market advantage for any participant in the health care market in Minnesota, including health plan companies, payers, and providers; new text end

new text begin (2) reidentify or attempt to reidentify an individual in the data; or new text end

new text begin (3) publicly report contract details between a health plan company and provider and derived from the data. new text end

new text begin (b) To implement paragraph (a), the commissioner shall: new text end

new text begin (1) establish detailed requirements for data access; a process for data users to apply to access and use the data; legally enforceable data use agreements to which data users must consent; a clear and robust oversight process for data access and use, including a data management plan, that ensures compliance with state and federal data privacy laws; agreements for state agencies and the University of Minnesota to ensure proper and efficient use and security of data; and technical assistance for users of the data and for stakeholders; new text end

new text begin (2) develop a fee schedule to support the cost of expanded access to and use of the data, provided the fees charged under the schedule do not create a barrier to access or use for those most affected by disparities; and new text end

new text begin (3) create a research advisory group to advise the commissioner on applications for data use under this subdivision, including an examination of the rigor of the research approach, the technical capabilities of the proposed user, and the ability of the proposed user to successfully safeguard the data. new text end

Sec. 41.

new text begin REPORT ON TRANSPARENCY OF HEALTH CARE PAYMENTS. new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The terms defined in this subdivision apply to this section. new text end

new text begin (b) "Commissioner" means the commissioner of health. new text end

new text begin (c) "Nonclaims-based payments" means payments to health care providers designed to support and reward value of health care services over volume of health care services and includes alternative payment models or incentives, payments for infrastructure expenditures or investments, and payments for workforce expenditures or investments. new text end

new text begin (d) "Nonpublic data" has the meaning given in Minnesota Statutes, section 13.02, subdivision 9. new text end

new text begin (e) "Primary care services" means integrated, accessible health care services provided by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Primary care services include but are not limited to preventive services, office visits, administration of vaccines, annual physicals, pre-operative physicals, assessments, care coordination, development of treatment plans, management of chronic conditions, and diagnostic tests. new text end

new text begin Subd. 2. new text end

new text begin Report. new text end

new text begin (a) To provide the legislature with information needed to meet the evolving health care needs of Minnesotans, the commissioner shall report to the legislature by February 15, 2024, on the volume and distribution of health care spending across payment models used by health plan companies and third-party administrators, with a particular focus on value-based care models and primary care spending. new text end

new text begin (b) The report must include specific health plan and third-party administrator estimates of health care spending for claims-based payments and nonclaims-based payments for the most recent available year, reported separately for Minnesotans enrolled in state health care programs, Medicare Advantage, and commercial health insurance. The report must also include recommendations on changes needed to gather better data from health plan companies and third-party administrators on the use of value-based payments that pay for value of health care services provided over volume of services provided, promote the health of all Minnesotans, reduce health disparities, and support the provision of primary care services and preventive services. new text end

new text begin (c) In preparing the report, the commissioner shall: new text end

new text begin (1) describe the form, manner, and timeline for submission of data by health plan companies and third-party administrators to produce estimates as specified in paragraph (b); new text end

new text begin (2) collect summary data that permits the computation of: new text end

new text begin (i) the percentage of total payments that are nonclaims-based payments; and new text end

new text begin (ii) the percentage of payments in item (i) that are for primary care services; new text end

new text begin (3) where data was not directly derived, specify the methods used to estimate data elements; new text end

new text begin (4) notwithstanding Minnesota Statutes, section 62U.04, subdivision 11, conduct analyses of the magnitude of primary care payments using data collected by the commissioner under Minnesota Statutes, section 62U.04; and new text end

new text begin (5) conduct interviews with health plan companies and third-party administrators to better understand the types of nonclaims-based payments and models in use, the purposes or goals of each, the criteria for health care providers to qualify for these payments, and the timing and structure of health plan companies or third-party administrators making these payments to health care provider organizations. new text end

new text begin (d) Health plan companies and third-party administrators must comply with data requests from the commissioner under this section within 60 days after receiving the request. new text end

new text begin (e) Data collected under this section is nonpublic data. Notwithstanding the definition of summary data in Minnesota Statutes, section 13.02, subdivision 19, summary data prepared under this section may be derived from nonpublic data. The commissioner shall establish procedures and safeguards to protect the integrity and confidentiality of any data maintained by the commissioner. new text end

Sec. 42.

new text begin STATEWIDE HEALTH CARE PROVIDER DIRECTORY. new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the meanings given. new text end

new text begin (b) "Health care provider" means a practicing provider that accepts reimbursement from a group purchaser. new text end

new text begin (c) "Health care provider directory" means an electronic catalog and index that supports the management of health care provider information, both individual and organizational, in a directory structure for public use to find available providers and networks and support state agency responsibilities. new text end

new text begin (d) "Group purchaser" has the meaning given in Minnesota Statutes, section 62J.03, subdivision 6. new text end

new text begin Subd. 2. new text end

new text begin Health care provider directory. new text end

new text begin The commissioner shall assess the feasibility and stakeholder commitment to develop, manage, and maintain a statewide electronic directory of health care providers. The assessment must take into consideration consumer information needs, state agency applications, stakeholder needs, technical requirements, alignment with national standards, governance, operations, legal and policy considerations, and existing directories. The commissioner shall conduct this assessment in consultation with stakeholders, including but not limited to consumers, group purchasers, health care providers, community health boards, and state agencies. new text end

Sec. 43.

new text begin REPEALER. new text end

new text begin Minnesota Statutes 2022, section 62J.84, subdivision 5, new text end new text begin is repealed. new text end

ARTICLE 3

DEPARTMENT OF HEALTH POLICY

Section 1.

Minnesota Statutes 2022, section 62J.17, subdivision 5a, is amended to read:

Subd. 5a.

Retrospective review.

(a) The commissioner shall retrospectively review each major spending commitment and deleted text begin notify the provider of the results of the review. The commissioner shall deleted text end determine whether the major spending commitment was appropriate. In making the determination, the commissioner may consider the following criteria: the major spending commitment's impact on the cost, access, and quality of health care; the clinical effectiveness and cost-effectiveness of the major spending commitment; and the alternatives available to the provider. new text begin If the major expenditure is determined to not be appropriate, the commissioner shall notify the provider. new text end

(b) The commissioner may not prevent or prohibit a major spending commitment subject to retrospective review. However, if the provider fails the retrospective review, any major spending commitments by that provider for the five-year period following the commissioner's decision are subject to prospective review under subdivision 6a.

Sec. 2.

Minnesota Statutes 2022, section 62Q.675, is amended to read:

62Q.675 HEARING AIDS deleted text begin ; PERSONS 18 OR YOUNGER deleted text end .

A health plan must cover hearing aids for new text begin all new text end individuals deleted text begin 18 years of age or younger deleted text end for hearing loss that is not correctable by other covered procedures. Coverage required under this section is limited to one hearing aid in each ear every three years. No special deductible, coinsurance, co-payment, or other limitation on the coverage under this section that is not generally applicable to other coverages under the plan may be imposed.

Sec. 3.

Minnesota Statutes 2022, section 144.1481, subdivision 1, is amended to read:

Subdivision 1.

Establishment; membership.

The commissioner of health shall establish a deleted text begin 16-member deleted text end Rural Health Advisory Committee. The committee shall consist of the following new text begin 22 new text end members, all of whom must reside outside the seven-county metropolitan area, as defined in section 473.121, subdivision 2:

(1) two members from the house of representatives of the state of Minnesota, one from the majority party and one from the minority party;

(2) two members from the senate of the state of Minnesota, one from the majority party and one from the minority party;

(3) a volunteer member of an ambulance service based outside the seven-county metropolitan area;

(4) a representative of a hospital located outside the seven-county metropolitan area;

(5) a representative of a nursing home located outside the seven-county metropolitan area;

(6) a medical doctor or doctor of osteopathic medicine licensed under chapter 147;

(7) a dentist licensed under chapter 150A;

new text begin (8) an allied dental personnel as defined in Minnesota Rules, part 3100.0100, subpart 5; new text end

deleted text begin (8) deleted text end new text begin (9) new text end deleted text begin a midlevel practitioner deleted text end new text begin an advanced practice professional new text end ;

deleted text begin (9) deleted text end new text begin (10) new text end a registered nurse or licensed practical nurse;

deleted text begin (10) deleted text end new text begin (11) new text end a licensed health care professional from an occupation not otherwise represented on the committee;

deleted text begin (11) deleted text end new text begin (12) new text end a representative of an institution of higher education located outside the seven-county metropolitan area that provides training for rural health care providers; deleted text begin and deleted text end

new text begin (13) a member of a Tribal Nation; new text end

new text begin (14) a representative of a local public health agency or community health board; new text end

new text begin (15) a health professional or advocate with experience working with people with mental illness; new text end

new text begin (16) a representative of a community organization that works with individuals experiencing health disparities; new text end

new text begin (17) an individual with expertise in economic development, or an employer working outside the seven-county metropolitan area; new text end

deleted text begin (12) three deleted text end new text begin (18) two new text end consumers, at least one of whom must be deleted text begin an advocate for persons who are mentally ill or developmentally disabled deleted text end new text begin from a community experiencing health disparities; and new text end

new text begin (19) one consumer who is an advocate for persons who are developmentally disabled new text end .

The commissioner will make recommendations for committee membership. Committee members will be appointed by the governor. In making appointments, the governor shall ensure that appointments provide geographic balance among those areas of the state outside the seven-county metropolitan area. The chair of the committee shall be elected by the members. The advisory committee is governed by section 15.059, except that the members do not receive per diem compensation.

Sec. 4.

Minnesota Statutes 2022, section 144.2151, is amended to read:

144.2151 new text begin FETAL DEATH new text end RECORD new text begin AND CERTIFICATE new text end OF BIRTH RESULTING IN STILLBIRTH.

Subdivision 1.

deleted text begin Filing deleted text end new text begin Registration new text end .

A new text begin fetal death new text end record deleted text begin of birth for each birth resulting in a stillbirth in this state, on or after August 1, 2005, deleted text end new text begin must be established new text end for deleted text begin which a deleted text end new text begin each new text end fetal death deleted text begin report is required deleted text end new text begin reported and registered new text end under section 144.222, subdivision 1 deleted text begin , shall be filed with the state registrar within five days after the birth if the parent or parents of the stillbirth request to have a record of birth resulting in stillbirth prepared deleted text end .

Subd. 2.

Information to parents.

The party responsible for filing a fetal death report under section 144.222, subdivision 1, shall advise the parent or parents of a stillbirth:

deleted text begin (1) that they may request preparation of a record of birth resulting in stillbirth; deleted text end

deleted text begin (2) that preparation of the record is optional; and deleted text end

deleted text begin (3) how to obtain a certified copy of the record if one is requested and prepared. deleted text end

new text begin (1) that the parent or parents may choose to provide a full name or provide only a last name for the record; new text end

new text begin (2) that the parent or parents may request a certificate of birth resulting in stillbirth after the fetal death record is established; new text end

new text begin (3) that the parent who gave birth may request an informational copy of the fetal death record; and new text end

new text begin (4) that the parent or parents named on the fetal death record and the party responsible for reporting the fetal death may correct or amend the record to protect the integrity and accuracy of vital records. new text end

Subd. 3.

deleted text begin Preparation deleted text end new text begin Responsibilities of the state registrar new text end .

deleted text begin (a) Within five days after delivery of a stillbirth, the parent or parents of the stillbirth may prepare and file the record with the state registrar if the parent or parents of the stillbirth, after being advised as provided in subdivision 2, request to have a record of birth resulting in stillbirth prepared. deleted text end

deleted text begin (b) If the parent or parents of the stillbirth do not choose to provide a full name for the stillbirth, the parent or parents may choose to file only a last name. deleted text end

deleted text begin (c) Either parent of the stillbirth or, if neither parent is available, another person with knowledge of the facts of the stillbirth shall attest to the accuracy of the personal data entered on the record in time to permit the filing of the record within five days after delivery. deleted text end

new text begin The state registrar shall: new text end

new text begin (1) prescribe the process to: new text end

new text begin (i) register a fetal death; new text end

new text begin (ii) request the certificate of birth resulting in stillbirth; and new text end

new text begin (iii) request the informational copy of a fetal death record; new text end

new text begin (2) prescribe a standardized format for the certificate of birth resulting in stillbirth, which shall integrate security features and be as similar as possible to a birth certificate; new text end

new text begin (3) issue a certificate of birth resulting in stillbirth or a statement of no vital record found to the parent or parents named on the fetal death record upon the parent's proper completion of an attestation provided by the commissioner and payment of the required fee; new text end

new text begin (4) correct or amend the fetal death record upon a request from the parent who gave birth, parents, or the person who registered the fetal death or filed the report; and new text end

new text begin (5) refuse to amend or correct the fetal death record when an applicant does not submit the minimum documentation required to amend the record or when the state registrar has cause to question the validity or completeness of the applicant's statements or any documentary evidence and the deficiencies are not corrected. The state registrar shall advise the applicant of the reason for this action and shall further advise the applicant of the right of appeal to a court with competent jurisdiction over the Department of Health. new text end

Subd. 4.

deleted text begin Retroactive application deleted text end new text begin Delayed registration new text end .

deleted text begin Notwithstanding subdivisions 1 to 3, deleted text end If a deleted text begin birth that deleted text end new text begin fetal death new text end occurred in this state at any time deleted text begin resulted in a stillbirth deleted text end for which a fetal death report was required under section 144.222, subdivision 1, but a deleted text begin record of birth resulting in stillbirth was not prepared under subdivision 3, a parent of the stillbirth may submit to the state registrar, on or after August 1, 2005, a written request for preparation of a record of birth resulting in stillbirth and evidence of the facts of the stillbirth in the form and manner specified by the state registrar. The state registrar shall prepare and file the record of birth resulting in stillbirth within 30 days after receiving satisfactory evidence of the facts of the stillbirth. deleted text end new text begin fetal death was not registered and a record was not established, a person responsible for registering the fetal death, the medical examiner or coroner with jurisdiction, or a parent may submit to the state registrar a written request to register the fetal death and submit the evidence to support the request. new text end

deleted text begin Subd. 5. deleted text end

deleted text begin Responsibilities of state registrar. deleted text end

deleted text begin The state registrar shall: deleted text end

deleted text begin (1) prescribe the form of and information to be included on a record of birth resulting in stillbirth, which shall be as similar as possible to the form of and information included on a record of birth; deleted text end

deleted text begin (2) prescribe the form of and information to be provided by the parent of a stillbirth requesting a record of birth resulting in stillbirth under subdivisions 3 and 4 and make this form available on the Department of Health's website; deleted text end

deleted text begin (3) issue a certified copy of a record of birth resulting in stillbirth to a parent of the stillbirth that is the subject of the record if: deleted text end

deleted text begin (i) a record of birth resulting in stillbirth has been prepared and filed under subdivision 3 or 4; and deleted text end

deleted text begin (ii) the parent requesting a certified copy of the record submits the request in writing; and deleted text end

deleted text begin (4) create and implement a process for entering, preparing, and handling stillbirth records identical or as close as possible to the processes for birth and fetal death records when feasible, but no later than the date on which the next reprogramming of the Department of Health's database for vital records is completed. deleted text end

Sec. 5.

Minnesota Statutes 2022, section 144.222, is amended to read:

144.222 new text begin FETAL DEATH new text end REPORTS deleted text begin OF FETAL OR INFANT DEATH deleted text end new text begin AND REGISTRATION new text end .

Subdivision 1.

Fetal death report required.

A fetal death deleted text begin report deleted text end must be deleted text begin filed deleted text end new text begin registered or reported new text end within five days of the death of a fetus for whom 20 or more weeks of gestation have elapsed, except for abortions defined under section 145.4241. A fetal death deleted text begin report must be prepared deleted text end new text begin must be registered or reported new text end in a format prescribed by the state registrar and filed in accordance with Minnesota Rules, parts 4601.0100 to 4601.2600 by:

(1) a person in charge of an institution or that person's authorized designee if a fetus is delivered in the institution or en route to the institution;

(2) a physician, certified nurse midwife, or other licensed medical personnel in attendance at or immediately after the delivery if a fetus is delivered outside an institution; or

(3) a parent or other person in charge of the disposition of the remains if a fetal death occurred without medical attendance at or immediately after the delivery.

deleted text begin Subd. 2. deleted text end

deleted text begin Sudden infant death deleted text end deleted text begin . deleted text end

deleted text begin Each infant death which is diagnosed as sudden infant death syndrome shall be reported within five days to the state registrar. deleted text end

Sec. 6.

Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision to read:

new text begin Subd. 2a. new text end

new text begin Connector. new text end

new text begin "Connector" means gooseneck, pigtail, and other service line connectors. A connector is typically a short section of piping not exceeding two feet that can be bent and used for connections between rigid service piping. new text end

Sec. 7.

Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision to read:

new text begin Subd. 3a. new text end

new text begin Galvanized requiring replacement. new text end

new text begin "Galvanized requiring replacement" means a galvanized service line that is or was at any time connected to a lead service line or lead status unknown service line, or is currently or was previously affixed to a lead connector. The majority of galvanized service lines fall under this category. new text end

Sec. 8.

Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision to read:

new text begin Subd. 3b. new text end

new text begin Galvanized service line. new text end

new text begin "Galvanized service line" means a service line made of iron or piping that has been dipped in zinc to prevent corrosion and rusting. new text end

Sec. 9.

Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision to read:

new text begin Subd. 3c. new text end

new text begin Lead connector. new text end

new text begin "Lead connector" means a connector made of lead. new text end

Sec. 10.

Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision to read:

new text begin Subd. 3d. new text end

new text begin Lead service line. new text end

new text begin "Lead service line" means a portion of pipe that is made of lead, which connects the water main to the building inlet. A lead service line may be owned by the water system, by the property owner, or both. new text end

Sec. 11.

Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision to read:

new text begin Subd. 3e. new text end

new text begin Lead status unknown service line or unknown service line. new text end

new text begin "Lead status unknown service line" or "unknown service line" means a service line that has not been demonstrated to meet or does not meet the definition of lead free in section 1417 of the Safe Drinking Water Act. new text end

Sec. 12.

Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision to read:

new text begin Subd. 3f. new text end

new text begin Nonlead service line. new text end

new text begin "Nonlead service line" means a service line determined through an evidence-based record, method, or technique not to be a lead service line or galvanized service line requiring replacement. Most nonlead service lines are made of copper or plastic. new text end

Sec. 13.

Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision to read:

new text begin Subd. 4a. new text end

new text begin Service line. new text end

new text begin "Service line" means a portion of pipe that connects the water main to the building inlet. A service line may be owned by the water system, by the property owner, or both. A service line may be made of many materials, such as lead, copper, galvanized steel, or plastic. new text end

Sec. 14.

new text begin [144.3853] CLASSIFICATION OF SERVICE LINES. new text end

new text begin Subdivision 1. new text end

new text begin Classification of lead status of service line. new text end

new text begin (a) A water system may classify the actual material of a service line, such as copper or plastic, as an alternative to classifying the service line as a nonlead service line, for the purpose of the lead service line inventory. new text end

new text begin (b) It is not necessary to physically verify the material composition, such as copper or plastic, of a service line for its lead status to be identified. For example, if records demonstrate the service line was installed after a municipal, state, or federal ban on the installation of lead service lines, the service line may be classified as a nonlead service line. new text end

new text begin Subd. 2. new text end

new text begin Lead connector. new text end

new text begin For the purposes of the lead service line inventory and lead service line replacement plan, if a service line has a lead connector, the service line shall be classified as a lead service line or a galvanized service line requiring replacement. new text end

new text begin Subd. 3. new text end

new text begin Galvanized service line. new text end

new text begin A galvanized service line may only be classified as a nonlead service line if there is documentation verifying it was never connected to a lead service line or lead connector. Rarely will a galvanized service line be considered a nonlead service line. new text end

Sec. 15.

Minnesota Statutes 2022, section 144.55, subdivision 3, is amended to read:

Subd. 3.

Standards for licensure.

