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

CHAPTER 79--H.F.No. 1362
An act
relating to state government; making changes to health and human
services; amending provisions related to licensing, the Minnesota family
investment program, child care, adult supports; fraud prevention, state-operated
services, the Minnesota sex offender program, the Department of Health, health
care programs, chemical and mental health; continuing care programs, and
public health; establishing the State-County Results, Accountability, and Service
Delivery Redesign; making technical changes; making forecast adjustments;
requiring reports; establishing and increasing fees; appropriating money;
amending Minnesota Statutes 2008, sections 60A.092, subdivision 2; 62D.03,
subdivision 4; 62D.05, subdivision 3; 62J.495; 62J.496; 62J.497, subdivisions
1, 2, by adding subdivisions; 62J.692, subdivision 7; 103I.208, subdivision
2; 119B.09, subdivision 7; 119B.13, subdivision 6; 119B.21, subdivisions 5,
10; 119B.231, subdivisions 2, 3, 4; 144.0724, subdivisions 2, 4, 8, by adding
subdivisions; 144.121, subdivisions 1a, 1b; 144.122; 144.1222, subdivision
1a; 144.125, subdivision 1; 144.226, subdivision 4; 144.72, subdivisions 1, 3;
144.9501, subdivisions 22b, 26a, by adding subdivisions; 144.9505, subdivisions
1g, 4; 144.9508, subdivisions 2, 3, 4; 144.9512, subdivision 2; 144.966, by
adding a subdivision; 144.97, subdivisions 2, 4, 6, by adding subdivisions;
144.98, subdivisions 1, 2, 3, by adding subdivisions; 144.99, subdivision
1; 144A.073, by adding a subdivision; 144A.44, subdivision 2; 144A.46,
subdivision 1; 145A.17, by adding a subdivision; 148.6445, by adding a
subdivision; 148D.180, subdivisions 1, 2, 3, 5; 148E.180, subdivisions 1, 2, 3, 5;
152.126, subdivisions 1, 2, 6; 153A.17; 157.15, by adding a subdivision; 157.16;
157.22; 176.011, subdivision 9; 245.462, subdivision 18; 245.470, subdivision
1; 245.4871, subdivision 27; 245.488, subdivision 1; 245A.03, by adding a
subdivision; 245A.10, subdivisions 2, 3; 245A.11, subdivision 2a, by adding
subdivisions; 245A.16, subdivisions 1, 3; 245C.03, subdivision 2; 245C.04,
subdivisions 1, 3; 245C.05, subdivision 4, by adding a subdivision; 245C.08,
subdivision 2; 245C.10, subdivision 3, by adding subdivisions; 245C.17, by
adding a subdivision; 245C.20; 245C.21, subdivision 1a; 245C.23, subdivision 2;
246.50, subdivision 5, by adding subdivisions; 246.51, by adding subdivisions;
246.511; 246.52; 246.54, subdivision 2; 246B.01, by adding subdivisions;
252.025, subdivision 7; 252.46, by adding a subdivision; 252.50, subdivision 1;
254A.02, by adding a subdivision; 254A.16, by adding a subdivision; 254B.03,
subdivisions 1, 3, by adding a subdivision; 254B.05, subdivision 1; 254B.09,
subdivision 2; 256.01, subdivision 2b, by adding subdivisions; 256.045,
subdivision 3; 256.476, subdivisions 5, 11; 256.962, subdivisions 2, 6; 256.969,
subdivisions 2b, 3a, by adding subdivisions; 256.975, subdivision 7; 256.983,
subdivision 1; 256B.04, subdivision 16; 256B.055, subdivisions 7, 12; 256B.056,
subdivisions 3c, 3d; 256B.057, by adding a subdivision; 256B.0575; 256B.0595,
subdivisions 1, 2; 256B.06, subdivisions 4, 5; 256B.0621, subdivision 2;
256B.0622, subdivision 2; 256B.0623, subdivision 5; 256B.0624, subdivisions
5, 8; 256B.0625, subdivisions 3, 3c, 6a, 7, 9, 11, 13, 13e, 13h, 17, 17a, 19a,
19c, 26, 42, 47, by adding subdivisions; 256B.0641, subdivision 3; 256B.0651;
256B.0652; 256B.0653; 256B.0654; 256B.0655, subdivisions 1b, 4; 256B.0657,
subdivisions 2, 6, 8, by adding a subdivision; 256B.08, by adding a subdivision;
256B.0911, subdivisions 1, 1a, 3, 3a, 3b, 3c, 4a, 5, 6, 7, by adding subdivisions;
256B.0913, subdivision 4; 256B.0915, subdivisions 3a, 3e, 3h, 5, by adding a
subdivision; 256B.0916, subdivision 2; 256B.0917, by adding a subdivision;
256B.092, subdivision 8a, by adding subdivisions; 256B.0943, subdivisions 1,
12; 256B.0944, by adding a subdivision; 256B.0947, subdivision 1; 256B.15,
subdivisions 1, 1a, 1h, 2, by adding subdivisions; 256B.199; 256B.37,
subdivisions 1, 5; 256B.434, subdivision 4, by adding a subdivision; 256B.437,
subdivision 6; 256B.441, subdivisions 55, 58, by adding a subdivision; 256B.49,
subdivisions 12, 13, 14, 17, by adding subdivisions; 256B.501, subdivision
4a; 256B.5011, subdivision 2; 256B.5012, by adding a subdivision; 256B.69,
subdivisions 5a, 5c, 5f, 23; 256B.76, subdivision 1; 256D.03, subdivision 4;
256D.44, subdivision 5; 256G.02, subdivision 6; 256I.03, subdivision 7; 256I.05,
subdivisions 1a, 7c; 256J.08, subdivision 73a; 256J.24, subdivision 5; 256J.425,
subdivisions 2, 3; 256J.45, subdivision 3; 256J.49, subdivisions 1, 4; 256J.521,
subdivision 2; 256J.545; 256J.561, subdivisions 2, 3; 256J.57, subdivision
1; 256J.575, subdivisions 3, 4, 6, 7; 256J.621; 256J.626, subdivision 7;
256J.95, subdivisions 3, 11, 12, 13; 256L.03, by adding a subdivision; 256L.04,
subdivisions 1, 7a, 10a, by adding a subdivision; 256L.05, subdivisions 1, 3, 3a,
by adding a subdivision; 256L.07, subdivisions 1, 2, 3, by adding a subdivision;
256L.11, subdivision 1; 256L.15, subdivisions 2, 3; 256L.17, subdivisions 3, 5;
259.67, by adding a subdivision; 270A.09, by adding a subdivision; 327.14,
by adding a subdivision; 327.15; 327.16; 327.20, subdivision 1, by adding a
subdivision; 501B.89, by adding a subdivision; 519.05; 604A.33, subdivision
1; 609.232, subdivision 11; 626.556, subdivision 3c; 626.5572, subdivisions
6, 13, 21; Laws 2003, First Special Session chapter 14, article 13C, section
2, subdivision 1, as amended; Laws 2007, chapter 147, article 19, section 3,
subdivision 4, as amended; proposing coding for new law in Minnesota Statutes,
chapters 62Q; 246B; 254B; 256; 256B; proposing coding for new law as
Minnesota Statutes, chapter 402A; repealing Minnesota Statutes 2008, sections
103I.112; 144.9501, subdivision 17b; 148D.180, subdivision 8; 245C.11,
subdivisions 1, 2; 246.51, subdivision 1; 246.53, subdivision 3; 256.962,
subdivision 7; 256B.0655, subdivisions 1, 1a, 1c, 1d, 1e, 1f, 1g, 1h, 1i, 2, 3, 5, 6,
7, 8, 9, 10, 11, 12, 13; 256B.071, subdivisions 1, 2, 3, 4; 256B.092, subdivision
5a; 256B.19, subdivision 1d; 256B.431, subdivision 23; 256I.06, subdivision
9; 256L.17, subdivision 6; 327.14, subdivisions 5, 6; Minnesota Rules, parts
4626.2015, subpart 9; 9555.6125, subpart 4, item B.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1
LICENSING

    Section 1. Minnesota Statutes 2008, section 245A.10, subdivision 2, is amended to
read:
    Subd. 2. County fees for background studies and licensing inspections. (a) For
purposes of family and group family child care licensing under this chapter, a county
agency may charge a fee to an applicant or license holder to recover the actual cost of
background studies, but in any case not to exceed $100 annually. A county agency may
also charge a license fee to an applicant or license holder not to exceed $50 for a one-year
license or $100 for a two-year license.
    (b) A county agency may charge a fee to a legal nonlicensed child care provider or
applicant for authorization to recover the actual cost of background studies completed
under section 119B.125, but in any case not to exceed $100 annually.
    (c) Counties may elect to reduce or waive the fees in paragraph (a) or (b):
    (1) in cases of financial hardship;
    (2) if the county has a shortage of providers in the county's area;
    (3) for new providers; or
    (4) for providers who have attained at least 16 hours of training before seeking
initial licensure.
    (d) Counties may allow providers to pay the applicant fees in paragraph (a) or (b) on
an installment basis for up to one year. If the provider is receiving child care assistance
payments from the state, the provider may have the fees under paragraph (a) or (b)
deducted from the child care assistance payments for up to one year and the state shall
reimburse the county for the county fees collected in this manner.
    (e) For purposes of adult foster care and child foster care licensing under this
chapter, a county agency may charge a fee to a corporate applicant or corporate license
holder to recover the actual cost of background studies. A county agency may also charge
a fee to a corporate applicant or corporate license holder to recover the actual cost of
licensing inspections, not to exceed $500 annually.
    (f) Counties may elect to reduce or waive the fees in paragraph (e) under the
following circumstances:
(1) in cases of financial hardship;
(2) if the county has a shortage of providers in the county's area; or
(3) for new providers.

    Sec. 2. Minnesota Statutes 2008, section 245A.10, subdivision 3, is amended to read:
    Subd. 3. Application fee for initial license or certification. (a) For fees required
under subdivision 1, an applicant for an initial license or certification issued by the
commissioner shall submit a $500 application fee with each new application required
under this subdivision. The application fee shall not be prorated, is nonrefundable, and
is in lieu of the annual license or certification fee that expires on December 31. The
commissioner shall not process an application until the application fee is paid.
(b) Except as provided in clauses (1) to (3), an applicant shall apply for a license
to provide services at a specific location.
(1) For a license to provide waivered residential-based habilitation services to
persons with developmental disabilities or related conditions under chapter 245B, an
applicant shall submit an application for each county in which the waivered services will
be provided. Upon licensure, the license holder may provide services to persons in that
county plus no more than three persons at any one time in each of up to ten additional
counties. A license holder in one county may not provide services under the home and
community-based waiver for persons with developmental disabilities to more than three
people in a second county without holding a separate license for that second county.
Applicants or licensees providing services under this clause to not more than three persons
remain subject to the inspection fees established in section 245A.10, subdivision 2, for
each location. The license issued by the commissioner must state the name of each
additional county where services are being provided to persons with developmental
disabilities. A license holder must notify the commissioner before making any changes
that would alter the license information listed under section 245A.04, subdivision 7,
paragraph (a), including any additional counties where persons with developmental
disabilities are being served.
(2) For a license to provide supported employment, crisis respite, or
semi-independent living services to persons with developmental disabilities or related
conditions under chapter 245B, an applicant shall submit a single application to provide
services statewide.
(3) For a license to provide independent living assistance for youth under section
245A.22, an applicant shall submit a single application to provide services statewide.

    Sec. 3. Minnesota Statutes 2008, section 245A.11, subdivision 2a, is amended to read:
    Subd. 2a. Adult foster care license capacity. The commissioner shall issue adult
foster care licenses with a maximum licensed capacity of four beds, including nonstaff
roomers and boarders, except that the commissioner may issue a license with a capacity of
five beds, including roomers and boarders, according to paragraphs (a) to (e).
(a) An adult foster care license holder may have a maximum license capacity of five
if all persons in care are age 55 or over and do not have a serious and persistent mental
illness or a developmental disability.
(b) The commissioner may grant variances to paragraph (a) to allow a foster care
provider with a licensed capacity of five persons to admit an individual under the age of 55
if the variance complies with section 245A.04, subdivision 9, and approval of the variance
is recommended by the county in which the licensed foster care provider is located.
(c) The commissioner may grant variances to paragraph (a) to allow the use of a fifth
bed for emergency crisis services for a person with serious and persistent mental illness
or a developmental disability, regardless of age, if the variance complies with section
245A.04, subdivision 9, and approval of the variance is recommended by the county in
which the licensed foster care provider is located.
(d) Notwithstanding paragraph (a), If the 2009 legislature adopts a rate reduction
that impacts providers of adult foster care services, the commissioner may issue an adult
foster care license with a capacity of five adults if the fifth bed does not increase the
overall statewide capacity of licensed adult foster care beds in homes that are not the
primary residence of the license holder, over the licensed capacity in such homes on July
1, 2009, as identified in a plan submitted to the commissioner by the county, when the
capacity is recommended by the county licensing agency of the county in which the
facility is located and if the recommendation verifies that:
(1) the facility meets the physical environment requirements in the adult foster
care licensing rule;
(2) the five-bed living arrangement is specified for each resident in the resident's:
(i) individualized plan of care;
(ii) individual service plan under section 256B.092, subdivision 1b, if required; or
(iii) individual resident placement agreement under Minnesota Rules, part
9555.5105, subpart 19, if required;
(3) the license holder obtains written and signed informed consent from each
resident or resident's legal representative documenting the resident's informed choice to
living in the home and that the resident's refusal to consent would not have resulted in
service termination; and
(4) the facility was licensed for adult foster care before March 1, 2003 2009.
(e) The commissioner shall not issue a new adult foster care license under paragraph
(d) after June 30, 2005 2011. The commissioner shall allow a facility with an adult foster
care license issued under paragraph (d) before June 30, 2005 2011, to continue with a
capacity of five adults if the license holder continues to comply with the requirements in
paragraph (d).
EFFECTIVE DATE.This section is effective July 1, 2009.

    Sec. 4. Minnesota Statutes 2008, section 245A.11, is amended by adding a subdivision
to read:
    Subd. 7a. Alternate overnight supervision technology; adult foster care license.
    (a) The commissioner may grant an applicant or license holder an adult foster care license
for a residence that does not have a caregiver in the residence during normal sleeping
hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B, but uses
monitoring technology to alert the license holder when an incident occurs that may
jeopardize the health, safety, or rights of a foster care recipient. The applicant or license
holder must comply with all other requirements under Minnesota Rules, parts 9555.5105
to 9555.6265, and the requirements under this subdivision. The license printed by the
commissioner must state in bold and large font:
    (1) that the facility is under electronic monitoring; and
    (2) the telephone number of the county's common entry point for making reports of
suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.
(b) Applications for a license under this section must be submitted directly to
the Department of Human Services licensing division. The licensing division must
immediately notify the host county and lead county contract agency and the host county
licensing agency. The licensing division must collaborate with the county licensing
agency in the review of the application and the licensing of the program.
    (c) Before a license is issued by the commissioner, and for the duration of the
license, the applicant or license holder must establish, maintain, and document the
implementation of written policies and procedures addressing the requirements in
paragraphs (d) through (f).
    (d) The applicant or license holder must have policies and procedures that:
    (1) establish characteristics of target populations that will be admitted into the home,
and characteristics of populations that will not be accepted into the home;
    (2) explain the discharge process when a foster care recipient requires overnight
supervision or other services that cannot be provided by the license holder due to the
limited hours that the license holder is on-site;
    (3) describe the types of events to which the program will respond with a physical
presence when those events occur in the home during time when staff are not on-site, and
how the license holder's response plan meets the requirements in paragraph (e), clause
(1) or (2);
    (4) establish a process for documenting a review of the implementation and
effectiveness of the response protocol for the response required under paragraph (e),
clause (1) or (2). The documentation must include:
    (i) a description of the triggering incident;
    (ii) the date and time of the triggering incident;
    (iii) the time of the response or responses under paragraph (e), clause (1) or (2);
    (iv) whether the response met the resident's needs;
    (v) whether the existing policies and response protocols were followed; and
    (vi) whether the existing policies and protocols are adequate or need modification.
    When no physical presence response is completed for a three-month period, the
license holder's written policies and procedures must require a physical presence response
drill be to conducted for which the effectiveness of the response protocol under paragraph
(e), clause (1) or (2), will be reviewed and documented as required under this clause; and
    (5) establish that emergency and nonemergency phone numbers are posted in a
prominent location in a common area of the home where they can be easily observed by a
person responding to an incident who is not otherwise affiliated with the home.
    (e) The license holder must document and include in the license application which
response alternative under clause (1) or (2) is in place for responding to situations that
present a serious risk to the health, safety, or rights of people receiving foster care services
in the home:
    (1) response alternative (1) requires only the technology to provide an electronic
notification or alert to the license holder that an event is underway that requires a response.
Under this alternative, no more than ten minutes will pass before the license holder will be
physically present on-site to respond to the situation; or
    (2) response alternative (2) requires the electronic notification and alert system
under alternative (1), but more than ten minutes may pass before the license holder is
present on-site to respond to the situation. Under alternative (2), all of the following
conditions are met:
    (i) the license holder has a written description of the interactive technological
applications that will assist the licenser holder in communicating with and assessing the
needs related to care, health, and safety of the foster care recipients. This interactive
technology must permit the license holder to remotely assess the well being of the foster
care recipient without requiring the initiation of the foster care recipient. Requiring the
foster care recipient to initiate a telephone call does not meet this requirement;
(ii) the license holder documents how the remote license holder is qualified and
capable of meeting the needs of the foster care recipients and assessing foster care
recipients' needs under item (i) during the absence of the license holder on-site;
(iii) the license holder maintains written procedures to dispatch emergency response
personnel to the site in the event of an identified emergency; and
    (iv) each foster care recipient's individualized plan of care, individual service plan
under section 256B.092, subdivision 1b, if required, or individual resident placement
agreement under Minnesota Rules, part 9555.5105, subpart 19, if required, identifies the
maximum response time, which may be greater than ten minutes, for the license holder
to be on-site for that foster care recipient.
    (f) All placement agreements, individual service agreements, and plans applicable
to the foster care recipient must clearly state that the adult foster care license category is
a program without the presence of a caregiver in the residence during normal sleeping
hours; the protocols in place for responding to situations that present a serious risk to
health, safety, or rights of foster care recipients under paragraph (e), clause (1) or (2); and a
signed informed consent from each foster care recipient or the person's legal representative
documenting the person's or legal representative's agreement with placement in the
program. If electronic monitoring technology is used in the home, the informed consent
form must also explain the following:
    (1) how any electronic monitoring is incorporated into the alternative supervision
system;
    (2) the backup system for any electronic monitoring in times of electrical outages or
other equipment malfunctions;
    (3) how the license holder is trained on the use of the technology;
    (4) the event types and license holder response times established under paragraph (e);
    (5) how the license holder protects the foster care recipient's privacy related to
electronic monitoring and related to any electronically recorded data generated by the
monitoring system. A foster care recipient may not be removed from a program under
this subdivision for failure to consent to electronic monitoring. The consent form must
explain where and how the electronically recorded data is stored, with whom it will be
shared, and how long it is retained; and
    (6) the risks and benefits of the alternative overnight supervision system.
    The written explanations under clauses (1) to (6) may be accomplished through
cross-references to other policies and procedures as long as they are explained to the
person giving consent, and the person giving consent is offered a copy.
(g) Nothing in this section requires the applicant or license holder to develop or
maintain separate or duplicative policies, procedures, documentation, consent forms, or
individual plans that may be required for other licensing standards, if the requirements of
this section are incorporated into those documents.
(h) The commissioner may grant variances to the requirements of this section
according to section 245A.04, subdivision 9.
(i) For the purposes of paragraphs (d) through (h), license holder has the meaning
under section 245A.2, subdivision 9, and additionally includes all staff, volunteers, and
contractors affiliated with the license holder.
(j) For the purposes of paragraph (e), the terms "assess" and "assessing" mean to
remotely determine what action the license holder needs to take to protect the well-being
of the foster care recipient.

