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Key: (1) language to be deleted (2) new language

                            CHAPTER 203-S.F.No. 1407 
                  An act relating to human services; modifying 
                  provisions in health care access programs; amending 
                  Minnesota Statutes 2000, sections 245B.02, by adding a 
                  subdivision; 245B.03, subdivision 1; 252.28, 
                  subdivisions 3a and 3b; 256B.056, subdivisions 1a and 
                  5a; 256B.0595, subdivisions 1 and 2; 256B.0625, 
                  subdivision 9; 256B.071, subdivision 2; 256B.094, 
                  subdivisions 6 and 8; 256B.5013, subdivision 1; 
                  256B.69, subdivision 3a; 256D.03, subdivision 3; and 
                  256L.15, subdivision 1a; Laws 1996, chapter 451, 
                  article 2, sections 61 and 62; repealing Minnesota 
                  Statutes 2000, section 256B.071, subdivision 5; Laws 
                  1995, chapter 178, article 2, section 46, subdivision 
                  10; Laws 1996, chapter 451, article 2, sections 12, 
                  14, 16, 18, 29, and 30. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  Minnesota Statutes 2000, section 245B.02, is 
        amended by adding a subdivision to read: 
           Subd. 23a.  [SUPPORTED EMPLOYMENT.] "Supported employment" 
        services include individualized counseling, individualized job 
        development and placement that produce an appropriate job match 
        for the individual and the employer, on-the-job training in work 
        and related work skills required for job performance, ongoing 
        supervision and monitoring of the person's performance, 
        long-term support services to assure job retention, training in 
        related skills essential to obtaining and retaining employment 
        such as the effective use of community resources, use of break 
        and lunch areas, transportation and mobility training, and 
        transportation between the individual's place of residence and 
        the work place when other forms of transportation are 
        unavailable or inaccessible. 
           Sec. 2.  Minnesota Statutes 2000, section 245B.03, 
        subdivision 1, is amended to read: 
           Subdivision 1.  [APPLICABILITY.] The standards in this 
        chapter govern services to persons with mental retardation or 
        related conditions receiving services from license holders 
        providing residential-based habilitation; day training and 
        habilitation services for adults; supported employment; 
        semi-independent living services; residential programs that 
        serve more than four consumers, including intermediate care 
        facilities for persons with mental retardation; and respite care 
        provided outside the consumer's home for more than four 
        consumers at the same time at a single site. 
           Sec. 3.  Minnesota Statutes 2000, section 252.28, 
        subdivision 3a, is amended to read: 
           Subd. 3a.  [LICENSING EXCEPTION.] (a) Notwithstanding the 
        provisions of subdivision 3, the commissioner may license 
        service sites, each accommodating up to six residents moving 
        from a 48-bed intermediate care facility for persons with mental 
        retardation or related conditions located in Dakota county that 
        is closing under section 252.292. 
           (b) Notwithstanding the provisions of any other state law 
        or administrative rule, the rate provisions of section 256I.05, 
        subdivision 1, apply to the exception in this subdivision. 
           (c) If a service site is licensed for six persons according 
        to this subdivision, the capacity of the license may remain at 
        six persons. 
           Sec. 4.  Minnesota Statutes 2000, section 252.28, 
        subdivision 3b, is amended to read: 
           Subd. 3b.  [OLMSTED COUNTY LICENSING EXEMPTION.] (a) 
        Notwithstanding subdivision 3, the commissioner may license 
        service sites each accommodating up to five residents moving 
        from a 43-bed intermediate care facility for persons with mental 
        retardation or related conditions located in Olmsted county that 
        is closing under section 252.292. 
           (b) Notwithstanding the provisions of any other state law 
        or administrative rule, the rate provisions of section 256I.05, 
        subdivision 1, apply to the exception in this subdivision. 
           (c) If a service site is licensed for five persons 
        according to this subdivision, the capacity of the license may 
        remain at five persons. 
           Sec. 5.  Minnesota Statutes 2000, section 256B.056, 
        subdivision 1a, is amended to read: 
           Subd. 1a.  [INCOME AND ASSETS GENERALLY.] Unless 
        specifically required by state law or rule or federal law or 
        regulation, the methodologies used in counting income and assets 
        to determine eligibility for medical assistance for persons 
        whose eligibility category is based on blindness, disability, or 
        age of 65 or more years, the methodologies for the supplemental 
        security income program shall be used.  For families and 
        children, which includes all other eligibility categories, the 
        methodologies under the state's AFDC plan in effect as of July 
        16, 1996, as required by the Personal Responsibility and Work 
        Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 
        Number 104-193, shall be used.  Effective upon federal approval, 
        in-kind contributions to, and payments made on behalf of, a 
        recipient, by an obligor, in satisfaction of or in addition to a 
        temporary or permanent order for child support or maintenance, 
        shall be considered income to the recipient.  For these 
        purposes, a "methodology" does not include an asset or income 
        standard, or accounting method, or method of determining 
        effective dates. 
           Sec. 6.  Minnesota Statutes 2000, section 256B.056, 
        subdivision 5a, is amended to read: 
           Subd. 5a.  [INDIVIDUALS ON FIXED OR EXCLUDED INCOME.] 
        Recipients of medical assistance who receive only fixed unearned 
        or excluded income, where such when that income is excluded from 
        consideration as income or unvarying in amount and timing of 
        receipt throughout the year, shall report and verify their 
        income annually. 
           Sec. 7.  Minnesota Statutes 2000, section 256B.0595, 
        subdivision 1, is amended to read: 
           Subdivision 1.  [PROHIBITED TRANSFERS.] (a) For transfers 
        of assets made on or before August 10, 1993, if a person or the 
        person's spouse has given away, sold, or disposed of, for less 
        than fair market value, any asset or interest therein, except 
        assets other than the homestead that are excluded under the 
        supplemental security program, within 30 months before or any 
        time after the date of institutionalization if the person has 
        been determined eligible for medical assistance, or within 30 
        months before or any time after the date of the first approved 
        application for medical assistance if the person has not yet 
        been determined eligible for medical assistance, the person is 
        ineligible for long-term care services for the period of time 
        determined under subdivision 2.  