(a) Notwithstanding the provisions of section 144.56, for the purpose of hospital licensure, the commissioner of health shall use as minimum standards the hospital certification regulations promulgated pursuant to title XVIII of the Social Security Act, United States Code, title 42, section 1395, et seq. The commissioner may use as minimum standards changes in the federal hospital certification regulations promulgated after May 7, 1981, if the commissioner finds that such changes are reasonably necessary to protect public health and safety. deleted text begin The commissioner shall also promulgate in rules additional minimum standards for new construction. deleted text end

new text begin (b) Hospitals must meet the applicable provisions of the 2022 edition of the Facility Guidelines Institute Guidelines for Design and Construction of Hospitals. This minimum design standard must be met for all new licenses, new construction, change of use, or change of occupancy for which plan review packages are received on or after January 1, 2024. For the purposes of this subdivision, "Facility Guidelines Institute Guidelines for Design and Construction of Hospitals" does not include any appendices to the guidelines. new text end

new text begin (c) The commissioner shall review each new edition of the guidelines to determine if they will be updated. If the commissioner decides to update the edition of the guidelines specified in paragraph (b) for purposes of this subdivision, the commissioner must notify the chairs and ranking minority members of the legislative committees with jurisdiction over health care and public safety of the planned update by January 15 of the year in which the new edition will become effective. Following notice from the commissioner, the new edition shall become effective for hospitals beginning August 1 of that year, unless otherwise provided in law. The commissioner shall, by publication in the State Register, specify a date by which hospitals must comply with the updated edition. The date by which hospitals must comply shall not be sooner than 12 months after publication of the commissioner's notice in the State Register and applies only to plan review submissions received on or after that date. new text end

new text begin (d) Hospitals shall be in compliance with all applicable state and local governing laws, regulations, standards, ordinances, and codes for fire safety, building, and zoning requirements. The commissioner shall develop guidance to outline how the commissioner will resolve conflicts between the guidelines and other applicable state and local governing laws, regulations, standards, ordinances, and codes for fire safety, building, and zoning. Guidance must be made publicly available at the time a new edition of the guidelines becomes effective and shall be periodically updated. new text end

deleted text begin (b) deleted text end new text begin (e) new text end Each hospital and outpatient surgical center shall establish policies and procedures to prevent the transmission of human immunodeficiency virus and hepatitis B virus to patients and within the health care setting. The policies and procedures shall be developed in conformance with the most recent recommendations issued by the United States Department of Health and Human Services, Public Health Service, Centers for Disease Control. The commissioner of health shall evaluate a hospital's compliance with the policies and procedures according to subdivision 4.

deleted text begin (c) deleted text end new text begin (f) new text end An outpatient surgical center must establish and maintain a comprehensive tuberculosis infection control program according to the most current tuberculosis infection control guidelines issued by the United States Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination, as published in CDC's Morbidity and Mortality Weekly Report (MMWR). This program must include a tuberculosis infection control plan that covers all paid and unpaid employees, contractors, students, and volunteers. The Department of Health shall provide technical assistance regarding implementation of the guidelines.

deleted text begin (d) deleted text end new text begin (g) new text end Written compliance with this subdivision must be maintained by the outpatient surgical center.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 16.

Minnesota Statutes 2022, section 144.6535, subdivision 1, is amended to read:

Subdivision 1.

Request for variance or waiver.

A hospital may request that the commissioner grant a variance or waiver from the provisions of deleted text begin Minnesota Rules, chapter 4640 or 4645 deleted text end new text begin section 144.55, subdivision 3, paragraph (b) new text end . A request for a variance or waiver must be submitted to the commissioner in writing. Each request must contain:

(1) the specific deleted text begin rule or rules deleted text end new text begin requirement new text end for which the variance or waiver is requested;

(2) the reasons for the request;

(3) the alternative measures that will be taken if a variance or waiver is granted;

(4) the length of time for which the variance or waiver is requested; and

(5) other relevant information deemed necessary by the commissioner to properly evaluate the request for the variance or waiver.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 17.

Minnesota Statutes 2022, section 144.6535, subdivision 2, is amended to read:

Subd. 2.

Criteria for evaluation.

The decision to grant or deny a variance or waiver must be based on the commissioner's evaluation of the following criteria:

(1) whether the variance or waiver will adversely affect the health, treatment, comfort, safety, or well-being of a patient;

(2) whether the alternative measures to be taken, if any, are equivalent to or superior to those prescribed in deleted text begin Minnesota Rules, chapter 4640 or 4645 deleted text end new text begin section 144.55, subdivision 3, paragraph (b) new text end ; and

(3) whether compliance with the deleted text begin rule or rules deleted text end new text begin requirements new text end would impose an undue burden upon the applicant.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 18.

Minnesota Statutes 2022, section 144.6535, subdivision 4, is amended to read:

Subd. 4.

Effect of alternative measures or conditions.

(a) Alternative measures or conditions attached to a variance or waiver have the same force and effect as the deleted text begin rules deleted text end new text begin requirement new text end under deleted text begin Minnesota Rules, chapter 4640 or 4645 deleted text end new text begin section 144.55, subdivision 3, paragraph (b) new text end , and are subject to the issuance of correction orders and penalty assessments in accordance with section 144.55.

(b) Fines for a violation of this section shall be in the same amount as that specified for the particular deleted text begin rule deleted text end new text begin requirement new text end for which the variance or waiver was requested.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024. new text end

Sec. 19.

Minnesota Statutes 2022, section 144.69, is amended to read:

144.69 CLASSIFICATION OF DATA ON INDIVIDUALS.

new text begin Subdivision 1. new text end

new text begin Data collected by the cancer reporting system. new text end

Notwithstanding any law to the contrary, including section 13.05, subdivision 9, data collected on individuals by the cancer deleted text begin surveillance deleted text end new text begin reporting new text end system, including the names and personal identifiers of persons required in section 144.68 to report, shall be private and may only be used for the purposes set forth in this section and sections 144.671, 144.672, and 144.68. Any disclosure other than is provided for in this section and sections 144.671, 144.672, and 144.68, is declared to be a misdemeanor and punishable as such. Except as provided by rule, and as part of an epidemiologic investigation, an officer or employee of the commissioner of health may interview patients named in any such report, or relatives of any such patient, only after deleted text begin the consent of deleted text end new text begin notifying new text end the attending physician, advanced practice registered nurse, physician assistant, or surgeon deleted text begin is obtained deleted text end . new text begin Research protections for patients must be consistent with section 13.04, subdivision 2, and Code of Federal Regulations, title 45, part 46. new text end

new text begin Subd. 2. new text end

new text begin Transfers of information to state cancer registries and federal government agencies. new text end

new text begin (a) Information containing personal identifiers of a non-Minnesota resident collected by the cancer reporting system may be provided to the statewide cancer registry of the nonresident's home state solely for the purposes consistent with this section and sections 144.671, 144.672, and 144.68, provided that the other state agrees to maintain the classification of the information as provided under subdivision 1. new text end

new text begin (b) Information, excluding direct identifiers such as name, Social Security number, telephone number, and street address, collected by the cancer reporting system may be provided to the Centers for Disease Control and Prevention's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results Program registry. new text end

Sec. 20.

Minnesota Statutes 2022, section 144.9501, subdivision 17, is amended to read:

Subd. 17.

Lead hazard reduction.

new text begin (a) new text end "Lead hazard reduction" means abatement new text begin , swab team services, new text end or interim controls undertaken to make a residence, child care facility, school, playground, or other location where lead hazards are identified lead-safe by complying with the lead standards and methods adopted under section 144.9508.

new text begin (b) Lead hazard reduction does not include renovation activity that is primarily intended to remodel, repair, or restore a given structure or dwelling rather than abate or control lead-based paint hazards. new text end

new text begin (c) Lead hazard reduction does not include activities that disturb painted surfaces that total: new text end

new text begin (1) less than 20 square feet (two square meters) on exterior surfaces; or new text end

new text begin (2) less than two square feet (0.2 square meters) in an interior room. new text end

Sec. 21.

Minnesota Statutes 2022, section 144.9501, subdivision 26a, is amended to read:

Subd. 26a.

Regulated lead work.

deleted text begin (a) deleted text end "Regulated lead work" means:

(1) abatement;

(2) interim controls;

(3) a clearance inspection;

(4) a lead hazard screen;

(5) a lead inspection;

(6) a lead risk assessment;

(7) lead project designer services;

(8) lead sampling technician services;

(9) swab team services;

(10) renovation activities; deleted text begin or deleted text end

new text begin (11) lead hazard reduction; or new text end

deleted text begin (11) deleted text end new text begin (12) new text end activities performed to comply with lead orders issued by deleted text begin a community health board deleted text end new text begin an assessing agency new text end .

deleted text begin (b) Regulated lead work does not include abatement, interim controls, swab team services, or renovation activities that disturb painted surfaces that total no more than: deleted text end

deleted text begin (1) 20 square feet (two square meters) on exterior surfaces; or deleted text end

deleted text begin (2) six square feet (0.6 square meters) in an interior room. deleted text end

Sec. 22.

Minnesota Statutes 2022, section 144.9501, subdivision 26b, is amended to read:

Subd. 26b.

Renovation.

new text begin (a) new text end "Renovation" means the modification of any pre-1978 affected property new text begin for compensation new text end that results in the disturbance of known or presumed lead-containing painted surfaces defined under section 144.9508, unless that activity is performed as lead hazard reduction. A renovation performed for the purpose of converting a building or part of a building into an affected property is a renovation under this subdivision.

new text begin (b) Renovation does not include minor repair and maintenance activities described in this paragraph. All activities that disturb painted surfaces and are performed within 30 days of other activities that disturb painted surfaces in the same room must be considered a single project when applying the criteria below. Unless the activity involves window replacement or demolition of a painted surface, building component, or portion of a structure, for purposes of this paragraph, "minor repair and maintenance" means activities that disturb painted surfaces totaling: new text end

new text begin (1) less than 20 square feet (two square meters) on exterior surfaces; or new text end

new text begin (2) less than six square feet (0.6 square meters) in an interior room. new text end

new text begin (c) Renovation does not include total demolition of a freestanding structure. For purposes of this paragraph, "total demolition" means demolition and disposal of all interior and exterior painted surfaces, including windows. Unpainted foundation building components remaining after total demolition may be reused. new text end

Sec. 23.

Minnesota Statutes 2022, section 144.9501, is amended by adding a subdivision to read:

new text begin Subd. 33. new text end

new text begin Compensation. new text end

new text begin "Compensation" means money or other mutually agreed upon form of payment given or received for regulated lead work, including rental payments, rental income, or salaries derived from rental payments. new text end

Sec. 24.

Minnesota Statutes 2022, section 144.9501, is amended by adding a subdivision to read:

new text begin Subd. 34. new text end

new text begin Individual. new text end

new text begin "Individual" means a natural person. new text end

Sec. 25.

Minnesota Statutes 2022, section 144.9505, subdivision 1, is amended to read:

Subdivision 1.

Licensing, certification, and permitting.

(a) Fees collected under this section shall be deposited into the state treasury and credited to the state government special revenue fund.

(b) Persons shall not advertise or otherwise present themselves as lead supervisors, lead workers, lead inspectors, lead risk assessors, lead sampling technicians, lead project designers, renovation firms, or lead firms unless they have licenses or certificates issued by the commissioner under this section.

(c) The fees required in this section for inspectors, risk assessors, and certified lead firms are waived for state or local government employees performing services for or as an assessing agency.

(d) deleted text begin An individual who is the owner of property on which regulated lead work is to be performed or an adult individual who is related to the property owner, as defined under section 245A.02, subdivision 13, is exempt from the requirements to obtain a license and pay a fee according to this section. deleted text end new text begin Individual residential property owners or an adult individual who is related to the property owner who performs regulated lead work on the residence are exempt from the licensure and firm certification requirements of this section. Notwithstanding the provisions of paragraphs (a) to (c), this exemption does not apply when the regulated lead work is a renovation performed for compensation, when a child with an elevated blood level has been identified in the residence or the building in which the residence is located, or when the residence is occupied by one or more individuals who are not related to the property owner, as defined under section 245A.02, subdivision 13. new text end

deleted text begin (e) A person that employs individuals to perform regulated lead work outside of the person's property must obtain certification as a certified lead firm. An individual who performs lead hazard reduction, lead hazard screens, lead inspections, lead risk assessments, clearance inspections, lead project designer services, lead sampling technician services, swab team services, and activities performed to comply with lead orders must be employed by a certified lead firm, unless the individual is a sole proprietor and does not employ any other individuals, the individual is employed by a person that does not perform regulated lead work outside of the person's property, or the individual is employed by an assessing agency. deleted text end

Sec. 26.

Minnesota Statutes 2022, section 144.9505, subdivision 1g, is amended to read:

Subd. 1g.

Certified lead firm.

A person who new text begin performs or new text end employs individuals to perform regulated lead work, with the exception of renovation, deleted text begin outside of the person's property deleted text end must obtain certification as a lead firm. The certificate must be in writing, contain an expiration date, be signed by the commissioner, and give the name and address of the person to whom it is issued. A lead firm certificate is valid for one year. The certification fee is $100, is nonrefundable, and must be submitted with each application. The lead firm certificate or a copy of the certificate must be readily available at the worksite for review by the contracting entity, the commissioner, and other public health officials charged with the health, safety, and welfare of the state's citizens.

Sec. 27.

Minnesota Statutes 2022, section 144.9505, subdivision 1h, is amended to read:

Subd. 1h.

Certified renovation firm.

A person who new text begin performs or new text end employs individuals to perform renovation deleted text begin activities outside of the person's property deleted text end new text begin for compensation new text end must obtain certification as a renovation firm. The certificate must be in writing, contain an expiration date, be signed by the commissioner, and give the name and address of the person to whom it is issued. A renovation firm certificate is valid for two years. The certification fee is $100, is nonrefundable, and must be submitted with each application. The renovation firm certificate or a copy of the certificate must be readily available at the worksite for review by the contracting entity, the commissioner, and other public health officials charged with the health, safety, and welfare of the state's citizens.

Sec. 28.

Minnesota Statutes 2022, section 144.9508, subdivision 2, is amended to read:

Subd. 2.

Regulated lead work standards and methods.

(a) The commissioner shall adopt rules establishing regulated lead work standards and methods in accordance with the provisions of this section, for lead in paint, dust, drinking water, and soil in a manner that protects public health and the environment for all residences, including residences also used for a commercial purpose, child care facilities, playgrounds, and schools.

(b) In the rules required by this section, the commissioner shall require lead hazard reduction of intact paint only if the commissioner finds that the intact paint is on a chewable or lead-dust producing surface that is a known source of actual lead exposure to a specific individual. The commissioner shall prohibit methods that disperse lead dust into the air that could accumulate to a level that would exceed the lead dust standard specified under this section. The commissioner shall work cooperatively with the commissioner of administration to determine which lead hazard reduction methods adopted under this section may be used for lead-safe practices including prohibited practices, preparation, disposal, and cleanup. The commissioner shall work cooperatively with the commissioner of the Pollution Control Agency to develop disposal procedures. In adopting rules under this section, the commissioner shall require the best available technology for regulated lead work methods, paint stabilization, and repainting.

(c) The commissioner of health shall adopt regulated lead work standards and methods for lead in bare soil in a manner to protect public health and the environment. The commissioner shall adopt a maximum standard of 100 parts of lead per million in bare soil. The commissioner shall set a soil replacement standard not to exceed 25 parts of lead per million. Soil lead hazard reduction methods shall focus on erosion control and covering of bare soil.

(d) The commissioner shall adopt regulated lead work standards and methods for lead in dust in a manner to protect the public health and environment. Dust standards shall use a weight of lead per area measure and include dust on the floor, on the window sills, and on window wells. Lead hazard reduction methods for dust shall focus on dust removal and other practices which minimize the formation of lead dust from paint, soil, or other sources.

(e) The commissioner shall adopt lead hazard reduction standards and methods for lead in drinking water both at the tap and public water supply system or private well in a manner to protect the public health and the environment. The commissioner may adopt the rules for controlling lead in drinking water as contained in Code of Federal Regulations, title 40, part 141. Drinking water lead hazard reduction methods may include an educational approach of minimizing lead exposure from lead in drinking water.

(f) The commissioner of the Pollution Control Agency shall adopt rules to ensure that removal of exterior lead-based coatings from residences and steel structures by abrasive blasting methods is conducted in a manner that protects health and the environment.

(g) All regulated lead work standards shall provide reasonable margins of safety that are consistent with more than a summary review of scientific evidence and an emphasis on overprotection rather than underprotection when the scientific evidence is ambiguous.

(h) No unit of local government shall have an ordinance or regulation governing regulated lead work standards or methods for lead in paint, dust, drinking water, or soil that require a different regulated lead work standard or method than the standards or methods established under this section.

(i) Notwithstanding paragraph (h), the commissioner may approve the use by a unit of local government of an innovative lead hazard reduction method which is consistent in approach with methods established under this section.

(j) The commissioner shall adopt rules for issuing lead orders required under section 144.9504, rules for notification of abatement or interim control activities requirements, and other rules necessary to implement sections 144.9501 to 144.9512.

(k) The commissioner shall adopt rules consistent with section 402(c)(3) of the Toxic Substances Control Act new text begin and all regulations adopted thereunder new text end to ensure that renovation in a pre-1978 affected property deleted text begin where a child or pregnant female resides deleted text end is conducted in a manner that protects health and the environment. Notwithstanding sections 14.125 and 14.128, the authority to adopt these rules does not expire.

(l) The commissioner shall adopt rules consistent with sections 406(a) and 406(b) of the Toxic Substances Control Act. Notwithstanding sections 14.125 and 14.128, the authority to adopt these rules does not expire.

Sec. 29.

Minnesota Statutes 2022, section 144A.06, subdivision 2, is amended to read:

Subd. 2.

New license required; change of ownership.

(a) The commissioner of health by rule shall prescribe procedures for licensure under this section.

(b) A new license is required and the prospective licensee must apply for a license prior to operating a currently licensed nursing home. The licensee must change whenever one of the following events occur:

(1) the form of the licensee's legal entity structure is converted or changed to a different type of legal entity structure;

(2) the licensee dissolves, consolidates, or merges with another legal organization and the licensee's legal organization does not survive;

(3) within the previous 24 months, 50 percent or more of the licensee's ownership interest is transferred, whether by a single transaction or multiple transactions to:

(i) a different person new text begin or multiple different persons new text end ; or

(ii) a person new text begin or multiple persons new text end who had less than a five percent ownership interest in the facility at the time of the first transaction; or

(4) any other event or combination of events that results in a substitution, elimination, or withdrawal of the licensee's responsibility for the facility.

Sec. 30.

Minnesota Statutes 2022, section 144A.071, subdivision 2, is amended to read:

Subd. 2.

Moratorium.

new text begin (a) new text end 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. Certified beds in facilities which do not allow medical assistance intake shall be deemed to be decertified for purposes of this section only.

new text begin (b) new text end 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.

new text begin (c) new text end In addition, the commissioner of health must not approve any construction project whose cost exceeds $1,000,000, unless:

deleted text begin (a) deleted text end new text begin (1) new text end any construction costs exceeding $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

deleted text begin (b) deleted text end new text begin (2) new text end the project:

deleted text begin (1) deleted text end new text begin (i) new text end has been approved through the process described in section 144A.073;

deleted text begin (2) deleted text end new text begin (ii) new text end meets an exception in subdivision 3 or 4a;

deleted text begin (3) deleted text end new text begin (iii) new text end is necessary to correct violations of state or federal law issued by the commissioner of health;

deleted text begin (4) deleted text end new text begin (iv) new text end is necessary to repair or replace a portion of the facility that was damaged by fire, lightning, ground shifts, or other such hazards, including environmental hazards, provided that the provisions of subdivision 4a, clause (a), are met; or

deleted text begin (5) deleted text end new text begin (v) new text end 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.

new text begin (d) new text end Prior to the final plan approval of any construction project, the commissioners of health and human services 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 commissioners and shall be considered as one construction project. Once the construction project is completed and prior to the final clearance by the commissioners, the total project construction costs for the construction project shall be submitted to the commissioners. 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.

new text begin (e) new text end The dollar thresholds for construction projects are as follows: for construction projects other than those authorized in deleted text begin clauses (1) to (6) deleted text end new text begin paragraph (c), clause (2), items (i) to (v) new text end , the dollar threshold is $1,000,000. For projects authorized after July 1, 1993, under deleted text begin clause (1) deleted text end new text begin paragraph (c), clause (2), item (i) new text end , 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 deleted text begin clauses (2) to (4) deleted text end new text begin paragraph (c), clause (2), items (ii) to (iv) new text end , 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).

new text begin (f) new text end 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.

new text begin (g) All construction projects approved through section 144A.073, subdivision 3, after March 1, 2020, are subject to the fair rental value property rate as described in section 256R.26. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from March 1, 2020. new text end

Sec. 31.

Minnesota Statutes 2022, section 144A.073, subdivision 3b, is amended to read:

Subd. 3b.

Amendments to approved projects.

(a) Nursing facilities that have received approval deleted text begin on or after July 1, 1993, deleted text end for exceptions to the moratorium on nursing homes through the process described in this section may request amendments to the designs of the projects by writing the commissioner within 15 months of receiving approval. Applicants shall submit supporting materials that demonstrate how the amended projects meet the criteria described in paragraph (b).

(b) The commissioner shall approve requests for amendments for projects approved deleted text begin on or after July 1, 1993, deleted text end according to the following criteria:

(1) the amended project designs must provide solutions to all of the problems addressed by the original application that are at least as effective as the original solutions;

(2) the amended project designs may not reduce the space in each resident's living area or in the total amount of common space devoted to resident and family uses by more than five percent;

(3) the costs deleted text begin recognized for reimbursement deleted text end of amended project designs shall be deleted text begin the threshold amount of the original proposal as identified according to section 144A.071, subdivision 2 deleted text end new text begin the cost estimate associated with the project as originally approved new text end , except under conditions described in clause (4); and

(4) total costs deleted text begin up to ten percent greater than the cost identified in clause (3) may be recognized for reimbursement if deleted text end new text begin of the amendment are no greater than ten percent of the cost estimate associated with the project as initially approved if new text end the proposer can document that one of the following circumstances is true:

(i) changes are needed due to a natural disaster;

(ii) conditions that affect the safety or durability of the project that could not have reasonably been known prior to approval are discovered;

(iii) state or federal law require changes in project design; or

(iv) documentable circumstances occur that are beyond the control of the owner and require changes in the design.

(c) Approval of a request for an amendment does not alter the expiration of approval of the project according to subdivision 3.

new text begin (d) Reimbursement for amendments to approved projects is independent of the actual construction costs and based on the allowable appraised value of the completed project. An approved project may not be amended to reduce the scope of an approved project. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from March 1, 2020. new text end

Sec. 32.

Minnesota Statutes 2022, section 144A.474, subdivision 3, is amended to read:

Subd. 3.

Survey process.