    Sec. 5. Minnesota Statutes 2008, section 245A.11, is amended by adding a subdivision
to read:
    Subd. 8b. Adult foster care data privacy and security. (a) An adult foster
care license holder who creates, collects, records, maintains, stores, or discloses any
individually identifiable recipient data, whether in an electronic or any other format,
must comply with the privacy and security provisions of applicable privacy laws and
regulations, including:
(1) the federal Health Insurance Portability and Accountability Act of 1996
(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations,
title 45, part 160, and subparts A and E of part 164; and
(2) the Minnesota Government Data Practices Act as codified in chapter 13.
(b) For purposes of licensure, the license holder shall be monitored for compliance
with the following data privacy and security provisions:
(1) the license holder must control access to data on foster care recipients according
to the definitions of public and private data on individuals under section 13.02;
classification of the data on individuals as private under section 13.46, subdivision 2;
and control over the collection, storage, use, access, protection, and contracting related
to data according to section 13.05, in which the license holder is assigned the duties
of a government entity;
(2) the license holder must provide each foster care recipient with a notice that
meets the requirements under section 13.04, in which the license holder is assigned the
duties of the government entity, and that meets the requirements of Code of Federal
Regulations, title 45, part 164.52. The notice shall describe the purpose for collection of
the data, and to whom and why it may be disclosed pursuant to law. The notice must
inform the recipient that the license holder uses electronic monitoring and, if applicable,
that recording technology is used;
(3) the license holder must not install monitoring cameras in bathrooms;
(4) electronic monitoring cameras must not be concealed from the foster care
recipients; and
(5) electronic video and audio recordings of foster care recipients shall not be stored
by the license holder for more than five days.
(c) The commissioner shall develop, and make available to license holders and
county licensing workers, a checklist of the data privacy provisions to be monitored
for purposes of licensure.

    Sec. 6. Minnesota Statutes 2008, section 245A.16, subdivision 1, is amended to read:
    Subdivision 1. Delegation of authority to agencies. (a) County agencies and
private agencies that have been designated or licensed by the commissioner to perform
licensing functions and activities under section 245A.04 and background studies for
adult foster care, family adult day services, and family child care, under chapter 245C; to
recommend denial of applicants under section 245A.05; to issue correction orders, to issue
variances, and recommend a conditional license under section 245A.06, or to recommend
suspending or revoking a license or issuing a fine under section 245A.07, shall comply
with rules and directives of the commissioner governing those functions and with this
section. The following variances are excluded from the delegation of variance authority
and may be issued only by the commissioner:
    (1) dual licensure of family child care and child foster care, dual licensure of child
and adult foster care, and adult foster care and family child care;
    (2) adult foster care maximum capacity;
    (3) adult foster care minimum age requirement;
    (4) child foster care maximum age requirement;
    (5) variances regarding disqualified individuals except that county agencies may
issue variances under section 245C.30 regarding disqualified individuals when the county
is responsible for conducting a consolidated reconsideration according to sections 245C.25
and 245C.27, subdivision 2, clauses (a) and (b), of a county maltreatment determination
and a disqualification based on serious or recurring maltreatment; and
    (6) the required presence of a caregiver in the adult foster care residence during
normal sleeping hours.
    (b) County agencies must report information about disqualification reconsiderations
under sections 245C.25 and 245C.27, subdivision 2, paragraphs (a) and (b), and variances
granted under paragraph (a), clause (5), to the commissioner at least monthly in a format
prescribed by the commissioner.
    (c) For family day care programs, the commissioner may authorize licensing reviews
every two years after a licensee has had at least one annual review.
    (d) For family adult day services programs, the commissioner may authorize
licensing reviews every two years after a licensee has had at least one annual review.
    (e) A license issued under this section may be issued for up to two years.

    Sec. 7. Minnesota Statutes 2008, section 245A.16, subdivision 3, is amended to read:
    Subd. 3. Recommendations to commissioner. The county or private agency
shall not make recommendations to the commissioner regarding licensure without first
conducting an inspection, and for adult foster care, family adult day services, and family
child care, a background study of the applicant under chapter 245C. The county or private
agency must forward its recommendation to the commissioner regarding the appropriate
licensing action within 20 working days of receipt of a completed application.

    Sec. 8. Minnesota Statutes 2008, section 245C.04, subdivision 1, is amended to read:
    Subdivision 1. Licensed programs. (a) The commissioner shall conduct a
background study of an individual required to be studied under section 245C.03,
subdivision 1
, at least upon application for initial license for all license types.
    (b) The commissioner shall conduct a background study of an individual required to
be studied under section 245C.03, subdivision 1, at reapplication for a license for adult
foster care, family adult day services, and family child care.
    (c) The commissioner is not required to conduct a study of an individual at the time
of reapplication for a license if the individual's background study was completed by the
commissioner of human services for an adult foster care license holder that is also:
    (1) registered under chapter 144D; or
    (2) licensed to provide home and community-based services to people with
disabilities at the foster care location and the license holder does not reside in the foster
care residence; and
    (3) the following conditions are met:
    (i) a study of the individual was conducted either at the time of initial licensure or
when the individual became affiliated with the license holder;
    (ii) the individual has been continuously affiliated with the license holder since
the last study was conducted; and
    (iii) the last study of the individual was conducted on or after October 1, 1995.
    (d) From July 1, 2007, to June 30, 2009, the commissioner of human services shall
conduct a study of an individual required to be studied under section 245C.03, at the
time of reapplication for a child foster care license. The county or private agency shall
collect and forward to the commissioner the information required under section 245C.05,
subdivisions 1, paragraphs (a) and (b), and 5, paragraphs (a) and (b). The background
study conducted by the commissioner of human services under this paragraph must
include a review of the information required under section 245C.08, subdivisions 1,
paragraph (a), clauses (1) to (5), 3, and 4.
    (e) The commissioner of human services shall conduct a background study of an
individual specified under section 245C.03, subdivision 1, paragraph (a), clauses (2)
to (6), who is newly affiliated with a child foster care license holder. The county or
private agency shall collect and forward to the commissioner the information required
under section 245C.05, subdivisions 1 and 5. The background study conducted by the
commissioner of human services under this paragraph must include a review of the
information required under section 245C.08, subdivisions 1, 3, and 4.
    (f) From January 1, 2010, to December 31, 2012, unless otherwise specified in
paragraph (c), the commissioner shall conduct a study of an individual required to be
studied under section 245C.03 at the time of reapplication for an adult foster care or family
adult day services license: (1) the county shall collect and forward to the commissioner
the information required under section 245C.05, subdivision 1, paragraphs (a) and (b),
and subdivision 5, paragraphs (a) and (b), for background studies conducted by the
commissioner for adult foster care and family adult day services when the license holder
resides in the adult foster care or family adult day services residence; (2) the license
holder shall collect and forward to the commissioner the information required under
section 245C.05, subdivisions 1, paragraphs (a) and (b); and 5, paragraphs (a) and (b),
for background studies conducted by the commissioner for adult foster care when the
license holder does not reside in the adult foster care residence; and (3) the background
study conducted by the commissioner under this paragraph must include a review of the
information required under section 245C.08, subdivision 1, paragraph (a), clauses (1)
to (5), and subdivisions 3 and 4.
(g) The commissioner shall conduct a background study of an individual specified
under section 245C.03, subdivision 1, paragraph (a), clauses (2) to (6), who is newly
affiliated with an adult foster care or family adult day services license holder: (1) the
county shall collect and forward to the commissioner the information required under
section 245C.05, subdivision 1, paragraphs (a) and (b), and subdivision 5, paragraphs (a)
and (b), for background studies conducted by the commissioner for adult foster care
and family adult day services when the license holder resides in the adult foster care or
family adult day services residence; (2) the license holder shall collect and forward to the
commissioner the information required under section 245C.05, subdivisions 1, paragraphs
(a) and (b); and 5, paragraphs (a) and (b), for background studies conducted by the
commissioner for adult foster care when the license holder does not reside in the adult
foster care residence; and (3) the background study conducted by the commissioner under
this paragraph must include a review of the information required under section 245C.08,
subdivision 1, paragraph (a), and subdivisions 3 and 4.
(h) Applicants for licensure, license holders, and other entities as provided in this
chapter must submit completed background study forms to the commissioner before
individuals specified in section 245C.03, subdivision 1, begin positions allowing direct
contact in any licensed program.
    (g) (i) For purposes of this section, a physician licensed under chapter 147 is
considered to be continuously affiliated upon the license holder's receipt from the
commissioner of health or human services of the physician's background study results.

    Sec. 9. Minnesota Statutes 2008, section 245C.05, is amended by adding a subdivision
to read:
    Subd. 2b. County agency to collect and forward information to the
commissioner. For background studies related to adult foster care and family adult
day services when the license holder resides in the adult foster care or family adult
day services residence, the county agency must collect the information required under
subdivision 1 and forward it to the commissioner.

    Sec. 10. Minnesota Statutes 2008, section 245C.05, subdivision 4, is amended to read:
    Subd. 4. Electronic transmission. For background studies conducted by the
Department of Human Services, the commissioner shall implement a system for the
electronic transmission of:
    (1) background study information to the commissioner;
    (2) background study results to the license holder; and
    (3) background study results to county and private agencies for background studies
conducted by the commissioner for child foster care; and
(4) background study results to county agencies for background studies conducted
by the commissioner for adult foster care and family adult day services.

    Sec. 11. Minnesota Statutes 2008, section 245C.08, subdivision 2, is amended to read:
    Subd. 2. Background studies conducted by a county agency. (a) For a background
study conducted by a county agency for adult foster care, family adult day services, and
family child care services, the commissioner shall review:
    (1) information from the county agency's record of substantiated maltreatment
of adults and the maltreatment of minors;
    (2) information from juvenile courts as required in subdivision 4 for individuals
listed in section 245C.03, subdivision 1, clauses (2), (5), and (6); and
    (3) information from the Bureau of Criminal Apprehension.
    (b) If the individual has resided in the county for less than five years, the study shall
include the records specified under paragraph (a) for the previous county or counties of
residence for the past five years.
    (c) Notwithstanding expungement by a court, the county agency may consider
information obtained under paragraph (a), clause (3), unless the commissioner received
notice of the petition for expungement and the court order for expungement is directed
specifically to the commissioner.

    Sec. 12. Minnesota Statutes 2008, section 245C.10, is amended by adding a
subdivision to read:
    Subd. 5. Adult foster care services. The commissioner shall recover the cost of
background studies required under section 245C.03, subdivision 1, for the purposes of
adult foster care and family adult day services licensing, through a fee of no more than
$20 per study charged to the license holder. The fees collected under this subdivision are
appropriated to the commissioner for the purpose of conducting background studies.

    Sec. 13. Minnesota Statutes 2008, section 245C.10, is amended by adding a
subdivision to read:
    Subd. 7. Private agencies. The commissioner shall recover the cost of conducting
background studies under section 245C.33 for studies initiated by private agencies for the
purpose of adoption through a fee of no more than $70 per study charged to the private
agency. The fees collected under this subdivision are appropriated to the commissioner for
the purpose of conducting background studies.

    Sec. 14. Minnesota Statutes 2008, section 245C.17, is amended by adding a
subdivision to read:
    Subd. 6. Notice to county agency. For studies on individuals related to a license
to provide adult foster care and family adult day services, the commissioner shall also
provide a notice of the background study results to the county agency that initiated the
background study.

    Sec. 15. Minnesota Statutes 2008, section 245C.20, is amended to read:
245C.20 LICENSE HOLDER RECORD KEEPING.
A licensed program shall document the date the program initiates a background
study under this chapter in the program's personnel files. When a background study is
completed under this chapter, a licensed program shall maintain a notice that the study
was undertaken and completed in the program's personnel files. Except when background
studies are initiated through the commissioner's online system, if a licensed program
has not received a response from the commissioner under section 245C.17 within 45
days of initiation of the background study request, the licensed program must contact the
commissioner human services licensing division to inquire about the status of the study. If
a license holder initiates a background study under the commissioner's online system, but
the background study subject's name does not appear in the list of active or recent studies
initiated by that license holder, the license holder must either contact the human services
licensing division or resubmit the background study information online for that individual.

    Sec. 16. Minnesota Statutes 2008, section 245C.21, subdivision 1a, is amended to read:
    Subd. 1a. Submission of reconsideration request to county or private agency. (a)
For disqualifications related to studies conducted by county agencies for family child care,
and for disqualifications related to studies conducted by the commissioner for child foster
care, adult foster care, and family adult day services, the individual shall submit the request
for reconsideration to the county or private agency that initiated the background study.
    (b) For disqualifications related to studies conducted by the commissioner for child
foster care, the individual shall submit the request for reconsideration to the private agency
that initiated the background study.
(c) A reconsideration request shall be submitted within 30 days of the individual's
receipt of the disqualification notice or the time frames specified in subdivision 2,
whichever time frame is shorter.
    (c) (d) The county or private agency shall forward the individual's request for
reconsideration and provide the commissioner with a recommendation whether to set aside
the individual's disqualification.

    Sec. 17. Minnesota Statutes 2008, section 245C.23, subdivision 2, is amended to read:
    Subd. 2. Commissioner's notice of disqualification that is not set aside. (a) The
commissioner shall notify the license holder of the disqualification and order the license
holder to immediately remove the individual from any position allowing direct contact
with persons receiving services from the license holder if:
    (1) the individual studied does not submit a timely request for reconsideration
under section 245C.21;
    (2) the individual submits a timely request for reconsideration, but the commissioner
does not set aside the disqualification for that license holder under section 245C.22;
    (3) an individual who has a right to request a hearing under sections 245C.27 and
256.045, or 245C.28 and chapter 14 for a disqualification that has not been set aside, does
not request a hearing within the specified time; or
    (4) an individual submitted a timely request for a hearing under sections 245C.27
and 256.045, or 245C.28 and chapter 14, but the commissioner does not set aside the
disqualification under section 245A.08, subdivision 5, or 256.045.
    (b) If the commissioner does not set aside the disqualification under section 245C.22,
and the license holder was previously ordered under section 245C.17 to immediately
remove the disqualified individual from direct contact with persons receiving services or
to ensure that the individual is under continuous, direct supervision when providing direct
contact services, the order remains in effect pending the outcome of a hearing under
sections 245C.27 and 256.045, or 245C.28 and chapter 14.
    (c) For background studies related to child foster care, the commissioner shall
also notify the county or private agency that initiated the study of the results of the
reconsideration.
(d) For background studies related to adult foster care and family adult day services,
the commissioner shall also notify the county that initiated the study of the results of
the reconsideration.

    Sec. 18. Minnesota Statutes 2008, section 256B.092, is amended by adding a
subdivision to read:
    Subd. 5b. Revised per diem based on legislated rate reduction. Notwithstanding
section 252.28, subdivision 3, paragraph (d), if the 2009 legislature adopts a rate reduction
that impacts payment to providers of adult foster care services, the commissioner may
issue adult foster care licenses that permit a capacity of five adults. The application for a
five-bed license must meet the requirements of section 245A.11, subdivision 2a. Prior to
admission of the fifth recipient of adult foster care services, the county must negotiate a
revised per diem rate for room and board and waiver services that reflects the legislated
rate reduction and results in an overall average per diem reduction for all foster care
recipients in that home. The revised per diem must allow the provider to maintain, as
much as possible, the level of services or enhanced services provided in the residence,
while mitigating the losses of the legislated rate reduction.
EFFECTIVE DATE.This section is effective July 1, 2009.

    Sec. 19. Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:
    Subd. 17. Cost of services and supports. (a) The commissioner shall ensure
that the average per capita expenditures estimated in any fiscal year for home and
community-based waiver recipients does not exceed the average per capita expenditures
that would have been made to provide institutional services for recipients in the absence
of the waiver.
(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
need-based methods for allocating to local agencies the home and community-based
waivered service resources available to support recipients with disabilities in need of
the level of care provided in a nursing facility or a hospital. The commissioner shall
allocate resources to single counties and county partnerships in a manner that reflects
consideration of:
(1) an incentive-based payment process for achieving outcomes;
(2) the need for a state-level risk pool;
(3) the need for retention of management responsibility at the state agency level; and
(4) a phase-in strategy as appropriate.
(c) Until the allocation methods described in paragraph (b) are implemented, the
annual allowable reimbursement level of home and community-based waiver services
shall be the greater of:
(1) the statewide average payment amount which the recipient is assigned under the
waiver reimbursement system in place on June 30, 2001, modified by the percentage of
any provider rate increase appropriated for home and community-based services; or
(2) an amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The
increased reimbursement level must be necessary to allow the recipient to be discharged
from an institution or to prevent imminent placement in an institution. The additional
reimbursement may be used to secure environmental modifications; assistive technology
and equipment; and increased costs for supervision, training, and support services
necessary to address the recipient's extraordinary needs. The commissioner may approve
an increased reimbursement level for up to one year of the recipient's relocation from an
institution or up to six months of a determination that a current waiver recipient is at
imminent risk of being placed in an institution.
(d) Beginning July 1, 2001, medically necessary private duty nursing services will be
authorized under this section as complex and regular care according to sections 256B.0651
and 256B.0653 to 256B.0656. The rate established by the commissioner for registered
nurse or licensed practical nurse services under any home and community-based waiver as
of January 1, 2001, shall not be reduced.
(e) Notwithstanding section 252.28, subdivision 3, paragraph (d), if the 2009
legislature adopts a rate reduction that impacts payment to providers of adult foster care
services, the commissioner may issue adult foster care licenses that permit a capacity of
five adults. The application for a five-bed license must meet the requirements of section
245A.11, subdivision 2a. Prior to admission of the fifth recipient of adult foster care
services, the county must negotiate a revised per diem rate for room and board and waiver
services that reflects the legislated rate reduction and results in an overall average per
diem reduction for all foster care recipients in that home. The revised per diem must allow
the provider to maintain, as much as possible, the level of services or enhanced services
provided in the residence, while mitigating the losses of the legislated rate reduction.
EFFECTIVE DATE.This section is effective July 1, 2009.