           (b) Effective for transfers made after August 10, 1993, a 
        person, a person's spouse, or any person, court, or 
        administrative body with legal authority to act in place of, on 
        behalf of, at the direction of, or upon the request of the 
        person or person's spouse, may not give away, sell, or dispose 
        of, for less than fair market value, any asset or interest 
        therein, except assets other than the homestead that are 
        excluded under the supplemental security income program, for the 
        purpose of establishing or maintaining medical assistance 
        eligibility.  For purposes of determining eligibility for 
        long-term care services, any transfer of such assets within 36 
        months before or any time after an institutionalized person 
        applies for medical assistance, or 36 months before or any time 
        after a medical assistance recipient becomes institutionalized, 
        for less than fair market value may be considered.  Any such 
        transfer is presumed to have been made for the purpose of 
        establishing or maintaining medical assistance eligibility and 
        the person is ineligible for long-term care services for the 
        period of time determined under subdivision 2, unless the person 
        furnishes convincing evidence to establish that the transaction 
        was exclusively for another purpose, or unless the transfer is 
        permitted under subdivision 3 or 4.  Notwithstanding the 
        provisions of this paragraph, in the case of payments from a 
        trust or portions of a trust that are considered transfers of 
        assets under federal law, any transfers made within 60 months 
        before or any time after an institutionalized person applies for 
        medical assistance and within 60 months before or any time after 
        a medical assistance recipient becomes institutionalized, may be 
        considered. 
           (c) This section applies to transfers, for less than fair 
        market value, of income or assets, including assets that are 
        considered income in the month received, such as inheritances, 
        court settlements, and retroactive benefit payments or income to 
        which the person or the person's spouse is entitled but does not 
        receive due to action by the person, the person's spouse, or any 
        person, court, or administrative body with legal authority to 
        act in place of, on behalf of, at the direction of, or upon the 
        request of the person or the person's spouse.  
           (d) This section applies to payments for care or personal 
        services provided by a relative, unless the compensation was 
        stipulated in a notarized, written agreement which was in 
        existence when the service was performed, the care or services 
        directly benefited the person, and the payments made represented 
        reasonable compensation for the care or services provided.  A 
        notarized written agreement is not required if payment for the 
        services was made within 60 days after the service was provided. 
           (e) This section applies to the portion of any asset or 
        interest that a person, a person's spouse, or any person, court, 
        or administrative body with legal authority to act in place of, 
        on behalf of, at the direction of, or upon the request of the 
        person or the person's spouse, transfers to any annuity that 
        exceeds the value of the benefit likely to be returned to the 
        person or spouse while alive, based on estimated life expectancy 
        using the life expectancy tables employed by the supplemental 
        security income program to determine the value of an agreement 
        for services for life.  The commissioner may adopt rules 
        reducing life expectancies based on the need for long-term care. 
           (f) For purposes of this section, long-term care services 
        include services in a nursing facility, services that are 
        eligible for payment according to section 256B.0625, subdivision 
        2, because they are provided in a swing bed, intermediate care 
        facility for persons with mental retardation, and home and 
        community-based services provided pursuant to sections 
        256B.0915, 256B.092, and 256B.49.  For purposes of this 
        subdivision and subdivisions 2, 3, and 4, "institutionalized 
        person" includes a person who is an inpatient in a nursing 
        facility or in a swing bed, or intermediate care facility for 
        persons with mental retardation or who is receiving home and 
        community-based services under sections 256B.0915, 256B.092, and 
        256B.49. 
           (g) Effective for transfers made on or after July 1, 1995, 
        or upon federal approval, whichever is later, a person, a 
        person's spouse, or any person, court, or administrative body 
        with legal authority to act in place of, on behalf of, at the 
        direction of, or upon the request of the person or person's 
        spouse, may not give away, sell, or dispose of, for less than 
        fair market value, any asset or interest therein, for the 
        purpose of establishing or maintaining medical assistance 
        eligibility.  For purposes of determining eligibility for 
        long-term care services, any transfer of such assets within 60 
        months before, or any time after, an institutionalized person 
        applies for medical assistance, or 60 months before, or any time 
        after, a medical assistance recipient becomes institutionalized, 
        for less than fair market value may be considered.  Any such 
        transfer is presumed to have been made for the purpose of 
        establishing or maintaining medical assistance eligibility and 
        the person is ineligible for long-term care services for the 
        period of time determined under subdivision 2, unless the person 
        furnishes convincing evidence to establish that the transaction 
        was exclusively for another purpose, or unless the transfer is 
        permitted under subdivision 3 or 4. 
           Sec. 8.  Minnesota Statutes 2000, section 256B.0595, 
        subdivision 2, is amended to read: 
           Subd. 2.  [PERIOD OF INELIGIBILITY.] (a) For any 
        uncompensated transfer occurring on or before August 10, 1993, 
        the number of months of ineligibility for long-term care 
        services shall be the lesser of 30 months, or the uncompensated 
        transfer amount divided by the average medical assistance rate 
        for nursing facility services in the state in effect on the date 
        of application.  The amount used to calculate the average 
        medical assistance payment rate shall be adjusted each July 1 to 
        reflect payment rates for the previous calendar year.  The 
        period of ineligibility begins with the month in which the 
        assets were transferred.  If the transfer was not reported to 
        the local agency at the time of application, and the applicant 
        received long-term care services during what would have been the 
        period of ineligibility if the transfer had been reported, a 
        cause of action exists against the transferee for the cost of 
        long-term care services provided during the period of 
        ineligibility, or for the uncompensated amount of the transfer, 
        whichever is less.  The action may be brought by the state or 
        the local agency responsible for providing medical assistance 
        under chapter 256G.  The uncompensated transfer amount is the 
        fair market value of the asset at the time it was given away, 
        sold, or disposed of, less the amount of compensation received.  