The survey process for core surveys shall include the following as applicable to the particular licensee and setting surveyed:

(1) presurvey review of pertinent documents and notification to the ombudsman for long-term care;

(2) an entrance conference with available staff;

(3) communication with managerial officials or the registered nurse in charge, if available, and ongoing communication with key staff throughout the survey regarding information needed by the surveyor, clarifications regarding home care requirements, and applicable standards of practice;

(4) presentation of written contact information to the provider about the survey staff conducting the survey, the supervisor, and the process for requesting a reconsideration of the survey results;

(5) a brief tour of deleted text begin a sample of deleted text end the deleted text begin housing with services establishments deleted text end new text begin establishment new text end in which the provider is providing home care services;

(6) a sample selection of home care clients;

(7) information-gathering through client and staff observations, client and staff interviews, and reviews of records, policies, procedures, practices, and other agency information;

(8) interviews of clients' family members, if available, with clients' consent when the client can legally give consent;

(9) except for complaint surveys conducted by the Office of Health Facilities Complaints, an deleted text begin on-site deleted text end exit conference deleted text begin , deleted text end with preliminary findings deleted text begin shared and deleted text end discussed with the provider new text begin within one business day after completion of survey activities new text end , deleted text begin documentation that an exit conference occurred, deleted text end and new text begin with new text end written information provided on the process for requesting a reconsideration of the survey results; and

(10) postsurvey analysis of findings and formulation of survey results, including correction orders when applicable.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2023. new text end

Sec. 33.

Minnesota Statutes 2022, section 144A.474, subdivision 9, is amended to read:

Subd. 9.

Follow-up surveys.

For providers that have Level 3 or Level 4 violations under subdivision 11, deleted text begin or any violations determined to be widespread, deleted text end the department shall conduct a follow-up survey within 90 calendar days of the survey. When conducting a follow-up survey, the surveyor will focus on whether the previous violations have been corrected and may also address any new violations that are observed while evaluating the corrections that have been made.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2023. new text end

Sec. 34.

Minnesota Statutes 2022, section 144A.474, subdivision 12, is amended to read:

Subd. 12.

Reconsideration.

(a) The commissioner shall make available to home care providers a correction order reconsideration process. This process may be used to challenge the correction order issued, including the level and scope described in subdivision 11, and any fine assessed. During the correction order reconsideration request, the issuance for the correction orders under reconsideration are not stayed, but the department shall post information on the website with the correction order that the licensee has requested a reconsideration and that the review is pending.

(b) A licensed home care provider may request from the commissioner, in writing, a correction order reconsideration regarding any correction order issued to the provider. The written request for reconsideration must be received by the commissioner within 15 deleted text begin calendar deleted text end new text begin business new text end days of the correction order receipt date. The correction order reconsideration shall not be reviewed by any surveyor, investigator, or supervisor that participated in the writing or reviewing of the correction order being disputed. The correction order reconsiderations may be conducted in person, by telephone, by another electronic form, or in writing, as determined by the commissioner. The commissioner shall respond in writing to the request from a home care provider for a correction order reconsideration within 60 days of the date the provider requests a reconsideration. The commissioner's response shall identify the commissioner's decision regarding each citation challenged by the home care provider.

(c) The findings of a correction order reconsideration process shall be one or more of the following:

(1) supported in full, the correction order is supported in full, with no deletion of findings to the citation;

(2) supported in substance, the correction order is supported, but one or more findings are deleted or modified without any change in the citation;

(3) correction order cited an incorrect home care licensing requirement, the correction order is amended by changing the correction order to the appropriate statutory reference;

(4) correction order was issued under an incorrect citation, the correction order is amended to be issued under the more appropriate correction order citation;

(5) the correction order is rescinded;

(6) fine is amended, it is determined that the fine assigned to the correction order was applied incorrectly; or

(7) the level or scope of the citation is modified based on the reconsideration.

(d) If the correction order findings are changed by the commissioner, the commissioner shall update the correction order website.

(e) This subdivision does not apply to temporary licensees.

Sec. 35.

Minnesota Statutes 2022, section 144A.4791, subdivision 10, is amended to read:

Subd. 10.

Termination of service plan.

(a) If a home care provider terminates a service plan with a client, and the client continues to need home care services, the home care provider shall provide the client and the client's representative, if any, with a written notice of termination which includes the following information:

(1) the effective date of termination;

(2) the reason for termination;

new text begin (3) for clients age 18 or older, a statement that the client may contact the Office of Ombudsman for Long-Term Care to request an advocate to assist regarding the termination and contact information for the office, including the office's central telephone number; new text end

deleted text begin (3) deleted text end new text begin (4) new text end a list of known licensed home care providers in the client's immediate geographic area;

deleted text begin (4) deleted text end new text begin (5) new text end a statement that the home care provider will participate in a coordinated transfer of care of the client to another home care provider, health care provider, or caregiver, as required by the home care bill of rights, section 144A.44, subdivision 1, clause (17);

deleted text begin (5) deleted text end new text begin (6) new text end the name and contact information of a person employed by the home care provider with whom the client may discuss the notice of termination; and

deleted text begin (6) deleted text end new text begin (7) new text end if applicable, a statement that the notice of termination of home care services does not constitute notice of termination of deleted text begin the housing with services contract with a housing with services establishment deleted text end new text begin any housing contract new text end .

(b) When the home care provider voluntarily discontinues services to all clients, the home care provider must notify the commissioner, lead agencies, and ombudsman for long-term care about its clients and comply with the requirements in this subdivision.

Sec. 36.

Minnesota Statutes 2022, section 148.512, subdivision 10a, is amended to read:

Subd. 10a.

Hearing aid.

"Hearing aid" means deleted text begin an instrument deleted text end new text begin a prescribed aid new text end , or any of its parts, worn in the ear canal and designed to or represented as being able to aid deleted text begin or enhance deleted text end human hearing. "Hearing aid" includes the aid's parts, attachments, or accessories, including, but not limited to, ear molds and behind the ear (BTE) devices with or without an ear mold. Batteries and cords are not parts, attachments, or accessories of a hearing aid. Surgically implanted hearing aids, and assistive listening devices not worn within the ear canal, are not hearing aids.

Sec. 37.

Minnesota Statutes 2022, section 148.512, subdivision 10b, is amended to read:

Subd. 10b.

Hearing aid dispensing.

"Hearing aid dispensing" means making ear mold impressions, prescribing deleted text begin , or recommending deleted text end a hearing aid, assisting the consumer in new text begin prescription new text end aid selection deleted text begin , selling hearing aids at retail deleted text end , or testing human hearing in connection with these activities regardless of whether the person conducting these activities has a monetary interest in the dispensing of new text begin prescription new text end hearing aids to the consumer. new text begin Hearing aid dispensing does not include selling over-the-counter hearing aids. new text end

Sec. 38.

Minnesota Statutes 2022, section 148.512, is amended by adding a subdivision to read:

new text begin Subd. 10c. new text end

new text begin Over-the-counter hearing aid or OTC hearing aid. new text end

new text begin "Over-the-counter hearing aid" or "OTC hearing aid" has the meaning given to that term in Code of Federal Regulations, title 21, section 800.30(b). new text end

Sec. 39.

Minnesota Statutes 2022, section 148.512, is amended by adding a subdivision to read:

new text begin Subd. 13a. new text end

new text begin Prescription hearing aid. new text end

new text begin "Prescription hearing aid" means a hearing aid requiring a prescription from a certified hearing aid dispenser or licensed audiologist that is not an OTC hearing aid. new text end

Sec. 40.

Minnesota Statutes 2022, section 148.513, is amended by adding a subdivision to read:

new text begin Subd. 4. new text end

new text begin Over-the-counter hearing aids. new text end

new text begin Nothing in sections 148.511 to 148.5198 shall preclude licensed audiologists from dispensing or selling over-the-counter hearing aids. new text end

Sec. 41.

Minnesota Statutes 2022, section 148.515, subdivision 6, is amended to read:

Subd. 6.

Dispensing audiologist examination requirements.

(a) Audiologists are exempt from the written examination requirement in section 153A.14, subdivision 2h, paragraph (a), clause (1).

(b) After July 31, 2005, all applicants for audiologist licensure under sections 148.512 to 148.5198 must achieve a passing score on the practical tests of proficiency described in section 153A.14, subdivision 2h, paragraph (a), clause (2), within the time period described in section 153A.14, subdivision 2h, paragraph (c).

(c) In order to dispense new text begin prescription new text end hearing aids as a sole proprietor, member of a partnership, or for a limited liability company, corporation, or any other entity organized for profit, a licensee who obtained audiologist licensure under sections 148.512 to 148.5198, before August 1, 2005, and who is not certified to dispense new text begin prescription new text end hearing aids under chapter 153A, must achieve a passing score on the practical tests of proficiency described in section 153A.14, subdivision 2h, paragraph (a), clause (2), within the time period described in section 153A.14, subdivision 2h, paragraph (c). All other audiologist licensees who obtained licensure before August 1, 2005, are exempt from the practical tests.

(d) An applicant for an audiology license who obtains a temporary license under section 148.5175 may dispense new text begin prescription new text end hearing aids only under supervision of a licensed audiologist who dispenses new text begin prescription new text end hearing aids.

Sec. 42.

Minnesota Statutes 2022, section 148.5175, is amended to read:

148.5175 TEMPORARY LICENSURE.

(a) The commissioner shall issue temporary licensure as a speech-language pathologist, an audiologist, or both, to an applicant who:

(1) submits a signed and dated affidavit stating that the applicant is not the subject of a disciplinary action or past disciplinary action in this or another jurisdiction and is not disqualified on the basis of section 148.5195, subdivision 3; and

(2) either:

(i) provides a copy of a current credential as a speech-language pathologist, an audiologist, or both, held in the District of Columbia or a state or territory of the United States; or

(ii) provides a copy of a current certificate of clinical competence issued by the American Speech-Language-Hearing Association or board certification in audiology by the American Board of Audiology.

(b) A temporary license issued to a person under this subdivision expires 90 days after it is issued or on the date the commissioner grants or denies licensure, whichever occurs first.

(c) Upon application, a temporary license shall be renewed twice to a person who is able to demonstrate good cause for failure to meet the requirements for licensure within the initial temporary licensure period and who is not the subject of a disciplinary action or disqualified on the basis of section 148.5195, subdivision 3. Good cause includes but is not limited to inability to take and complete the required practical exam for dispensing new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end .

(d) Upon application, a temporary license shall be issued to a person who meets the requirements of section 148.515, subdivisions 2a and 4, but has not completed the requirement in section 148.515, subdivision 6.

Sec. 43.

Minnesota Statutes 2022, section 148.5195, subdivision 3, is amended to read:

Subd. 3.

Grounds for disciplinary action by commissioner.

The commissioner may take any of the disciplinary actions listed in subdivision 4 on proof that the individual has:

(1) intentionally submitted false or misleading information to the commissioner or the advisory council;

(2) failed, within 30 days, to provide information in response to a written request by the commissioner or advisory council;

(3) performed services of a speech-language pathologist or audiologist in an incompetent or negligent manner;

(4) violated sections 148.511 to 148.5198;

(5) failed to perform services with reasonable judgment, skill, or safety due to the use of alcohol or drugs, or other physical or mental impairment;

(6) violated any state or federal law, rule, or regulation, and the violation is a felony or misdemeanor, an essential element of which is dishonesty, or which relates directly or indirectly to the practice of speech-language pathology or audiology. Conviction for violating any state or federal law which relates to speech-language pathology or audiology is necessarily considered to constitute a violation, except as provided in chapter 364;

(7) aided or abetted another person in violating any provision of sections 148.511 to 148.5198;

(8) been or is being disciplined by another jurisdiction, if any of the grounds for the discipline is the same or substantially equivalent to those under sections 148.511 to 148.5198;

(9) not cooperated with the commissioner or advisory council in an investigation conducted according to subdivision 1;

(10) advertised in a manner that is false or misleading;

(11) engaged in conduct likely to deceive, defraud, or harm the public; or demonstrated a willful or careless disregard for the health, welfare, or safety of a client;

(12) failed to disclose to the consumer any fee splitting or any promise to pay a portion of a fee to any other professional other than a fee for services rendered by the other professional to the client;

(13) engaged in abusive or fraudulent billing practices, including violations of federal Medicare and Medicaid laws, Food and Drug Administration regulations, or state medical assistance laws;

(14) obtained money, property, or services from a consumer through the use of undue influence, high pressure sales tactics, harassment, duress, deception, or fraud;

(15) performed services for a client who had no possibility of benefiting from the services;

(16) failed to refer a client for medical evaluation or to other health care professionals when appropriate or when a client indicated symptoms associated with diseases that could be medically or surgically treated;

(17) had the certification required by chapter 153A denied, suspended, or revoked according to chapter 153A;

(18) used the term doctor of audiology, doctor of speech-language pathology, AuD, or SLPD without having obtained the degree from an institution accredited by the North Central Association of Colleges and Secondary Schools, the Council on Academic Accreditation in Audiology and Speech-Language Pathology, the United States Department of Education, or an equivalent;

(19) failed to comply with the requirements of section 148.5192 regarding supervision of speech-language pathology assistants; or

(20) if the individual is an audiologist or certified new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispenser:

(i) prescribed deleted text begin or otherwise recommended deleted text end to a consumer or potential consumer the use of a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end , unless the prescription from a physician deleted text begin or recommendation from deleted text end new text begin , new text end an audiologist new text begin , new text end or new text begin a new text end certified dispenser is in writing, is based on an audiogram that is delivered to the consumer or potential consumer when the prescription deleted text begin or recommendation deleted text end is made, and bears the following information in all capital letters of 12-point or larger boldface type: "THIS PRESCRIPTION deleted text begin OR RECOMMENDATION deleted text end MAY BE FILLED BY, AND new text begin PRESCRIPTION new text end HEARING deleted text begin INSTRUMENTS deleted text end new text begin AIDS new text end MAY BE PURCHASED FROM, THE LICENSED AUDIOLOGIST OR CERTIFIED DISPENSER OF YOUR CHOICE";

(ii) failed to give a copy of the audiogram, upon which the prescription deleted text begin or recommendation deleted text end is based, to the consumer when the consumer requests a copy;

(iii) failed to provide the consumer rights brochure required by section 148.5197, subdivision 3;

(iv) failed to comply with restrictions on sales of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end in sections 148.5197, subdivision 3, and 148.5198;

(v) failed to return a consumer's new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end used as a trade-in or for a discount in the price of a new new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end when requested by the consumer upon cancellation of the purchase agreement;

(vi) failed to follow Food and Drug Administration or Federal Trade Commission regulations relating to dispensing new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end ;

(vii) failed to dispense a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end in a competent manner or without appropriate training;

(viii) delegated new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing authority to a person not authorized to dispense a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end under this chapter or chapter 153A;

(ix) failed to comply with the requirements of an employer or supervisor of a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispenser trainee;

(x) violated a state or federal court order or judgment, including a conciliation court judgment, relating to the activities of the individual's new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing; or

(xi) failed to include on the audiogram the practitioner's printed name, credential type, credential number, signature, and date.

Sec. 44.

Minnesota Statutes 2022, section 148.5196, subdivision 1, is amended to read:

Subdivision 1.

Membership.

The commissioner shall appoint 12 persons to a Speech-Language Pathologist and Audiologist Advisory Council. The 12 persons must include:

(1) three public members, as defined in section 214.02. Two of the public members shall be either persons receiving services of a speech-language pathologist or audiologist, or family members of or caregivers to such persons, and at least one of the public members shall be either a hearing deleted text begin instrument deleted text end new text begin aid new text end user or an advocate of one;

(2) three speech-language pathologists licensed under sections 148.511 to 148.5198, one of whom is currently and has been, for the five years immediately preceding the appointment, engaged in the practice of speech-language pathology in Minnesota and each of whom is employed in a different employment setting including, but not limited to, private practice, hospitals, rehabilitation settings, educational settings, and government agencies;

(3) one speech-language pathologist licensed under sections 148.511 to 148.5198, who is currently and has been, for the five years immediately preceding the appointment, employed by a Minnesota public school district or a Minnesota public school district consortium that is authorized by Minnesota Statutes and who is licensed in speech-language pathology by the Professional Educator Licensing and Standards Board;

(4) three audiologists licensed under sections 148.511 to 148.5198, two of whom are currently and have been, for the five years immediately preceding the appointment, engaged in the practice of audiology and the dispensing of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end in Minnesota and each of whom is employed in a different employment setting including, but not limited to, private practice, hospitals, rehabilitation settings, educational settings, industry, and government agencies;

(5) one nonaudiologist new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispenser recommended by a professional association representing new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensers; and

(6) one physician licensed under chapter 147 and certified by the American Board of Otolaryngology, Head and Neck Surgery.

Sec. 45.

Minnesota Statutes 2022, section 148.5197, is amended to read:

148.5197 HEARING AID DISPENSING.

Subdivision 1.

Content of contracts.

Oral statements made by an audiologist or certified dispenser regarding the provision of warranties, refunds, and service on the new text begin prescription new text end hearing aid or aids dispensed must be written on, and become part of, the contract of sale, specify the item or items covered, and indicate the person or business entity obligated to provide the warranty, refund, or service.

Subd. 2.

Required use of license number.

The audiologist's license number or certified dispenser's certificate number must appear on all contracts, bills of sale, and receipts used in the sale of new text begin prescription new text end hearing aids.

Subd. 3.

Consumer rights information.

An audiologist or certified dispenser shall, at the time of the deleted text begin recommendation or deleted text end prescription, give a consumer rights brochure, prepared by the commissioner and containing information about legal requirements pertaining to dispensing of new text begin prescription new text end hearing aids, to each potential consumer of a new text begin prescription new text end hearing aid. The brochure must contain information about the consumer information center described in section 153A.18. A contract for a new text begin prescription new text end hearing aid must note the receipt of the brochure by the consumer, along with the consumer's signature or initials.

Subd. 4.

Liability for contracts.

Owners of entities in the business of dispensing new text begin prescription new text end hearing aids, employers of audiologists or persons who dispense new text begin prescription new text end hearing aids, supervisors of trainees or audiology students, and hearing aid dispensers conducting the transaction at issue are liable for satisfying all terms of contracts, written or oral, made by their agents, employees, assignees, affiliates, or trainees, including terms relating to products, repairs, warranties, service, and refunds. The commissioner may enforce the terms of new text begin prescription new text end hearing aid contracts against the principal, employer, supervisor, or dispenser who conducted the transaction and may impose any remedy provided for in this chapter.

Sec. 46.

Minnesota Statutes 2022, section 148.5198, is amended to read:

148.5198 RESTRICTION ON SALE OF new text begin PRESCRIPTION new text end HEARING AIDS.

Subdivision 1.

45-calendar-day guarantee and buyer right to cancel.

(a) An audiologist or certified dispenser dispensing a new text begin prescription new text end hearing aid in this state must comply with paragraphs (b) and (c).

(b) The audiologist or certified dispenser must provide the buyer with a 45-calendar-day written money-back guarantee. The guarantee must permit the buyer to cancel the purchase for any reason within 45 calendar days after receiving the new text begin prescription new text end hearing aid by giving or mailing written notice of cancellation to the audiologist or certified dispenser. If the buyer mails the notice of cancellation, the 45-calendar-day period is counted using the postmark date, to the date of receipt by the audiologist or certified dispenser. If the new text begin prescription new text end hearing aid must be repaired, remade, or adjusted during the 45-calendar-day money-back guarantee period, the running of the 45-calendar-day period is suspended one day for each 24-hour period that the new text begin prescription new text end hearing aid is not in the buyer's possession. A repaired, remade, or adjusted new text begin prescription new text end hearing aid must be claimed by the buyer within three business days after notification of availability, after which time the running of the 45-calendar-day period resumes. The guarantee must entitle the buyer, upon cancellation, to receive a refund of payment within 30 days of return of the new text begin prescription new text end hearing aid to the audiologist or certified dispenser. The audiologist or certified dispenser may retain as a cancellation fee no more than $250 of the buyer's total purchase price of the new text begin prescription new text end hearing aid.

(c) The audiologist or certified dispenser shall provide the buyer with a contract written in plain English, that contains uniform language and provisions that meet the requirements under the Plain Language Contract Act, sections 325G.29 to 325G.36. The contract must include, but is not limited to, the following: in immediate proximity to the space reserved for the signature of the buyer, or on the first page if there is no space reserved for the signature of the buyer, a clear and conspicuous disclosure of the following specific statement in all capital letters of no less than 12-point boldface type: "MINNESOTA STATE LAW GIVES THE BUYER THE RIGHT TO CANCEL THIS PURCHASE FOR ANY REASON AT ANY TIME PRIOR TO MIDNIGHT OF THE 45TH CALENDAR DAY AFTER RECEIPT OF THE new text begin PRESCRIPTION new text end HEARING AID(S). THIS CANCELLATION MUST BE IN WRITING AND MUST BE GIVEN OR MAILED TO THE AUDIOLOGIST OR CERTIFIED DISPENSER. IF THE BUYER DECIDES TO RETURN THE new text begin PRESCRIPTION new text end HEARING AID(S) WITHIN THIS 45-CALENDAR-DAY PERIOD, THE BUYER WILL RECEIVE A REFUND OF THE TOTAL PURCHASE PRICE OF THE AID(S) FROM WHICH THE AUDIOLOGIST OR CERTIFIED DISPENSER MAY RETAIN AS A CANCELLATION FEE NO MORE THAN $250."

Subd. 2.

Itemized repair bill.