    Sec. 20. WAIVER.
By December 1, 2009, the commissioner shall request all federal approvals and
waiver amendments to the disability home and community-based waivers to allow properly
licensed adult foster care homes to provide residential services for up to five individuals.
EFFECTIVE DATE.This section is effective July 1, 2009.

    Sec. 21. REPEALER.
(a) Minnesota Statutes 2008, section 245C.11, subdivisions 1 and 2, are repealed.
(b) Minnesota Statutes 2008, section 256B.092, subdivision 5a, is repealed effective
July 1, 2009.
(c) Minnesota Rules, part 9555.6125, subpart 4, item B, is repealed.

ARTICLE 2
MFIP/CHILD CARE/ADULT SUPPORTS/FRAUD PREVENTION

    Section 1. Minnesota Statutes 2008, section 119B.09, subdivision 7, is amended to read:
    Subd. 7. Date of eligibility for assistance. (a) The date of eligibility for child
care assistance under this chapter is the later of the date the application was signed; the
beginning date of employment, education, or training; the date the infant is born for
applicants to the at-home infant care program; or the date a determination has been made
that the applicant is a participant in employment and training services under Minnesota
Rules, part 3400.0080, or chapter 256J.
    (b) Payment ceases for a family under the at-home infant child care program when a
family has used a total of 12 months of assistance as specified under section 119B.035.
Payment of child care assistance for employed persons on MFIP is effective the date of
employment or the date of MFIP eligibility, whichever is later. Payment of child care
assistance for MFIP or DWP participants in employment and training services is effective
the date of commencement of the services or the date of MFIP or DWP eligibility,
whichever is later. Payment of child care assistance for transition year child care must be
made retroactive to the date of eligibility for transition year child care.
(c) Notwithstanding paragraph (b), payment of child care assistance for participants
eligible under section 119B.05 may only be made retroactive for a maximum of six
months from the date of application for child care assistance.
EFFECTIVE DATE.This section is effective October 1, 2009.

    Sec. 2. Minnesota Statutes 2008, section 119B.13, subdivision 6, is amended to read:
    Subd. 6. Provider payments. (a) Counties or the state shall make vendor payments
to the child care provider or pay the parent directly for eligible child care expenses.
(b) If payments for child care assistance are made to providers, the provider shall
bill the county for services provided within ten days of the end of the service period. If
bills are submitted within ten days of the end of the service period, a county or the state
shall issue payment to the provider of child care under the child care fund within 30 days
of receiving a bill from the provider. Counties or the state may establish policies that
make payments on a more frequent basis.
(c) All bills If a provider has received an authorization of care and been issued a
billing form for an eligible family, the bill must be submitted within 60 days of the last
date of service on the bill. A county may pay a bill submitted more than 60 days after
the last date of service if the provider shows good cause why the bill was not submitted
within 60 days. Good cause must be defined in the county's child care fund plan under
section 119B.08, subdivision 3, and the definition of good cause must include county
error. A county may not pay any bill submitted more than a year after the last date of
service on the bill.
(d) If a provider provided care for a time period without receiving an authorization
of care and a billing form for an eligible family, payment of child care assistance may only
be made retroactively for a maximum of six months from the date the provider is issued
an authorization of care and billing form.
(e) A county may stop payment issued to a provider or may refuse to pay a bill
submitted by a provider if:
(1) the provider admits to intentionally giving the county materially false information
on the provider's billing forms; or
(2) a county finds by a preponderance of the evidence that the provider intentionally
gave the county materially false information on the provider's billing forms.
(e) (f) A county's payment policies must be included in the county's child care plan
under section 119B.08, subdivision 3. If payments are made by the state, in addition to
being in compliance with this subdivision, the payments must be made in compliance
with section 16A.124.
EFFECTIVE DATE.This section is effective October 1, 2009.

    Sec. 3. Minnesota Statutes 2008, section 119B.21, subdivision 5, is amended to read:
    Subd. 5. Child care services grants. (a) A child care resource and referral program
designated under section 119B.19, subdivision 1a, may award child care services grants
for:
    (1) creating new licensed child care facilities and expanding existing facilities,
including, but not limited to, supplies, equipment, facility renovation, and remodeling;
    (2) improving licensed child care facility programs;
    (3) staff training and development services including, but not limited to, in-service
training, curriculum development, accreditation, certification, consulting, resource
centers, program and resource materials, supporting effective teacher-child interactions,
child-focused teaching, and content-driven classroom instruction;
    (4) interim financing;
    (5) capacity building through the purchase of appropriate technology to create,
enhance, and maintain business management systems;
    (6) emergency assistance for child care programs;
    (7) new programs or projects for the creation, expansion, or improvement of
programs that serve ethnic immigrant and refugee communities; and
    (8) targeted recruitment initiatives to expand and build the capacity of the child
care system and to improve the quality of care provided by legal nonlicensed child care
providers.
    (b) A child care resource and referral program designated under section 119B.19,
subdivision 1a
, may award child care services grants to:
    (1) licensed providers;
    (2) providers in the process of being licensed;
    (3) corporations or public agencies that develop or provide child care services;
    (4) school-age care programs;
    (5) legal nonlicensed or family, friend, and neighbor care providers; or
    (6) any combination of clauses (1) to (5).
    (c) A recipient of a child care services grant for facility improvements, interim
financing, or staff training and development must provide a 25 percent local match.
(d) Beginning July 1, 2009, grants under this subdivision shall be increasingly
awarded for activities that improve provider quality, including activities under paragraph
(a), clauses (1) to (3) and (7).

    Sec. 4. Minnesota Statutes 2008, section 119B.21, subdivision 10, is amended to read:
    Subd. 10. Family child care technical assistance grants. (a) A child care resource
and referral organization designated under section 119B.19, subdivision 1a, may award
technical assistance grants of up to $1,000. These grants may be used for:
    (1) facility improvements, including, but not limited to, improvements to meet
licensing requirements;
    (2) improvements to expand a child care facility or program;
    (3) toys, materials, and equipment to improve the learning environment;
    (4) technology and software to create, enhance, and maintain business management
systems;
    (5) start-up costs;
    (6) staff training and development; and
    (7) other uses approved by the commissioner.
    (b) A child care resource and referral program may award family child care technical
assistance grants to:
    (1) licensed family child care providers;
    (2) child care providers in the process of becoming licensed; or
    (3) legal nonlicensed or family, friend, and neighbor care providers.
    (c) A local match is not required for a family child care technical assistance grant.
(d) Beginning July 1, 2009, grants under this subdivision shall be increasingly
awarded for activities that improve provider quality, including activities under paragraph
(a), clauses (1), (3), and (6).

    Sec. 5. Minnesota Statutes 2008, section 119B.231, subdivision 2, is amended to read:
    Subd. 2. Provider eligibility. (a) To be considered for an SRSA, a provider shall
apply to the commissioner or have been chosen as an SRSA provider prior to June 30,
2009, and have complied with all requirements of the SRSA agreement. Priority for funds
is given to providers who had agreements prior to June 30, 2009. If sufficient funds are
available, the commissioner shall make applications available to additional providers. To
be eligible to apply for an SRSA, a provider shall:
    (1) be eligible for child care assistance payments under chapter 119B;
    (2) have at least 25 percent of the children enrolled with the provider subsidized
through the child care assistance program;
    (3) provide full-time, full-year child care services; and
    (4) serve at least one child who is subsidized through the child care assistance
program and who is expected to enter kindergarten within the following 30 months have
obtained a level 3 or 4 star rating under the voluntary Parent Aware quality rating system.
    (b) The commissioner may waive the 25 percent requirement in paragraph (a),
clause (2), if necessary to achieve geographic distribution of SRSA providers and diversity
of types of care provided by SRSA providers.
    (c) An eligible provider who would like to enter into an SRSA with the commissioner
shall submit an SRSA application. To determine whether to enter into an SRSA with a
provider, the commissioner shall evaluate the following factors:
    (1) the qualifications of the provider and the provider's staff provider's Parent
Aware rating score;
    (2) the provider's staff-child ratios;
    (3) the provider's curriculum;
    (4) the provider's current or planned parent education activities;
    (5) (2) the provider's current or planned social service and employment linkages;
    (6) the provider's child development assessment plan;
    (7) (3) the geographic distribution needed for SRSA providers;
    (8) (4) the inclusion of a variety of child care delivery models; and
    (9) (5) other related factors determined by the commissioner.

    Sec. 6. Minnesota Statutes 2008, section 119B.231, subdivision 3, is amended to read:
    Subd. 3. Family and child eligibility. (a) A family eligible to choose an SRSA
provider for their children shall:
    (1) be eligible to receive child care assistance under any provision in chapter 119B
except section 119B.035;
    (2) be in an authorized activity for an average of at least 35 hours per week when
initial eligibility is determined; and
    (3) include a child who has not yet entered kindergarten.
    (b) A family who is determined to be eligible to choose an SRSA provider remains
eligible to be paid at a higher rate through the SRSA provider when the following
conditions exist:
    (1) the child attends child care with the SRSA provider a minimum of 25 hours per
week, on average;
    (2) the family has a child who has not yet entered kindergarten; and
    (3) the family maintains eligibility under chapter 119B except section 119B.035.
    (c) For the 12 months After initial eligibility has been determined, a decrease in the
family's authorized activities to an average of less than 35 hours per week does not result
in ineligibility for the SRSA rate. A family must continue to maintain eligibility under this
chapter and be in an authorized activity.
    (d) A family that moves between counties but continues to use the same SRSA
provider shall continue to receive SRSA funding for the increased payments.

    Sec. 7. Minnesota Statutes 2008, section 119B.231, subdivision 4, is amended to read:
    Subd. 4. Requirements of providers. An SRSA must include assessment,
evaluation, and reporting requirements that promote the goals of improved school
readiness and movement toward appropriate child development milestones. A provider
who enters into an SRSA shall comply with all SRSA requirements, including the
assessment, evaluation, and reporting requirements in the SRSA. Providers who have been
selected previously for SRSAs must begin the process to obtain a rating using Parent
Aware according to timelines established by the commissioner. If the initial Parent Aware
rating is less than three stars, the provider must submit a plan to improve the rating. If
a 3 or 4 star rating is not obtained within established timelines, the commissioner may
consider continuation of the agreement, depending upon the progress made and other
factors. Providers who apply and are selected for a new SRSA agreement on or after July
1, 2009, must have a level 3 or 4 star rating under the voluntary Parent Aware quality
rating system at the time the SRSA agreement is signed.

    Sec. 8. Minnesota Statutes 2008, section 145A.17, is amended by adding a subdivision
to read:
    Subd. 4a. Home visitors as MFIP employment and training service providers.
The county social service agency and the local public health department may mutually
agree to utilize home visitors under this section as MFIP employment and training service
providers under section 256J.49, subdivision 4, for MFIP participants who are: (1) ill or
incapacitated under section 256J.425, subdivision 2; or (2) minor caregivers under section
256J.54. The county social service agency and the local public health department may
also mutually agree to utilize home visitors to provide outreach to MFIP families who are
being sanctioned or who have been terminated from MFIP due to the 60-month time limit.

    Sec. 9. Minnesota Statutes 2008, section 256.045, subdivision 3, is amended to read:
    Subd. 3. State agency hearings. (a) State agency hearings are available for the
following:
    (1) any person applying for, receiving or having received public assistance, medical
care, or a program of social services granted by the state agency or a county agency or
the federal Food Stamp Act whose application for assistance is denied, not acted upon
with reasonable promptness, or whose assistance is suspended, reduced, terminated, or
claimed to have been incorrectly paid;
    (2) any patient or relative aggrieved by an order of the commissioner under section
252.27;
    (3) a party aggrieved by a ruling of a prepaid health plan;
    (4) except as provided under chapter 245C, any individual or facility determined by
a lead agency to have maltreated a vulnerable adult under section 626.557 after they have
exercised their right to administrative reconsideration under section 626.557;
    (5) any person whose claim for foster care payment according to a placement of the
child resulting from a child protection assessment under section 626.556 is denied or not
acted upon with reasonable promptness, regardless of funding source;
    (6) any person to whom a right of appeal according to this section is given by other
provision of law;
    (7) an applicant aggrieved by an adverse decision to an application for a hardship
waiver under section 256B.15;
    (8) an applicant aggrieved by an adverse decision to an application or redetermination
for a Medicare Part D prescription drug subsidy under section 256B.04, subdivision 4a;
    (9) except as provided under chapter 245A, an individual or facility determined
to have maltreated a minor under section 626.556, after the individual or facility has
exercised the right to administrative reconsideration under section 626.556; or
    (10) except as provided under chapter 245C, an individual disqualified under sections
245C.14 and 245C.15, on the basis of serious or recurring maltreatment; a preponderance
of the evidence that the individual has committed an act or acts that meet the definition
of any of the crimes listed in section 245C.15, subdivisions 1 to 4; or for failing to make
reports required under section 626.556, subdivision 3, or 626.557, subdivision 3. Hearings
regarding a maltreatment determination under clause (4) or (9) and a disqualification under
this clause in which the basis for a disqualification is serious or recurring maltreatment,
which has not been set aside under sections 245C.22 and 245C.23, shall be consolidated
into a single fair hearing. In such cases, the scope of review by the human services referee
shall include both the maltreatment determination and the disqualification. The failure to
exercise the right to an administrative reconsideration shall not be a bar to a hearing under
this section if federal law provides an individual the right to a hearing to dispute a finding
of maltreatment. Individuals and organizations specified in this section may contest the
specified action, decision, or final disposition before the state agency by submitting a
written request for a hearing to the state agency within 30 days after receiving written
notice of the action, decision, or final disposition, or within 90 days of such written notice
if the applicant, recipient, patient, or relative shows good cause why the request was not
submitted within the 30-day time limit.; or
    (11) any person with an outstanding debt resulting from receipt of public assistance,
medical care, or the federal Food Stamp Act who is contesting a setoff claim by the
Department of Human Services or a county agency. The scope of the appeal is the validity
of the claimant agency's intention to request a setoff of a refund under chapter 270A
against the debt.
    (b) The hearing for an individual or facility under paragraph (a), clause (4), (9), or
(10), is the only administrative appeal to the final agency determination specifically,
including a challenge to the accuracy and completeness of data under section 13.04.
Hearings requested under paragraph (a), clause (4), apply only to incidents of maltreatment
that occur on or after October 1, 1995. Hearings requested by nursing assistants in nursing
homes alleged to have maltreated a resident prior to October 1, 1995, shall be held as a
contested case proceeding under the provisions of chapter 14. Hearings requested under
paragraph (a), clause (9), apply only to incidents of maltreatment that occur on or after
July 1, 1997. A hearing for an individual or facility under paragraph (a), clause (9), is
only available when there is no juvenile court or adult criminal action pending. If such
action is filed in either court while an administrative review is pending, the administrative
review must be suspended until the judicial actions are completed. If the juvenile court
action or criminal charge is dismissed or the criminal action overturned, the matter may be
considered in an administrative hearing.
    (c) For purposes of this section, bargaining unit grievance procedures are not an
administrative appeal.
    (d) The scope of hearings involving claims to foster care payments under paragraph
(a), clause (5), shall be limited to the issue of whether the county is legally responsible
for a child's placement under court order or voluntary placement agreement and, if so,
the correct amount of foster care payment to be made on the child's behalf and shall not
include review of the propriety of the county's child protection determination or child
placement decision.
    (e) A vendor of medical care as defined in section 256B.02, subdivision 7, or a
vendor under contract with a county agency to provide social services is not a party and
may not request a hearing under this section, except if assisting a recipient as provided in
subdivision 4.
    (f) An applicant or recipient is not entitled to receive social services beyond the
services prescribed under chapter 256M or other social services the person is eligible
for under state law.
    (g) The commissioner may summarily affirm the county or state agency's proposed
action without a hearing when the sole issue is an automatic change due to a change in
state or federal law.

    Sec. 10. Minnesota Statutes 2008, section 256.983, subdivision 1, is amended to read:
    Subdivision 1. Programs established. Within the limits of available appropriations,
the commissioner of human services shall require the maintenance of budget neutral
fraud prevention investigation programs in the counties participating in the fraud
prevention investigation project established under this section. If funds are sufficient,
the commissioner may also extend fraud prevention investigation programs to other
counties provided the expansion is budget neutral to the state. Under any expansion, the
commissioner has the final authority in decisions regarding the creation and realignment
of individual county or regional operations.

    Sec. 11. Minnesota Statutes 2008, section 256I.03, subdivision 7, is amended to read:
    Subd. 7. Countable income. "Countable income" means all income received by an
applicant or recipient less any applicable exclusions or disregards. For a recipient of any
cash benefit from the SSI program, countable income means the SSI benefit limit in effect
at the time the person is in a GRH setting less $20, less the medical assistance personal
needs allowance. If the SSI limit has been reduced for a person due to events occurring
prior to the persons entering the GRH setting, countable income means actual income less
any applicable exclusions and disregards.
EFFECTIVE DATE.This section is effective April 1, 2010.

    Sec. 12. Minnesota Statutes 2008, section 256I.05, subdivision 7c, is amended to read:
    Subd. 7c. Demonstration project. The commissioner is authorized to pursue the
expansion of a demonstration project under federal food stamp regulation for the purpose
of gaining additional federal reimbursement of food and nutritional costs currently paid by
the state group residential housing program. The commissioner shall seek approval no
later than January 1, 2004 October 1, 2009. Any reimbursement received is nondedicated
revenue to the general fund.

    Sec. 13. Minnesota Statutes 2008, section 256J.24, subdivision 5, is amended to read:
    Subd. 5. MFIP transitional standard. The MFIP transitional standard is based
on the number of persons in the assistance unit eligible for both food and cash assistance
unless the restrictions in subdivision 6 on the birth of a child apply. The following table
represents the transitional standards effective October 1, 2007 April 1, 2009.

Number of Eligible People
Transitional Standard
Cash Portion
Food Portion

1
$391 $428:
$250
$141 $178

2
$698 $764:
$437
$261$327

3
$910$1,005:
$532
$378$473

4
$1,091 $1,217:
$621
$470 $596

5
$1,245 $1,393:
$697
$548 $696

6
$1,425$1,602:
$773
$652 $829

7
$1,553 $1,748:
$850
$703$898

8
$1,713 $1,934:
$916
$797$1,018

9
$1,871 $2,119:
$980
$891$1,139

10
$2,024 $2,298:
$1,035
$989 $1,263

over 10
add $151 $178:
$53
$98 $125

per additional member.
    The commissioner shall annually publish in the State Register the transitional
standard for an assistance unit sizes 1 to 10 including a breakdown of the cash and food
portions.
EFFECTIVE DATE.This section is effective retroactively from April 1, 2009.