           (b) For uncompensated transfers made after August 10, 1993, 
        the number of months of ineligibility for long-term care 
        services shall be the total uncompensated value of the resources 
        transferred divided by the average medical assistance rate for 
        nursing facility services in the state in effect on the date of 
        application.  The amount used to calculate the average medical 
        assistance payment rate shall be adjusted each July 1 to reflect 
        payment rates for the previous calendar year.  The period of 
        ineligibility begins with the month in which the assets were 
        transferred except that if one or more uncompensated transfers 
        are made during a period of ineligibility, the total assets 
        transferred during the ineligibility period shall be combined 
        and a penalty period calculated to begin in the month the first 
        uncompensated transfer was made.  If the transfer was not 
        reported to the local agency at the time of application, and the 
        applicant received medical assistance services during what would 
        have been the period of ineligibility if the transfer had been 
        reported, a cause of action exists against the transferee for 
        the cost of medical assistance services provided during the 
        period of ineligibility, or for the uncompensated amount of the 
        transfer, whichever is less.  The action may be brought by the 
        state or the local agency responsible for providing medical 
        assistance under chapter 256G.  The uncompensated transfer 
        amount is the fair market value of the asset at the time it was 
        given away, sold, or disposed of, less the amount of 
        compensation received.  Effective for transfers made on or after 
        March 1, 1996, involving persons who apply for medical 
        assistance on or after April 13, 1996, no cause of action exists 
        for a transfer unless: 
           (1) the transferee knew or should have known that the 
        transfer was being made by a person who was a resident of a 
        long-term care facility or was receiving that level of care in 
        the community at the time of the transfer; 
           (2) the transferee knew or should have known that the 
        transfer was being made to assist the person to qualify for or 
        retain medical assistance eligibility; or 
           (3) the transferee actively solicited the transfer with 
        intent to assist the person to qualify for or retain eligibility 
        for medical assistance.  
           (c) If a calculation of a penalty period results in a 
        partial month, payments for long-term care services shall be 
        reduced in an amount equal to the fraction, except that in 
        calculating the value of uncompensated transfers, if the total 
        value of all uncompensated transfers made in a month not 
        included in an existing penalty period does not exceed $500, 
        then such transfers shall be disregarded for each month prior to 
        the month of application for or during receipt of medical 
        assistance. 
           Sec. 9.  Minnesota Statutes 2000, section 256B.0625, 
        subdivision 9, is amended to read: 
           Subd. 9.  [DENTAL SERVICES.] Medical assistance covers 
        dental services.  Dental services include, with prior 
        authorization, fixed cast metal restorations bridges that are 
        cost-effective for persons who cannot use removable dentures 
        because of their medical condition. 
           Sec. 10.  Minnesota Statutes 2000, section 256B.071, 
        subdivision 2, is amended to read: 
           Subd. 2.  [TECHNICAL ASSISTANCE TO PROVIDERS.] (a) The 
        commissioner shall establish a technical assistance program to 
        require providers of services and equipment under this section 
        to maximize collections from the federal Medicare program.  The 
        technical assistance may include the provision of materials to 
        help providers determine those services and equipment likely to 
        be reimbursed by Medicare.  The technical assistance may also 
        include the provision of computer software to providers to 
        assist in this process.  The commissioner may expand the 
        technical assistance program to include providers of other 
        services under this chapter. 
           (b) Any provider of home care services enrolled in the 
        medical assistance program, or county public health nursing 
        agency responsible for personal care assessments, or county case 
        managers for alternative care or medical assistance waiver 
        programs, is required to use the method developed and supplied 
        by the department of human services for determining Medicare 
        coverage for home care equipment and services provided to dual 
        entitlees to ensure appropriate billing of Medicare.  The method 
        will be developed in two phases; the first phase is a manual 
        system effective July 1, 1996, and the second phase will 
        automate the manual procedure by expanding the current Medicaid 
        Management Information System (MMIS) effective January 1, 1997.  
        Both methods will determine Medicare coverage for the dates of 
        service and Medicare coverage for home care services, and create 
        an audit trail including reports.  Both methods will be linked 
        to prior authorization, therefore, either method must be used 
        before home care services are authorized and when there is a 
        change of condition affecting medical assistance authorization.  
        The department will conduct periodic reviews of participant 
        performance with the method and upon demonstrating appropriate 
        referral and billing of Medicare, participants may be determined 
        exempt from regular performance audits.  
           Sec. 11.  Minnesota Statutes 2000, section 256B.094, 
        subdivision 6, is amended to read: 
           Subd. 6.  [MEDICAL ASSISTANCE REIMBURSEMENT OF CASE 
        MANAGEMENT SERVICES.] (a) Medical assistance reimbursement for 
        services under this section shall be made on a monthly basis.  
        Payment is based on face-to-face or telephone contacts between 
        the case manager and the client, client's family, primary 
        caregiver, legal representative, or other relevant person 
        identified as necessary to the development or implementation of 
        the goals of the individual service plan regarding the status of 
        the client, the individual service plan, or the goals for the 
        client.  These contacts must meet the minimum standards in 
        clauses (1) and (2):  
           (1) there must be a face-to-face contact at least once a 
        month except as provided in clause (2); and 
           (2) for a client placed outside of the county of financial 
        responsibility, or a client served by tribal social services 
        placed outside the reservation, in an excluded time facility 
        under section 256G.02, subdivision 6, or through the Interstate 
        Compact on the Placement of Children, section 260.851, and the 
        placement in either case is more than 60 miles beyond the county 
        or reservation boundaries, there must be at least one contact 
        per month and not more than two consecutive months without a 
        face-to-face contact. 
           (b) Except as provided under paragraph (c), the payment 
        rate is established using time study data on activities of 
        provider service staff and reports required under sections 
        245.482, 256.01, subdivision 2, paragraph (17), and 256E.08, 
        subdivision 8. 
           (c) Payments for tribes may be made according to section 
        256B.0625 or other relevant federally approved rate setting 
        methodology for child welfare targeted case management provided 
        by Indian health services and facilities operated by a tribe or 
        tribal organization. 