Any audiologist, certified dispenser, or company who agrees to repair a new text begin prescription new text end hearing aid must provide the owner of the new text begin prescription new text end hearing aid, or the owner's representative, with a bill that describes the repair and services rendered. The bill must also include the repairing audiologist's, certified dispenser's, or company's name, address, and telephone number.

This subdivision does not apply to an audiologist, certified dispenser, or company that repairs a new text begin prescription new text end hearing aid pursuant to an express warranty covering the entire new text begin prescription new text end hearing aid and the warranty covers the entire cost, both parts and labor, of the repair.

Subd. 3.

Repair warranty.

Any guarantee of new text begin prescription new text end hearing aid repairs must be in writing and delivered to the owner of the new text begin prescription new text end hearing aid, or the owner's representative, stating the repairing audiologist's, certified dispenser's, or company's name, address, telephone number, length of guarantee, model, and serial number of the new text begin prescription new text end hearing aid and all other terms and conditions of the guarantee.

Subd. 4.

Misdemeanor.

A person found to have violated this section is guilty of a misdemeanor.

Subd. 5.

Additional.

In addition to the penalty provided in subdivision 4, a person found to have violated this section is subject to the penalties and remedies provided in section 325F.69, subdivision 1.

Subd. 6.

Estimates.

Upon the request of the owner of a new text begin prescription new text end hearing aid or the owner's representative for a written estimate and prior to the commencement of repairs, a repairing audiologist, certified dispenser, or company shall provide the customer with a written estimate of the price of repairs. If a repairing audiologist, certified dispenser, or company provides a written estimate of the price of repairs, it must not charge more than the total price stated in the estimate for the repairs. If the repairing audiologist, certified dispenser, or company after commencing repairs determines that additional work is necessary to accomplish repairs that are the subject of a written estimate and if the repairing audiologist, certified dispenser, or company did not unreasonably fail to disclose the possible need for the additional work when the estimate was made, the repairing audiologist, certified dispenser, or company may charge more than the estimate for the repairs if the repairing audiologist, certified dispenser, or company immediately provides the owner or owner's representative a revised written estimate pursuant to this section and receives authorization to continue with the repairs. If continuation of the repairs is not authorized, the repairing audiologist, certified dispenser, or company shall return the new text begin prescription new text end hearing aid as close as possible to its former condition and shall release the new text begin prescription new text end hearing aid to the owner or owner's representative upon payment of charges for repairs actually performed and not in excess of the original estimate.

Sec. 47.

Minnesota Statutes 2022, section 151.37, subdivision 12, is amended to read:

Subd. 12.

Administration of opiate antagonists for drug overdose.

(a) A licensed physician, a licensed advanced practice registered nurse authorized to prescribe drugs pursuant to section 148.235, or a licensed physician assistant may authorize the following individuals to administer opiate antagonists, as defined in section 604A.04, subdivision 1:

(1) an emergency medical responder registered pursuant to section 144E.27;

(2) a peace officer as defined in section 626.84, subdivision 1, paragraphs (c) and (d);

(3) correctional employees of a state or local political subdivision;

(4) staff of community-based health disease prevention or social service programs;

(5) a volunteer firefighter; and

(6) a deleted text begin licensed school deleted text end nurse or deleted text begin certified public health nurse deleted text end new text begin any other personnel new text end employed by, or under contract with, a deleted text begin school board under section 121A.21 deleted text end new text begin charter, public, or private school new text end .

(b) For the purposes of this subdivision, opiate antagonists may be administered by one of these individuals only if:

(1) the licensed physician, licensed physician assistant, or licensed advanced practice registered nurse has issued a standing order to, or entered into a protocol with, the individual; and

(2) the individual has training in the recognition of signs of opiate overdose and the use of opiate antagonists as part of the emergency response to opiate overdose.

(c) Nothing in this section prohibits the possession and administration of naloxone pursuant to section 604A.04.

new text begin (d) Notwithstanding section 148.235, subdivisions 8 and 9, a licensed practical nurse is authorized to possess and administer according to this subdivision an opiate antagonist in a school setting. new text end

Sec. 48.

Minnesota Statutes 2022, section 152.28, subdivision 1, is amended to read:

Subdivision 1.

Health care practitioner duties.

(a) Prior to a patient's enrollment in the registry program, a health care practitioner shall:

(1) determine, in the health care practitioner's medical judgment, whether a patient suffers from a qualifying medical condition, and, if so determined, provide the patient with a certification of that diagnosis;

(2) advise patients, registered designated caregivers, and parents, legal guardians, or spouses who are acting as caregivers of the existence of any nonprofit patient support groups or organizations;

(3) provide explanatory information from the commissioner to patients with qualifying medical conditions, including disclosure to all patients about the experimental nature of therapeutic use of medical cannabis; the possible risks, benefits, and side effects of the proposed treatment; the application and other materials from the commissioner; and provide patients with the Tennessen warning as required by section 13.04, subdivision 2; and

(4) agree to continue treatment of the patient's qualifying medical condition and report medical findings to the commissioner.

(b) Upon notification from the commissioner of the patient's enrollment in the registry program, the health care practitioner shall:

(1) participate in the patient registry reporting system under the guidance and supervision of the commissioner;

(2) report health records of the patient throughout the ongoing treatment of the patient to the commissioner in a manner determined by the commissioner and in accordance with subdivision 2;

(3) determine, on a yearly basis, if the patient continues to suffer from a qualifying medical condition and, if so, issue the patient a new certification of that diagnosis; and

(4) otherwise comply with all requirements developed by the commissioner.

(c) A health care practitioner may deleted text begin conduct a patient assessment to issue a recertification as required under paragraph (b), clause (3), via deleted text end new text begin utilize new text end telehealth, as defined in section 62A.673, subdivision 2 new text begin , for certifications and recertifications new text end .

(d) Nothing in this section requires a health care practitioner to participate in the registry program.

Sec. 49.

Minnesota Statutes 2022, section 152.29, subdivision 3a, is amended to read:

Subd. 3a.

Transportation of medical cannabis; new text begin transport new text end staffing.

(a) A medical cannabis manufacturer may staff a transport motor vehicle with only one employee if the medical cannabis manufacturer is transporting medical cannabis to either a certified laboratory for the purpose of testing or a facility for the purpose of disposal. If the medical cannabis manufacturer is transporting medical cannabis for any other purpose or destination, the transport motor vehicle must be staffed with a minimum of two employees as required by rules adopted by the commissioner.

(b) Notwithstanding paragraph (a), a medical cannabis manufacturer that is only transporting hemp for any purpose may staff the transport motor vehicle with only one employee.

new text begin (c) A medical cannabis manufacturer may contract with a third party for armored car services for deliveries of medical cannabis from its production facility to distribution facilities. A medical cannabis manufacturer that contracts for armored car services remains responsible for the transportation manifest and inventory tracking requirements in rules adopted by the commissioner. new text end

new text begin (d) Department of Health staff may transport medical cannabis for the purposes of delivering medical cannabis and other samples to a laboratory for testing under rules adopted by the commissioner and in cases of special investigations when the commissioner has determined there is a potential threat to public health. The transport motor vehicle must be staffed with a minimum of two Department of Health employees. The employees must carry with them their Department of Health identification card and a transport manifest. new text end

Sec. 50.

Minnesota Statutes 2022, section 153A.13, subdivision 3, is amended to read:

Subd. 3.

Hearing deleted text begin instrument deleted text end new text begin aid new text end .

"Hearing deleted text begin instrument deleted text end new text begin aid new text end " means an instrument deleted text begin , or any of its parts, worn in the ear canal and designed to or represented as being able to aid or enhance human hearing. "Hearing instrument" includes the instrument's parts, attachments, or accessories, including, but not limited to, ear molds and behind the ear (BTE) devices with or without an ear mold. Batteries and cords are not parts, attachments, or accessories of a hearing instrument. Surgically implanted hearing instruments, and assistive listening devices not worn within the ear canal, are not hearing instruments. deleted text end new text begin as defined in section 148.512, subdivision 10a. new text end

Sec. 51.

Minnesota Statutes 2022, section 153A.13, subdivision 4, is amended to read:

Subd. 4.

Hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing.

"Hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing" deleted text begin means making ear mold impressions, prescribing, or recommending a hearing instrument, assisting the consumer in instrument selection, selling hearing instruments at retail, or testing human hearing in connection with these activities regardless of whether the person conducting these activities has a monetary interest in the sale of hearing instruments to the consumer. deleted text end new text begin has the meaning given in section 148.512, subdivision 10b. new text end

Sec. 52.

Minnesota Statutes 2022, section 153A.13, subdivision 5, is amended to read:

Subd. 5.

Dispenser of hearing deleted text begin instruments deleted text end new text begin aids new text end .

"Dispenser of hearing deleted text begin instruments deleted text end new text begin aids new text end " means a natural person who engages in new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing new text begin , new text end whether or not certified by the commissioner of health or licensed by an existing health-related board, except that a person described as follows is not a dispenser of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end :

(1) a student participating in supervised field work that is necessary to meet requirements of an accredited educational program if the student is designated by a title which clearly indicates the student's status as a student trainee; or

(2) a person who helps a dispenser of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end in an administrative or clerical manner and does not engage in new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing.

A person who offers to dispense a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end , or a person who advertises, holds out to the public, or otherwise represents that the person is authorized to dispense new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids, new text end must be certified by the commissioner except when the person is an audiologist as defined in section 148.512.

Sec. 53.

Minnesota Statutes 2022, section 153A.13, subdivision 6, is amended to read:

Subd. 6.

Advisory council.

"Advisory council" means the Minnesota Hearing deleted text begin Instrument deleted text end new text begin Aid new text end Dispenser Advisory Council, or a committee of deleted text begin it deleted text end new text begin the council new text end , established under section 153A.20.

Sec. 54.

Minnesota Statutes 2022, section 153A.13, subdivision 7, is amended to read:

Subd. 7.

ANSI.

"ANSI" means deleted text begin ANSI S3.6-1989, deleted text end American National Standard Specification for Audiometers deleted text begin from the American National Standards Institute. This document is available through the Minitex interlibrary loan system deleted text end new text begin as defined in the United States Food and Drug Administration, Code of Federal Regulations, title 21, section 874.1050 new text end .

Sec. 55.

Minnesota Statutes 2022, section 153A.13, subdivision 9, is amended to read:

Subd. 9.

Supervision.

"Supervision" means monitoring activities of, and accepting responsibility for, the new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing activities of a trainee.

Sec. 56.

Minnesota Statutes 2022, section 153A.13, subdivision 10, is amended to read:

Subd. 10.

Direct supervision or directly supervised.

"Direct supervision" or "directly supervised" means the on-site and contemporaneous location of a supervisor and trainee, when the supervisor observes the trainee engaging in new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing with a consumer.

Sec. 57.

Minnesota Statutes 2022, section 153A.13, subdivision 11, is amended to read:

Subd. 11.

Indirect supervision or indirectly supervised.

"Indirect supervision" or "indirectly supervised" means the remote and independent performance of new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing by a trainee when authorized under section 153A.14, subdivision 4a, paragraph (b).

Sec. 58.

Minnesota Statutes 2022, section 153A.13, is amended by adding a subdivision to read:

new text begin Subd. 12. new text end

new text begin Over-the-counter hearing aid or OTC hearing aid. new text end

new text begin "Over-the-counter hearing aid" or "OTC hearing aid" has the meaning given in section 148.512, subdivision 10c. new text end

Sec. 59.

Minnesota Statutes 2022, section 153A.13, is amended by adding a subdivision to read:

new text begin Subd. 13. new text end

new text begin Prescription hearing aid. new text end

new text begin "Prescription hearing aid" has the meaning given in section 148.512, subdivision 13a. new text end

Sec. 60.

Minnesota Statutes 2022, section 153A.14, subdivision 1, is amended to read:

Subdivision 1.

Application for certificate.

An applicant must:

(1) be 21 years of age or older;

(2) apply to the commissioner for a certificate to dispense new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end on application forms provided by the commissioner;

(3) at a minimum, provide the applicant's name, Social Security number, business address and phone number, employer, and information about the applicant's education, training, and experience in testing human hearing and fitting new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end ;

(4) include with the application a statement that the statements in the application are true and correct to the best of the applicant's knowledge and belief;

(5) include with the application a written and signed authorization that authorizes the commissioner to make inquiries to appropriate regulatory agencies in this or any other state where the applicant has sold new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end ;

(6) submit certification to the commissioner that the applicant's audiometric equipment has been calibrated to meet current ANSI standards within 12 months of the date of the application;

(7) submit evidence of continuing education credits, if required;

(8) submit all fees as required under section 153A.17; and

(9) consent to a fingerprint-based criminal history records check required under section 144.0572, pay all required fees, and cooperate with all requests for information. An applicant must complete a new criminal background check if more than one year has elapsed since the applicant last applied for a license.

Sec. 61.

Minnesota Statutes 2022, section 153A.14, subdivision 2, is amended to read:

Subd. 2.

Issuance of certificate.

(a) The commissioner shall issue a certificate to each dispenser of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end who applies under subdivision 1 if the commissioner determines that the applicant is in compliance with this chapter, has passed an examination administered by the commissioner, has met the continuing education requirements, if required, and has paid the fee set by the commissioner. The commissioner may reject or deny an application for a certificate if there is evidence of a violation or failure to comply with this chapter.

(b) The commissioner shall not issue a certificate to an applicant who refuses to consent to a criminal history background check as required by section 144.0572 within 90 days after submission of an application or fails to submit fingerprints to the Department of Human Services. Any fees paid by the applicant to the Department of Health shall be forfeited if the applicant refuses to consent to the background study.

Sec. 62.

Minnesota Statutes 2022, section 153A.14, subdivision 2h, is amended to read:

Subd. 2h.

Certification by examination.

An applicant must achieve a passing score, as determined by the commissioner, on an examination according to paragraphs (a) to (c).

(a) The examination must include, but is not limited to:

(1) A written examination approved by the commissioner covering the following areas as they pertain to new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end selling:

(i) basic physics of sound;

(ii) the anatomy and physiology of the ear;

(iii) the function of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end ; and

(iv) the principles of new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end selection.

(2) Practical tests of proficiency in the following techniques as they pertain to new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end selling:

(i) pure tone audiometry, including air conduction testing and bone conduction testing;

(ii) live voice or recorded voice speech audiometry including speech recognition (discrimination) testing, most comfortable loudness level, and uncomfortable loudness measurements of tolerance thresholds;

(iii) masking when indicated;

(iv) recording and evaluation of audiograms and speech audiometry to determine proper selection and fitting of a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end ;

(v) taking ear mold impressions;

(vi) using an otoscope for the visual observation of the entire ear canal; and

(vii) state and federal laws, rules, and regulations.

(b) The practical examination shall be administered by the commissioner at least twice a year.

(c) An applicant must achieve a passing score on all portions of the examination within a two-year period. An applicant who does not achieve a passing score on all portions of the examination within a two-year period must retake the entire examination and achieve a passing score on each portion of the examination. An applicant who does not apply for certification within one year of successful completion of the examination must retake the examination and achieve a passing score on each portion of the examination. An applicant may not take any part of the practical examination more than three times in a two-year period.

Sec. 63.

Minnesota Statutes 2022, section 153A.14, subdivision 2i, is amended to read:

Subd. 2i.

Continuing education requirement.

On forms provided by the commissioner, each certified dispenser must submit with the application for renewal of certification evidence of completion of ten course hours of continuing education earned within the 12-month period of November 1 to October 31, between the effective and expiration dates of certification. Continuing education courses must be directly related to new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing and approved by the International Hearing Society, the American Speech-Language-Hearing Association, or the American Academy of Audiology. Evidence of completion of the ten course hours of continuing education must be submitted by December 1 of each year. This requirement does not apply to dispensers certified for less than one year.

Sec. 64.

Minnesota Statutes 2022, section 153A.14, subdivision 2j, is amended to read:

Subd. 2j.

Required use of certification number.

The certification holder must use the certification number on all contracts, bills of sale, and receipts used in the sale of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end .

Sec. 65.

Minnesota Statutes 2022, section 153A.14, subdivision 4, is amended to read:

Subd. 4.

Dispensing of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end without certificate.

Except as provided in subdivisions 4a and 4c, and in sections 148.512 to 148.5198, it is unlawful for any person not holding a valid certificate to dispense a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end as defined in section 153A.13, subdivision 3. A person who dispenses a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end without the certificate required by this section is guilty of a gross misdemeanor.

Sec. 66.

Minnesota Statutes 2022, section 153A.14, subdivision 4a, is amended to read:

Subd. 4a.

Trainees.

(a) A person who is not certified under this section may dispense new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end as a trainee for a period not to exceed 12 months if the person:

(1) submits an application on forms provided by the commissioner;

(2) is under the supervision of a certified dispenser meeting the requirements of this subdivision;

(3) meets all requirements for certification except passage of the examination required by this section; and

(4) uses the title "dispenser trainee" in contacts with the patients, clients, or consumers.

(b) A certified new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispenser may not supervise more than two trainees at the same time and may not directly supervise more than one trainee at a time. The certified dispenser is responsible for all actions or omissions of a trainee in connection with the dispensing of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end . A certified dispenser may not supervise a trainee if there are any commissioner, court, or other orders, currently in effect or issued within the last five years, that were issued with respect to an action or omission of a certified dispenser or a trainee under the certified dispenser's supervision.

Until taking and passing the practical examination testing the techniques described in subdivision 2h, paragraph (a), clause (2), trainees must be directly supervised in all areas described in subdivision 4b, and the activities tested by the practical examination. Thereafter, trainees may dispense new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end under indirect supervision until expiration of the trainee period. Under indirect supervision, the trainee must complete two monitored activities a week. Monitored activities may be executed by correspondence, telephone, or other telephonic devices, and include, but are not limited to, evaluation of audiograms, written reports, and contracts. The time spent in supervision must be recorded and the record retained by the supervisor.

Sec. 67.

Minnesota Statutes 2022, section 153A.14, subdivision 4b, is amended to read:

Subd. 4b.

new text begin Prescription new text end hearing testing protocol.

A dispenser when conducting a hearing test for the purpose of new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing must:

(1) comply with the United States Food and Drug Administration warning regarding potential medical conditions required by Code of Federal Regulations, title 21, section deleted text begin 801.420 deleted text end new text begin 801.422 new text end ;

(2) complete a case history of the client's hearing;

(3) inspect the client's ears with an otoscope; and

(4) conduct the following tests on both ears of the client and document the results, and if for any reason one of the following tests cannot be performed pursuant to the United States Food and Drug Administration guidelines, an audiologist shall evaluate the hearing and the need for a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end :

(i) air conduction at 250, 500, 1,000, 2,000, 4,000, and 8,000 Hertz. When a difference of 20 dB or more occurs between adjacent octave frequencies the interoctave frequency must be tested;

(ii) bone conduction at 500, 1,000, 2,000, and 4,000 Hertz for any frequency where the air conduction threshold is greater than 15 dB HL;

(iii) monaural word recognition (discrimination), with a minimum of 25 words presented for each ear; and

(iv) loudness discomfort level, monaural, for setting a new text begin prescription new text end hearing deleted text begin instrument's deleted text end new text begin aid's new text end maximum power output; and

(5) include masking in all tests whenever necessary to ensure accurate results.

Sec. 68.

Minnesota Statutes 2022, section 153A.14, subdivision 4c, is amended to read:

Subd. 4c.

Reciprocity.

(a) A person who has dispensed new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end in another jurisdiction may dispense new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end as a trainee under indirect supervision if the person:

(1) satisfies the provisions of subdivision 4a, paragraph (a);

(2) submits a signed and dated affidavit stating that the applicant is not the subject of a disciplinary action or past disciplinary action in this or another jurisdiction and is not disqualified on the basis of section 153A.15, subdivision 1; and

(3) provides a copy of a current credential as a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispenser held in the District of Columbia or a state or territory of the United States.

(b) A person becoming a trainee under this subdivision who fails to take and pass the practical examination described in subdivision 2h, paragraph (a), clause (2), when next offered must cease dispensing new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end unless under direct supervision.

Sec. 69.

Minnesota Statutes 2022, section 153A.14, subdivision 4e, is amended to read:

Subd. 4e.

new text begin Prescription new text end hearing aids; enforcement.

Costs incurred by the Minnesota Department of Health for conducting investigations of unlicensed new text begin prescription new text end hearing aid deleted text begin dispensers deleted text end new text begin dispensing new text end shall be apportioned between all licensed or credentialed professions that dispense new text begin prescription new text end hearing aids.

Sec. 70.

Minnesota Statutes 2022, section 153A.14, subdivision 6, is amended to read:

Subd. 6.

new text begin Prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end to comply with federal and state requirements.

The commissioner shall ensure that new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end are dispensed in compliance with state requirements and the requirements of the United States Food and Drug Administration. Failure to comply with state or federal regulations may be grounds for enforcement actions under section 153A.15, subdivision 2.

Sec. 71.

Minnesota Statutes 2022, section 153A.14, subdivision 9, is amended to read:

Subd. 9.

Consumer rights.

A new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispenser shall comply with the requirements of sections 148.5195, subdivision 3, clause (20); 148.5197; and 148.5198.

Sec. 72.

Minnesota Statutes 2022, section 153A.14, subdivision 11, is amended to read:

Subd. 11.

Requirement to maintain current information.

A dispenser must notify the commissioner in writing within 30 days of the occurrence of any of the following:

(1) a change of name, address, home or business telephone number, or business name;

(2) the occurrence of conduct prohibited by section 153A.15;

(3) a settlement, conciliation court judgment, or award based on negligence, intentional acts, or contractual violations committed in the dispensing of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end by the dispenser; and

(4) the cessation of new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing activities as an individual or a business.