    Sec. 14. Minnesota Statutes 2008, section 256J.425, subdivision 2, is amended to read:
    Subd. 2. Ill or incapacitated. (a) An assistance unit subject to the time limit in
section 256J.42, subdivision 1, is eligible to receive months of assistance under a hardship
extension if the participant who reached the time limit belongs to any of the following
groups:
(1) participants who are suffering from an illness, injury, or incapacity which
has been certified by a qualified professional when the illness, injury, or incapacity is
expected to continue for more than 30 days and prevents the person from obtaining or
retaining employment severely limits the person's ability to obtain or maintain suitable
employment. These participants must follow the treatment recommendations of the
qualified professional certifying the illness, injury, or incapacity;
(2) participants whose presence in the home is required as a caregiver because of
the illness, injury, or incapacity of another member in the assistance unit, a relative in the
household, or a foster child in the household when the illness or incapacity and the need
for a person to provide assistance in the home has been certified by a qualified professional
and is expected to continue for more than 30 days; or
(3) caregivers with a child or an adult in the household who meets the disability or
medical criteria for home care services under section 256B.0651, subdivision 1, paragraph
(c), or a home and community-based waiver services program under chapter 256B, or
meets the criteria for severe emotional disturbance under section 245.4871, subdivision
6
, or for serious and persistent mental illness under section 245.462, subdivision 20,
paragraph (c). Caregivers in this category are presumed to be prevented from obtaining
or retaining employment.
(b) An assistance unit receiving assistance under a hardship extension under this
subdivision may continue to receive assistance as long as the participant meets the criteria
in paragraph (a), clause (1), (2), or (3).

    Sec. 15. Minnesota Statutes 2008, section 256J.425, subdivision 3, is amended to read:
    Subd. 3. Hard-to-employ participants. (a) An assistance unit subject to the time
limit in section 256J.42, subdivision 1, is eligible to receive months of assistance under
a hardship extension if the participant who reached the time limit belongs to any of the
following groups:
(1) a person who is diagnosed by a licensed physician, psychological practitioner,
or other qualified professional, as developmentally disabled or mentally ill, and that
condition prevents the person from obtaining or retaining unsubsidized employment the
condition severely limits the person's ability to obtain or maintain suitable employment;
(2) a person who:
(i) has been assessed by a vocational specialist or the county agency to be
unemployable for purposes of this subdivision; or
(ii) has an IQ below 80 who has been assessed by a vocational specialist or a county
agency to be employable, but not at a level that makes the participant eligible for an
extension under subdivision 4 the condition severely limits the person's ability to obtain or
maintain suitable employment. The determination of IQ level must be made by a qualified
professional. In the case of a non-English-speaking person: (A) the determination must
be made by a qualified professional with experience conducting culturally appropriate
assessments, whenever possible; (B) the county may accept reports that identify an
IQ range as opposed to a specific score; (C) these reports must include a statement of
confidence in the results;
(3) a person who is determined by a qualified professional to be learning disabled,
and the disability condition severely limits the person's ability to obtain, perform, or
maintain suitable employment. For purposes of the initial approval of a learning disability
extension, the determination must have been made or confirmed within the previous 12
months. In the case of a non-English-speaking person: (i) the determination must be made
by a qualified professional with experience conducting culturally appropriate assessments,
whenever possible; and (ii) these reports must include a statement of confidence in the
results. If a rehabilitation plan for a participant extended as learning disabled is developed
or approved by the county agency, the plan must be incorporated into the employment
plan. However, a rehabilitation plan does not replace the requirement to develop and
comply with an employment plan under section 256J.521; or
(4) a person who has been granted a family violence waiver, and who is complying
with an employment plan under section 256J.521, subdivision 3.
(b) For purposes of this section, "severely limits the person's ability to obtain or
maintain suitable employment" means that a qualified professional has determined that the
person's condition prevents the person from working 20 or more hours per week.

    Sec. 16. Minnesota Statutes 2008, section 256J.49, subdivision 1, is amended to read:
    Subdivision 1. Scope. The terms used in sections 256J.50 256J.425 to 256J.72 have
the meanings given them in this section.

    Sec. 17. Minnesota Statutes 2008, section 256J.49, subdivision 4, is amended to read:
    Subd. 4. Employment and training service provider. "Employment and training
service provider" means:
(1) a public, private, or nonprofit agency with which a county has contracted to
provide employment and training services and which is included in the county's service
agreement submitted under section 256J.626, subdivision 4; or
(2) a county agency, if the county has opted to provide employment and training
services and the county has indicated that fact in the service agreement submitted under
section 256J.626, subdivision 4; or
(3) a local public health department under section 145A.17, subdivision 3a, that a
county has designated to provide employment and training services and is included in the
county's service agreement submitted under section 256J.626, subdivision 4.
Notwithstanding section 116L.871, an employment and training services provider
meeting this definition may deliver employment and training services under this chapter.

    Sec. 18. Minnesota Statutes 2008, section 256J.521, subdivision 2, is amended to read:
    Subd. 2. Employment plan; contents. (a) Based on the assessment under
subdivision 1, the job counselor and the participant must develop an employment plan
that includes participation in activities and hours that meet the requirements of section
256J.55, subdivision 1. The purpose of the employment plan is to identify for each
participant the most direct path to unsubsidized employment and any subsequent steps that
support long-term economic stability. The employment plan should be developed using
the highest level of activity appropriate for the participant. Activities must be chosen from
clauses (1) to (6), which are listed in order of preference. Notwithstanding this order of
preference for activities, priority must be given for activities related to a family violence
waiver when developing the employment plan. The employment plan must also list the
specific steps the participant will take to obtain employment, including steps necessary
for the participant to progress from one level of activity to another, and a timetable for
completion of each step. Levels of activity include:
    (1) unsubsidized employment;
    (2) job search;
    (3) subsidized employment or unpaid work experience;
    (4) unsubsidized employment and job readiness education or job skills training;
    (5) unsubsidized employment or unpaid work experience and activities related to
a family violence waiver or preemployment needs; and
    (6) activities related to a family violence waiver or preemployment needs.
    (b) Participants who are determined to possess sufficient skills such that the
participant is likely to succeed in obtaining unsubsidized employment must job search at
least 30 hours per week for up to six weeks and accept any offer of suitable employment.
The remaining hours necessary to meet the requirements of section 256J.55, subdivision
1
, may be met through participation in other work activities under section 256J.49,
subdivision 13
. The participant's employment plan must specify, at a minimum: (1)
whether the job search is supervised or unsupervised; (2) support services that will
be provided; and (3) how frequently the participant must report to the job counselor.
Participants who are unable to find suitable employment after six weeks must meet
with the job counselor to determine whether other activities in paragraph (a) should be
incorporated into the employment plan. Job search activities which are continued after six
weeks must be structured and supervised.
    (c) Beginning July 1, 2004, activities and hourly requirements in the employment
plan may be adjusted as necessary to accommodate the personal and family circumstances
of participants identified under section 256J.561, subdivision 2, paragraph (d). Participants
who no longer meet the provisions of section 256J.561, subdivision 2, paragraph (d),
must meet with the job counselor within ten days of the determination to revise the
employment plan.
    (d) Participants who are determined to have barriers to obtaining or retaining
employment that will not be overcome during six weeks of job search under paragraph (b)
must work with the job counselor to develop an employment plan that addresses those
barriers by incorporating appropriate activities from paragraph (a), clauses (1) to (6).
The employment plan must include enough hours to meet the participation requirements
in section 256J.55, subdivision 1, unless a compelling reason to require fewer hours
is noted in the participant's file.
    (e) (d) The job counselor and the participant must sign the employment plan to
indicate agreement on the contents.
    (f) (e) Except as provided under paragraph (g) (f), failure to develop or comply with
activities in the plan, or voluntarily quitting suitable employment without good cause, will
result in the imposition of a sanction under section 256J.46.
    (g) (f) When a participant fails to meet the agreed upon hours of participation in paid
employment because the participant is not eligible for holiday pay and the participant's
place of employment is closed for a holiday, the job counselor shall not impose a sanction
or increase the hours of participation in any other activity, including paid employment, to
offset the hours that were missed due to the holiday.
    (h) (g) Employment plans must be reviewed at least every three months to determine
whether activities and hourly requirements should be revised. The job counselor is
encouraged to allow participants who are participating in at least 20 hours of work
activities to also participate in education and training activities in order to meet the federal
hourly participation rates.

    Sec. 19. Minnesota Statutes 2008, section 256J.545, is amended to read:
256J.545 FAMILY VIOLENCE WAIVER CRITERIA.
    (a) In order to qualify for a family violence waiver, an individual must provide
documentation of past or current family violence which may prevent the individual from
participating in certain employment activities.
    (b) The following items may be considered acceptable documentation or verification
of family violence:
    (1) police, government agency, or court records;
    (2) a statement from a battered women's shelter staff with knowledge of the
circumstances or credible evidence that supports the sworn statement;
    (3) a statement from a sexual assault or domestic violence advocate with knowledge
of the circumstances or credible evidence that supports the sworn statement; or
    (4) a statement from professionals from whom the applicant or recipient has sought
assistance for the abuse.
    (c) A claim of family violence may also be documented by a sworn statement from
the applicant or participant and a sworn statement from any other person with knowledge
of the circumstances or credible evidence that supports the client's statement.

    Sec. 20. Minnesota Statutes 2008, section 256J.561, subdivision 2, is amended to read:
    Subd. 2. Participation requirements. (a) All MFIP caregivers, except caregivers
who meet the criteria in subdivision 3, must participate in employment services develop an
individualized employment plan that identifies the activities the participant is required to
participate in and the required hours of participation. Except as specified in paragraphs (b)
to (d), the employment plan must meet the requirements of section 256J.521, subdivision
2
, contain allowable work activities, as defined in section 256J.49, subdivision 13, and,
include at a minimum, the number of participation hours required under section 256J.55,
subdivision 1
.
(b) Minor caregivers and caregivers who are less than age 20 who have not
completed high school or obtained a GED are required to comply with section 256J.54.
(c) A participant who has a family violence waiver shall develop and comply with
an employment plan under section 256J.521, subdivision 3.
(d) As specified in section 256J.521, subdivision 2, paragraph (c), a participant who
meets any one of the following criteria may work with the job counselor to develop an
employment plan that contains less than the number of participation hours under section
256J.55, subdivision 1. Employment plans for participants covered under this paragraph
must be tailored to recognize the special circumstances of caregivers and families
including limitations due to illness or disability and caregiving needs:
(1) a participant who is age 60 or older;
(2) a participant who has been diagnosed by a qualified professional as suffering
from an illness or incapacity that is expected to last for 30 days or more, including a
pregnant participant who is determined to be unable to obtain or retain employment due
to the pregnancy; or
(3) a participant who is determined by a qualified professional as being needed in
the home to care for an ill or incapacitated family member, including caregivers with a
child or an adult in the household who meets the disability or medical criteria for home
care services under section 256B.0651, subdivision 1, paragraph (c), or a home and
community-based waiver services program under chapter 256B, or meets the criteria for
severe emotional disturbance under section 245.4871, subdivision 6, or for serious and
persistent mental illness under section 245.462, subdivision 20, paragraph (c).
(e) For participants covered under paragraphs (c) and (d), the county shall review
the participant's employment services status every three months to determine whether
conditions have changed. When it is determined that the participant's status is no longer
covered under paragraph (c) or (d), the county shall notify the participant that a new or
revised employment plan is needed. The participant and job counselor shall meet within
ten days of the determination to revise the employment plan.
(b) Participants who meet the eligibility requirements in section 256J.575,
subdivision 3, must develop a family stabilization services plan that meets the
requirements in section 256J.575, subdivision 5.
(c) Minor caregivers and caregivers who are less than age 20 who have not
completed high school or obtained a GED must develop an education plan that meets the
requirements in section 256J.54.
(d) Participants with a family violence waiver must develop an employment plan
that meets the requirements in section 256J.521, which cover the provisions in section
256J.575, subdivision 5.
(e) All other participants must develop an employment plan that meets the
requirements of section 256J.521, subdivision 2, and contains allowable work activities,
as defined in section 256J.49, subdivision 13. The employment plan must include, at a
minimum, the number of participation hours required under section 256J.55, subdivision 1.

    Sec. 21. Minnesota Statutes 2008, section 256J.561, subdivision 3, is amended to read:
    Subd. 3. Child under 12 weeks months of age. (a) A participant who has a
natural born child who is less than 12 weeks months of age who meets the criteria in this
subdivision is not required to participate in employment services until the child reaches
12 weeks months of age. To be eligible for this provision, the assistance unit must not
have already used this provision or the previously allowed child under age one exemption.
However, an assistance unit that has an approved child under age one exemption at the
time this provision becomes effective may continue to use that exemption until the child
reaches one year of age.
(b) The provision in paragraph (a) ends the first full month after the child reaches
12 weeks months of age. This provision is available only once in a caregiver's lifetime.
In a two-parent household, only one parent shall be allowed to use this provision. The
participant and job counselor must meet within ten days after the child reaches 12 weeks
months of age to revise the participant's employment plan.
EFFECTIVE DATE.This section is effective March 1, 2010.

    Sec. 22. Minnesota Statutes 2008, section 256J.57, subdivision 1, is amended to read:
    Subdivision 1. Good cause for failure to comply. The county agency shall not
impose the sanction under section 256J.46 if it determines that the participant has good
cause for failing to comply with the requirements of sections 256J.515 to 256J.57. Good
cause exists when:
(1) appropriate child care is not available;
(2) the job does not meet the definition of suitable employment;
(3) the participant is ill or injured;
(4) a member of the assistance unit, a relative in the household, or a foster child in
the household is ill and needs care by the participant that prevents the participant from
complying with the employment plan;
(5) the participant is unable to secure necessary transportation;
(6) the participant is in an emergency situation that prevents compliance with the
employment plan;
(7) the schedule of compliance with the employment plan conflicts with judicial
proceedings;
(8) a mandatory MFIP meeting is scheduled during a time that conflicts with a
judicial proceeding or a meeting related to a juvenile court matter, or a participant's work
schedule;
(9) the participant is already participating in acceptable work activities;
(10) the employment plan requires an educational program for a caregiver under age
20, but the educational program is not available;
(11) activities identified in the employment plan are not available;
(12) the participant is willing to accept suitable employment, but suitable
employment is not available; or
(13) the participant documents other verifiable impediments to compliance with the
employment plan beyond the participant's control; or
(14) the documentation needed to determine if a participant is eligible for family
stabilization services is not available, but there is information that the participant may
qualify and the participant is cooperating with the county or employment service provider's
efforts to obtain the documentation necessary to determine eligibility.
The job counselor shall work with the participant to reschedule mandatory meetings
for individuals who fall under clauses (1), (3), (4), (5), (6), (7), and (8).

    Sec. 23. Minnesota Statutes 2008, section 256J.575, subdivision 3, is amended to read:
    Subd. 3. Eligibility. (a) The following MFIP or diversionary work program (DWP)
participants are eligible for the services under this section:
    (1) a participant who meets the requirements for or has been granted a hardship
extension under section 256J.425, subdivision 2 or 3, except that it is not necessary for
the participant to have reached or be approaching 60 months of eligibility for this section
to apply;
    (2) a participant who is applying for Supplemental Security Income or Social
Security disability insurance; and
    (3) a participant who is a noncitizen who has been in the United States for 12 or
fewer months; and
(4) a participant who is age 60 or older.
    (b) Families must meet all other eligibility requirements for MFIP established in
this chapter. Families are eligible for financial assistance to the same extent as if they
were participating in MFIP.
    (c) A participant under paragraph (a), clause (3), must be provided with English as a
second language opportunities and skills training for up to 12 months. After 12 months,
the case manager and participant must determine whether the participant should continue
with English as a second language classes or skills training, or both, and continue to
receive family stabilization services.
(d) If a county agency or employment services provider has information that
an MFIP participant may meet the eligibility criteria set forth in this subdivision, the
county agency or employment services provider must assist the participant in obtaining
the documentation necessary to determine eligibility. Until necessary documentation is
obtained, the participant must be treated as an eligible participant under subdivisions 5 to 7.
EFFECTIVE DATE.This section is effective July 1, 2009, except the amendment
to paragraph (a) striking "or diversionary work program (DWP)" is effective March 1,
2010.

    Sec. 24. Minnesota Statutes 2008, section 256J.575, subdivision 4, is amended to read:
    Subd. 4. Universal participation. All caregivers must participate in family
stabilization services as defined in subdivision 2, except for caregivers exempt under
section 256J.561, subdivision 3.
EFFECTIVE DATE.This section is effective March 1, 2010.

    Sec. 25. Minnesota Statutes 2008, section 256J.575, subdivision 6, is amended to read:
    Subd. 6. Cooperation with services requirements. (a) To be eligible, A participant
who is eligible for family stabilization services under this section shall comply with
paragraphs (b) to (d).
    (b) Participants shall engage in family stabilization plan services for the appropriate
number of hours per week that the activities are scheduled and available, unless good
cause exists for not doing so, as defined in section 256J.57, subdivision 1. The appropriate
number of hours must be based on the participant's plan.
    (c) The case manager shall review the participant's progress toward the goals in the
family stabilization plan every six months to determine whether conditions have changed,
including whether revisions to the plan are needed.
    (d) A participant's requirement to comply with any or all family stabilization plan
requirements under this subdivision is excused when the case management services,
training and educational services, or family support services identified in the participant's
family stabilization plan are unavailable for reasons beyond the control of the participant,
including when money appropriated is not sufficient to provide the services.

    Sec. 26. Minnesota Statutes 2008, section 256J.575, subdivision 7, is amended to read:
    Subd. 7. Sanctions. (a) The county agency or employment services provider must
follow the requirements of this subdivision at the time the county agency or employment
services provider has information that an MFIP recipient may meet the eligibility criteria
in subdivision 3.
(b) The financial assistance grant of a participating family is reduced according to
section 256J.46, if a participating adult fails without good cause to comply or continue
to comply with the family stabilization plan requirements in this subdivision, unless
compliance has been excused under subdivision 6, paragraph (d).
    (b) (c) Given the purpose of the family stabilization services in this section and the
nature of the underlying family circumstances that act as barriers to both employment and
full compliance with program requirements, there must be a review by the county agency
prior to imposing a sanction to determine whether the plan was appropriated to the needs
of the participant and family, and. There must be a current assessment by a behavioral
health or medical professional confirming that the participant in all ways had the ability to
comply with the plan, as confirmed by a behavioral health or medical professional.
    (c) (d) Prior to the imposition of a sanction, the county agency or employment
services provider shall review the participant's case to determine if the family stabilization
plan is still appropriate and meet with the participant face-to-face. The participant may
bring an advocate The county agency or employment services provider must inform the
participant of the right to bring an advocate to the face-to-face meeting.
    During the face-to-face meeting, the county agency shall:
    (1) determine whether the continued noncompliance can be explained and mitigated
by providing a needed family stabilization service, as defined in subdivision 2, paragraph
(d);
    (2) determine whether the participant qualifies for a good cause exception under
section 256J.57, or if the sanction is for noncooperation with child support requirements,
determine if the participant qualifies for a good cause exemption under section 256.741,
subdivision 10;
    (3) determine whether activities in the family stabilization plan are appropriate
based on the family's circumstances;
    (4) explain the consequences of continuing noncompliance;
    (5) identify other resources that may be available to the participant to meet the
needs of the family; and
    (6) inform the participant of the right to appeal under section 256J.40.
    If the lack of an identified activity or service can explain the noncompliance, the
county shall work with the participant to provide the identified activity.
    (d) If the participant fails to come to the face-to-face meeting, the case manager or a
designee shall attempt at least one home visit. If a face-to-face meeting is not conducted,
the county agency shall send the participant a written notice that includes the information
under paragraph (c).
    (e) After the requirements of paragraphs (c) and (d) are met and prior to imposition
of a sanction, the county agency shall provide a notice of intent to sanction under section
256J.57, subdivision 2, and, when applicable, a notice of adverse action under section
256J.31.
    (f) Section 256J.57 applies to this section except to the extent that it is modified
by this subdivision.