           (d) Payment for case management provided by county or 
        tribal social services contracted vendors shall be based on a 
        monthly rate negotiated by the host county or tribal social 
        services.  The negotiated rate must not exceed the rate charged 
        by the vendor for the same service to other payers.  If the 
        service is provided by a team of contracted vendors, the county 
        or tribal social services may negotiate a team rate with a 
        vendor who is a member of the team.  The team shall determine 
        how to distribute the rate among its members.  No reimbursement 
        received by contracted vendors shall be returned to the county 
        or tribal social services, except to reimburse the county or 
        tribal social services for advance funding provided by the 
        county or tribal social services to the vendor. 
           (e) If the service is provided by a team that includes 
        contracted vendors and county or tribal social services staff, 
        the costs for county or tribal social services staff 
        participation in the team shall be included in the rate for 
        county or tribal social services provided services.  In this 
        case, the contracted vendor and the county or tribal social 
        services may each receive separate payment for services provided 
        by each entity in the same month.  To prevent duplication of 
        services, each entity must document, in the recipient's file, 
        the need for team case management and a description of the roles 
        and services of the team members. 
           Separate payment rates may be established for different 
        groups of providers to maximize reimbursement as determined by 
        the commissioner.  The payment rate will be reviewed annually 
        and revised periodically to be consistent with the most recent 
        time study and other data.  Payment for services will be made 
        upon submission of a valid claim and verification of proper 
        documentation described in subdivision 7.  Federal 
        administrative revenue earned through the time study, or under 
        paragraph (c), shall be distributed according to earnings, to 
        counties, reservations, or groups of counties or reservations 
        which have the same payment rate under this subdivision, and to 
        the group of counties or reservations which are not certified 
        providers under section 256F.10.  The commissioner shall modify 
        the requirements set out in Minnesota Rules, parts 9550.0300 to 
        9550.0370, as necessary to accomplish this. 
           Sec. 12.  Minnesota Statutes 2000, section 256B.094, 
        subdivision 8, is amended to read: 
           Subd. 8.  [PAYMENT LIMITATION.] Services that are not 
        eligible for payment as a child welfare targeted case management 
        service include, but are not limited to:  
           (1) assessments prior to opening a case; 
           (2) therapy and treatment services; 
           (3) legal services, including legal advocacy, for the 
        client; 
           (4) information and referral services that are part of a 
        county's community social services plan, that are not provided 
        to an eligible recipient; 
           (5) outreach services including outreach services provided 
        through the community support services program; 
           (6) services that are not documented as required under 
        subdivision 7 and Minnesota Rules, parts 9505.1800 to 
        9505.1880 9505.2165 and 9505.2175; 
           (7) services that are otherwise eligible for payment on a 
        separate schedule under rules of the department of human 
        services; 
           (8) services to a client that duplicate the same case 
        management service from another case manager; 
           (9) case management services provided to patients or 
        residents in a medical assistance facility except as described 
        under subdivision 2, clause (9); and 
           (10) for children in foster care, group homes, or 
        residential care, payment for case management services is 
        limited to case management services that focus on permanency 
        planning or return to the family home and that do not duplicate 
        the facility's discharge planning services. 
           Sec. 13.  Minnesota Statutes 2000, section 256B.5013, 
        subdivision 1, is amended to read: 
           Subdivision 1.  [VARIABLE RATE ADJUSTMENTS.] For rate years 
        beginning on or after October 1, 2000, when there is a 
        documented increase in the resource needs of a current ICF/MR 
        recipient or recipients, or a person is admitted to a facility 
        who requires additional resources, the county of financial 
        responsibility may recommend approval of a variable rate to 
        enable the facility to meet the individual's increased needs 
        based on the recipient's screening.  Variable rate adjustments 
        made under this subdivision replace payments for persons with 
        special needs under section 256B.501, subdivision 8, and 
        payments for persons with special needs for crisis intervention 
        services under section 256B.501, subdivision 8a.  Resource needs 
        directly attributable to an individual that may be considered 
        under the variable rate adjustment include increased direct 
        staff hours and, other specialized services, and equipment, and 
        human resources.  The guidelines in paragraphs (a) to (d) apply 
        for the payment rate adjustments under this section. 
           (a) All persons must be screened according to section 
        256B.092, subdivisions 7 and 8, prior to implementation of the 
        new payment system, and annually thereafter, and when a variable 
        rate is being requested due to changes in the needs of the 
        recipient.  Screening data shall be analyzed to develop broad 
        profiles of the functional characteristics of recipients. 
        Screening data shall be used to monitor changes as follows: 
           Criteria to be used to develop these profiles shall 
        include, but not be limited to: 
           (1) the functional ability of a recipient to care for and 
        maintain the recipient's own basic needs; 
           (2) the intensity of any aggressive or destructive 
        behavior; and 
           (3) any history of obstructive behavior in combination with 
        a diagnosis of psychosis or neurosis;. 
           (b) A variable rate may be recommended for increased 
        service needs such as: 
           (4) (1) a need for resources due to a change in resident 
        day program participation because the resident:  (i) has reached 
        the age of 65 or has a change in health condition that makes it 
        difficult for the person to participate in day training and 
        habilitation services over an extended period of time because it 
        is medically contraindicated; and (ii) has expressed a desire 
        for change through the developmental disabilities mental 
        retardation and related conditions screening process under 
        section 256B.092; and 
           (5) (2) a need for additional resources for intensive 
        short-term training programming which is necessary prior to a 
        recipient's discharge to a less restrictive, more integrated 
        setting. 
           The recipients' screenings Recommendations for a variable 
        rate shall be used to link resource needs to funding.  The 
        resource profile shall determine the level of funding.  The 
        variable rate must be applied to expenses related to increased 
        direct staff hours and, other specialized services, and 
        equipment, and human resources.  
           (b) (c) A recipient must be screened by the county of 
        financial responsibility using the developmental disabilities 
        screening document completed immediately prior to approval of a 
        variable rate by the county.  A comparison of the updated 
        screening and the previous screening must demonstrate an 
        increase in resource needs. 