Sec. 73.

Minnesota Statutes 2022, section 153A.14, is amended by adding a subdivision to read:

new text begin Subd. 12. new text end

new text begin Over-the-counter hearing aids. new text end

new text begin Nothing in this chapter shall preclude certified hearing aid dispensers from dispensing or selling over-the-counter hearing aids. new text end

Sec. 74.

Minnesota Statutes 2022, section 153A.15, subdivision 1, is amended to read:

Subdivision 1.

Prohibited acts.

The commissioner may take enforcement action as provided under subdivision 2 against a dispenser of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end for the following acts and conduct:

(1) dispensing a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end to a minor person 18 years or younger unless evaluated by an audiologist for hearing evaluation and new text begin prescription new text end hearing aid evaluation;

(2) being disciplined through a revocation, suspension, restriction, or limitation by another state for conduct subject to action under this chapter;

(3) presenting advertising that is false or misleading;

(4) providing the commissioner with false or misleading statements of credentials, training, or experience;

(5) engaging in conduct likely to deceive, defraud, or harm the public; or demonstrating a willful or careless disregard for the health, welfare, or safety of a consumer;

(6) splitting fees or promising to pay a portion of a fee to any other professional other than a fee for services rendered by the other professional to the client;

(7) engaging in abusive or fraudulent billing practices, including violations of federal Medicare and Medicaid laws, Food and Drug Administration regulations, or state medical assistance laws;

(8) obtaining money, property, or services from a consumer through the use of undue influence, high pressure sales tactics, harassment, duress, deception, or fraud;

(9) performing the services of a certified hearing deleted text begin instrument deleted text end new text begin aid new text end dispenser in an incompetent or negligent manner;

(10) failing to comply with the requirements of this chapter as an employer, supervisor, or trainee;

(11) failing to provide information in a timely manner in response to a request by the commissioner, commissioner's designee, or the advisory council;

(12) being convicted within the past five years of violating any laws of the United States, or any state or territory of the United States, and the violation is a felony, gross misdemeanor, or misdemeanor, an essential element of which relates to new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing, except as provided in chapter 364;

(13) failing to cooperate with the commissioner, the commissioner's designee, or the advisory council in any investigation;

(14) failing to perform new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing with reasonable judgment, skill, or safety due to the use of alcohol or drugs, or other physical or mental impairment;

(15) failing to fully disclose actions taken against the applicant or the applicant's legal authorization to dispense new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end in this or another state;

(16) violating a state or federal court order or judgment, including a conciliation court judgment, relating to the activities of the applicant in new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing;

(17) having been or being disciplined by the commissioner of the Department of Health, or other authority, in this or another jurisdiction, if any of the grounds for the discipline are the same or substantially equivalent to those in sections 153A.13 to 153A.18;

(18) misrepresenting the purpose of hearing tests, or in any way communicating that the hearing test or hearing test protocol required by section 153A.14, subdivision 4b, is a medical evaluation, a diagnostic hearing evaluation conducted by an audiologist, or is other than a test to select a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end , except that the new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispenser can determine the need for or recommend the consumer obtain a medical evaluation consistent with requirements of the United States Food and Drug Administration;

(19) violating any of the provisions of sections 148.5195, subdivision 3, clause (20); 148.5197; 148.5198; and 153A.13 to 153A.18; and

(20) aiding or abetting another person in violating any of the provisions of sections 148.5195, subdivision 3, clause (20); 148.5197; 148.5198; and 153A.13 to 153A.18.

Sec. 75.

Minnesota Statutes 2022, section 153A.15, subdivision 2, is amended to read:

Subd. 2.

Enforcement actions.

When the commissioner finds that a dispenser of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end has violated one or more provisions of this chapter, the commissioner may do one or more of the following:

(1) deny or reject the application for a certificate;

(2) revoke the certificate;

(3) suspend the certificate;

(4) impose, for each violation, a civil penalty that deprives the dispenser of any economic advantage gained by the violation and that reimburses the Department of Health for costs of the investigation and proceeding resulting in disciplinary action, including the amount paid for services of the Office of Administrative Hearings, the amount paid for services of the Office of the Attorney General, attorney fees, court reporters, witnesses, reproduction of records, advisory council members' per diem compensation, department staff time, and expenses incurred by advisory council members and department staff;

(5) censure or reprimand the dispenser;

(6) revoke or suspend the right to supervise trainees;

(7) revoke or suspend the right to be a trainee;

(8) impose a civil penalty not to exceed $10,000 for each separate violation; or

(9) any other action reasonably justified by the individual case.

Sec. 76.

Minnesota Statutes 2022, section 153A.15, subdivision 4, is amended to read:

Subd. 4.

Penalties.

Except as provided in section 153A.14, subdivision 4, a person violating this chapter is guilty of a misdemeanor. The commissioner may impose an automatic civil penalty equal to one-fourth the renewal fee on each new text begin prescription new text end hearing deleted text begin instrument seller deleted text end new text begin aid dispenser new text end who fails to renew the certificate required in section 153A.14 by the renewal deadline.

Sec. 77.

Minnesota Statutes 2022, section 153A.17, is amended to read:

153A.17 EXPENSES; FEES.

(a) The expenses for administering the certification requirements, including the complaint handling system for new text begin prescription new text end hearing aid dispensers in sections 153A.14 and 153A.15, and the Consumer Information Center under section 153A.18, must be paid from initial application and examination fees, renewal fees, penalties, and fines. The commissioner shall only use fees collected under this section for the purposes of administering this chapter. The legislature must not transfer money generated by these fees from the state government special revenue fund to the general fund. deleted text begin Surcharges collected by the commissioner of health deleted text end deleted text begin under section deleted text end deleted text begin 16E.22 deleted text end deleted text begin are not subject to this paragraph. deleted text end

(b) The fees are as follows:

(1) the initial certification application fee is $772.50;

(2) the annual renewal certification application fee is $750;

(3) the initial examination fee for the practical portion is $1,200, and $600 for each time it is taken, thereafter; for individuals meeting the requirements of section 148.515, subdivision 2, the fee for the practical portion of the new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing examination is $600 each time it is taken;

(4) the trainee application fee is $230;

(5) the penalty fee for late submission of a renewal application is $260; and

(6) the fee for verification of certification to other jurisdictions or entities is $25.

(c) The commissioner may prorate the certification fee for new applicants based on the number of quarters remaining in the annual certification period.

(d) All fees are nonrefundable. All fees, penalties, and fines received must be deposited in the state government special revenue fund.

(e) Hearing instrument dispensers who were certified before January 1, 2018, shall pay a onetime surcharge of $22.50 to renew their certification when it expires after October 31, 2020. The surcharge shall cover the commissioner's costs associated with criminal background checks.

Sec. 78.

Minnesota Statutes 2022, section 153A.175, is amended to read:

153A.175 PENALTY FEES.

(a) The penalty fee for holding oneself out as a hearing deleted text begin instrument deleted text end new text begin aid new text end dispenser without a current certificate after the credential has expired and before it is renewed is one-half the amount of the certificate renewal fee for any part of the first day, plus one-half the certificate renewal fee for any part of any subsequent days up to 30 days.

(b) The penalty fee for applicants who hold themselves out as hearing deleted text begin instrument deleted text end new text begin aid new text end dispensers after expiration of the trainee period and before being issued a certificate is one-half the amount of the certificate application fee for any part of the first day, plus one-half the certificate application fee for any part of any subsequent days up to 30 days. This paragraph does not apply to applicants not qualifying for a certificate who hold themselves out as hearing deleted text begin instrument deleted text end new text begin aid new text end dispensers.

(c) The penalty fee for practicing new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing and failing to submit a continuing education report by the due date with the correct number or type of hours in the correct time period is $200 plus $200 for each missing clock hour. "Missing" means not obtained between the effective and expiration dates of the certificate, the one-month period following the certificate expiration date, or the 30 days following notice of a penalty fee for failing to report all continuing education hours. The certificate holder must obtain the missing number of continuing education hours by the next reporting due date.

(d) Civil penalties and discipline incurred by certificate holders prior to August 1, 2005, for conduct described in paragraph (a), (b), or (c) shall be recorded as nondisciplinary penalty fees. Payment of a penalty fee does not preclude any disciplinary action reasonably justified by the individual case.

Sec. 79.

Minnesota Statutes 2022, section 153A.18, is amended to read:

153A.18 CONSUMER INFORMATION CENTER.

The commissioner shall establish a Consumer Information Center to assist actual and potential purchasers of new text begin prescription new text end hearing aids by providing them with information regarding new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end sales. The Consumer Information Center shall disseminate information about consumers' legal rights related to new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end sales, provide information relating to complaints about dispensers of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end , and provide information about outreach and advocacy services for consumers of new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end . In establishing the center and developing the information, the commissioner shall consult with representatives of new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensers, audiologists, physicians, and consumers.

Sec. 80.

Minnesota Statutes 2022, section 153A.20, is amended to read:

153A.20 HEARING deleted text begin INSTRUMENT deleted text end new text begin AID new text end DISPENSER ADVISORY COUNCIL.

Subdivision 1.

Membership.

(a) The commissioner shall appoint seven persons to a Hearing deleted text begin Instrument deleted text end new text begin Aid new text end Dispenser Advisory Council.

(b) The seven persons must include:

(1) three public members, as defined in section 214.02. At least one of the public members shall be a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end user and one of the public members shall be either a new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end user or an advocate of one;

(2) three hearing deleted text begin instrument deleted text end new text begin aid new text end dispensers certified under sections 153A.14 to 153A.20, each of whom is currently, and has been for the five years immediately preceding their appointment, engaged in new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing in Minnesota and who represent the occupation of new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end dispensing and who are not audiologists; and

(3) one audiologist licensed as an audiologist under chapter 148 who dispenses new text begin prescription new text end hearing deleted text begin instruments deleted text end new text begin aids new text end , recommended by a professional association representing audiologists and speech-language pathologists.

(c) The factors the commissioner may consider when appointing advisory council members include, but are not limited to, professional affiliation, geographical location, and type of practice.

(d) No two members of the advisory council shall be employees of, or have binding contracts requiring sales exclusively for, the same new text begin prescription new text end hearing deleted text begin instrument deleted text end new text begin aid new text end manufacturer or the same employer.

Subd. 2.

Organization.

The advisory council shall be organized and administered according to section 15.059. The council may form committees to carry out its duties.

Subd. 3.

Duties.

At the commissioner's request, the advisory council shall:

(1) advise the commissioner regarding hearing deleted text begin instrument deleted text end new text begin aid new text end dispenser certification standards;

(2) provide for distribution of information regarding hearing deleted text begin instrument deleted text end new text begin aid new text end dispenser certification standards;

(3) review investigation summaries of competency violations and make recommendations to the commissioner as to whether the allegations of incompetency are substantiated; and

(4) perform other duties as directed by the commissioner.

Sec. 81.

Minnesota Statutes 2022, section 256B.434, subdivision 4f, is amended to read:

Subd. 4f.

Construction project rate adjustments effective October 1, 2006.

(a) Effective October 1, 2006, facilities reimbursed under this section may receive a property rate adjustment for construction projects exceeding the threshold in section 256B.431, subdivision 16, and below the threshold in section 144A.071, subdivision 2, deleted text begin clause (a) deleted text end new text begin paragraph (c), clause (1) new text end . For these projects, capital assets purchased shall be counted as construction project costs for a rate adjustment request made by a facility if they are: (1) purchased within 24 months of the completion of the construction project; (2) purchased after the completion date of any prior construction project; and (3) are not purchased prior to July 14, 2005. Except as otherwise provided in this subdivision, the definitions, rate calculation methods, and principles in sections 144A.071 and 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, shall be used to calculate rate adjustments for allowable construction projects under this subdivision and section 144A.073. Facilities completing construction projects between October 1, 2005, and October 1, 2006, are eligible to have a property rate adjustment effective October 1, 2006. Facilities completing projects after October 1, 2006, are eligible for a property rate adjustment effective on the first day of the month following the completion date. Facilities completing projects after January 1, 2018, are eligible for a property rate adjustment effective on the first day of the month of January or July, whichever occurs immediately following the completion date.

(b) Notwithstanding subdivision 18, as of July 14, 2005, facilities with rates set under section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, that commenced a construction project on or after October 1, 2004, and do not have a contract under subdivision 3 by September 30, 2006, are eligible to request a rate adjustment under section 256B.431, subdivision 10, through September 30, 2006. If the request results in the commissioner determining a rate adjustment is allowable, the rate adjustment is effective on the first of the month following project completion. These facilities shall be allowed to accumulate construction project costs for the period October 1, 2004, to September 30, 2006.

(c) Facilities shall be allowed construction project rate adjustments no sooner than 12 months after completing a previous construction project. Facilities must request the rate adjustment according to section 256B.431, subdivision 10.

(d) Capacity days shall be computed according to Minnesota Rules, part 9549.0060, subpart 11. For rate calculations under this section, the number of licensed beds in the nursing facility shall be the number existing after the construction project is completed and the number of days in the nursing facility's reporting period shall be 365.

(e) The value of assets to be recognized for a total replacement project as defined in section 256B.431, subdivision 17d, shall be computed as described in clause (1). The value of assets to be recognized for all other projects shall be computed as described in clause (2).

(1) Replacement-cost-new limits under section 256B.431, subdivision 17e, and the number of beds allowed under subdivision 3a, paragraph (c), shall be used to compute the maximum amount of assets allowable in a facility's property rate calculation. If a facility's current request for a rate adjustment results from the completion of a construction project that was previously approved under section 144A.073, the assets to be used in the rate calculation cannot exceed the lesser of the amount determined under sections 144A.071, subdivision 2, and 144A.073, subdivision 3b, or the actual allowable costs of the construction project. A current request that is not the result of a project under section 144A.073 cannot exceed the limit under section 144A.071, subdivision 2, paragraph deleted text begin (a) deleted text end new text begin (c), clause (1) new text end . Applicable credits must be deducted from the cost of the construction project.

(2)(i) Replacement-cost-new limits under section 256B.431, subdivision 17e, and the number of beds allowed under section 256B.431, subdivision 3a, paragraph (c), shall be used to compute the maximum amount of assets allowable in a facility's property rate calculation.

(ii) The value of a facility's assets to be compared to the amount in item (i) begins with the total appraised value from the last rate notice a facility received when its rates were set under section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080. This value shall be indexed by the factor in section 256B.431, subdivision 3f, paragraph (a), for each rate year the facility received an inflation factor on its property-related rate when its rates were set under this section. The value of assets listed as previous capital additions, capital additions, and special projects on the facility's base year rate notice and the value of assets related to a construction project for which the facility received a rate adjustment when its rates were determined under this section shall be added to the indexed appraised value.

(iii) The maximum amount of assets to be recognized in computing a facility's rate adjustment after a project is completed is the lesser of the aggregate replacement-cost-new limit computed in (i) minus the assets recognized in (ii) or the actual allowable costs of the construction project.

(iv) If a facility's current request for a rate adjustment results from the completion of a construction project that was previously approved under section 144A.073, the assets to be added to the rate calculation cannot exceed the lesser of the amount determined under sections 144A.071, subdivision 2, and 144A.073, subdivision 3b, or the actual allowable costs of the construction project. A current request that is not the result of a project under section 144A.073 cannot exceed the limit stated in section 144A.071, subdivision 2, paragraph deleted text begin (a) deleted text end new text begin (c), clause (1) new text end . Assets disposed of as a result of a construction project and applicable credits must be deducted from the cost of the construction project.

(f) For construction projects approved under section 144A.073, allowable debt may never exceed the lesser of the cost of the assets purchased, the threshold limit in section 144A.071, subdivision 2, or the replacement-cost-new limit less previously existing capital debt.

(g) For construction projects that were not approved under section 144A.073, allowable debt is limited to the lesser of the threshold in section 144A.071, subdivision 2, for such construction projects or the applicable limit in paragraph (e), clause (1) or (2), less previously existing capital debt. Amounts of debt taken out that exceed the costs of a construction project shall not be allowed regardless of the use of the funds.

For all construction projects being recognized, interest expense and average debt shall be computed based on the first 12 months following project completion. "Previously existing capital debt" means capital debt recognized on the last rate determined under section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, and the amount of debt recognized for a construction project for which the facility received a rate adjustment when its rates were determined under this section.

For a total replacement project as defined in section 256B.431, subdivision 17d, the value of previously existing capital debt shall be zero.

(h) In addition to the interest expense allowed from the application of paragraph (f), the amounts allowed under section 256B.431, subdivision 17a, paragraph (a), clauses (2) and (3), will be added to interest expense.

(i) The equity portion of the construction project shall be computed as the allowable assets in paragraph (e), less the average debt in paragraph (f). The equity portion must be multiplied by 5.66 percent and the allowable interest expense in paragraph (f) must be added. This sum must be divided by 95 percent of capacity days to compute the construction project rate adjustment.

(j) For projects that are not a total replacement of a nursing facility, the amount in paragraph (i) is adjusted for nonreimbursable areas and then added to the current property payment rate of the facility.

(k) For projects that are a total replacement of a nursing facility, the amount in paragraph (i) becomes the new property payment rate after being adjusted for nonreimbursable areas. Any amounts existing in a facility's rate before the effective date of the construction project for equity incentives under section 256B.431, subdivision 16; capital repairs and replacements under section 256B.431, subdivision 15; or refinancing incentives under section 256B.431, subdivision 19, shall be removed from the facility's rates.

(l) No additional equipment allowance is allowed under Minnesota Rules, part 9549.0060, subpart 10, as the result of construction projects under this section. Allowable equipment shall be included in the construction project costs.

(m) Capital assets purchased after the completion date of a construction project shall be counted as construction project costs for any future rate adjustment request made by a facility under section 144A.071, subdivision 2, deleted text begin clause (a) deleted text end new text begin paragraph (c), clause (1) new text end , if they are purchased within 24 months of the completion of the future construction project.

(n) In subsequent rate years, the property payment rate for a facility that results from the application of this subdivision shall be the amount inflated in subdivision 4.

(o) Construction projects are eligible for an equity incentive under section 256B.431, subdivision 16. When computing the equity incentive for a construction project under this subdivision, only the allowable costs and allowable debt related to the construction project shall be used. The equity incentive shall not be a part of the property payment rate and not inflated under subdivision 4. Effective October 1, 2006, all equity incentives for nursing facilities reimbursed under this section shall be allowed for a duration determined under section 256B.431, subdivision 16, paragraph (c).

Sec. 82.

new text begin EFFECTIVE DATE CHANGE. new text end

new text begin The effective date for 2023 H.F. 100, article 6, section 24, if enacted during the 2023 regular legislative session, is July 1, 2023. This section prevails over any contrary effective date for H.F. 100, article 6, section 24, enacted during the 2023 regular legislative session, regardless of order of enactment. new text end

Sec. 83.

new text begin REPEALER. new text end

new text begin (a) new text end new text begin Minnesota Statutes 2022, section 144.9505, subdivision 3, new text end new text begin is repealed. new text end

new text begin (b) new text end new text begin Minnesota Statutes 2022, section 153A.14, subdivision 5, new text end new text begin is repealed. new text end

new text begin (c) new text end new text begin Minnesota Rules, parts 4640.1500; 4640.1600; 4640.1700; 4640.1800; 4640.1900; 4640.2000; 4640.2100; 4640.2200; 4640.2300; 4640.2400; 4640.2500; 4640.2600; 4640.2700; 4640.2800; 4640.2900; 4640.3000; 4640.3100; 4640.3200; 4640.3300; 4640.3400; 4640.3500; 4640.3600; 4640.3700; 4640.3800; 4640.3900; 4640.4000; 4640.4100; 4640.4200; 4640.4300; 4640.6100; 4640.6200; 4640.6300; 4640.6400; 4645.0300; 4645.0400; 4645.0500; 4645.0600; 4645.0700; 4645.0800; 4645.0900; 4645.1000; 4645.1100; 4645.1200; 4645.1300; 4645.1400; 4645.1500; 4645.1600; 4645.1700; 4645.1800; 4645.1900; 4645.2000; 4645.2100; 4645.2200; 4645.2300; 4645.2400; 4645.2500; 4645.2600; 4645.2700; 4645.2800; 4645.2900; 4645.3000; 4645.3100; 4645.3200; 4645.3300; 4645.3400; 4645.3500; 4645.3600; 4645.3700; 4645.3800; 4645.3805; 4645.3900; 4645.4000; 4645.4100; 4645.4200; 4645.4300; 4645.4400; 4645.4500; 4645.4600; 4645.4700; 4645.4800; 4645.4900; 4645.5100; and 4645.5200, new text end new text begin are repealed effective January 1, 2024. new text end

ARTICLE 4

DEPARTMENT OF HEALTH

Section 1.

Minnesota Statutes 2022, section 12A.08, subdivision 3, is amended to read:

Subd. 3.

Implementation.

To implement the requirements of this section, the commissioner may cooperate with private health care providers and facilities new text begin , Tribal nations, new text end and community health boards as defined in section 145A.02 deleted text begin , deleted text end new text begin ; new text end provide grants to assist community health boards deleted text begin , deleted text end new text begin and Tribal nations; new text end use volunteer services of individuals qualified to provide public health services deleted text begin , deleted text end new text begin ; new text end and enter into cooperative or mutual aid agreements to provide public health services.

Sec. 2.

Minnesota Statutes 2022, section 13.10, subdivision 5, is amended to read:

Subd. 5.