    Sec. 27. Minnesota Statutes 2008, section 256J.621, is amended to read:
256J.621 WORK PARTICIPATION CASH BENEFITS.
    (a) Effective October 1, 2009, upon exiting the diversionary work program (DWP)
or upon terminating the Minnesota family investment program with earnings, a participant
who is employed may be eligible for work participation cash benefits of $75 $50 per
month to assist in meeting the family's basic needs as the participant continues to move
toward self-sufficiency.
    (b) To be eligible for work participation cash benefits, the participant shall not
receive MFIP or diversionary work program assistance during the month and the
participant or participants must meet the following work requirements:
    (1) if the participant is a single caregiver and has a child under six years of age, the
participant must be employed at least 87 hours per month;
    (2) if the participant is a single caregiver and does not have a child under six years of
age, the participant must be employed at least 130 hours per month; or
    (3) if the household is a two-parent family, at least one of the parents must be
employed an average of at least 130 hours per month.
    Whenever a participant exits the diversionary work program or is terminated from
MFIP and meets the other criteria in this section, work participation cash benefits are
available for up to 24 consecutive months.
    (c) Expenditures on the program are maintenance of effort state funds under
a separate state program for participants under paragraph (b), clauses (1) and (2).
Expenditures for participants under paragraph (b), clause (3), are nonmaintenance of effort
funds. Months in which a participant receives work participation cash benefits under this
section do not count toward the participant's MFIP 60-month time limit.

    Sec. 28. Minnesota Statutes 2008, section 256J.626, subdivision 7, is amended to read:
    Subd. 7. Performance base funds. (a) For the purpose of this section, the following
terms have the meanings given.
(1) "Caseload Reduction Credit" (CRC) means the measure of how much Minnesota
TANF and separate state program caseload has fallen relative to federal fiscal year 2005
based on caseload data from October 1 to September 30.
(2) "TANF participation rate target" means a 50 percent participation rate reduced by
the CRC for the previous year.
(b) For calendar year 2009 2010 and yearly thereafter, each county and tribe will be
allocated 95 percent of their initial calendar year allocation. Counties and tribes will be
allocated additional funds based on performance as follows:
    (1) a county or tribe that achieves a 50 percent the TANF participation rate target
or a five percentage point improvement over the previous year's TANF participation rate
under section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive
months for the most recent year for which the measurements are available, will receive an
additional allocation equal to 2.5 percent of its initial allocation; and
    (2) a county or tribe that performs within or above its range of expected performance
on the annualized three-year self-support index under section 256J.751, subdivision 2,
clause (6), will receive an additional allocation equal to 2.5 percent of its initial allocation;
and
    (3) a county or tribe that does not achieve a 50 percent the TANF participation rate
target or a five percentage point improvement over the previous year's TANF participation
rate under section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive
months for the most recent year for which the measurements are available, will not
receive an additional 2.5 percent of its initial allocation until after negotiating a multiyear
improvement plan with the commissioner; or
    (4) a county or tribe that does not perform within or above its range of expected
performance on the annualized three-year self-support index under section 256J.751,
subdivision 2
, clause (6), will not receive an additional allocation equal to 2.5 percent
of its initial allocation until after negotiating a multiyear improvement plan with the
commissioner.
    (b) (c) For calendar year 2009 and yearly thereafter, performance-based funds for
a federally approved tribal TANF program in which the state and tribe have in place
a contract under section 256.01, addressing consolidated funding, will be allocated as
follows:
    (1) a tribe that achieves the participation rate approved in its federal TANF plan
using the average of 12 consecutive months for the most recent year for which the
measurements are available, will receive an additional allocation equal to 2.5 percent of
its initial allocation; and
    (2) a tribe that performs within or above its range of expected performance on the
annualized three-year self-support index under section 256J.751, subdivision 2, clause (6),
will receive an additional allocation equal to 2.5 percent of its initial allocation; or
    (3) a tribe that does not achieve the participation rate approved in its federal TANF
plan using the average of 12 consecutive months for the most recent year for which the
measurements are available, will not receive an additional allocation equal to 2.5 percent
of its initial allocation until after negotiating a multiyear improvement plan with the
commissioner; or
    (4) a tribe that does not perform within or above its range of expected performance
on the annualized three-year self-support index under section 256J.751, subdivision
2
, clause (6), will not receive an additional allocation equal to 2.5 percent until after
negotiating a multiyear improvement plan with the commissioner.
    (c) (d) Funds remaining unallocated after the performance-based allocations
in paragraph (a) (b) are available to the commissioner for innovation projects under
subdivision 5.
    (d) (1) If available funds are insufficient to meet county and tribal allocations under
paragraph (a) (b), the commissioner may make available for allocation funds that are
unobligated and available from the innovation projects through the end of the current
biennium.
    (2) If after the application of clause (1) funds remain insufficient to meet county
and tribal allocations under paragraph (a) (b), the commissioner must proportionally
reduce the allocation of each county and tribe with respect to their maximum allocation
available under paragraph (a) (b).

    Sec. 29. Minnesota Statutes 2008, section 256J.95, subdivision 3, is amended to read:
    Subd. 3. Eligibility for diversionary work program. (a) Except for the categories
of family units listed below, all family units who apply for cash benefits and who
meet MFIP eligibility as required in sections 256J.11 to 256J.15 are eligible and must
participate in the diversionary work program. Family units that are not eligible for the
diversionary work program include:
    (1) child only cases;
    (2) a single-parent family unit that includes a child under 12 weeks months of age.
A parent is eligible for this exception once in a parent's lifetime and is not eligible if
the parent has already used the previously allowed child under age one exemption from
MFIP employment services;
    (3) a minor parent without a high school diploma or its equivalent;
    (4) an 18- or 19-year-old caregiver without a high school diploma or its equivalent
who chooses to have an employment plan with an education option;
    (5) a caregiver age 60 or over;
    (6) family units with a caregiver who received DWP benefits in the 12 months prior
to the month the family applied for DWP, except as provided in paragraph (c);
    (7) family units with a caregiver who received MFIP within the 12 months prior to
the month the family unit applied for DWP;
    (8) a family unit with a caregiver who received 60 or more months of TANF
assistance;
    (9) a family unit with a caregiver who is disqualified from DWP or MFIP due to
fraud; and
    (10) refugees and asylees as defined in Code of Federal Regulations, title 45, part
400, subpart d, section 400.43, who arrived in the United States in the 12 months prior to
the date of application for family cash assistance.
    (b) A two-parent family must participate in DWP unless both caregivers meet the
criteria for an exception under paragraph (a), clauses (1) through (5), or the family unit
includes a parent who meets the criteria in paragraph (a), clause (6), (7), (8), (9), or (10).
    (c) Once DWP eligibility is determined, the four months run consecutively. If a
participant leaves the program for any reason and reapplies during the four-month period,
the county must redetermine eligibility for DWP.
EFFECTIVE DATE.This section is effective March 1, 2010.

    Sec. 30. Minnesota Statutes 2008, section 256J.95, subdivision 11, is amended to read:
    Subd. 11. Universal participation required. (a) All DWP caregivers, except
caregivers who meet the criteria in paragraph (d), are required to participate in DWP
employment services. Except as specified in paragraphs (b) and (c), employment plans
under DWP must, at a minimum, meet the requirements in section 256J.55, subdivision 1.
(b) A caregiver who is a member of a two-parent family that is required to participate
in DWP who would otherwise be ineligible for DWP under subdivision 3 may be allowed
to develop an employment plan under section 256J.521, subdivision 2, paragraph (c), that
may contain alternate activities and reduced hours.
(c) A participant who is a victim of family violence shall be allowed to develop an
employment plan under section 256J.521, subdivision 3. A claim of family violence must
be documented by the applicant or participant by providing a sworn statement which is
supported by collateral documentation in section 256J.545, paragraph (b).
(d) One parent in a two-parent family unit that has a natural born child under 12
weeks months of age is not required to have an employment plan until the child reaches 12
weeks months of age unless the family unit has already used the exclusion under section
256J.561, subdivision 3, or the previously allowed child under age one exemption under
section 256J.56, paragraph (a), clause (5).
(e) The provision in paragraph (d) ends the first full month after the child reaches 12
weeks months of age. This provision is allowable only once in a caregiver's lifetime. In a
two-parent household, only one parent shall be allowed to use this category.
(f) The participant and job counselor must meet within ten working days after the
child reaches 12 weeks months of age to revise the participant's employment plan. The
employment plan for a family unit that has a child under 12 weeks months of age that has
already used the exclusion in section 256J.561 or the previously allowed child under
age one exemption under section 256J.56, paragraph (a), clause (5), must be tailored to
recognize the caregiving needs of the parent.
EFFECTIVE DATE.This section is effective March 1, 2010.

    Sec. 31. Minnesota Statutes 2008, section 256J.95, subdivision 12, is amended to read:
    Subd. 12. Conversion or referral to MFIP. (a) If at any time during the DWP
application process or during the four-month DWP eligibility period, it is determined that
a participant is unlikely to benefit from the diversionary work program, the county shall
convert or refer the participant to MFIP as specified in paragraph (d). Participants who are
determined to be unlikely to benefit from the diversionary work program must develop
and sign an employment plan. Participants who meet any one of the criteria in paragraph
(b) shall be considered to be unlikely to benefit from DWP, provided the necessary
documentation is available to support the determination.
(b) A participant who: meets the eligibility requirements under section 256J.575,
subdivision 3, must be considered to be unlikely to benefit from DWP, provided the
necessary documentation is available to support the determination.
(1) has been determined by a qualified professional as being unable to obtain or retain
employment due to an illness, injury, or incapacity that is expected to last at least 60 days;
(2) is required in the home as a caregiver because of the illness, injury, or incapacity,
of a family member, or a relative in the household, or a foster child, and the illness, injury,
or incapacity and the need for a person to provide assistance in the home has been certified
by a qualified professional and is expected to continue more than 60 days;
(3) is determined by a qualified professional as being needed in the home to care for
a child or adult meeting the special medical criteria in section 256J.561, subdivision 2,
paragraph (d), clause (3);
(4) is pregnant and is determined by a qualified professional as being unable to
obtain or retain employment due to the pregnancy; or
(5) has applied for SSI or SSDI.
(c) In a two-parent family unit, both parents must be if one parent is determined
to be unlikely to benefit from the diversionary work program before, the family unit
can must be converted or referred to MFIP.
(d) A participant who is determined to be unlikely to benefit from the diversionary
work program shall be converted to MFIP and, if the determination was made within 30
days of the initial application for benefits, no additional application form is required.
A participant who is determined to be unlikely to benefit from the diversionary work
program shall be referred to MFIP and, if the determination is made more than 30
days after the initial application, the participant must submit a program change request
form. The county agency shall process the program change request form by the first of
the following month to ensure that no gap in benefits is due to delayed action by the
county agency. In processing the program change request form, the county must follow
section 256J.32, subdivision 1, except that the county agency shall not require additional
verification of the information in the case file from the DWP application unless the
information in the case file is inaccurate, questionable, or no longer current.
(e) The county shall not request a combined application form for a participant who
has exhausted the four months of the diversionary work program, has continued need for
cash and food assistance, and has completed, signed, and submitted a program change
request form within 30 days of the fourth month of the diversionary work program. The
county must process the program change request according to section 256J.32, subdivision
1
, except that the county agency shall not require additional verification of information
in the case file unless the information is inaccurate, questionable, or no longer current.
When a participant does not request MFIP within 30 days of the diversionary work
program benefits being exhausted, a new combined application form must be completed
for any subsequent request for MFIP.
EFFECTIVE DATE.This section is effective March 1, 2010.

    Sec. 32. Minnesota Statutes 2008, section 256J.95, subdivision 13, is amended to read:
    Subd. 13. Immediate referral to employment services. Within one working day of
determination that the applicant is eligible for the diversionary work program, but before
benefits are issued to or on behalf of the family unit, the county shall refer all caregivers to
employment services. The referral to the DWP employment services must be in writing
and must contain the following information:
(1) notification that, as part of the application process, applicants are required to
develop an employment plan or the DWP application will be denied;
(2) the employment services provider name and phone number;
(3) the date, time, and location of the scheduled employment services interview;
(4) the immediate availability of supportive services, including, but not limited to,
child care, transportation, and other work-related aid; and
(5) (4) the rights, responsibilities, and obligations of participants in the program,
including, but not limited to, the grounds for good cause, the consequences of refusing or
failing to participate fully with program requirements, and the appeal process.

    Sec. 33. Minnesota Statutes 2008, section 259.67, is amended by adding a subdivision
to read:
    Subd. 3b. Extension; adoption finalized after age 16. A child who has attained the
age of 16 prior to finalization of their adoption is eligible for extension of the adoption
assistance agreement to the date the child attains age 21 if the child is:
    (1) completing a secondary education program or a program leading to an equivalent
credential;
    (2) enrolled in an institution which provides postsecondary or vocational education;
    (3) participating in a program or activity designed to promote or remove barriers to
employment;
    (4) employed for at least 80 hours per month; or
    (5) incapable of doing any of the activities described in clauses (1) to (4) due to a
medical condition which incapability is supported by regularly updated information in
the case plan of the child.
EFFECTIVE DATE.This section is effective October 1, 2010.

    Sec. 34. Minnesota Statutes 2008, section 270A.09, is amended by adding a
subdivision to read:
    Subd. 1b. Department of Human Services claims. Notwithstanding subdivision 1,
any debtor contesting a setoff claim by the Department of Human Services or a county
agency whose claim relates to a debt resulting from receipt of public assistance, medical
care, or the federal Food Stamp Act shall have a hearing conducted in the same manner as
an appeal under sections 256.045 and 256.0451.

    Sec. 35. AMERICAN INDIAN CHILD WELFARE PROJECTS.
Notwithstanding Minnesota Statutes, section 16A.28, the commissioner of human
services shall extend payment of state fiscal year 2009 funds in state fiscal year 2010
to tribes participating in the American Indian child welfare projects under Minnesota
Statutes, section 256.01, subdivision 14b. Future extensions of payment for a tribe
participating in the Indian child welfare projects under Minnesota Statutes, section 256.01,
subdivision 14b, must be granted according to the commissioner's authority under
Minnesota Statutes, section 16A.28.

    Sec. 36. REPEALER.
Minnesota Statutes 2008, section 256I.06, subdivision 9, is repealed.

ARTICLE 3
STATE-OPERATED SERVICES/MINNESOTA SEX OFFENDER PROGRAM

    Section 1. Minnesota Statutes 2008, section 246.50, subdivision 5, is amended to read:
    Subd. 5. Cost of care. "Cost of care" means the commissioner's charge for services
provided to any person admitted to a state facility.
For purposes of this subdivision, "charge for services" means the cost of services,
treatment, maintenance, bonds issued for capital improvements, depreciation of buildings
and equipment, and indirect costs related to the operation of state facilities. The
commissioner may determine the charge for services on an anticipated average per diem
basis as an all inclusive charge per facility, per disability group, or per treatment program.
The commissioner may determine a charge per service, using a method that includes direct
and indirect costs usual and customary fee charged for services provided to clients. The
usual and customary fee shall be established in a manner required to appropriately bill
services to all payers and shall include the costs related to the operations of any program
offered by the state.

    Sec. 2. Minnesota Statutes 2008, section 246.50, is amended by adding a subdivision
to read:
    Subd. 10. State-operated community-based program. "State-operated
community-based program" means any program operated in the community including
community behavioral health hospitals, crisis centers, residential facilities, outpatient
services, and other community-based services developed and operated by the state and
under the commissioner's control.

    Sec. 3. Minnesota Statutes 2008, section 246.50, is amended by adding a subdivision
to read:
    Subd. 11. Health plan company. "Health plan company" has the meaning given it
in section 62Q.01, subdivision 4, and also includes a demonstration provider as defined in
section 256B.69, subdivision 2, paragraph (b), a county or group of counties participating
in county-based purchasing according to section 256B.692, and a children's mental health
collaborative under contract to provide medical assistance for individuals enrolled in
the prepaid medical assistance and MinnesotaCare programs under sections 245.493 to
245.495.

    Sec. 4. Minnesota Statutes 2008, section 246.51, is amended by adding a subdivision
to read:
    Subd. 1a. Clients in state-operated community-based programs; determination.
The commissioner shall determine available health plan coverage from a health plan
company for services provided to clients admitted to a state-operated community-based
program. If the health plan coverage requires a co-pay or deductible, or if there is no
available health plan coverage, the commissioner shall determine or redetermine, what
part of the noncovered cost of care, if any, the client is able to pay. If the client is unable to
pay the uncovered cost of care, the commissioner shall determine the client's relatives'
ability to pay. The client and relatives shall provide to the commissioner documents and
proof necessary to determine the client and relatives' ability to pay. Failure to provide the
commissioner with sufficient information to determine ability to pay may make the client
or relatives liable for the full cost of care until the time when sufficient information is
provided. If it is determined that the responsible party does not have the ability to pay,
the commissioner shall waive payment of the portion that exceeds ability to pay under
the determination.

    Sec. 5. Minnesota Statutes 2008, section 246.51, is amended by adding a subdivision
to read:
    Subd. 1b. Clients served by regional treatment centers or nursing homes;
determination. The commissioner shall determine or redetermine, if necessary, what part
of the cost of care, if any, a client served in regional treatment centers or nursing homes
operated by state-operated services, is able to pay. If the client is unable to pay the full cost
of care, the commissioner shall determine if the client's relatives have the ability to pay.
The client and relatives shall provide to the commissioner documents and proof necessary
to determine the client and relatives' ability to pay. Failure to provide the commissioner
with sufficient information to determine ability to pay may make the client or relatives
liable for the full cost of care until the time when sufficient information is provided. No
parent shall be liable for the cost of care given a client at a regional treatment center after
the client has reached the age of 18 years.

    Sec. 6. Minnesota Statutes 2008, section 246.511, is amended to read:
246.511 RELATIVE RESPONSIBILITY.
Except for chemical dependency services paid for with funds provided under chapter
254B, a client's relatives shall not, pursuant to the commissioner's authority under section
246.51, be ordered to pay more than ten percent of the cost of the following: (1) for
services provided in a community-based service, the noncovered cost of care as determined
under the ability to pay determination; and (2) for services provided at a regional treatment
center operated by state-operated services, 20 percent of the cost of care, unless they
reside outside the state. Parents of children in state facilities shall have their responsibility
to pay determined according to section 252.27, subdivision 2, or in rules adopted under
chapter 254B if the cost of care is paid under chapter 254B. The commissioner may
accept voluntary payments in excess of ten 20 percent. The commissioner may require
full payment of the full per capita cost of care in state facilities for clients whose parent,
parents, spouse, guardian, or conservator do not reside in Minnesota.