           (c) (d) Rate adjustments projected to exceed the authorized 
        funding level associated with the person's profile must be 
        submitted to the commissioner. 
           (d) (e) The county of financial responsibility must 
        indicate the projected length of time that the additional 
        funding may be needed for the individual.  The need to continue 
        an individual variable rate must be reviewed at the end of the 
        anticipated duration of need but at least annually through the 
        completion of the developmental disabilities screening document. 
           Sec. 14.  Minnesota Statutes 2000, section 256B.69, 
        subdivision 3a, is amended to read: 
           Subd. 3a.  [COUNTY AUTHORITY.] (a) The commissioner, when 
        implementing the general assistance medical care, or medical 
        assistance prepayment program within a county, must include the 
        county board in the process of development, approval, and 
        issuance of the request for proposals to provide services to 
        eligible individuals within the proposed county.  County boards 
        must be given reasonable opportunity to make recommendations 
        regarding the development, issuance, review of responses, and 
        changes needed in the request for proposals.  The commissioner 
        must provide county boards the opportunity to review each 
        proposal based on the identification of community needs under 
        chapters 145A and 256E and county advocacy activities.  If a 
        county board finds that a proposal does not address certain 
        community needs, the county board and commissioner shall 
        continue efforts for improving the proposal and network prior to 
        the approval of the contract.  The county board shall make 
        recommendations regarding the approval of local networks and 
        their operations to ensure adequate availability and access to 
        covered services.  The provider or health plan must respond 
        directly to county advocates and the state prepaid medical 
        assistance ombudsperson regarding service delivery and must be 
        accountable to the state regarding contracts with medical 
        assistance and general assistance medical care funds.  The 
        county board may recommend a maximum number of participating 
        health plans after considering the size of the enrolling 
        population; ensuring adequate access and capacity; considering 
        the client and county administrative complexity; and considering 
        the need to promote the viability of locally developed health 
        plans.  The county board or a single entity representing a group 
        of county boards and the commissioner shall mutually select 
        health plans for participation at the time of initial 
        implementation of the prepaid medical assistance program in that 
        county or group of counties and at the time of contract renewal. 
        The commissioner shall also seek input for contract requirements 
        from the county or single entity representing a group of county 
        boards at each contract renewal and incorporate those 
        recommendations into the contract negotiation process.  The 
        commissioner, in conjunction with the county board, shall 
        actively seek to develop a mutually agreeable timetable prior to 
        the development of the request for proposal, but counties must 
        agree to initial enrollment beginning on or before January 1, 
        1999, in either the prepaid medical assistance and general 
        assistance medical care programs or county-based purchasing 
        under section 256B.692.  At least 90 days before enrollment in 
        the medical assistance and general assistance medical care 
        prepaid programs begins in a county in which the prepaid 
        programs have not been established, the commissioner shall 
        provide a report to the chairs of senate and house committees 
        having jurisdiction over state health care programs which 
        verifies that the commissioner complied with the requirements 
        for county involvement that are specified in this subdivision. 
           (b) The commissioner shall seek a federal waiver to allow a 
        fee-for-service plan option to MinnesotaCare enrollees.  The 
        commissioner shall develop an increase of the premium fees 
        required under section 256L.06 up to 20 percent of the premium 
        fees for the enrollees who elect the fee-for-service option.  
        Prior to implementation, the commissioner shall submit this fee 
        schedule to the chair and ranking minority member of the senate 
        health care committee, the senate health care and family 
        services funding division, the house of representatives health 
        and human services committee, and the house of representatives 
        health and human services finance division. 
           (c) At the option of the county board, the board may 
        develop contract requirements related to the achievement of 
        local public health goals to meet the health needs of medical 
        assistance and general assistance medical care enrollees.  These 
        requirements must be reasonably related to the performance of 
        health plan functions and within the scope of the medical 
        assistance and general assistance medical care benefit sets.  If 
        the county board and the commissioner mutually agree to such 
        requirements, the department shall include such requirements in 
        all health plan contracts governing the prepaid medical 
        assistance and general assistance medical care programs in that 
        county at initial implementation of the program in that county 
        and at the time of contract renewal.  The county board may 
        participate in the enforcement of the contract provisions 
        related to local public health goals. 
           (d) (c) For counties in which prepaid medical assistance 
        and general assistance medical care programs have not been 
        established, the commissioner shall not implement those programs 
        if a county board submits acceptable and timely preliminary and 
        final proposals under section 256B.692, until county-based 
        purchasing is no longer operational in that county.  For 
        counties in which prepaid medical assistance and general 
        assistance medical care programs are in existence on or after 
        September 1, 1997, the commissioner must terminate contracts 
        with health plans according to section 256B.692, subdivision 5, 
        if the county board submits and the commissioner accepts 
        preliminary and final proposals according to that subdivision.  
        The commissioner is not required to terminate contracts that 
        begin on or after September 1, 1997, according to section 
        256B.692 until two years have elapsed from the date of initial 
        enrollment. 
           (e) (d) In the event that a county board or a single entity 
        representing a group of county boards and the commissioner 
        cannot reach agreement regarding:  (i) the selection of 
        participating health plans in that county; (ii) contract 
        requirements; or (iii) implementation and enforcement of county 
        requirements including provisions regarding local public health 
        goals, the commissioner shall resolve all disputes after taking 
        into account the recommendations of a three-person mediation 
        panel.  The panel shall be composed of one designee of the 
        president of the association of Minnesota counties, one designee 
        of the commissioner of human services, and one designee of the 
        commissioner of health. 
           (f) (e) If a county which elects to implement county-based 
        purchasing ceases to implement county-based purchasing, it is 
        prohibited from assuming the responsibility of county-based 
        purchasing for a period of five years from the date it 
        discontinues purchasing. 