Adoption records.

Notwithstanding any provision of this new text begin or any other new text end chapter, adoption records shall be treated as provided in sections 259.53, 259.61, 259.79, and 259.83 to deleted text begin 259.89 deleted text end new text begin 259.88 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2024. new text end

Sec. 3.

Minnesota Statutes 2022, section 13.465, subdivision 8, is amended to read:

Subd. 8.

Adoption records.

Various adoption records are classified under section 259.53, subdivision 1. Access to the original birth record of a person who has been adopted is governed by section deleted text begin 259.89 deleted text end new text begin 144.2252 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2024. new text end

Sec. 4.

Minnesota Statutes 2022, section 16A.151, subdivision 2, is amended to read:

Subd. 2.

Exceptions.

(a) If a state official litigates or settles a matter on behalf of specific injured persons or entities, this section does not prohibit distribution of money to the specific injured persons or entities on whose behalf the litigation or settlement efforts were initiated. If money recovered on behalf of injured persons or entities cannot reasonably be distributed to those persons or entities because they cannot readily be located or identified or because the cost of distributing the money would outweigh the benefit to the persons or entities, the money must be paid into the general fund.

(b) Money recovered on behalf of a fund in the state treasury other than the general fund may be deposited in that fund.

(c) This section does not prohibit a state official from distributing money to a person or entity other than the state in litigation or potential litigation in which the state is a defendant or potential defendant.

(d) State agencies may accept funds as directed by a federal court for any restitution or monetary penalty under United States Code, title 18, section 3663(a)(3), or United States Code, title 18, section 3663A(a)(3). Funds received must be deposited in a special revenue account and are appropriated to the commissioner of the agency for the purpose as directed by the federal court.

(e) Tobacco settlement revenues as defined in section 16A.98, subdivision 1, paragraph (t), may be deposited as provided in section 16A.98, subdivision 12.

(f) Any money received by the state resulting from a settlement agreement or an assurance of discontinuance entered into by the attorney general of the state, or a court order in litigation brought by the attorney general of the state, on behalf of the state or a state agency, related to alleged violations of consumer fraud laws in the marketing, sale, or distribution of opioids in this state or other alleged illegal actions that contributed to the excessive use of opioids, must be deposited in the settlement account established in the opiate epidemic response fund under section 256.043, subdivision 1. This paragraph does not apply to attorney fees and costs awarded to the state or the Attorney General's Office, to contract attorneys hired by the state or Attorney General's Office, or to other state agency attorneys.

(g) Notwithstanding paragraph (f), if money is received from a settlement agreement or an assurance of discontinuance entered into by the attorney general of the state or a court order in litigation brought by the attorney general of the state on behalf of the state or a state agency against a consulting firm working for an opioid manufacturer or opioid wholesale drug distributor, the commissioner shall deposit any money received into the settlement account established within the opiate epidemic response fund under section 256.042, subdivision 1. Notwithstanding section 256.043, subdivision 3a, paragraph (a), any amount deposited into the settlement account in accordance with this paragraph shall be appropriated to the commissioner of human services to award as grants as specified by the opiate epidemic response advisory council in accordance with section 256.043, subdivision 3a, paragraph (d).

new text begin (h) Any money received by the state resulting from a settlement agreement or an assurance of discontinuance entered into by the attorney general of the state, or a court order in litigation brought by the attorney general of the state on behalf of the state or a state agency related to alleged violations of consumer fraud laws in the marketing, sale, or distribution of electronic nicotine delivery systems in this state or other alleged illegal actions that contributed to the exacerbation of youth nicotine use, must be deposited in the tobacco use prevention account under section 144.398. This paragraph does not apply to: (1) attorney fees and costs awarded or paid to the state or the Attorney General's Office; (2) contract attorneys hired by the state or Attorney General's Office; or (3) other state agency attorneys. The commissioner of management and budget must transfer to the tobacco use prevention account, any money subject to this paragraph that is received by the state before the enactment of this paragraph. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from April 1, 2023, and applies to settlement agreements or assurances of discontinuance entered into, or court orders issued, on or after that date. new text end

Sec. 5.

Minnesota Statutes 2022, section 103I.005, subdivision 17a, is amended to read:

Subd. 17a.

deleted text begin Temporary boring deleted text end new text begin Submerged closed loop heat exchanger new text end .

deleted text begin "Temporary boring" deleted text end new text begin "Submerged closed loop heat exchanger" new text end means deleted text begin an excavation that is 15 feet or more in depth, is sealed within 72 hours of the time of construction, and is drilled, cored, washed, driven, dug, jetted, or otherwise constructed to deleted text end new text begin a heating and cooling device that new text end :

(1) deleted text begin conduct physical, chemical, or biological testing of groundwater, including groundwater quality monitoring deleted text end new text begin is installed in a water supply well new text end ;

(2) deleted text begin monitor or measure physical, chemical, radiological, or biological parameters of earth materials or earth fluids, including hydraulic conductivity, bearing capacity, or resistance deleted text end new text begin utilizes the convective flow of groundwater as the primary medium of heat exchange new text end ;

(3) deleted text begin measure groundwater levels, including use of a piezometer deleted text end new text begin contains water as the heat transfer fluid new text end ; and

(4) deleted text begin determine groundwater flow direction or velocity deleted text end new text begin operates using a nonconsumptive recirculation new text end .

new text begin A submerged closed loop heat exchanger includes other necessary appurtenances such as submersible pumps, a heat exchanger, and piping. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 6.

Minnesota Statutes 2022, section 103I.005, is amended by adding a subdivision to read:

new text begin Subd. 17b. new text end

new text begin Temporary boring. new text end

new text begin "Temporary boring" means an excavation that is 15 feet or more in depth, is sealed within 72 hours of the time of construction, and is drilled, cored, washed, driven, dug, jetted, or otherwise constructed to: new text end

new text begin (1) conduct physical, chemical, or biological testing of groundwater, including groundwater quality monitoring; new text end

new text begin (2) monitor or measure physical, chemical, radiological, or biological parameters of earth materials or earth fluids, including hydraulic conductivity, bearing capacity, or resistance; new text end

new text begin (3) measure groundwater levels, including use of a piezometer; and new text end

new text begin (4) determine groundwater flow direction or velocity. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 7.

Minnesota Statutes 2022, section 103I.005, subdivision 20a, is amended to read:

Subd. 20a.

Water supply well.

"Water supply well" means a well that is not a dewatering well or environmental well and includes wells used:

(1) for potable water supply;

(2) for irrigation;

(3) for agricultural, commercial, or industrial water supply;

(4) for heating or cooling; deleted text begin and deleted text end

(5) new text begin for containing a submerged closed loop heat exchanger; and new text end

new text begin (6) new text end for testing water yield for irrigation, commercial or industrial uses, residential supply, or public water supply.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 8.

Minnesota Statutes 2022, 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 water supply well that is not in use under a maintenance permit, $175 annually;

(2) for an environmental well that is unsealed under a maintenance permit, $175 annually except no fee is required for an environmental well owned by a federal agency, state agency, or local unit of government that is unsealed under a maintenance permit. "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 community health board, or other special purpose district or authority with local jurisdiction in water and related land resources management;

(3) for environmental wells that are unsealed under a maintenance permit, $175 annually per site regardless of the number of environmental wells located on site;

(4) for a groundwater thermal exchange device, in addition to the notification fee for water supply wells, $275, which includes the state core function fee;

(5) for a bored geothermal heat exchanger with less than ten tons of heating/cooling capacity, $275;

(6) for a bored geothermal heat exchanger with ten to 50 tons of heating/cooling capacity, $515;

(7) for a bored geothermal heat exchanger with greater than 50 tons of heating/cooling capacity, $740;

(8) for a dewatering well that is unsealed under a maintenance permit, $175 annually for each dewatering well, except a dewatering project comprising more than five dewatering wells shall be issued a single permit for $875 annually for dewatering wells recorded on the permit; deleted text begin and deleted text end

(9) for an elevator boring, $275 for each boring new text begin ; and new text end

new text begin (10) for a submerged closed loop heat exchanger system, in addition to the notification fee for water supply wells, $3,250, which includes the state core function fee new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 9.

Minnesota Statutes 2022, section 103I.208, is amended by adding a subdivision to read:

new text begin Subd. 3. new text end

new text begin Rules. new text end

new text begin The commissioner shall adopt rules to implement requirements for the permitting and installation of submerged closed loop heat exchangers according to chapter 14. The commissioner may use the monitoring data required by section 107, to amend rules governing the installation of submerged closed loop heat exchanger systems. Rules for which notice is published in the State Register before December 31, 2025, may be adopted using the expedited rulemaking process in section 14.389, subdivision 5. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. new text end

Sec. 10.

new text begin [103I.209] SUBMERGED CLOSED LOOP HEAT EXCHANGER SYSTEM; REQUIREMENTS. new text end

new text begin Subdivision 1. new text end

new text begin Permit required. new text end

new text begin After the effective date of this section, a person must not install a submerged closed loop heat exchanger in a water supply well without a permit granted by the commissioner. A submerged closed loop heat exchanger system approved by a variance granted by the commissioner prior to the effective date of this section may continue to operate without obtaining a permit under this section or section 103I.210. new text end

new text begin Subd. 2. new text end

new text begin Construction. new text end

new text begin (a) A water supply well constructed to house a submerged closed loop heat exchanger must be constructed by a licensed well contractor and the submerged closed loop heat exchanger must be installed by a licensed well contractor. new text end

new text begin (b) The commissioner may consider a variance under Minnesota Rules, part 4725.0410, to the screen configuration requirements under Minnesota Rules, part 4725.2750, to allow any combination of screen, casing, leader, riser, sump, or other piping so long as the screen configuration does not interconnect aquifers or extend through a confining layer. The commissioner must consider rules for these screen configurations during the expedited rulemaking process authorized by section 103I.208, subdivision 3. new text end

new text begin (c) A water supply well used for a submerged closed loop heat exchanger must comply with the requirements of this chapter and Minnesota Rules, chapter 4725. new text end

new text begin Subd. 3. new text end

new text begin Heat transfer fluid. new text end

new text begin Water used as heat transfer fluid must be sourced from a potable supply. The heat transfer fluid may be amended with additives to inhibit corrosion or microbial activity. Any additive used must be ANSI/NSF-60 certified. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment and expires on December 31 of the year that the permanent rules are adopted pursuant to section 103I.208, subdivision 3. new text end

Sec. 11.

new text begin [103I.210] SUBMERGED CLOSED LOOP HEAT EXCHANGER SYSTEM; TEMPORARY PERMITS. new text end

new text begin Subdivision 1. new text end

new text begin Definition. new text end

new text begin For purposes of this section, "permit holder" means persons who receive a permit under this section and includes the property owner and licensed well contractor. new text end

new text begin Subd. 2. new text end

new text begin Permit; limitations. new text end

new text begin (a) The commissioner must issue a permit for the installation of a submerged closed loop heat exchanger system as provided in this section. The property owner or the property owner's agent must submit to the commissioner a permit application on a form provided by the commissioner, or in a format approved by the commissioner. The application must be legible and must contain: new text end

new text begin (1) the name, license number, and signature of the well contractor installing the submerged closed loop heat exchanger; new text end

new text begin (2) the name, address, and signature of the owner of the submerged closed loop heat exchanger system, and property owner, if different; new text end

new text begin (3) the township number, range number, section, and one quartile, and the property street address if assigned, of the proposed submerged closed loop heat exchanger system; new text end

new text begin (4) a description of existing wells to be utilized or any wells proposed to be constructed including the unique well numbers, locations, well depth, diameters of bore holes and casing, depth of casing, grouting methods and materials, and dates of construction; new text end

new text begin (5) the specifications for piping including the materials to be used for piping, the closed loop water treatment protocol, and the provisions for pressure testing the system; new text end

new text begin (6) a diagram of the proposed system; and new text end

new text begin (7) any additional information the commissioner deems necessary to protect the public health and safety of the groundwater. new text end

new text begin (b) The fees collected under this subdivision must be deposited in the state government special revenue fund. new text end

new text begin (c) Permit holders must allow for the inspection of the submerged closed loop heat exchanger system by the commissioner during working hours. new text end

new text begin (d) The commissioner must not limit the number of permits available for submerged closed loop heat exchanger systems or the size of systems. A system may consist of more than one submerged closed loop heat exchanger. A variance is not required to install or operate a submerged closed loop heat exchanger in the water supply well. new text end

new text begin (e) Permit holders must comply with this section, this chapter, and Minnesota Rules, chapter 4725. new text end

new text begin (f) A permit holder must inform the Minnesota Duty Officer of the failure or leak of a submerged closed loop heat exchanger. new text end

new text begin (g) A water supply well containing a submerged closed loop heat exchanger must meet the isolation distance requirements under Minnesota Rules, part 4725.4450. The commissioner may consider a variance under Minnesota Rules, part 4725.0410, to the isolation distance requirements under Minnesota Rules, part 4725.4450, for a water supply well containing a submerged closed loop heat exchanger for the sole purpose of heating and cooling if the property on which the water supply well will be located has limited space and a water supply well cannot be constructed to meet isolation distance requirements. The commissioner shall consider including isolation distance requirements during the expedited rulemaking process authorized by section 103I.208, subdivision 3. new text end

new text begin Subd. 3. new text end

new text begin Permit conditions. new text end

new text begin Permit holders must construct, install, operate, maintain, and report on the submerged closed loop heat exchanger system to comply with permit conditions identified by the commissioner, which must address: new text end

new text begin (1) notification to the commissioner at intervals specified in the permit conditions; new text end

new text begin (2) material and design specifications and standards; new text end

new text begin (3) heat exchange fluid requirements; new text end

new text begin (4) signage requirements; new text end

new text begin (5) backflow prevention requirements; new text end

new text begin (6) pressure tests of the system; new text end

new text begin (7) documentation of the system construction; new text end

new text begin (8) requirements for maintenance and repair of the system; new text end

new text begin (9) removal of the system upon termination of use or failure; new text end

new text begin (10) disclosure of the system at the time of property transfer; new text end

new text begin (11) requirement to obtain approval from the commissioner prior to deviation of the approved plans and conditions; and new text end

new text begin (12) any additional information the commissioner deems necessary to protect public health and safety of the groundwater. new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment and expires on December 31 of the year that the permanent rules are adopted pursuant to section 103I.208, subdivision 3. new text end

Sec. 12.

new text begin [115.7411] ADVISORY COUNCIL ON WATER SUPPLY SYSTEMS AND WASTEWATER TREATMENT FACILITIES. new text end

new text begin Subdivision 1. new text end

new text begin Purpose; membership. new text end

new text begin The Advisory Council on Water Supply Systems and Wastewater Treatment Facilities shall advise the commissioners of health and the Pollution Control Agency regarding classification of water supply systems and wastewater treatment facilities, qualifications and competency evaluation of water supply system operators and wastewater treatment facility operators, and additional laws, rules, and procedures that may be desirable for regulating the operation of water supply systems and of wastewater treatment facilities. The advisory council is composed of 11 voting members, of whom: new text end

new text begin (1) one member must be from the Department of Health, Division of Environmental Health, appointed by the commissioner of health; new text end

new text begin (2) one member must be from the Pollution Control Agency appointed by the commissioner of the Pollution Control Agency; new text end

new text begin (3) three members must be certified water supply system operators, appointed by the commissioner of health, one of whom must represent a nonmunicipal community or nontransient noncommunity water supply system; new text end

new text begin (4) three members must be certified wastewater treatment facility operators, appointed by the commissioner of the Pollution Control Agency; new text end

new text begin (5) one member must be a representative from an organization representing municipalities, appointed by the commissioner of health with the concurrence of the commissioner of the Pollution Control Agency; and new text end

new text begin (6) two members must be members of the public who are not associated with water supply systems or wastewater treatment facilities. One must be appointed by the commissioner of health and the other by the commissioner of the Pollution Control Agency. Consideration should be given to one of these members being a representative of academia knowledgeable in water or wastewater matters. new text end

new text begin Subd. 2. new text end

new text begin Geographic representation. new text end

new text begin At least one of the water supply system operators and at least one of the wastewater treatment facility operators must be from outside the seven-county metropolitan area and one wastewater treatment facility operator must be from the Metropolitan Council. new text end

new text begin Subd. 3. new text end

new text begin Terms; compensation. new text end

new text begin The terms of the appointed members and the compensation and removal of all members are governed by section 15.059. new text end

new text begin Subd. 4. new text end

new text begin Officers. new text end

new text begin When new members are appointed to the council, a chair must be elected at the next council meeting. The Department of Health representative shall serve as secretary of the council. new text end

Sec. 13.

Minnesota Statutes 2022, section 121A.335, is amended to read:

121A.335 LEAD IN SCHOOL DRINKING WATER.

Subdivision 1.

Model plan.

The commissioners of health and education shall jointly develop a model plan to require school districts to accurately and efficiently test for the presence of lead in water in public school buildings serving students in kindergarten through grade 12. To the extent possible, the commissioners shall base the plan on the standards established by the United States Environmental Protection Agency. The plan may be based on the technical guidance in the Department of Health's document, "Reducing Lead in Drinking Water: A Technical Guidance for Minnesota's School and Child Care Facilities." new text begin The plan must include recommendations for remediation efforts when testing reveals the presence of lead at or above five parts per billion. new text end

Subd. 2.

School plans.

new text begin (a) new text end By July 1, 2018, the board of each school district or charter school must adopt the commissioners' model plan or develop and adopt an alternative plan to accurately and efficiently test for the presence of lead in water in school buildings serving prekindergarten students and students in kindergarten through grade 12.

new text begin (b) By July 1, 2024, a school district or charter school must revise its plan to include its policies and procedures for ensuring consistent water quality throughout the district's or charter school's facilities. The plan must document the routine water management strategies and procedures used in each building or facility to maintain water quality and reduce exposure to lead. A district or charter school must base the plan on the United States Environmental Protection Agency's "Ensuring Drinking Water Quality in Schools During and After Extended Closures" fact sheet and the United States Environmental Protection Agency's "3Ts Toolkit for Reducing Lead in Drinking Water in Schools and Child Care Facilities" manual. A district or charter school's plan must be publicly available upon request. new text end

Subd. 3.

Frequency of testing.

(a) The plan under subdivision 2 must include a testing schedule for every building serving prekindergarten through grade 12 students. The schedule must require that each building be tested at least once every five years. A school district or charter school must begin testing school buildings by July 1, 2018, and complete testing of all buildings that serve students within five years.

(b) A school district or charter school that finds lead at a specific location providing cooking or drinking water within a facility must formulate, make publicly available, and implement a plan that is consistent with established guidelines and recommendations to ensure that student exposure to lead is deleted text begin minimized deleted text end new text begin reduced to below five parts per billion as verified by a retest new text end . This includes, when a school district or charter school finds the presence of lead deleted text begin at a level where action should be taken as set by the guidance deleted text end new text begin at or above five parts per billion new text end in any water deleted text begin source deleted text end new text begin fixture new text end that can provide cooking or drinking water, immediately shutting off the water deleted text begin source deleted text end new text begin fixture new text end or making it unavailable until the hazard has been deleted text begin minimized deleted text end new text begin remediated as verified by a retest new text end .

new text begin (c) A school district or charter school must test for the presence of lead after completing remediation activities required under this section to confirm that the water contains lead at a level below five parts per billion. new text end

Subd. 4.

Ten-year facilities plan.

A school district may include lead testing and remediation as a part of its ten-year facilities plan under section 123B.595.

Subd. 5.