    Sec. 7. Minnesota Statutes 2008, section 246.52, is amended to read:
246.52 PAYMENT FOR CARE; ORDER; ACTION.
The commissioner shall issue an order to the client or the guardian of the estate, if
there be one, and relatives determined able to pay requiring them to pay monthly to the
state of Minnesota the amounts so determined the total of which shall not exceed the full
cost of care. Such order shall specifically state the commissioner's determination and shall
be conclusive unless appealed from as herein provided. When a client or relative fails to
pay the amount due hereunder the attorney general, upon request of the commissioner,
may institute, or direct the appropriate county attorney to institute, civil action to recover
such amount.

    Sec. 8. Minnesota Statutes 2008, section 246.54, subdivision 2, is amended to read:
    Subd. 2. Exceptions. (a) Subdivision 1 does not apply to services provided at the
Minnesota Security Hospital, the Minnesota sex offender program, or the Minnesota
extended treatment options program. For services at these facilities, a county's payment
shall be made from the county's own sources of revenue and payments shall be paid as
follows: payments to the state from the county shall equal ten percent of the cost of care,
as determined by the commissioner, for each day, or the portion thereof, that the client
spends at the facility. If payments received by the state under sections 246.50 to 246.53
exceed 90 percent of the cost of care, the county shall be responsible for paying the state
only the remaining amount. The county shall not be entitled to reimbursement from the
client, the client's estate, or from the client's relatives, except as provided in section 246.53.
    (b) Regardless of the facility to which the client is committed, subdivision 1 does
not apply to the following individuals:
    (1) clients who are committed as mentally ill and dangerous under section 253B.02,
subdivision 17;
    (2) clients who are committed as sexual psychopathic personalities under section
253B.02, subdivision 18b; and
    (3) clients who are committed as sexually dangerous persons under section 253B.02,
subdivision 18c.
    For each of the individuals in clauses (1) to (3), the payment by the county to the state
shall equal ten percent of the cost of care for each day as determined by the commissioner.

    Sec. 9. Minnesota Statutes 2008, section 246B.01, is amended by adding a subdivision
to read:
    Subd. 1a. Client. "Client" means a person who is admitted to the Minnesota sex
offender program or subject to a court hold order under section 253B.185 for the purpose
of assessment, diagnosis, care, treatment, supervision, or other services provided by the
Minnesota sex offender program.

    Sec. 10. Minnesota Statutes 2008, section 246B.01, is amended by adding a
subdivision to read:
    Subd. 1b. Client's county. "Client's county" means the county of the client's
legal settlement for poor relief purposes at the time of commitment. If the client has no
legal settlement for poor relief in this state, it means the county of commitment, except
that when a client with no legal settlement for poor relief is committed while serving a
sentence at a penal institution, it means the county from which the client was sentenced.

    Sec. 11. Minnesota Statutes 2008, section 246B.01, is amended by adding a subdivision
to read:
    Subd. 2b. Cost of care. "Cost of care" means the commissioner's charge for
housing and treatment services provided to any person admitted to the Minnesota sex
offender program.
For purposes of this subdivision, "charge for housing and treatment services" means
the cost of services, treatment, maintenance, bonds issued for capital improvements,
depreciation of buildings and equipment, and indirect costs related to the operation of
state facilities. The commissioner may determine the charge for services on an anticipated
average per diem basis as an all-inclusive charge per facility.

    Sec. 12. Minnesota Statutes 2008, section 246B.01, is amended by adding a
subdivision to read:
    Subd. 2d. Local social services agency. "Local social services agency" means the
local social services agency of the client's county as defined in subdivision 1b and of the
county of commitment, and any other local social services agency possessing information
regarding, or requested by the commissioner to investigate, the financial circumstances
of a client.

    Sec. 13. [246B.07] PAYMENT FOR CARE AND TREATMENT:
DETERMINATION.
    Subdivision 1. Procedures. The commissioner shall determine or redetermine, if
necessary, what amount of the cost of care, if any, the client is able to pay. The client shall
provide to the commissioner documents and proof necessary to determine the ability to
pay. Failure to provide the commissioner with sufficient information to determine ability
to pay may make the client liable for the full cost of care until the time when sufficient
information is provided.
    Subd. 2. Rules. The commissioner shall use the standards in section 246.51,
subdivision 2, to determine the client's liability for the care provided by the Minnesota sex
offender program.
    Subd. 3. Applicability. The commissioner may recover, under sections 246B.07 to
246B.10, the cost of any care provided by the Minnesota sex offender program.

    Sec. 14. [246B.08] PAYMENT FOR CARE; ORDER; ACTION.
The commissioner shall issue an order to the client or the guardian of the estate, if
there is one, requiring the client or guardian to pay to the state the amounts determined, the
total of which must not exceed the full cost of care. The order must specifically state the
commissioner's determination and must be conclusive, unless appealed. If a client fails to
pay the amount due, the attorney general, upon request of the commissioner, may institute,
or direct the appropriate county attorney to institute a civil action to recover the amount.

    Sec. 15. [246B.09] CLAIM AGAINST ESTATE OF DECEASED CLIENT.
    Subdivision 1. Client's estate. Upon the death of a client, or a former client, the
total cost of care provided to the client, less the amount actually paid toward the cost of
care by the client, must be filed by the commissioner as a claim against the estate of the
client with the court having jurisdiction to probate the estate, and all proceeds collected
by the state in the case must be divided between the state and county in proportion to
the cost of care each has borne.
    Subd. 2. Preferred status. An estate claim in subdivision 1 must be considered an
expense of the last illness for purposes of section 524.3-805.
If the commissioner determines that the property or estate of a client is not more
than needed to care for and maintain the spouse and minor or dependent children of a
deceased client, the commissioner has the power to compromise the claim of the state in a
manner deemed just and proper.
    Subd. 3. Exception from statute of limitations. Any statute of limitations that
limits the commissioner in recovering the cost of care obligation incurred by a client or
former client must not apply to any claim against an estate made under this section to
recover cost of care.

    Sec. 16. [246B.10] LIABILITY OF COUNTY; REIMBURSEMENT.
The client's county shall pay to the state a portion of the cost of care provided in
the Minnesota sex offender program to a client who has legally settled in that county. A
county's payment must be made from the county's own sources of revenue and payments
must equal ten percent of the cost of care, as determined by the commissioner, for each
day or portion of a day, that the client spends at the facility. If payments received by the
state under this chapter exceed 90 percent of the cost of care, the county is responsible
for paying the state the remaining amount. The county is not entitled to reimbursement
from the client, the client's estate, or from the client's relatives, except as provided in
section 246B.07.

    Sec. 17. Minnesota Statutes 2008, section 252.025, subdivision 7, is amended to read:
    Subd. 7. Minnesota extended treatment options. The commissioner shall develop
by July 1, 1997, the Minnesota extended treatment options to serve Minnesotans who have
developmental disabilities and exhibit severe behaviors which present a risk to public
safety. This program is statewide and must provide specialized residential services in
Cambridge and an array of community support community-based services statewide with
sufficient levels of care and a sufficient number of specialists to ensure that individuals
referred to the program receive the appropriate care. The individuals working in the
community-based services under this section are state employees supervised by the
commissioner of human services. No layoffs shall occur as a result of restructuring
under this section.

    Sec. 18. REQUIRING THE DEVELOPMENT OF COMMUNITY-BASED
MENTAL HEALTH SERVICES FOR PATIENTS COMMITTED TO THE
ANOKA-METRO REGIONAL TREATMENT CENTER.
In consultation with community partners, the commissioner of human services
shall develop an array of community-based services to transform the current services
now provided to patients at the Anoka-Metro Regional Treatment Center. The
community-based services may be provided in facilities with 16 or fewer beds, and must
provide the appropriate level of care for the patients being admitted to the facilities. The
planning for this transition must be completed by October 1, 2009, with an initial report
to the committee chairs of health and human services by November 30, 2009, and a
semiannual report on progress until the transition is completed. The commissioner of
human services shall solicit interest from stakeholders and potential community partners.
The individuals working in the community-based services facilities under this section are
state employees supervised by the commissioner of human services. No layoffs shall
occur as a result of restructuring under this section.

    Sec. 19. REPEALER.
Minnesota Statutes 2008, sections 246.51, subdivision 1; and 246.53, subdivision
3, are repealed.

ARTICLE 4
DEPARTMENT OF HEALTH

    Section 1. Minnesota Statutes 2008, section 62J.495, is amended to read:
62J.495 HEALTH INFORMATION TECHNOLOGY AND
INFRASTRUCTURE.
    Subdivision 1. Implementation. By January 1, 2015, all hospitals and health care
providers must have in place an interoperable electronic health records system within their
hospital system or clinical practice setting. The commissioner of health, in consultation
with the e-Health Information Technology and Infrastructure Advisory Committee,
shall develop a statewide plan to meet this goal, including uniform standards to be used
for the interoperable system for sharing and synchronizing patient data across systems.
The standards must be compatible with federal efforts. The uniform standards must be
developed by January 1, 2009, with a status report on the development of these standards
submitted to the legislature by January 15, 2008 and updated on an ongoing basis. The
commissioner shall include an update on standards development as part of an annual
report to the legislature.
    Subd. 1a. Definitions. (a) "Certified electronic health record technology" means an
electronic health record that is certified pursuant to section 3001(c)(5) of the HITECH
Act to meet the standards and implementation specifications adopted under section 3004
as applicable.
(b) "Commissioner" means the commissioner of health.
(c) "Pharmaceutical electronic data intermediary" means any entity that provides
the infrastructure to connect computer systems or other electronic devices utilized
by prescribing practitioners with those used by pharmacies, health plans, third party
administrators, and pharmacy benefit manager in order to facilitate the secure transmission
of electronic prescriptions, refill authorization requests, communications, and other
prescription-related information between such entities.
(d) "HITECH Act" means the Health Information Technology for Economic and
Clinical Health Act in division A, title XIII and division B, title IV of the American
Recovery and Reinvestment Act of 2009, including federal regulations adopted under
that act.
(e) "Interoperable electronic health record" means an electronic health record that
securely exchanges health information with another electronic health record system that
meets national requirements for certification under the HITECH Act.
(f) "Qualified electronic health record" means an electronic record of health-related
information on an individual that includes patient demographic and clinical health
information and has the capacity to:
(1) provide clinical decision support;
(2) support physician order entry;
(3) capture and query information relevant to health care quality; and
(4) exchange electronic health information with, and integrate such information
from, other sources.
    Subd. 2. E-Health Information Technology and Infrastructure Advisory
Committee. (a) The commissioner shall establish a an e-Health Information Technology
and Infrastructure Advisory Committee governed by section 15.059 to advise the
commissioner on the following matters:
    (1) assessment of the adoption and effective use of health information technology by
the state, licensed health care providers and facilities, and local public health agencies;
    (2) recommendations for implementing a statewide interoperable health information
infrastructure, to include estimates of necessary resources, and for determining standards
for administrative clinical data exchange, clinical support programs, patient privacy
requirements, and maintenance of the security and confidentiality of individual patient
data;
    (3) recommendations for encouraging use of innovative health care applications
using information technology and systems to improve patient care and reduce the cost
of care, including applications relating to disease management and personal health
management that enable remote monitoring of patients' conditions, especially those with
chronic conditions; and
    (4) other related issues as requested by the commissioner.
    (b) The members of the e-Health Information Technology and Infrastructure
Advisory Committee shall include the commissioners, or commissioners' designees, of
health, human services, administration, and commerce and additional members to be
appointed by the commissioner to include persons representing Minnesota's local public
health agencies, licensed hospitals and other licensed facilities and providers, private
purchasers, the medical and nursing professions, health insurers and health plans, the
state quality improvement organization, academic and research institutions, consumer
advisory organizations with an interest and expertise in health information technology, and
other stakeholders as identified by the Health Information Technology and Infrastructure
Advisory Committee commissioner to fulfill the requirements of section 3013, paragraph
(g) of the HITECH Act.
    (c) The commissioner shall prepare and issue an annual report not later than January
30 of each year outlining progress to date in implementing a statewide health information
infrastructure and recommending future projects action on policy and necessary resources
to continue the promotion of adoption and effective use of health information technology.
(d) Notwithstanding section 15.059, this subdivision expires June 30, 2015.
    Subd. 3. Interoperable electronic health record requirements. (a) To meet the
requirements of subdivision 1, hospitals and health care providers must meet the following
criteria when implementing an interoperable electronic health records system within their
hospital system or clinical practice setting.
(a) The electronic health record must be a qualified electronic health record.
    (b) The electronic health record must be certified by the Certification Commission
for Healthcare Information Technology, or its successor Office of the National Coordinator
pursuant to the HITECH Act. This criterion only applies to hospitals and health care
providers whose practice setting is a practice setting covered by the Certification
Commission for Healthcare Information Technology certifications only if a certified
electronic health record product for the provider's particular practice setting is available.
This criterion shall be considered met if a hospital or health care provider is using an
electronic health records system that has been certified within the last three years, even if a
more current version of the system has been certified within the three-year period.
(c) The electronic health record must meet the standards established according to
section 3004 of the HITECH Act as applicable.
(d) The electronic health record must have the ability to generate information on
clinical quality measures and other measures reported under sections 4101, 4102, and
4201 of the HITECH Act.
    (c) (e) A health care provider who is a prescriber or dispenser of controlled
substances legend drugs must have an electronic health record system that meets the
requirements of section 62J.497.
    Subd. 4. Coordination with national HIT activities. (a) The commissioner,
in consultation with the e-Health Advisory Committee, shall update the statewide
implementation plan required under subdivision 2 and released June 2008, to be consistent
with the updated Federal HIT Strategic Plan released by the Office of the National
Coordinator in accordance with section 3001 of the HITECH Act. The statewide plan
shall meet the requirements for a plan required under section 3013 of the HITECH Act.
(b) The commissioner, in consultation with the e-Health Advisory Committee, shall
work to ensure coordination between state, regional, and national efforts to support and
accelerate efforts to effectively use health information technology to improve the quality
and coordination of health care and continuity of patient care among health care providers,
to reduce medical errors, to improve population health, to reduce health disparities, and
to reduce chronic disease. The commissioner's coordination efforts shall include but not
be limited to:
(1) assisting in the development and support of health information technology
regional extension centers established under section 3012(c) of the HITECH Act to
provide technical assistance and disseminate best practices; and
(2) providing supplemental information to the best practices gathered by regional
centers to ensure that the information is relayed in a meaningful way to the Minnesota
health care community.
(c) The commissioner, in consultation with the e-Health Advisory Committee, shall
monitor national activity related to health information technology and shall coordinate
statewide input on policy development. The commissioner shall coordinate statewide
responses to proposed federal health information technology regulations in order to ensure
that the needs of the Minnesota health care community are adequately and efficiently
addressed in the proposed regulations. The commissioner's responses may include, but
are not limited to:
(1) reviewing and evaluating any standard, implementation specification, or
certification criteria proposed by the national HIT standards committee;
(2) reviewing and evaluating policy proposed by the national HIT policy
committee relating to the implementation of a nationwide health information technology
infrastructure;
(3) monitoring and responding to activity related to the development of quality
measures and other measures as required by section 4101 of the HITECH Act. Any
response related to quality measures shall consider and address the quality efforts required
under chapter 62U; and
(4) monitoring and responding to national activity related to privacy, security, and
data stewardship of electronic health information and individually identifiable health
information.
(d) To the extent that the state is either required or allowed to apply, or designate an
entity to apply for or carry out activities and programs under section 3013 of the HITECH
Act, the commissioner of health, in consultation with the e-Health Advisory Committee
and the commissioner of human services, shall be the lead applicant or sole designating
authority. The commissioner shall make such designations consistent with the goals and
objectives of sections 62J.495 to 62J.497, and sections 62J.50 to 62J.61.
(e) The commissioner of human services shall apply for funding necessary to
administer the incentive payments to providers authorized under title IV of the American
Recovery and Reinvestment Act.
(f) The commissioner shall include in the report to the legislature information on the
activities of this subdivision and provide recommendations on any relevant policy changes
that should be considered in Minnesota.
    Subd. 5. Collection of data for assessment and eligibility determination. (a)
The commissioner of health, in consultation with the commissioner of human services,
may require providers, dispensers, group purchasers, and pharmaceutical electronic data
intermediaries to submit data in a form and manner specified by the commissioner to
assess the status of adoption, effective use, and interoperability of electronic health
records for the purpose of:
(1) demonstrating Minnesota's progress on goals established by the Office of the
National Coordinator to accelerate the adoption and effective use of health information
technology established under the HITECH Act;
(2) assisting the Center for Medicare and Medicaid Services and Department of
Human Services in determining eligibility of health care professionals and hospitals
to receive federal incentives for the adoption and effective use of health information
technology under the HITECH Act or other federal incentive programs;
(3) assisting the Office of the National Coordinator in completing required
assessments of the impact of the implementation and effective use of health information
technology in achieving goals identified in the national strategic plan, and completing
studies required by the HITECH Act;
(4) providing the data necessary to assist the Office of the National Coordinator in
conducting evaluations of regional extension centers as required by the HITECH Act; and
(5) other purposes as necessary to support the implementation of the HITECH Act.
(b) The commissioner shall coordinate with the commissioner of human services
and other state agencies in the collection of data required under this section to:
(1) avoid duplicative reporting requirements;
(2) maximize efficiencies in the development of reports on state activities as
required by HITECH; and
(3) determine health professional and hospital eligibility for incentives available
under the HITECH Act.
(c) The commissioner must not collect data or publish analyses that identify, or could
potentially identify, individual patients. The commissioner must not collect individual
data in identified or de-identified form.