           (g) (f) Notwithstanding the requirement in this subdivision 
        that a county must agree to initial enrollment on or before 
        January 1, 1999, the commissioner shall grant a delay in the 
        implementation of the county-based purchasing authorized in 
        section 256B.692 until federal waiver authority and approval has 
        been granted, if the county or group of counties has submitted a 
        preliminary proposal for county-based purchasing by September 1, 
        1997, has not already implemented the prepaid medical assistance 
        program before January 1, 1998, and has submitted a written 
        request for the delay to the commissioner by July 1, 1998.  In 
        order for the delay to be continued, the county or group of 
        counties must also submit to the commissioner the following 
        information by December 1, 1998.  The information must: 
           (1) identify the proposed date of implementation, as 
        determined under section 256B.692, subdivision 5; 
           (2) include copies of the county board resolutions which 
        demonstrate the continued commitment to the implementation of 
        county-based purchasing by the proposed date.  County board 
        authorization may remain contingent on the submission of a final 
        proposal which meets the requirements of section 256B.692, 
        subdivision 5, paragraph (b); 
           (3) demonstrate actions taken for the establishment of a 
        governance structure between the participating counties and 
        describe how the fiduciary responsibilities of county-based 
        purchasing will be allocated between the counties, if more than 
        one county is involved in the proposal; 
           (4) describe how the risk of a deficit will be managed in 
        the event expenditures are greater than total capitation 
        payments.  This description must identify how any of the 
        following strategies will be used: 
           (i) risk contracts with licensed health plans; 
           (ii) risk arrangements with providers who are not licensed 
        health plans; 
           (iii) risk arrangements with other licensed insurance 
        entities; and 
           (iv) funding from other county resources; 
           (5) include, if county-based purchasing will not contract 
        with licensed health plans or provider networks, letters of 
        interest from local providers in at least the categories of 
        hospital, physician, mental health, and pharmacy which express 
        interest in contracting for services.  These letters must 
        recognize any risk transfer identified in clause (4), item (ii); 
        and 
           (6) describe the options being considered to obtain the 
        administrative services required in section 256B.692, 
        subdivision 3, clauses (3) and (5). 
           (h) (g) For counties which receive a delay under this 
        subdivision, the final proposals required under section 
        256B.692, subdivision 5, paragraph (b), must be submitted at 
        least six months prior to the requested implementation date.  
        Authority to implement county-based purchasing remains 
        contingent on approval of the final proposal as required under 
        section 256B.692. 
           (i) (h) If the commissioner is unable to provide 
        county-specific, individual-level fee-for-service claims to 
        counties by June 4, 1998, the commissioner shall grant a delay 
        under paragraph (g) (f) of up to 12 months in the implementation 
        of county-based purchasing, and shall require implementation not 
        later than January 1, 2000.  In order to receive an extension of 
        the proposed date of implementation under this paragraph, a 
        county or group of counties must submit a written request for 
        the extension to the commissioner by August 1, 1998, must submit 
        the information required under paragraph (g) (f) by December 1, 
        1998, and must submit a final proposal as provided under 
        paragraph (h) (g). 
           (j) (i) Notwithstanding other requirements of this 
        subdivision, the commissioner shall not require the 
        implementation of the county-based purchasing authorized in 
        section 256B.692 until six months after federal waiver approval 
        has been obtained for county-based purchasing, if the county or 
        counties have submitted the final plan as required in section 
        256B.692, subdivision 5.  The commissioner shall allow the 
        county or counties which submitted information under section 
        256B.692, subdivision 5, to submit supplemental or additional 
        information which was not possible to submit by April 1, 1999.  
        A county or counties shall continue to submit the required 
        information and substantive detail necessary to obtain a prompt 
        response and waiver approval.  If amendments to the final plan 
        are necessary due to the terms and conditions of the waiver 
        approval, the commissioner shall allow the county or group of 
        counties 60 days to make the necessary amendments to the final 
        plan and shall not require implementation of the county-based 
        purchasing until six months after the revised final plan has 
        been submitted. 
           Sec. 15.  Minnesota Statutes 2000, section 256D.03, 
        subdivision 3, is amended to read: 
           Subd. 3.  [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 
        (a) General assistance medical care may be paid for any person 
        who is not eligible for medical assistance under chapter 256B, 
        including eligibility for medical assistance based on a 
        spenddown of excess income according to section 256B.056, 
        subdivision 5, or MinnesotaCare as defined in paragraph (b), 
        except as provided in paragraph (c); and: 
           (1) who is receiving assistance under section 256D.05, 
        except for families with children who are eligible under 
        Minnesota family investment program-statewide (MFIP-S), who is 
        having a payment made on the person's behalf under sections 
        256I.01 to 256I.06, or who resides in group residential housing 
        as defined in chapter 256I and can meet a spenddown using the 
        cost of remedial services received through group residential 
        housing; or 
           (2)(i) who is a resident of Minnesota; and whose equity in 
        assets is not in excess of $1,000 per assistance unit.  Exempt 
        assets, the reduction of excess assets, and the waiver of excess 
        assets must conform to the medical assistance program in chapter 
        256B, with the following exception:  the maximum amount of 
        undistributed funds in a trust that could be distributed to or 
        on behalf of the beneficiary by the trustee, assuming the full 
        exercise of the trustee's discretion under the terms of the 
        trust, must be applied toward the asset maximum; and 
           (ii) who has countable income not in excess of the 
        assistance standards established in section 256B.056, 
        subdivision 4, or whose excess income is spent down according to 
        section 256B.056, subdivision 5, using a six-month budget 
        period.  The method for calculating earned income disregards and 
        deductions for a person who resides with a dependent child under 
        age 21 shall follow section 256B.056, subdivision 1a.  However, 
        if a disregard of $30 and one-third of the remainder has been 
        applied to the wage earner's income, the disregard shall not be 
        applied again until the wage earner's income has not been 
        considered in an eligibility determination for general 
        assistance, general assistance medical care, medical assistance, 
        or MFIP-S for 12 consecutive months.  The earned income and work 
        expense deductions for a person who does not reside with a 
        dependent child under age 21 shall be the same as the method 
        used to determine eligibility for a person under section 
        256D.06, subdivision 1, except the disregard of the first $50 of 
        earned income is not allowed; 
           (3) who would be eligible for medical assistance except 
        that the person resides in a facility that is determined by the 
        commissioner or the federal Health Care Financing Administration 
        to be an institution for mental diseases; or 
           (4) who is ineligible for medical assistance under chapter 
        256B or general assistance medical care under any other 
        provision of this section, and is receiving care and 
        rehabilitation services from a nonprofit center established to 
        serve victims of torture.  These individuals are eligible for 
        general assistance medical care only for the period during which 
        they are receiving services from the center.  During this period 
        of eligibility, individuals eligible under this clause shall not 
        be required to participate in prepaid general assistance medical 
        care.  