Reporting.

new text begin (a) new text end A school district or charter school deleted text begin that has tested its buildings for the presence of lead shall make the results of the testing available to the public for review and must notify parents of the availability of the information. School districts and charter schools must follow the actions outlined in guidance from the commissioners of health and education. deleted text end new text begin must send parents an annual notice that includes the district's or charter school's annual testing and remediation plan, information about how to find test results, and a description of remediation efforts on the district website. The district or charter school must update the lead testing and remediation information on its website at least annually. In addition to the annual notice, the district or charter school must include in an official school handbook or official school policy guide information on how parents may find the test results and a description of remediation efforts on the district or charter school website and how often this information is updated. new text end

new text begin (b) new text end If a test conducted under subdivision 3, paragraph (a), reveals the presence of lead new text begin at or new text end above deleted text begin a level where action should be taken as set by the guidance deleted text end new text begin five parts per billion new text end , the school district or charter school must, within 30 days of receiving the test result, either remediate the presence of lead to below deleted text begin the level set in guidance deleted text end new text begin five parts per billion new text end , verified by retest, or directly notify parents of the test result. deleted text begin The school district or charter school must make the water source unavailable until the hazard has been minimized. deleted text end

new text begin (c) Starting July 1, 2024, school districts and charter schools must report their test results and remediation activities to the commissioner of health in the form and manner determined by the commissioner in consultation with school districts and charter schools, by July 1 of each year. The commissioner of health must post and annually update the test results and remediation efforts on the department website by school site. new text end

new text begin (d) A district or charter school must maintain a record of lead testing results and remediation activities for at least 15 years. new text end

new text begin Subd. 6. new text end

new text begin Public water systems. new text end

new text begin (a) A district or charter school is not financially responsible for remediation of documented elevated lead levels in drinking water caused by the presence of lead infrastructure owned by a public water supply utility providing water to the school facility, such as lead service lines, meters, galvanized service lines downstream of lead, or lead connectors. The district or charter school must communicate with the public water system regarding its documented significant contribution to lead contamination in school drinking water and request from the public water system a plan for reducing the lead contamination. new text end

new text begin (b) If the infrastructure is jointly owned by a district or charter school and a public water supply utility, the district or charter school must attempt to coordinate any needed replacements of lead service lines with the public water supply utility. new text end

new text begin (c) A district or charter school may defer its remediation activities under this section until after the elevated lead level in the public water system's infrastructure is remediated and postremediation testing does not detect an elevated lead level in the drinking water that passes through that infrastructure. A district or charter school may also defer its remediation activities if the public water supply exceeds the federal Safe Drinking Water Act lead action level or is in violation of the Safe Drinking Water Act Lead and Copper Rule. new text end

new text begin Subd. 7. new text end

new text begin Commissioner recommendations. new text end

new text begin By January 1, 2026, and every five years thereafter, the commissioner of health must report to the legislative committees having jurisdiction over health and kindergarten through grade 12 education any recommended changes to this section. The recommendations must be based on currently available scientific evidence regarding the effects of lead in drinking water. new text end

Sec. 14.

new text begin [144.0526] MINNESOTA ONE HEALTH ANTIMICROBIAL STEWARDSHIP COLLABORATIVE. new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of health shall establish the Minnesota One Health Antimicrobial Stewardship Collaborative. The commissioner shall appoint a director to execute operations, conduct health education, and provide technical assistance. new text end

new text begin Subd. 2. new text end

new text begin Commissioner's duties. new text end

new text begin The commissioner of health shall oversee a program to: new text end

new text begin (1) maintain the position of director of One Health Antimicrobial Stewardship to lead state antimicrobial stewardship initiatives across human, animal, and environmental health; new text end

new text begin (2) communicate to professionals and the public the interconnectedness of human, animal, and environmental health, especially related to preserving the efficacy of antibiotic medications, which are a shared resource; new text end

new text begin (3) leverage new and existing partnerships. The commissioner of health shall consult and collaborate with academic institutions, industry and community organizations, and organizations and agencies in fields including but not limited to health care, veterinary medicine, and animal agriculture to inform strategies for education, practice improvement, and research in all settings where antimicrobial products are used; new text end

new text begin (4) ensure that veterinary settings have education and strategies needed to practice appropriate antibiotic prescribing, implement clinical antimicrobial stewardship programs, and prevent transmission of antimicrobial-resistant microbes; and new text end

new text begin (5) support collaborative research and programmatic initiatives to improve the understanding of the impact of antimicrobial use and resistance in the natural environment. new text end

new text begin Subd. 3. new text end

new text begin Biennial report. new text end

new text begin By January 15, 2025, and every two years thereafter, the commissioner of health shall report to the chairs and ranking minority members of the legislative committees with primary jurisdiction over health policy and finance on the work accomplished by the commissioner under this section and the collaborative research conducted in the previous two years and on program goals for the upcoming two years. new text end

Sec. 15.

new text begin [144.0528] COMPREHENSIVE DRUG OVERDOSE AND MORBIDITY PREVENTION ACT. new text end

new text begin Subdivision 1. new text end

new text begin Definition. new text end

new text begin For the purpose of this section, "drug overdose and morbidity" means health problems that people experience after inhaling, ingesting, or injecting medicines in quantities that exceed prescription status; medicines taken that are prescribed to a different person; medicines that have been adulterated or adjusted by contaminants intentionally or unintentionally; or nonprescription drugs in amounts that result in morbidity or mortality. new text end

new text begin Subd. 2. new text end

new text begin Establishment. new text end

new text begin The commissioner of health shall establish a comprehensive drug overdose and morbidity program to conduct comprehensive drug overdose and morbidity prevention activities, epidemiologic investigations and surveillance, and evaluation to monitor, address, and prevent drug overdoses statewide through integrated strategies that include the following: new text end

new text begin (1) advance access to evidence-based nonnarcotic pain management services; new text end

new text begin (2) implement culturally specific interventions and prevention programs with population and community groups in greatest need, including those who are pregnant and their infants; new text end

new text begin (3) enhance overdose prevention and supportive services for people experiencing homelessness. This strategy includes funding for emergency and short-term housing subsidies through the homeless overdose prevention hub and expanding support for syringe services programs serving people experiencing homelessness statewide; new text end

new text begin (4) equip employers to promote health and well-being of employees by addressing substance misuse and drug overdose; new text end

new text begin (5) improve outbreak detection and identification of substances involved in overdoses through the expansion of the Minnesota Drug Overdose and Substance Use Surveillance Activity (MNDOSA); new text end

new text begin (6) implement Tackling Overdose With Networks (TOWN) community prevention programs; new text end

new text begin (7) identify, address, and respond to drug overdose and morbidity in those who are pregnant or have just given birth through multitiered approaches that may: new text end

new text begin (i) promote medication-assisted treatment options; new text end

new text begin (ii) support programs that provide services in accord with evidence-based care models for mental health and substance abuse disorder; new text end

new text begin (iii) collaborate with interdisciplinary and professional organizations that focus on quality improvement initiatives related to substance use disorder; and new text end

new text begin (iv) implement substance use disorder-related recommendations from the maternal mortality review committee, as appropriate; and new text end

new text begin (8) design a system to assess, address, and prevent the impacts of drug overdose and morbidity on those who are pregnant, their infants, and children. Specifically, the commissioner of health may: new text end

new text begin (i) inform health care providers and the public of the prevalence, risks, conditions, and treatments associated with substance use disorders involving or affecting pregnancies, infants, and children; and new text end

new text begin (ii) identify communities, families, infants, and children affected by substance use disorder in order to recommend focused interventions, prevention, and services. new text end

new text begin Subd. 3. new text end

new text begin Partnerships. new text end

new text begin The commissioner of health may consult with sovereign Tribal nations, the Minnesota Departments of Human Services, Corrections, Public Safety, and Education, local public health agencies, care providers and insurers, community organizations that focus on substance abuse risks and recovery, individuals affected by substance use disorders, and any other individuals, entities, and organizations as necessary to carry out the goals of this section. new text end

new text begin Subd. 4. new text end

new text begin Grants authorized. new text end

new text begin (a) The commissioner of health may award grants, as funding allows, to entities and organizations focused on addressing and preventing the negative impacts of drug overdose and morbidity. Examples of activities the commissioner may consider for these grant awards include: new text end

new text begin (1) developing, implementing, or promoting drug overdose and morbidity prevention programs and activities; new text end

new text begin (2) community outreach and other efforts addressing the root causes of drug overdose and morbidity; new text end

new text begin (3) identifying risk and protective factors relating to drug overdose and morbidity that contribute to identification, development, or improvement of prevention strategies and community outreach; new text end

new text begin (4) developing or providing trauma-informed drug overdose and morbidity prevention and services; new text end

new text begin (5) developing or providing culturally and linguistically appropriate drug overdose and morbidity prevention and services, and programs that target and serve historically underserved communities; new text end

new text begin (6) working collaboratively with educational institutions, including school districts, to implement drug overdose and morbidity prevention strategies for students, teachers, and administrators; new text end

new text begin (7) working collaboratively with sovereign Tribal nations, care providers, nonprofit organizations, for-profit organizations, government entities, community-based organizations, and other entities to implement substance misuse and drug overdose prevention strategies within their communities; and new text end

new text begin (8) creating or implementing quality improvement initiatives to improve drug overdose and morbidity treatment and outcomes. new text end

new text begin (b) Any organization or government entity receiving grant money under this section must collect and make available to the commissioner of health aggregate data related to the activity funded by the program under this section. The commissioner of health shall use the information and data from the program evaluation to inform the administration of existing Department of Health programming and the development of Department of Health policies, programs, and procedures. new text end

new text begin Subd. 5. new text end

new text begin Promotion; administration. new text end

new text begin In fiscal years 2026 and beyond, the commissioner may spend up to 25 percent of the total funding appropriated for the comprehensive drug overdose and morbidity program in each fiscal year to promote, administer, support, and evaluate the programs authorized under this section and to provide technical assistance to program grantees. new text end

new text begin Subd. 6. new text end

new text begin External contributions. new text end

new text begin The commissioner may accept contributions from governmental and nongovernmental sources and may apply for grants to supplement state appropriations for the programs authorized under this section. Contributions and grants received from the sources identified in this subdivision to advance the purpose of this section are appropriated to the commissioner for the comprehensive drug overdose and morbidity program. new text end

new text begin Subd. 7. new text end

new text begin Program evaluation. new text end

new text begin Beginning February 28, 2024, the commissioner of health shall report every even-numbered year to the legislative committees with jurisdiction over health detailing the expenditures of funds authorized under this section. The commissioner shall use the data to evaluate the effectiveness of the program. The commissioner must include in the report: new text end

new text begin (1) the number of organizations receiving grant money under this section; new text end

new text begin (2) the number of individuals served by the grant programs; new text end

new text begin (3) a description and analysis of the practices implemented by program grantees; and new text end

new text begin (4) best practices recommendations to prevent drug overdose and morbidity, including culturally relevant best practices and recommendations focused on historically underserved communities. new text end

new text begin Subd. 8. new text end

new text begin Measurement. new text end

new text begin Notwithstanding any law to the contrary, the commissioner of health shall assess and evaluate grants and contracts awarded using available data sources, including but not limited to the Minnesota All Payer Claims Database (MN APCD), the Minnesota Behavioral Risk Factor Surveillance System (BRFSS), the Minnesota Student Survey, vital records, hospitalization data, syndromic surveillance, and the Minnesota Electronic Health Record Consortium. new text end

Sec. 16.

new text begin [144.0752] CULTURAL COMMUNICATIONS. new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of health shall establish: new text end

new text begin (1) a cultural communications program that advances culturally and linguistically appropriate communication services for communities most impacted by health disparities that include limited English proficient (LEP) populations, refugees, immigrant communities, American Indians, populations of color, LGBTQ+ populations, persons who are deaf, deafblind, or hard of hearing and who use American Sign Language, and people living with disabilities; and new text end

new text begin (2) a position that works with department and division leadership to ensure that the department follows the National Standards for Culturally and Linguistically Appropriate Services (CLAS) Standards. new text end

new text begin Subd. 2. new text end

new text begin Commissioner's duties. new text end

new text begin The commissioner of health shall oversee a program to: new text end

new text begin (1) align the department services, policies, procedures, and governance with the National CLAS Standards, establish culturally and linguistically appropriate goals, policies, and management accountability, and apply them throughout the organization's planning and operations; new text end

new text begin (2) ensure the department services respond to the cultural and linguistic diversity of Minnesotans and that the department partners with the community to design, implement, and evaluate policies, practices, and services that are aligned with the national cultural and linguistic appropriateness standard; and new text end

new text begin (3) ensure the department leadership, workforce, and partners embed culturally and linguistically appropriate policies and practices into leadership and public health program planning, intervention, evaluation, and dissemination. new text end

new text begin Subd. 3. new text end

new text begin Eligible contractors. new text end

new text begin The commissioner may enter into contracts to implement this section. Organizations eligible to receive contract funding under this section include: new text end

new text begin (1) master contractors that are selected through the state to provide language and communication services; and new text end

new text begin (2) organizations that are able to provide services for languages that master contractors are unable to cover. new text end

Sec. 17.

new text begin [144.0754] OFFICE OF AFRICAN AMERICAN HEALTH; DUTIES. new text end

new text begin (a) The commissioner shall establish the Office of African American Health to address the unique public health needs of African American Minnesotans. The office must work to develop solutions and systems to address identified health disparities of African American Minnesotans arising from a context of cumulative and historical discrimination and disadvantages in multiple systems, including but not limited to housing, education, employment, gun violence, incarceration, environmental factors, and health care discrimination. The office shall: new text end

new text begin (1) convene the African American Health State Advisory Council under section 144.0755 to advise the commissioner on issues and to develop specific, targeted policy solutions to improve the health of African American Minnesotans, with a focus on United States born African Americans; new text end

new text begin (2) based upon input from and collaboration with the African American Health State Advisory Council, health indicators, and identified disparities, conduct analysis and develop policy and program recommendations and solutions targeted at improving African American health outcomes; new text end

new text begin (3) coordinate and conduct community engagement across multiple systems, sectors, and communities to address racial disparities in labor force participation, educational achievement, and involvement with the criminal justice system that impact African American health and well-being; new text end

new text begin (4) conduct data analysis and research to support policy goals and solutions; new text end

new text begin (5) award and administer African American health special emphasis grants to health and community-based organizations to plan and develop programs targeted at improving African American health outcomes, based upon needs identified by the council, health indicators, and identified disparities and addressing historical trauma and systems of United States born African American Minnesotans; and new text end

new text begin (6) develop and administer Department of Health immersion experiences for students in secondary education and community colleges to improve diversity of the public health workforce and introduce career pathways that contribute to reducing health disparities. new text end

new text begin (b) By January 15, 2025, and every two years thereafter, the commissioner of health shall report to the chairs and ranking minority members of the legislative committees with primary jurisdiction over health policy and finance on the work accomplished by the Office of African American Health during the previous two years and on goals of the office for the upcoming two years. new text end

Sec. 18.

new text begin [144.0755] AFRICAN AMERICAN HEALTH STATE ADVISORY COUNCIL. new text end

new text begin Subdivision 1. new text end

new text begin Establishment; members. new text end

new text begin (a) The commissioner of health shall establish and administer the African American Health State Advisory Council. The African American Health State Advisory Council shall include no fewer than 12 or more than 20 members from any of the following groups: new text end

new text begin (1) representatives of community-based organizations serving or advocating for African American citizens; new text end

new text begin (2) at-large community leaders or elders, as nominated by other council members; new text end

new text begin (3) African American individuals who provide and receive health care services; new text end

new text begin (4) African American secondary or college students; new text end

new text begin (5) health or human service professionals serving African American communities or clients; new text end

new text begin (6) representatives with research or academic expertise in racial equity; and new text end

new text begin (7) other members that the commissioner deems appropriate to facilitate the goals and duties of the council. new text end

new text begin (b) The commissioner shall make recommendations for council membership and, after considering recommendations from the council, shall appoint a chair or chairs of the council. Council members shall be appointed by the governor. new text end

new text begin Subd. 2. new text end

new text begin Terms. new text end

new text begin A term shall be for two years and appointees may be reappointed to serve two additional terms. The commissioner shall recommend appointments to replace members vacating their positions in a timely manner, no more than three months after the council reviews panel recommendations. new text end

new text begin Subd. 3. new text end

new text begin Duties of commissioner. new text end

new text begin The commissioner or commissioner's designee shall: new text end

new text begin (1) maintain and actively engage with the council established in this section; new text end

new text begin (2) based on recommendations of the council, review identified department or other related policies or practices that maintain health inequities and disparities that particularly affect African Americans in Minnesota; new text end

new text begin (3) in partnership with the council, recommend or implement action plans and resources necessary to address identified disparities and advance African American health equity; new text end

new text begin (4) support interagency collaboration to advance African American health equity; and new text end

new text begin (5) support member participation in the council, including participation in educational and community engagement events across Minnesota that specifically address African American health equity. new text end

new text begin Subd. 4. new text end

new text begin Duties of council. new text end

new text begin The council shall: new text end

new text begin (1) identify health disparities found in African American communities and contributing factors; new text end

new text begin (2) recommend to the commissioner for review any statutes, rules, or administrative policies or practices that would address African American health disparities; new text end

new text begin (3) recommend policies and strategies to the commissioner of health to address disparities specifically affecting African American health; new text end

new text begin (4) form work groups of council members who are persons who provide and receive services and representatives of advocacy groups; new text end

new text begin (5) provide the work groups with clear guidelines, standardized parameters, and tasks for the work groups to accomplish; and new text end

new text begin (6) annually submit to the commissioner a report that summarizes the activities of the council, identifies disparities specially affecting the health of African American Minnesotans, and makes recommendations to address identified disparities. new text end

new text begin Subd. 5. new text end

new text begin Duties of council members. new text end

new text begin The members of the council shall: new text end

new text begin (1) attend scheduled meetings with no more than three absences per year, participate in scheduled meetings, and prepare for meetings by reviewing meeting notes; new text end

new text begin (2) maintain open communication channels with respective constituencies; new text end

new text begin (3) identify and communicate issues and risks that may impact the timely completion of tasks; new text end

new text begin (4) participate in any activities the council or commissioner deems appropriate and necessary to facilitate the goals and duties of the council; and new text end

new text begin (5) participate in work groups to carry out council duties. new text end

new text begin Subd. 6. new text end

new text begin Staffing; office space; equipment. new text end

new text begin The commissioner shall provide the advisory council with staff support, office space, and access to office equipment and services. new text end

new text begin Subd. 7. new text end

new text begin Reimbursement. new text end

new text begin Compensation and reimbursement for travel and expenses incurred for council activities are governed by section 15.059, subdivision 3. new text end

Sec. 19.

new text begin [144.0756] AFRICAN AMERICAN HEALTH SPECIAL EMPHASIS GRANT PROGRAM. new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of health shall establish the African American health special emphasis grant program administered by the Office of African American Health. The purposes of the program are to: new text end

new text begin (1) identify disparities impacting African American health arising from cumulative and historical discrimination and disadvantages in multiple systems, including but not limited to housing, education, employment, gun violence, incarceration, environmental factors, and health care discrimination; and new text end

new text begin (2) develop community-based solutions that incorporate a multisector approach to addressing identified disparities impacting African American health. new text end

new text begin Subd. 2. new text end

new text begin Requests for proposals; accountability; data collection. new text end

new text begin As directed by the commissioner of health, the Office of African American Health shall: new text end

new text begin (1) develop a request for proposals for an African American health special emphasis grant program in consultation with community stakeholders; new text end

new text begin (2) provide outreach, technical assistance, and program development guidance to potential qualifying organizations or entities; new text end

new text begin (3) review responses to requests for proposals in consultation with community stakeholders and award grants under this section; new text end

new text begin (4) establish a transparent and objective accountability process in consultation with community stakeholders, focused on outcomes that grantees agree to achieve; new text end

new text begin (5) provide grantees with access to summary and other public data to assist grantees in establishing and implementing effective community-led solutions; and new text end

new text begin (6) collect and maintain data on outcomes reported by grantees. new text end

new text begin Subd. 3. new text end

new text begin Eligible grantees. new text end

new text begin Organizations eligible to receive grant funding under this section include nonprofit organizations or entities that work with African American communities or are focused on addressing disparities impacting the health of African American communities. new text end

new text begin Subd. 4. new text end

new text begin Strategic consideration and priority of proposals; grant awards. new text end

new text begin In developing the requests for proposals and awarding the grants, the commissioner and the Office of African American Health shall consider building upon the existing capacity of communities and on developing capacity where it is lacking. Proposals shall focus on addressing health equity issues specific to United States-born African American communities; addressing the health impact of historical trauma; reducing health disparities experienced by United States-born African American communities; and incorporating a multisector approach to addressing identified disparities. new text end

new text begin Subd. 5. new text end

new text begin Report. new text end

new text begin Grantees must report grant program outcomes to the commissioner on the forms and according to timelines established by the commissioner. new text end

Sec. 20.

new text begin [144.0757] OFFICE OF AMERICAN INDIAN HEALTH. new text end

new text begin Subdivision 1. new text end

new text begin Duties. new text end

new text begin The Office of American Indian Health is established to address unique public health needs of American Indian Tribal communities in Minnesota. The office shall: new text end

new text begin (1) coordinate with Minnesota's Tribal Nations and urban American Indian community-based organizations to identify underlying causes of health disparities, address unique health needs of Minnesota's Tribal communities, and develop public health approaches to achieve health equity; new text end

new text begin (2) strengthen capacity of American Indian and community-based organizations and Tribal Nations to address identified health disparities and needs; new text end

new text begin (3) administer state and federal grant funding opportunities targeted to improve the health of American Indians; new text end

new text begin (4) provide overall leadership for targeted development of holistic health and wellness strategies to improve health and to support Tribal and urban American Indian public health leadership and self-sufficiency; new text end

new text begin (5) provide technical assistance to Tribal and American Indian urban community leaders to develop culturally appropriate activities to address public health emergencies; new text end

new text begin (6) develop and administer the department immersion experiences for American Indian students in secondary education and community colleges to improve diversity of the public health workforce and introduce career pathways that contribute to reducing health disparities; and new text end

new text begin (7) identify and promote workforce development strategies for Department of Health staff to work with the American Indian population and Tribal Nations more effectively in Minnesota. new text end

new text begin Subd. 2. new text end

new text begin Grants and contracts. new text end

new text begin To carry out these duties, the office may contract with or provide grants to qualifying entities. new text end

new text begin Subd. 3. new text end

new text begin Reporting. new text end

new text begin By January 15, 2025, and every two years thereafter, the commissioner of health shall report to the chairs and ranking minority members of the legislative committees with primary jurisdiction over health policy and finance on the work accomplished by the Office of American Indian Health during the previous two years and on goals of the office for the upcoming two years. new text end

Sec. 21.

new text begin [144.0758] AMERICAN INDIAN HEALTH SPECIAL EMPHASIS GRANTS. new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of health shall establish the American Indian health special emphasis grant program. The purposes of the program are to: new text end

new text begin (1) plan and develop programs targeted to address continuing and persistent health disparities of Minnesota's American Indian population and improve American Indian health outcomes based upon needs identified by health indicators and identified disparities; new text end

new text begin (2) identify disparities in American Indian health arising from cumulative and historical discrimination; and new text end

new text begin (3) plan and develop community-based solutions with a multisector approach to addressing identified disparities in American Indian health. new text end

new text begin Subd. 2. new text end

new text begin Commissioner's duties. new text end

new text begin The commissioner of health shall: new text end

new text begin (1) develop a request for proposals for an American Indian health special emphasis grant program in consultation with Minnesota's Tribal Nations and urban American Indian community-based organizations based upon needs identified by the community, health indicators, and identified disparities; new text end

new text begin (2) provide outreach, technical assistance, and program development guidance to potential qualifying organizations or entities; new text end

new text begin (3) review responses to requests for proposals in consultation with community stakeholders and award grants under this section; new text end

new text begin (4) establish a transparent and objective accountability process in consultation with community stakeholders focused on outcomes that grantees agree to achieve; new text end

new text begin (5) provide grantees with access to data to assist grantees in establishing and implementing effective community-led solutions; and new text end

new text begin (6) collect and maintain data on outcomes reported by grantees. new text end

new text begin Subd. 3. new text end

new text begin Eligible grantees. new text end

new text begin Organizations eligible to receive grant funding under this section are Minnesota's Tribal Nations and urban American Indian community-based organizations. new text end

new text begin Subd. 4. new text end

new text begin Strategic consideration and priority of proposals; grant awards. new text end

new text begin In developing the proposals and awarding the grants, the commissioner shall consider building upon the existing capacity of Minnesota's Tribal Nations and urban American Indian community-based organizations and on developing capacity where it is lacking. Proposals may focus on addressing health equity issues specific to Tribal and urban American Indian communities; addressing the health impact of historical trauma; reducing health disparities experienced by American Indian communities; and incorporating a multisector approach to addressing identified disparities. new text end

new text begin Subd. 5. new text end

new text begin Report. new text end

new text begin Grantees must report grant program outcomes to the commissioner on the forms and according to the timelines established by the commissioner. new text end

Sec. 22.

new text begin [144.0759] PUBLIC HEALTH AMERICORPS. new text end

new text begin The commissioner may award a grant to a statewide, nonprofit organization to support Public Health AmeriCorps members. The organization awarded the grant shall provide the commissioner with any information needed by the commissioner to evaluate the program in the form and according to timelines specified by the commissioner. new text end

Sec. 23.