    Sec. 2. Minnesota Statutes 2008, section 62J.496, is amended to read:
62J.496 ELECTRONIC HEALTH RECORD SYSTEM REVOLVING
ACCOUNT AND LOAN PROGRAM.
    Subdivision 1. Account establishment. (a) An account is established to: provide
loans to eligible borrowers to assist in financing the installation or support of an
interoperable health record system. The system must provide for the interoperable
exchange of health care information between the applicant and, at a minimum, a hospital
system, pharmacy, and a health care clinic or other physician group.
(1) finance the purchase of certified electronic health records or qualified electronic
health records as defined in section 62J.495, subdivision 1a;
(2) enhance the utilization of electronic health record technology, which may include
costs associated with upgrading the technology to meet the criteria necessary to be a
certified electronic health record or a qualified electronic health record;
(3) train personnel in the use of electronic health record technology; and
(4) improve the secure electronic exchange of health information.
(b) Amounts deposited in the account, including any grant funds obtained through
federal or other sources, loan repayments, and interest earned on the amounts shall be
used only for awarding loans or loan guarantees, as a source of reserve and security for
leveraged loans, or for the administration of the account.
(c) The commissioner may accept contributions to the account from private sector
entities subject to the following provisions:
(1) the contributing entity may not specify the recipient or recipients of any loan
issued under this subdivision;
(2) the commissioner shall make public the identity of any private contributor to the
loan fund, as well as the amount of the contribution provided; and
(3) the commissioner may issue letters of commendation or make other awards that
have no financial value to any such entity.
A contributing entity may not specify that the recipient or recipients of any loan use
specific products or services, nor may the contributing entity imply that a contribution is
an endorsement of any specific product or service.
(d) The commissioner may use the loan funds to reimburse private sector entities
for any contribution made to the loan fund. Reimbursement to private entities may not
exceed the principle amount contributed to the loan fund.
(e) The commissioner may use funds deposited in the account to guarantee, or
purchase insurance for, a local obligation if the guarantee or purchase would improve
credit market access or reduce the interest rate applicable to the obligation involved.
(f) The commissioner may use funds deposited in the account as a source of revenue
or security for the payment of principal and interest on revenue or bonds issued by the
state if the proceeds of the sale of the bonds will be deposited into the loan fund.
    Subd. 2. Eligibility. (a) "Eligible borrower" means one of the following:
(1) federally qualified health centers;
    (1) (2) community clinics, as defined under section 145.9268;
    (2) (3) nonprofit or local unit of government hospitals eligible for rural hospital
capital improvement grants, as defined in section 144.148 licensed under sections 144.50
to 144.56;
    (3) physician clinics located in a community with a population of less than 50,000
according to United States Census Bureau statistics and outside the seven-county
metropolitan area;
(4) individual or small group physician practices that are focused primarily on
primary care;
    (4) (5) nursing facilities licensed under sections 144A.01 to 144A.27; and
(6) local public health departments as defined in chapter 145A; and
    (5) (7) other providers of health or health care services approved by the
commissioner for which interoperable electronic health record capability would improve
quality of care, patient safety, or community health.
(b) The commissioner shall administer the loan fund to prioritize support and
assistance to:
(1) critical access hospitals;
(2) federally qualified health centers;
(3) entities that serve uninsured, underinsured, and medically underserved
individuals, regardless of whether such area is urban or rural; and
(4) individual or small group practices that are primarily focused on primary care.
    (b) To be eligible for a loan under this section, the (c) An eligible applicant must
submit a loan application to the commissioner of health on forms prescribed by the
commissioner. The application must include, at a minimum:
    (1) the amount of the loan requested and a description of the purpose or project
for which the loan proceeds will be used;
    (2) a quote from a vendor;
    (3) a description of the health care entities and other groups participating in the
project;
    (4) evidence of financial stability and a demonstrated ability to repay the loan; and
    (5) a description of how the system to be financed interconnects interoperates or
plans in the future to interconnect interoperate with other health care entities and provider
groups located in the same geographical area;
(6) a plan on how the certified electronic health record technology will be maintained
and supported over time; and
(7) any other requirements for applications included or developed pursuant to
section 3014 of the HITECH Act.
    Subd. 3. Loans. (a) The commissioner of health may make a no interest loan or
low interest loan to a provider or provider group who is eligible under subdivision 2
on a first-come, first-served basis provided that the applicant is able to comply with this
section consistent with the priorities established in subdivision 2. The total accumulative
loan principal must not exceed $1,500,000 $3,000,000 per loan. The interest rate for each
loan, if imposed, shall not exceed the current market interest rate. The commissioner of
health has discretion over the size, interest rate, and number of loans made. Nothing in
this section shall require the commissioner to make a loan to an eligible borrower under
subdivision 2.
    (b) The commissioner of health may prescribe forms and establish an application
process and, notwithstanding section 16A.1283, may impose a reasonable nonrefundable
application fee to cover the cost of administering the loan program. Any application
fees imposed and collected under the electronic health records system revolving account
and loan program in this section are appropriated to the commissioner of health for the
duration of the loan program. The commissioner may apply for and use all federal funds
available through the HITECH Act to administer the loan program.
    (c) For loans approved prior to July 1, 2009, the borrower must begin repaying the
principal no later than two years from the date of the loan. Loans must be amortized no
later than six years from the date of the loan.
(d) For loans granted on January 1, 2010, or thereafter, the borrower must begin
repaying the principle no later than one year from the date of the loan. Loans must be
amortized no later than six years after the date of the loan.
    (d) Repayments (e) All repayments and interest paid on each loan must be credited
to the account.
(f) The loan agreement shall include the assurances that borrower meets requirements
included or developed pursuant to section 3014 of the HITECH Act. The requirements
shall include, but are not limited to:
(1) submitting reports on quality measures in compliance with regulations adopted
by the federal government;
(2) demonstrating that any certified electronic health record technology purchased,
improved, or otherwise financially supported by this loan program is used to exchange
health information in a manner that, in accordance with law and standards applicable to
the exchange of information, improves the quality of health care;
(3) including a plan on how the borrower intends to maintain and support the
certified electronic health record technology over time and the resources expected to be
used to maintain and support the technology purchased with the loan; and
(4) complying with other requirements the secretary may require to use loans funds
under the HITECH Act.
    Subd. 4. Data classification. Data collected by the commissioner of health on the
application to determine eligibility under subdivision 2 and to monitor borrowers' default
risk or collect payments owed under subdivision 3 are (1) private data on individuals as
defined in section 13.02, subdivision 12; and (2) nonpublic data as defined in section
13.02, subdivision 9. The names of borrowers and the amounts of the loans granted
are public data.

    Sec. 3. Minnesota Statutes 2008, section 62J.497, subdivision 1, is amended to read:
    Subdivision 1. Definitions. For the purposes of this section, the following terms
have the meanings given.
(a) "Backward compatible" means that the newer version of a data transmission
standard would retain, at a minimum, the full functionality of the versions previously
adopted, and would permit the successful completion of the applicable transactions with
entities that continue to use the older versions.
    (a) (b) "Dispense" or "dispensing" has the meaning given in section 151.01,
subdivision
30. Dispensing does not include the direct administering of a controlled
substance to a patient by a licensed health care professional.
    (b) (c) "Dispenser" means a person authorized by law to dispense a controlled
substance, pursuant to a valid prescription.
    (c) (d) "Electronic media" has the meaning given under Code of Federal Regulations,
title 45, part 160.103.
    (d) (e) "E-prescribing" means the transmission using electronic media of prescription
or prescription-related information between a prescriber, dispenser, pharmacy benefit
manager, or group purchaser, either directly or through an intermediary, including
an e-prescribing network. E-prescribing includes, but is not limited to, two-way
transmissions between the point of care and the dispenser and two-way transmissions
related to eligibility, formulary, and medication history information.
    (e) (f) "Electronic prescription drug program" means a program that provides for
e-prescribing.
    (f) (g) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.
    (g) (h) "HL7 messages" means a standard approved by the standards development
organization known as Health Level Seven.
    (h) (i) "National Provider Identifier" or "NPI" means the identifier described under
Code of Federal Regulations, title 45, part 162.406.
    (i) (j) "NCPDP" means the National Council for Prescription Drug Programs, Inc.
    (j) (k) "NCPDP Formulary and Benefits Standard" means the National Council for
Prescription Drug Programs Formulary and Benefits Standard, Implementation Guide,
Version 1, Release 0, October 2005.
    (k) (l) "NCPDP SCRIPT Standard" means the National Council for Prescription
Drug Programs Prescriber/Pharmacist Interface SCRIPT Standard, Implementation
Guide Version 8, Release 1 (Version 8.1), October 2005, or the most recent standard
adopted by the Centers for Medicare and Medicaid Services for e-prescribing under
Medicare Part D as required by section 1860D-4(e)(4)(D) of the Social Security Act, and
regulations adopted under it. The standards shall be implemented according to the Centers
for Medicare and Medicaid Services schedule for compliance. Subsequently released
versions of the NCPDP SCRIPT Standard may be used, provided that the new version
of the standard is backward compatible to the current version adopted by the Centers for
Medicare and Medicaid Services.
    (l) (m) "Pharmacy" has the meaning given in section 151.01, subdivision 2.
    (m) (n) "Prescriber" means a licensed health care professional who is authorized to
prescribe a controlled substance under section 152.12, subdivision 1. practitioner, other
than a veterinarian, as defined in section 151.01, subdivision 23.
    (n) (o) "Prescription-related information" means information regarding eligibility for
drug benefits, medication history, or related health or drug information.
    (o) (p) "Provider" or "health care provider" has the meaning given in section 62J.03,
subdivision 8.

    Sec. 4. Minnesota Statutes 2008, section 62J.497, subdivision 2, is amended to read:
    Subd. 2. Requirements for electronic prescribing. (a) Effective January 1, 2011,
all providers, group purchasers, prescribers, and dispensers must establish and, maintain,
and use an electronic prescription drug program that complies. This program must comply
with the applicable standards in this section for transmitting, directly or through an
intermediary, prescriptions and prescription-related information using electronic media.
    (b) Nothing in this section requires providers, group purchasers, prescribers, or
dispensers to conduct the transactions described in this section. If transactions described in
this section are conducted, they must be done electronically using the standards described
in this section. Nothing in this section requires providers, group purchasers, prescribers,
or dispensers to electronically conduct transactions that are expressly prohibited by other
sections or federal law.
    (c) Providers, group purchasers, prescribers, and dispensers must use either HL7
messages or the NCPDP SCRIPT Standard to transmit prescriptions or prescription-related
information internally when the sender and the recipient are part of the same legal entity. If
an entity sends prescriptions outside the entity, it must use the NCPDP SCRIPT Standard
or other applicable standards required by this section. Any pharmacy within an entity
must be able to receive electronic prescription transmittals from outside the entity using
the adopted NCPDP SCRIPT Standard. This exemption does not supersede any Health
Insurance Portability and Accountability Act (HIPAA) requirement that may require the
use of a HIPAA transaction standard within an organization.
    (d) Entities transmitting prescriptions or prescription-related information where the
prescriber is required by law to issue a prescription for a patient to a nonprescribing
provider that in turn forwards the prescription to a dispenser are exempt from the
requirement to use the NCPDP SCRIPT Standard when transmitting prescriptions or
prescription-related information.

    Sec. 5. Minnesota Statutes 2008, section 62J.497, is amended by adding a subdivision
to read:
    Subd. 4. Development and use of uniform formulary exception form. (a) The
commissioner of health, in consultation with the Minnesota Administrative Uniformity
Committee, shall develop by July 1, 2009, or six weeks after enactment of this subdivision,
whichever is later, a uniform formulary exception form that allows health care providers
to request exceptions from group purchaser formularies using a uniform form. Upon
development of the form, all health care providers must submit requests for formulary
exceptions using the uniform form, and all group purchasers must accept this form from
health care providers.
    (b) No later than January 1, 2011, the uniform formulary exception form must be
accessible and submitted by health care providers, and accepted and processed by group
purchasers, through secure electronic transmissions. Facsimile shall not be considered
secure electronic transmissions.

    Sec. 6. Minnesota Statutes 2008, section 62J.497, is amended by adding a subdivision
to read:
    Subd. 5. Electronic drug prior authorization standardization and transmission.
    (a) The commissioner of health, in consultation with the Minnesota e-Health Advisory
Committee and the Minnesota Administrative Uniformity Committee, shall, by February
15, 2010, identify an outline on how best to standardize drug prior authorization request
transactions between providers and group purchasers with the goal of maximizing
administrative simplification and efficiency in preparation for electronic transmissions.
    (b) No later than January 1, 2011, drug prior authorization requests must be
accessible and submitted by health care providers, and accepted and processed by group
purchasers, electronically through secure electronic transmissions. Facsimile shall not be
considered electronic transmission.

    Sec. 7. [62Q.676] MEDICATION THERAPY MANAGEMENT.
    A pharmacy benefit manager that provides prescription drug services must make
available medication therapy management services for enrollees taking four or more
prescriptions to treat or prevent two or more chronic medical conditions. For purposes
of this section, "medication therapy management" means the provision of the following
pharmaceutical care services by, or under the supervision of, a licensed pharmacist to
optimize the therapeutic outcomes of the patient's medications:
    (1) performing a comprehensive medication review to identify, resolve, and prevent
medication-related problems, including adverse drug events;
    (2) communicating essential information to the patient's other primary care
providers; and
    (3) providing verbal education and training designed to enhance patient
understanding and appropriate use of the patient's medications.
    Nothing in this section shall be construed to expand or modify the scope of practice
of the pharmacist as defined in section 151.01, subdivision 27.

    Sec. 8. Minnesota Statutes 2008, 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
Finance. All fees proposed to be prescribed in rules shall be reasonable. The fees shall be
in an amount so that the total fees collected by the commissioner will, where practical,
approximate the cost to the commissioner in administering the program. All fees collected
shall be deposited in the state treasury and credited to the state government special revenue
fund unless otherwise specifically appropriated by law for specific purposes.
    (b) The commissioner may charge a fee for voluntary certification of medical
laboratories and environmental laboratories, and for environmental and medical laboratory
services provided by the department, without complying with paragraph (a) or chapter 14.
Fees charged for environment and medical laboratory services provided by the department
must be approximately equal to the costs of providing the services.
    (c) The commissioner may develop a schedule of fees for diagnostic evaluations
conducted at clinics held by the services for children with 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
$7,555$7,655 plus $13$16 per bed

Non-JCAHO and non-AOA hospitals
$5,180$5,280 plus $247$250 per bed

Nursing home
$183 plus $91 per bed
    The commissioner shall set license fees for outpatient surgical centers, boarding care
homes, and supervised living facilities at the following levels:

Outpatient surgical centers
$3,349$3,712

Boarding care homes
$183 plus $91 per bed

Supervised living facilities
$183 plus $91 per bed.
    (e) Unless prohibited by federal law, the commissioner of health shall charge
applicants the following fees to cover the cost of any initial certification surveys required
to determine a provider's eligibility to participate in the Medicare or Medicaid program:

Prospective payment surveys for 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.

    Sec. 9. Minnesota Statutes 2008, section 144.226, subdivision 4, is amended to read:
    Subd. 4. Vital records surcharge. (a) In addition to any fee prescribed under
subdivision 1, there is a nonrefundable surcharge of $2 for each certified and noncertified
birth, stillbirth, or death record, and for a certification that the record cannot be found.
The local or state registrar shall forward this amount to the commissioner of finance to
be deposited into the state government special revenue fund. This surcharge shall not be
charged under those circumstances in which no fee for a birth, stillbirth, or death record is
permitted under subdivision 1, paragraph (a).
(b) Effective August 1, 2005, to June 30, 2009, the surcharge in paragraph (a) shall
be is $4.

    Sec. 10. Minnesota Statutes 2008, section 148.6445, is amended by adding a
subdivision to read:
    Subd. 2a. Duplicate license fee. The fee for a duplicate license is $25.

ARTICLE 5
HEALTH CARE

    Section 1. Minnesota Statutes 2008, section 60A.092, subdivision 2, is amended to
read:
    Subd. 2. Licensed assuming insurer. Reinsurance is ceded to an assuming insurer
if the assuming insurer is licensed to transact insurance or reinsurance in this state. For
purposes of reinsuring any health risk, an insurer is defined under section 62A.63.

    Sec. 2. Minnesota Statutes 2008, section 62D.03, subdivision 4, is amended to read:
    Subd. 4. Application requirements. Each application for a certificate of authority
shall be verified by an officer or authorized representative of the applicant, and shall be
in a form prescribed by the commissioner of health. Each application shall include the
following:
(a) a copy of the basic organizational document, if any, of the applicant and of
each major participating entity; such as the articles of incorporation, or other applicable
documents, and all amendments thereto;
(b) a copy of the bylaws, rules and regulations, or similar document, if any, and all
amendments thereto which regulate the conduct of the affairs of the applicant and of
each major participating entity;
(c) a list of the names, addresses, and official positions of the following:
(1) all members of the board of directors, or governing body of the local government
unit, and the principal officers and shareholders of the applicant organization; and
(2) all members of the board of directors, or governing body of the local government
unit, and the principal officers of the major participating entity and each shareholder
beneficially owning more than ten percent of any voting stock of the major participating
entity;
The commissioner may by rule identify persons included in the term "principal
officers";
(d) a full disclosure of the extent and nature of any contract or financial arrangements
between the following:
(1) the health maintenance organization and the persons listed in clause (c)(1);
(2) the health maintenance organization and the persons listed in clause (c)(2);
(3) each major participating entity and the persons listed in clause (c)(1) concerning
any financial relationship with the health maintenance organization; and
(4) each major participating entity and the persons listed in clause (c)(2) concerning
any financial relationship with the health maintenance organization;
(e) the name and address of each participating entity and the agreed upon duration of
each contract or agreement;
(f) a copy of the form of each contract binding the participating entities and the
health maintenance organization. Contractual provisions shall be consistent with the
purposes of sections 62D.01 to 62D.30, in regard to the services to be performed under the
contract, the manner in which payment for services is determined, the nature and extent
of responsibilities to be retained by the health maintenance organization, the nature and
extent of risk sharing permissible, and contractual termination provisions;
(g) a copy of each contract binding major participating entities and the health
maintenance organization. Contract information filed with the commissioner shall be
confidential and subject to the provisions of section 13.37, subdivision 1, clause (b), upon
the request of the health maintenance organization.
Upon initial filing of each contract, the health maintenance organization shall file
a separate document detailing the projected annual expenses to the major participating
entity in performing the contract and the projected annual revenues received by the entity
from the health maintenance organization for such performance. The commissioner
shall disapprove any contract with a major participating entity if the contract will result
in an unreasonable expense under section 62D.19. The commissioner shall approve or
disapprove a contract within 30 days of filing.
Within 120 days of the anniversary of the implementation of each contract, the
health maintenance organization shall file a document detailing the actual expenses
incurred and reported by the major participating entity in performing the contract in the
preceding year and the actual revenues received from the health maintenance organization
by the entity in payment for the performance;
(h) a statement generally describing the health maintenance organization, its health
maintenance contracts and separate health service contracts, facilities, and personnel,
including a statement describing the manner in which the applicant proposes to provide
enrollees with comprehensive health maintenance services and separate health services;
(i) a copy of the form of each evidence of coverage to be issued to the enrollees;
(j) a copy of the form of each individual or group health maintenance contract
and each separate health service contract which is to be issued to enrollees or their
representatives;
(k) financial statements showing the applicant's assets, liabilities, and sources of
financial support. If the applicant's financial affairs are audited by independent certified
public accountants, a copy of the applicant's most recent certified financial statement
may be deemed to satisfy this requirement;
(l) a description of the proposed method of marketing the plan, a schedule of
proposed charges, and a financial plan which includes a three-year projection of the
expenses and income and other sources of future capital;
(m) a statement reasonably describing the geographic area or areas to be served and
the type or types of enrollees to be served;
(n) a description of the complaint procedures to be utilized as required under section
62D.11;
(o) a description of the procedures and programs to be implemented to meet the
requirements of section 62D.04, subdivision 1, clauses (b) and (c) and to monitor the
quality of health care provided to enrollees;
(p) a description of the mechanism by which enrollees will be afforded an
opportunity to participate in matters of policy and operation under section 62D.06;
(q) a copy of any agreement between the health maintenance organization and
an insurer or, including any nonprofit health service corporation or another health
maintenance organization, regarding reinsurance, stop-loss coverage, insolvency
coverage, or any other type of coverage for potential costs of health services, as authorized
in sections 62D.04, subdivision 1, clause (f), 62D.05, subdivision 3, and 62D.13;
(r) a copy of the conflict of interest policy which applies to all members of the board
of directors and the principal officers of the health maintenance organization, as described
in section 62D.04, subdivision 1, paragraph (g). All currently licensed health maintenance
organizations shall also file a conflict of interest policy with the commissioner within 60
days after August 1, 1990, or at a later date if approved by the commissioner;
(s) a copy of the statement that describes the health maintenance organization's prior
authorization administrative procedures; and
(t) other information as the commissioner of health may reasonably require to be
provided.