           (b) Beginning January 1, 2000, applicants or recipients who 
        meet all eligibility requirements of MinnesotaCare as defined in 
        sections 256L.01 to 256L.16, and are: 
           (i) adults with dependent children under 21 whose gross 
        family income is equal to or less than 275 percent of the 
        federal poverty guidelines; or 
           (ii) adults without children with earned income and whose 
        family gross income is between 75 percent of the federal poverty 
        guidelines and the amount set by section 256L.04, subdivision 7, 
        shall be terminated from general assistance medical care upon 
        enrollment in MinnesotaCare.  Earned income is deemed available 
        to family members as defined in section 256D.02, subdivision 8.  
           (c) For services rendered on or after July 1, 1997, 
        eligibility is limited to one month prior to application if the 
        person is determined eligible in the prior month.  A 
        redetermination of eligibility must occur every 12 months.  
        Beginning January 1, 2000, Minnesota health care program 
        applications completed by recipients and applicants who are 
        persons described in paragraph (b), may be returned to the 
        county agency to be forwarded to the department of human 
        services or sent directly to the department of human services 
        for enrollment in MinnesotaCare.  If all other eligibility 
        requirements of this subdivision are met, eligibility for 
        general assistance medical care shall be available in any month 
        during which a MinnesotaCare eligibility determination and 
        enrollment are pending.  Upon notification of eligibility for 
        MinnesotaCare, notice of termination for eligibility for general 
        assistance medical care shall be sent to an applicant or 
        recipient.  If all other eligibility requirements of this 
        subdivision are met, eligibility for general assistance medical 
        care shall be available until enrollment in MinnesotaCare 
        subject to the provisions of paragraph (e). 
           (d) The date of an initial Minnesota health care program 
        application necessary to begin a determination of eligibility 
        shall be the date the applicant has provided a name, address, 
        and social security number, signed and dated, to the county 
        agency or the department of human services.  If the applicant is 
        unable to provide an initial application when health care is 
        delivered due to a medical condition or disability, a health 
        care provider may act on the person's behalf to complete the 
        initial application.  The applicant must complete the remainder 
        of the application and provide necessary verification before 
        eligibility can be determined.  The county agency must assist 
        the applicant in obtaining verification if necessary.  On the 
        basis of information provided on the completed application, an 
        applicant who meets the following criteria shall be determined 
        eligible beginning in the month of application: 
           (1) has gross income less than 90 percent of the applicable 
        income standard; 
           (2) has liquid assets that total within $300 of the asset 
        standard; 
           (3) does not reside in a long-term care facility; and 
           (4) meets all other eligibility requirements. 
        The applicant must provide all required verifications within 30 
        days' notice of the eligibility determination or eligibility 
        shall be terminated. 
           (e) County agencies are authorized to use all automated 
        databases containing information regarding recipients' or 
        applicants' income in order to determine eligibility for general 
        assistance medical care or MinnesotaCare.  Such use shall be 
        considered sufficient in order to determine eligibility and 
        premium payments by the county agency. 
           (f) General assistance medical care is not available for a 
        person in a correctional facility unless the person is detained 
        by law for less than one year in a county correctional or 
        detention facility as a person accused or convicted of a crime, 
        or admitted as an inpatient to a hospital on a criminal hold 
        order, and the person is a recipient of general assistance 
        medical care at the time the person is detained by law or 
        admitted on a criminal hold order and as long as the person 
        continues to meet other eligibility requirements of this 
        subdivision.  
           (g) General assistance medical care is not available for 
        applicants or recipients who do not cooperate with the county 
        agency to meet the requirements of medical assistance.  General 
        assistance medical care is limited to payment of emergency 
        services only for applicants or recipients as described in 
        paragraph (b), whose MinnesotaCare coverage is denied or 
        terminated for nonpayment of premiums as required by sections 
        256L.06 and 256L.07.  
           (h) In determining the amount of assets of an individual, 
        there shall be included any asset or interest in an asset, 
        including an asset excluded under paragraph (a), that was given 
        away, sold, or disposed of for less than fair market value 
        within the 60 months preceding application for general 
        assistance medical care or during the period of eligibility.  
        Any transfer described in this paragraph shall be presumed to 
        have been for the purpose of establishing eligibility for 
        general assistance medical care, unless the individual furnishes 
        convincing evidence to establish that the transaction was 
        exclusively for another purpose.  For purposes of this 
        paragraph, the value of the asset or interest shall be the fair 
        market value at the time it was given away, sold, or disposed 
        of, less the amount of compensation received.  For any 
        uncompensated transfer, the number of months of ineligibility, 
        including partial months, shall be calculated by dividing the 
        uncompensated transfer amount by the average monthly per person 
        payment made by the medical assistance program to skilled 
        nursing facilities for the previous calendar year.  The 
        individual shall remain ineligible until this fixed period has 
        expired.  The period of ineligibility may exceed 30 months, and 
        a reapplication for benefits after 30 months from the date of 
        the transfer shall not result in eligibility unless and until 
        the period of ineligibility has expired.  The period of 
        ineligibility begins in the month the transfer was reported to 
        the county agency, or if the transfer was not reported, the 
        month in which the county agency discovered the transfer, 
        whichever comes first.  For applicants, the period of 
        ineligibility begins on the date of the first approved 
        application. 