Minnesota Statutes 2022, section 144.122, is amended to read:

144.122 LICENSE, PERMIT, AND SURVEY FEES.

(a) The state commissioner of health, by rule, may prescribe 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 Management and Budget. 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 disabilities 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 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) and American Osteopathic Association (AOA) hospitals	$7,655 plus $16 per bed
Non-JCAHO and non-AOA hospitals	$5,280 plus $250 per bed
Nursing home	$183 plus $91 per bed until June 30, 2018. $183 plus $100 per bed between July 1, 2018, and June 30, 2020. $183 plus $105 per bed beginning July 1, 2020.

The commissioner shall set license fees for outpatient surgical centers, boarding care homes, supervised living facilities, assisted living facilities, and assisted living facilities with dementia care at the following levels:

Outpatient surgical centers	$3,712
Boarding care homes	$183 plus $91 per bed
Supervised living facilities	$183 plus $91 per bed.
Assisted living facilities with dementia care	$3,000 plus $100 per resident.
Assisted living facilities	$2,000 plus $75 per resident.

Fees collected under this paragraph are nonrefundable. The fees are nonrefundable even if received before July 1, 2017, for licenses or registrations being issued effective July 1, 2017, or later.

(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 hospitals	$	900
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 outpatient facilities	$	1,200
Hospice providers	$	1,700
Ambulatory surgical providers	$	1,800
Hospitals	$	4,200
Other provider categories or additional resurveys required to complete initial certification	Actual surveyor costs: average surveyor cost x 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.

(f) Notwithstanding section 16A.1283, the commissioner may adjust the fees assessed on assisted living facilities and assisted living facilities with dementia care under paragraph (d), in a revenue-neutral manner in accordance with the requirements of this paragraph:

(1) a facility seeking to renew a license shall pay a renewal fee in an amount that is up to ten percent lower than the applicable fee in paragraph (d) if residents who receive home and community-based waiver services under chapter 256S and section 256B.49 comprise more than 50 percent of the facility's capacity in the calendar year prior to the year in which the renewal application is submitted; and

(2) a facility seeking to renew a license shall pay a renewal fee in an amount that is up to ten percent higher than the applicable fee in paragraph (d) if residents who receive home and community-based waiver services under chapter 256S and section 256B.49 comprise less than 50 percent of the facility's capacity during the calendar year prior to the year in which the renewal application is submitted.

The commissioner may annually adjust the percentages in clauses (1) and (2), to ensure this paragraph is implemented in a revenue-neutral manner. The commissioner shall develop a method for determining capacity thresholds in this paragraph in consultation with the commissioner of human services and must coordinate the administration of this paragraph with the commissioner of human services for purposes of verification.

new text begin (g) The commissioner shall charge hospitals an annual licensing base fee of $1,826 per hospital, plus an additional $23 per licensed bed or bassinet fee. Revenue shall be deposited to the state government special revenue fund and credited toward trauma hospital designations under sections 144.605 and 144.6071. new text end

Sec. 24.

new text begin [144.1462] COMMUNITY HEALTH WORKERS; GRANTS AUTHORIZED. new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of health shall support collaboration and coordination between state and community partners to develop, refine, and expand the community health workers profession in Minnesota; equip community health workers to address health needs; and to improve health outcomes. This work must address the social conditions that impact community health and well-being in public safety, social services, youth and family services, schools, and neighborhood associations. new text end

new text begin Subd. 2. new text end

new text begin Grants and contracts authorized; eligibility. new text end

new text begin The commissioner of health shall award grants or enter into contracts to expand and strengthen the community health worker workforce across Minnesota. The grant recipients or contractor shall include at least one not-for-profit community organization serving, convening, and supporting community health workers statewide. new text end

new text begin Subd. 3. new text end

new text begin Evaluation. new text end

new text begin The commissioner of health shall design, conduct, and evaluate the community health worker initiative using measures such as workforce capacity, employment opportunity, reach of services, and return on investment, as well as descriptive measures of the existing community health worker models as they compare with the national community health workers' landscape. These initial measures point to longer-term change in social determinants of health and rates of death and injury by suicide, overdose, firearms, alcohol, and chronic disease. new text end

new text begin Subd. 4. new text end

new text begin Report. new text end

new text begin Grant recipients and contractors must report program outcomes to the department annually and by the guidelines established by the commissioner. new text end

Sec. 25.

Minnesota Statutes 2022, section 144.1505, is amended to read:

144.1505 HEALTH PROFESSIONALS CLINICAL TRAINING EXPANSION new text begin AND RURAL AND UNDERSERVED CLINICAL ROTATIONS new text end GRANT deleted text begin PROGRAM deleted text end new text begin PROGRAMS new text end .

Subdivision 1.

Definitions.

For purposes of this section, the following definitions apply:

(1) "eligible advanced practice registered nurse program" means a program that is located in Minnesota and is currently accredited as a master's, doctoral, or postgraduate level advanced practice registered nurse program by the Commission on Collegiate Nursing Education or by the Accreditation Commission for Education in Nursing, or is a candidate for accreditation;

(2) "eligible dental therapy program" means a dental therapy education program or advanced dental therapy education program that is located in Minnesota and is either:

(i) approved by the Board of Dentistry; or

(ii) currently accredited by the Commission on Dental Accreditation;

(3) "eligible mental health professional program" means a program that is located in Minnesota and is listed as a mental health professional program by the appropriate accrediting body for clinical social work, psychology, marriage and family therapy, or licensed professional clinical counseling, or is a candidate for accreditation;

(4) "eligible pharmacy program" means a program that is located in Minnesota and is currently accredited as a doctor of pharmacy program by the Accreditation Council on Pharmacy Education;

(5) "eligible physician assistant program" means a program that is located in Minnesota and is currently accredited as a physician assistant program by the Accreditation Review Commission on Education for the Physician Assistant, or is a candidate for accreditation;

(6) "mental health professional" means an individual providing clinical services in the treatment of mental illness who meets one of the qualifications under section 245.462, subdivision 18; deleted text begin and deleted text end

new text begin (7) "eligible physician training program" means a physician residency training program located in Minnesota and that is currently accredited by the accrediting body or has presented a credible plan as a candidate for accreditation; new text end

new text begin (8) "eligible dental program" means a dental education program or a dental residency training program located in Minnesota and that is currently accredited by the accrediting body or has presented a credible plan as a candidate for accreditation; and new text end

deleted text begin (7) deleted text end new text begin (9) new text end "project" means a project to establish or expand clinical training for physician assistants, advanced practice registered nurses, pharmacists, dental therapists, advanced dental therapists, or mental health professionals in Minnesota.

Subd. 2.

deleted text begin Program deleted text end new text begin Programs new text end .

(a) new text begin For advanced practice provider clinical training expansion grants, new text end the commissioner of health shall award health professional training site grants to eligible physician assistant, advanced practice registered nurse, pharmacy, dental therapy, and mental health professional programs to plan and implement expanded clinical training. A planning grant shall not exceed $75,000, and a training grant shall not exceed $150,000 for the first year, $100,000 for the second year, and $50,000 for the third year per program.

new text begin (b) For health professional rural and underserved clinical rotations grants, the commissioner of health shall award health professional training site grants to eligible physician, physician assistant, advanced practice registered nurse, pharmacy, dentistry, dental therapy, and mental health professional programs to augment existing clinical training programs to add rural and underserved rotations or clinical training experiences, such as credential or certificate rural tracks or other specialized training. For physician and dentist training, the expanded training must include rotations in primary care settings such as community clinics, hospitals, health maintenance organizations, or practices in rural communities. new text end

deleted text begin (b) deleted text end new text begin (c) new text end Funds may be used for:

(1) establishing or expanding new text begin rotations and new text end clinical training deleted text begin for physician assistants, advanced practice registered nurses, pharmacists, dental therapists, advanced dental therapists, and mental health professionals in Minnesota deleted text end ;

(2) recruitment, training, and retention of students and faculty;

(3) connecting students with appropriate clinical training sites, internships, practicums, or externship activities;

(4) travel and lodging for students;

(5) faculty, student, and preceptor salaries, incentives, or other financial support;

(6) development and implementation of cultural competency training;

(7) evaluations;

(8) training site improvements, fees, equipment, and supplies required to establish, maintain, or expand a deleted text begin physician assistant, advanced practice registered nurse, pharmacy, dental therapy, or mental health professional deleted text end training program; and

(9) supporting clinical education in which trainees are part of a primary care team model.

Subd. 3.

Applications.

Eligible physician assistant, advanced practice registered nurse, pharmacy, dental therapy, new text begin dental, physician, new text end and mental health professional programs seeking a grant shall apply to the commissioner. Applications must include a description of the number of additional students who will be trained using grant funds; attestation that funding will be used to support an increase in the number of clinical training slots; a description of the problem that the proposed project will address; a description of the project, including all costs associated with the project, sources of funds for the project, detailed uses of all funds for the project, and the results expected; and a plan to maintain or operate any component included in the project after the grant period. The applicant must describe achievable objectives, a timetable, and roles and capabilities of responsible individuals in the organization. new text begin Applicants applying under subdivision 2, paragraph (b), must include information about length of training and training site settings, geographic location of rural sites, and rural populations expected to be served. new text end

Subd. 4.

Consideration of applications.

The commissioner shall review each application to determine whether or not the application is complete and whether the program and the project are eligible for a grant. In evaluating applications, the commissioner shall score each application based on factors including, but not limited to, the applicant's clarity and thoroughness in describing the project and the problems to be addressed, the extent to which the applicant has demonstrated that the applicant has made adequate provisions to ensure proper and efficient operation of the training program once the grant project is completed, the extent to which the proposed project is consistent with the goal of increasing access to primary care and mental health services for rural and underserved urban communities, the extent to which the proposed project incorporates team-based primary care, and project costs and use of funds.

Subd. 5.

Program oversight.

The commissioner shall determine the amount of a grant to be given to an eligible program based on the relative score of each eligible program's application new text begin , including rural locations as applicable under subdivision 2, paragraph (b) new text end , other relevant factors discussed during the review, and the funds available to the commissioner. Appropriations made to the program do not cancel and are available until expended. During the grant period, the commissioner may require and collect from programs receiving grants any information necessary to evaluate the program.

Sec. 26.

new text begin [144.1507] PRIMARY CARE RESIDENCY TRAINING GRANT PROGRAM. new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the meanings given. new text end

new text begin (b) "Eligible program" means a program that meets the following criteria: new text end

new text begin (1) is located in Minnesota; new text end

new text begin (2) trains medical residents in the specialties of family medicine, general internal medicine, general pediatrics, psychiatry, geriatrics, or general surgery in rural residency training programs or in community-based ambulatory care centers that primarily serve the underserved; and new text end

new text begin (3) is accredited by the Accreditation Council for Graduate Medical Education or presents a credible plan to obtain accreditation. new text end

new text begin (c) "Rural residency training program" means a residency program that provides an initial year of training in an accredited residency program in Minnesota. The subsequent years of the residency program are based in rural communities, utilizing local clinics and community hospitals, with specialty rotations in nearby regional medical centers. new text end

new text begin (d) "Community-based ambulatory care centers" means federally qualified health centers, community mental health centers, rural health clinics, health centers operated by the Indian Health Service, an Indian Tribe or Tribal organization, or an urban American Indian organization or an entity receiving funds under Title X of the Public Health Service Act. new text end

new text begin (e) "Eligible project" means a project to establish and maintain a rural residency training program. new text end

new text begin Subd. 2. new text end

new text begin Rural residency training program. new text end

new text begin (a) The commissioner of health shall award rural residency training program grants to eligible programs to plan, implement, and sustain rural residency training programs. A rural residency training program grant shall not exceed $250,000 per year for up to three years for planning and development, and $225,000 per resident per year for each year thereafter to sustain the program. new text end

new text begin (b) Funds may be spent to cover the costs of: new text end

new text begin (1) planning related to establishing accredited rural residency training programs; new text end

new text begin (2) obtaining accreditation by the Accreditation Council for Graduate Medical Education or another national body that accredits rural residency training programs; new text end

new text begin (3) establishing new rural residency training programs; new text end

new text begin (4) recruitment, training, and retention of new residents and faculty related to the new rural residency training program; new text end

new text begin (5) travel and lodging for new residents; new text end

new text begin (6) faculty, new resident, and preceptor salaries related to new rural residency training programs; new text end

new text begin (7) training site improvements, fees, equipment, and supplies required for new rural residency training programs; and new text end

new text begin (8) supporting clinical education in which trainees are part of a primary care team model. new text end

new text begin Subd. 3. new text end

new text begin Applications for rural residency training program grants. new text end

new text begin Eligible programs seeking a grant shall apply to the commissioner. Applications must include the number of new primary care rural residency training program slots planned, under development or under contract; a description of the training program, including location of the established residency program and rural training sites; a description of the project, including all costs associated with the project; all sources of funds for the project; detailed uses of all funds for the project; the results expected; proof of eligibility for federal graduate medical education funding, if applicable; and a plan to seek the funding. The applicant must describe achievable objectives, a timetable, and the roles and capabilities of responsible individuals in the organization. new text end

new text begin Subd. 4. new text end

new text begin Consideration of grant applications. new text end

new text begin The commissioner shall review each application to determine if the residency program application is complete, if the proposed rural residency program and residency slots are eligible for a grant, and if the program is eligible for federal graduate medical education funding, and when the funding is available. If eligible programs are not eligible for federal graduate medical education funding, the commissioner may award continuation funding to the eligible program beyond the initial grant period. The commissioner shall award grants to support training programs in family medicine, general internal medicine, general pediatrics, psychiatry, geriatrics, general surgery, and other primary care focus areas. new text end

new text begin Subd. 5. new text end

new text begin Program oversight. new text end

new text begin During the grant period, the commissioner may require and collect from grantees any information necessary to evaluate the program. Notwithstanding section 16A.28, subdivision 6, encumbrances for grants under this section issued by June 30 of each year may be certified for a period of up to five years beyond the year in which the funds were originally appropriated. new text end

Sec. 27.

new text begin [144.1508] CLINICAL HEALTH CARE TRAINING. new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the meanings given. new text end

new text begin (b) "Accredited clinical training" means the clinical training provided by a medical education program that is accredited through an organization recognized by the Department of Education, the Centers for Medicare and Medicaid Services, or another national body that reviews the accrediting organizations for multiple disciplines and whose standards for recognizing accrediting organizations are reviewed and approved by the commissioner of health. new text end

new text begin (c) "Clinical medical education program" means the accredited clinical training of physicians, medical students, residents, doctors of pharmacy practitioners, doctors of chiropractic, dentists, advanced practice nurses, clinical nurse specialists, certified registered nurse anesthetists, nurse practitioners, certified nurse midwives, physician assistants, dental therapists and advanced dental therapists, psychologists, clinical social workers, community paramedics, community health workers, and other medical professions as determined by the commissioner. new text end

new text begin (d) "Commissioner" means the commissioner of health. new text end

new text begin (e) "Eligible entity" means an organization that is located in Minnesota, provides a clinical medical education experience, and hosts students, residents, or other trainee types as determined by the commissioner, and is from an accredited Minnesota teaching program and institution. new text end

new text begin (f) "Eligible trainee FTEs" means the number of trainees, as measured by full-time equivalent counts, that are training in Minnesota at an entity with either currently active medical assistance enrollment status and a National Provider Identification (NPI) number or documentation that they provide sliding fee services. Training may occur in an inpatient or ambulatory patient care setting or alternative setting as determined by the commissioner. Training that occurs in nursing facility settings is not eligible for funding under this section. new text end

new text begin (g) "Teaching institution" means a hospital, medical center, clinic, or other organization that conducts a clinical medical education program in Minnesota that is accountable to the accrediting body. new text end

new text begin (h) "Trainee" means a student, resident, fellow, or other postgraduate involved in a clinical medical education program from an accredited Minnesota teaching program and institution. new text end

new text begin Subd. 2. new text end

new text begin Application process. new text end

new text begin (a) An eligible entity hosting clinical trainees from a clinical medical education program and teaching institution is eligible for funds under subdivision 3, if the entity: new text end

new text begin (1) is funded in part by sliding fee scale services or enrolled in the Minnesota health care program; new text end

new text begin (2) faces increased financial pressure as a result of competition with nonteaching patient care entities; and new text end

new text begin (3) emphasizes primary care or specialties that are in undersupply in rural or underserved areas of Minnesota. new text end

new text begin (b) An entity hosting a clinical medical education program for advanced practice nursing is eligible for funds under subdivision 3, if the program meets the eligibility requirements in paragraph (a), clauses (1) to (3), and is sponsored by the University of Minnesota Academic Health Center, the Mayo Foundation, or an institution that is part of the Minnesota State Colleges and Universities system or members of the Minnesota Private College Council. new text end

new text begin (c) An application must be submitted to the commissioner by an eligible entity through the teaching institution and contain the following information: new text end

new text begin (1) the official name and address and the site addresses of the clinical medical education programs where eligible trainees are hosted; new text end

new text begin (2) the name, title, and business address of those persons responsible for administering the funds; new text end

new text begin (3) for each applicant, the type and specialty orientation of trainees in the program; the name, entity address, medical assistance provider number, and national provider identification number of each training site used in the program, as appropriate; the federal tax identification number of each training site, where available; the total number of eligible trainee FTEs at each site; and new text end

new text begin (4) other supporting information the commissioner deems necessary. new text end

new text begin (d) An applicant that does not provide information requested by the commissioner shall not be eligible for funds for the current funding cycle. new text end

new text begin Subd. 3. new text end

new text begin Distribution of funds. new text end

new text begin (a) The commissioner may distribute funds for clinical training in areas of Minnesota and for the professions listed in subdivision 1, paragraph (c), determined by the commissioner as a high need area and profession shortage area. The commissioner shall annually distribute medical education funds to qualifying applicants under this section based on the costs to train, service level needs, and profession or training site shortages. Use of funds is limited to related clinical training costs for eligible programs. new text end

new text begin (b) To ensure the quality of clinical training, eligible entities must demonstrate that they hold contracts in good standing with eligible educational institutions that specify the terms, expectations, and outcomes of the clinical training conducted at sites. Funds shall be distributed in an administrative process determined by the commissioner to be efficient. new text end

new text begin Subd. 4. new text end

new text begin Report. new text end

new text begin (a) Teaching institutions receiving funds under this section must sign and submit a medical education grant verification report (GVR) to verify funding was distributed as specified in the GVR. If the teaching institution fails to submit the GVR by the stated deadline, the teaching institution is required to return the full amount of funds received to the commissioner within 30 days of receiving notice from the commissioner. The commissioner shall distribute returned funds to the appropriate training sites in accordance with the commissioner's approval letter. new text end

new text begin (b) Teaching institutions receiving funds under this section must provide any other information the commissioner deems appropriate to evaluate the effectiveness of the use of funds for medical education. new text end

Sec. 28.

Minnesota Statutes 2022, section 144.218, subdivision 1, is amended to read:

Subdivision 1.

Adoption.

Upon receipt of a certified copy of an order, decree, or certificate of adoption, the state registrar shall register a replacement vital record in the new name of the adopted person. The original record of birth is deleted text begin confidential deleted text end new text begin private data new text end pursuant to section 13.02, subdivision deleted text begin 3 deleted text end new text begin 12 new text end , and shall not be disclosed except pursuant to court order or section 144.2252. The information contained on the original birth record, except for the registration number, shall be provided on request to a parent who is named on the original birth record. Upon the receipt of a certified copy of a court order of annulment of adoption the state registrar shall restore the original vital record to its original place in the file.

new text begin EFFECTIVE DATE.