           (i) When determining eligibility for any state benefits 
        under this subdivision, the income and resources of all 
        noncitizens shall be deemed to include their sponsor's income 
        and resources as defined in the Personal Responsibility and Work 
        Opportunity Reconciliation Act of 1996, title IV, Public Law 
        Number 104-193, sections 421 and 422, and subsequently set out 
        in federal rules. 
           (j)(1) An undocumented noncitizen or a nonimmigrant is 
        ineligible for general assistance medical care other than 
        emergency services.  For purposes of this subdivision, a 
        nonimmigrant is an individual in one or more of the classes 
        listed in United States Code, title 8, section 1101(a)(15), and 
        an undocumented noncitizen is an individual who resides in the 
        United States without the approval or acquiescence of the 
        Immigration and Naturalization Service. 
           (2) This paragraph does not apply to a child under age 18, 
        to a Cuban or Haitian entrant as defined in Public Law Number 
        96-422, section 501(e)(1) or (2)(a), or to a noncitizen who is 
        aged, blind, or disabled as defined in Code of Federal 
        Regulations, title 42, sections 435.520, 435.530, 435.531, 
        435.540, and 435.541, or effective October 1, 1998, to an 
        individual eligible for general assistance medical care under 
        paragraph (a), clause (4), who cooperates with the Immigration 
        and Naturalization Service to pursue any applicable immigration 
        status, including citizenship, that would qualify the individual 
        for medical assistance with federal financial participation. 
           (k) For purposes of paragraphs (g) and (j), "emergency 
        services" has the meaning given in Code of Federal Regulations, 
        title 42, section 440.255(b)(1), except that it also means 
        services rendered because of suspected or actual pesticide 
        poisoning. 
           (l) Notwithstanding any other provision of law, a 
        noncitizen who is ineligible for medical assistance due to the 
        deeming of a sponsor's income and resources, is ineligible for 
        general assistance medical care. 
           Sec. 16.  Minnesota Statutes 2000, section 256L.15, 
        subdivision 1a, is amended to read: 
           Subd. 1a.  [PAYMENT OPTIONS.] The commissioner may offer 
        the following payment options to an enrollee: 
           (1) payment by check; 
           (2) payment by credit card; 
           (3) payment by recurring automatic checking withdrawal; 
           (4) payment by one-time electronic transfer of funds; 
           (5) payment by wage withholding with the consent of the 
        employer and the employee; or 
           (6) payment by using state tax refund payments. 
           At application or reapplication, a MinnesotaCare applicant 
        or enrollee may authorize the commissioner to use the Revenue 
        Recapture Act in chapter 270A to collect funds from the 
        applicant's or enrollee's state income tax refund for the 
        purposes of meeting all or part of the applicant's or enrollee's 
        MinnesotaCare premium obligation for the forthcoming year.  The 
        applicant or enrollee may authorize the commissioner to apply 
        for the state working family tax credit on behalf of the 
        applicant or enrollee.  The setoff due under this subdivision 
        shall not be subject to the $10 fee under section 270A.07, 
        subdivision 1.  
           Sec. 17.  Laws 1996, chapter 451, article 2, section 61, is 
        amended to read: 
           Sec. 61.  [REPEALER.] 
           Minnesota Statutes 1995 Supplement, sections 256B.15, 
        subdivision 5; 256G.05, subdivision 1; and 256G.07, subdivision 
        3a, are repealed.  
           Sec. 18.  Laws 1996, chapter 451, article 2, section 62, is 
        amended to read: 
           Sec. 62.  [EFFECTIVE DATE; APPLICATION.] 
           (a) Sections 12, 14, 16, 18, 29, 30, and the portion of 
        section 61 that repeals section 256B.15, subdivision 5, are 
        effective the day following final enactment to the extent 
        permitted by federal law.  If any provisions of these sections 
        are prohibited by federal law, the provisions shall become 
        effective when federal law is changed to permit their 
        application or a waiver is received.  The commissioner of human 
        services shall notify the revisor of statutes when federal law 
        is enacted or a waiver is received and publish a notice in the 
        State Register.  The commissioner must include the notice in the 
        first State Register published after the effective date of the 
        federal changes.  
           (b) If, by July 1, 1996, any provisions of the sections 
        mentioned in paragraph (a) are not effective because of 
        prohibitions in federal law, the commissioner shall apply to the 
        federal government for a waiver of those prohibitions, and those 
        provisions shall become effective upon receipt of a federal 
        waiver, notification to the revisor of statutes, and publication 
        of a notice in the State Register to that effect.  If the 
        commissioner applies for a waiver of the lookback period, the 
        commissioner shall seek the longest lookback period the health 
        care financing administration will approve, not to exceed 72 
        months. 
           (c) Section 54 applies to estates of decedents dying on or 
        after its effective date.  Section 55 applies to estates where 
        the notice under Minnesota Statutes, section 524.3-801, 
        paragraph (a), was first published on or after its effective 
        date.  Section 55 does not affect any right or duty to provide 
        notice to known creditors, including a local agency, before its 
        effective date. 
           (d) (b) Sections 7, 13, 15, 17, 33, 34, 35, 38, and 60 are 
        effective the day following final enactment. 
           (e) (c) Section 11 is effective retroactive to October 1, 1993. 
           (f) (d) Sections 8, 22, subdivision 3, and 34 are effective 
        upon federal approval. 
           (g) (e) Sections 10 and 31 are effective upon receipt of 
        federal approval, retroactive to January 1, 1996. 
           Sec. 19.  [REPEALER.] 
           (a) Laws 1995, chapter 178, article 2, section 46, 
        subdivision 10; and Laws 1996, chapter 451, article 2, sections 
        12, 14, 16, 18, 29, and 30, are repealed. 
           (b) Minnesota Statutes 2000, section 256B.071, subdivision 
        5, is repealed. 
           Presented to the governor May 25, 2001 
           Signed by the governor May 29, 2001, 11:23 a.m.

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