    Sec. 3. Minnesota Statutes 2008, section 62D.05, subdivision 3, is amended to read:
    Subd. 3. Contracts; health services. A health maintenance organization may
contract with providers of health care services to render the services the health maintenance
organization has promised to provide under the terms of its health maintenance contracts,
may, subject to section 62D.12, subdivision 11, enter into separate prepaid dental contracts,
or other separate health service contracts, may, subject to the limitations of section
62D.04, subdivision 1, clause (f), contract with insurance companies and, including
nonprofit health service plan corporations or other health maintenance organizations,
for insurance, indemnity or reimbursement of its cost of providing health care services
for enrollees or against the risks incurred by the health maintenance organization, may
contract with insurance companies and nonprofit health service plan corporations for
insolvency insurance coverage, and may contract with insurance companies and nonprofit
health service plan corporations to insure or cover the enrollees' costs and expenses in the
health maintenance organization, including the customary prepayment amount and any
co-payment obligations, and may contract to provide reinsurance or insolvency insurance
coverage to health insurers or nonprofit health service plan corporations.

    Sec. 4. Minnesota Statutes 2008, section 62J.692, subdivision 7, is amended to read:
    Subd. 7. Transfers from the commissioner of human services. (a) The amount
transferred according to section 256B.69, subdivision 5c, paragraph (a), clause (1), shall
be distributed by the commissioner annually to clinical medical education programs that
meet the qualifications of subdivision 3 based on the formula in subdivision 4, paragraph
(a) Of the amount transferred according to section 256B.69, subdivision 5c, paragraph (a),
clauses (1) to (4), $21,714,000 shall be distributed as follows:
(1) $2,157,000 shall be distributed by the commissioner to the University of
Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40;
(2) $1,035,360 shall be distributed by the commissioner to the Hennepin County
Medical Center for clinical medical education;
(3) $17,400,000 shall be distributed by the commissioner to the University of
Minnesota Board of Regents for purposes of medical education;
(4) $1,121,640 shall be distributed by the commissioner to clinical medical education
dental innovation grants in accordance with subdivision 7a; and
(5) the remainder of the amount transferred according to section 256B.69,
subdivision 5c, clauses (1) to (4), shall be distributed by the commissioner annually to
clinical medical education programs that meet the qualifications of subdivision 3 based on
the formula in subdivision 4, paragraph (a).
(b) Fifty percent of the amount transferred according to section 256B.69, subdivision
5c
, paragraph (a), clause (2), shall be distributed by the commissioner to the University of
Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40. Of
the remaining amount transferred according to section 256B.69, subdivision 5c, paragraph
(a), clause (2), 24 percent of the amount shall be distributed by the commissioner to
the Hennepin County Medical Center for clinical medical education. The remaining 26
percent of the amount transferred shall be distributed by the commissioner in accordance
with subdivision 7a. If the federal approval is not obtained for the matching funds under
section 256B.69, subdivision 5c, paragraph (a), clause (2), 100 percent of the amount
transferred under this paragraph shall be distributed by the commissioner to the University
of Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40.
(c) The amount transferred according to section 256B.69, subdivision 5c, paragraph
(a), clauses (3) and (4), shall be distributed by the commissioner upon receipt to the
University of Minnesota Board of Regents for the purposes of clinical graduate medical
education.

    Sec. 5. Minnesota Statutes 2008, section 256.01, subdivision 2b, is amended to read:
    Subd. 2b. Performance payments. (a) The commissioner shall develop and
implement a pay-for-performance system to provide performance payments to eligible
medical groups and clinics that demonstrate optimum care in serving individuals
with chronic diseases who are enrolled in health care programs administered by the
commissioner under chapters 256B, 256D, and 256L. The commissioner may receive any
federal matching money that is made available through the medical assistance program
for managed care oversight contracted through vendors, including consumer surveys,
studies, and external quality reviews as required by the federal Balanced Budget Act of
1997, Code of Federal Regulations, title 42, part 438-managed care, subpart E-external
quality review. Any federal money received for managed care oversight is appropriated
to the commissioner for this purpose. The commissioner may expend the federal money
received in either year of the biennium.
    (b) Effective July 1, 2008, or upon federal approval, whichever is later, the
commissioner shall develop and implement a patient incentive health program to provide
incentives and rewards to patients who are enrolled in health care programs administered
by the commissioner under chapters 256B, 256D, and 256L, and who have agreed to and
have met personal health goals established with the patients' primary care providers to
manage a chronic disease or condition, including but not limited to diabetes, high blood
pressure, and coronary artery disease.

    Sec. 6. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision
to read:
    Subd. 18a. Public Assistance Reporting Information System. (a) Effective
October 1, 2009, the commissioner shall comply with the federal requirements in Public
Law 110-379 in implementing the Public Assistance Reporting Information System
(PARIS) to determine eligibility for all individuals applying for:
(1) health care benefits under chapters 256B, 256D, and 256L; and
(2) public benefits under chapters 119B, 256D, 256I, and the supplemental nutrition
assistance program.
(b) The commissioner shall determine eligibility under paragraph (a) by performing
data matches, including matching with medical assistance, cash, child care, and
supplemental assistance programs operated by other states.
EFFECTIVE DATE.This section is effective October 1, 2009.

    Sec. 7. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision
to read:
    Subd. 18b. Protections for American Indians. Effective February 18, 2009, the
commissioner shall comply with the federal requirements in the American Recovery and
Reinvestment Act of 2009, Public Law 111-5, section 5006, regarding American Indians.

    Sec. 8. Minnesota Statutes 2008, section 256.962, subdivision 2, is amended to read:
    Subd. 2. Outreach grants. (a) The commissioner shall award grants to public and
private organizations, regional collaboratives, and regional health care outreach centers
for outreach activities, including, but not limited to:
    (1) providing information, applications, and assistance in obtaining coverage
through Minnesota public health care programs;
    (2) collaborating with public and private entities such as hospitals, providers, health
plans, legal aid offices, pharmacies, insurance agencies, and faith-based organizations to
develop outreach activities and partnerships to ensure the distribution of information
and applications and provide assistance in obtaining coverage through Minnesota health
care programs; and
    (3) providing or collaborating with public and private entities to provide multilingual
and culturally specific information and assistance to applicants in areas of high
uninsurance in the state or populations with high rates of uninsurance; and
(4) targeting geographic areas with high rates of (i) eligible but unenrolled children,
including children who reside in rural areas, or (ii) racial and ethnic minorities and health
disparity populations.
    (b) The commissioner shall ensure that all outreach materials are available in
languages other than English.
    (c) The commissioner shall establish an outreach trainer program to provide
training to designated individuals from the community and public and private entities on
application assistance in order for these individuals to provide training to others in the
community on an as-needed basis.

    Sec. 9. Minnesota Statutes 2008, section 256.962, subdivision 6, is amended to read:
    Subd. 6. School districts and charter schools. (a) At the beginning of each school
year, a school district or charter school shall provide information to each student on the
availability of health care coverage through the Minnesota health care programs and how
to obtain an application for the Minnesota health care programs.
    (b) For each child who is determined to be eligible for the free and reduced-price
school lunch program, the district shall provide the child's family with information on how
to obtain an application for the Minnesota health care programs and application assistance.
    (c) A school district or charter school shall also ensure that applications and
information on application assistance are available at early childhood education sites and
public schools located within the district's jurisdiction.
    (d) (c) Each district shall designate an enrollment specialist to provide application
assistance and follow-up services with families who have indicated an interest in receiving
information or an application for the Minnesota health care program. A district is eligible
for the application assistance bonus described in subdivision 5.
    (e) Each (d) If a school district or charter school maintains a district Web site, the
school district or charter school shall provide on their its Web site a link to information on
how to obtain an application and application assistance.

    Sec. 10. [256.964] DENTAL CARE PILOT PROJECTS.
The commissioner shall authorize pilot projects to reduce the total cost to the state
for dental services provided to enrollees of the state public health care programs by
reducing hospital emergency room costs for preventable or nonemergency dental services.
As part of the project, a community dental clinic or dental provider, in collaboration with a
hospital emergency room, shall provide urgent care dental services as an alternative to the
hospital emergency room for nonemergency dental care. The project participants shall
establish a process to divert a patient presenting at the emergency room for nonemergency
dental care to the dental community clinic or to an appropriate dental provider. The
commissioner may establish special payment rates for urgent care services provided and
may change or waive existing payment policies in order to adequately reimburse providers
for providing cost-effective alternative services in an outpatient or urgent care setting.
The commissioner may establish a project in conjunction with the initiative authorized
under section 256.963.

    Sec. 11. Minnesota Statutes 2008, section 256.969, subdivision 2b, is amended to read:
    Subd. 2b. Operating payment rates. In determining operating payment rates for
admissions occurring on or after the rate year beginning January 1, 1991, and every two
years after, or more frequently as determined by the commissioner, the commissioner
shall obtain operating data from an updated base year and establish operating payment
rates per admission for each hospital based on the cost-finding methods and allowable
costs of the Medicare program in effect during the base year. Rates under the general
assistance medical care, medical assistance, and MinnesotaCare programs shall not be
rebased to more current data on January 1, 1997, January 1, 2005, and for the first 24
months of the rebased period beginning January 1, 2009, and for the first three months of
the rebased period beginning January 1, 2011. From April 1, 2011, to March 31, 2012,
rates shall be rebased at 39.2 percent of the full value of the rebasing percentage change.
Effective April 1, 2012, rates shall be rebased at full value. The base year operating
payment rate per admission is standardized by the case mix index and adjusted by the
hospital cost index, relative values, and disproportionate population adjustment. The
cost and charge data used to establish operating rates shall only reflect inpatient services
covered by medical assistance and shall not include property cost information and costs
recognized in outlier payments.

    Sec. 12. Minnesota Statutes 2008, section 256.969, subdivision 3a, is amended to read:
    Subd. 3a. Payments. (a) Acute care hospital billings under the medical
assistance program must not be submitted until the recipient is discharged. However,
the commissioner shall establish monthly interim payments for inpatient hospitals that
have individual patient lengths of stay over 30 days regardless of diagnostic category.
Except as provided in section 256.9693, medical assistance reimbursement for treatment
of mental illness shall be reimbursed based on diagnostic classifications. Individual
hospital payments established under this section and sections 256.9685, 256.9686, and
256.9695, in addition to third party and recipient liability, for discharges occurring during
the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
inpatient services paid for the same period of time to the hospital. This payment limitation
shall be calculated separately for medical assistance and general assistance medical
care services. The limitation on general assistance medical care shall be effective for
admissions occurring on or after July 1, 1991. Services that have rates established under
subdivision 11 or 12, must be limited separately from other services. After consulting with
the affected hospitals, the commissioner may consider related hospitals one entity and
may merge the payment rates while maintaining separate provider numbers. The operating
and property base rates per admission or per day shall be derived from the best Medicare
and claims data available when rates are established. The commissioner shall determine
the best Medicare and claims data, taking into consideration variables of recency of the
data, audit disposition, settlement status, and the ability to set rates in a timely manner.
The commissioner shall notify hospitals of payment rates by December 1 of the year
preceding the rate year. The rate setting data must reflect the admissions data used to
establish relative values. Base year changes from 1981 to the base year established for the
rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
1. The commissioner may adjust base year cost, relative value, and case mix index data
to exclude the costs of services that have been discontinued by the October 1 of the year
preceding the rate year or that are paid separately from inpatient services. Inpatient stays
that encompass portions of two or more rate years shall have payments established based
on payment rates in effect at the time of admission unless the date of admission preceded
the rate year in effect by six months or more. In this case, operating payment rates for
services rendered during the rate year in effect and established based on the date of
admission shall be adjusted to the rate year in effect by the hospital cost index.
    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
payment, before third-party liability and spenddown, made to hospitals for inpatient
services is reduced by .5 percent from the current statutory rates.
    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Mental health services within diagnosis related groups 424 to 432, and
facilities defined under subdivision 16 are excluded from this paragraph.
    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
fee-for-service admissions occurring on or after July 1, 2005, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 6.0 percent
from the current statutory rates. Mental health services within diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
assistance does not include general assistance medical care. Payments made to managed
care plans shall be reduced for services provided on or after January 1, 2006, to reflect
this reduction.
    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
3.46 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
1.9 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after July 1, 2009, through June 30, 2010, to reflect this reduction.
    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
for fee-for-service admissions occurring on or after July 1, 2010, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 1.79 percent
from the current statutory rates. Mental health services with diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Payments made to managed care plans shall be reduced for services provided on or after
July 1, 2010, to reflect this reduction.
(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
payment for fee-for-service admissions occurring on or after July 1, 2009, made to
hospitals for inpatient services before third-party liability and spenddown, is reduced
one percent from the current statutory rates. Facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced for
services provided on or after October 1, 2009, to reflect this reduction.

    Sec. 13. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision
to read:
    Subd. 3b. Nonpayment for hospital-acquired conditions and for certain
treatments. (a) The commissioner must not make medical assistance payments to a
hospital for any costs of care that result from a condition listed in paragraph (c), if the
condition was hospital acquired.
    (b) For purposes of this subdivision, a condition is hospital acquired if it is not
identified by the hospital as present on admission. For purposes of this subdivision,
medical assistance includes general assistance medical care and MinnesotaCare.
(c) The prohibition in paragraph (a) applies to payment for each hospital-acquired
condition listed in this paragraph that is represented by an ICD-9-CM diagnosis code and
is designated as a complicating condition or a major complicating condition:
(1) foreign object retained after surgery (ICD-9-CM codes 998.4 or 998.7);
(2) air embolism (ICD-9-CM code 999.1);
(3) blood incompatibility (ICD-9-CM code 999.6);
(4) pressure ulcers stage III or IV (ICD-9-CM codes 707.23 or 707.24);
(5) falls and trauma, including fracture, dislocation, intracranial injury, crushing
injury, burn, and electric shock (ICD-9-CM codes with these ranges on the complicating
condition and major complicating condition list: 800-829; 830-839; 850-854; 925-929;
940-949; and 991-994);
(6) catheter-associated urinary tract infection (ICD-9-CM code 996.64);
(7) vascular catheter-associated infection (ICD-9-CM code 999.31);
(8) manifestations of poor glycemic control (ICD-9-CM codes 249.10; 249.11;
249.20; 249.21; 250.10; 250.11; 250.12; 250.13; 250.20; 250.21; 250.22; 250.23; and
251.0);
(9) surgical site infection (ICD-9-CM codes 996.67 or 998.59) following certain
orthopedic procedures (procedure codes 81.01; 81.02; 81.03; 81.04; 81.05; 81.06; 81.07;
81.08; 81.23; 81.24; 81.31; 81.32; 81.33; 81.34; 81.35; 81.36; 81.37; 81.38; 81.83; and
81.85);
(10) surgical site infection (ICD-9-CM code 998.59) following bariatric surgery
(procedure codes 44.38; 44.39; or 44.95) for a principal diagnosis of morbid obesity
(ICD-9-CM code 278.01);
(11) surgical site infection, mediastinitis (ICD-9-CM code 519.2) following coronary
artery bypass graft (procedure codes 36.10 to 36.19); and
(12) deep vein thrombosis (ICD-9-CM codes 453.40 to 453.42) or pulmonary
embolism (ICD-9-CM codes 415.11 or 415.91) following total knee replacement
(procedure code 81.54) or hip replacement (procedure codes 00.85 to 00.87 or 81.51
to 81.52).
(d) The prohibition in paragraph (a) applies to any additional payments that result
from a hospital-acquired condition listed in paragraph (c), including, but not limited to,
additional treatment or procedures, readmission to the facility after discharge, increased
length of stay, change to a higher diagnostic category, or transfer to another hospital. In
the event of a transfer to another hospital, the hospital where the condition listed under
paragraph (c) was acquired is responsible for any costs incurred at the hospital to which
the patient is transferred.
(e) A hospital shall not bill a recipient of services for any payment disallowed under
this subdivision.

    Sec. 14. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision
to read:
    Subd. 28. Temporary rate increase for qualifying hospitals. For the period
from April 1, 2009, to September 30, 2010, for each hospital with a medical assistance
utilization rate equal to or greater than 25 percent during the base year, the commissioner
shall provide an equal percentage rate increase for each medical assistance admission. The
commissioner shall estimate the percentage rate increase using as the state share of the
increase the amount available under section 256B.199, paragraph (d). The commissioner
shall settle up payments to qualifying hospitals based on actual payments under that
section and actual hospital admissions.
EFFECTIVE DATE.This section is effective the day following final enactment.

    Sec. 15. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision
to read:
    Subd. 29. Reimbursement for the fee increase for the early hearing detection
and intervention program. For services provided on or after July 1, 2010, in addition to
any other payment under this section, the commissioner shall reimburse hospitals for the
increase in the fee for the early hearing detection and intervention program described in
section 144.125, subdivision 1, paid by the hospital for public program recipients.

    Sec. 16. [256B.032] ELIGIBLE VENDORS OF MEDICAL CARE.
(a) Effective January 1, 2011, the commissioner shall establish performance
thresholds for health care providers included in the provider peer grouping system
developed by the commissioner of health under section 62U.04. The thresholds shall be
set at the 10th percentile of the combined cost and quality measure used for provider peer
grouping, and separate thresholds shall be set for hospital and physician services.
(b) Beginning January 1, 2012, any health care provider with a combined cost and
quality score below the threshold set in paragraph (a) shall be prohibited from enrolling
as a vendor of medical care in the medical assistance, general assistance medical care,
or MinnesotaCare programs, and shall not be eligible for direct payments under those
programs or for payments made by managed care plans under their contracts with the
commissioner under section 256B.69 or 256L.12. A health care provider that is prohibited
from enrolling as a vendor or receiving payments under this paragraph may reenroll
effective January 1 of any subsequent year if the provider's most recent combined cost and
quality score exceeds the threshold established in paragraph (a).
(c) Notwithstanding paragraph (b), a provider may continue to participate as a vendor
or as part of a managed care plan provider network if the commissioner determines that a
contract with the provider is necessary to ensure adequate access to health care services.
(d) By January 15, 2013, the commissioner shall report to the legislature on the
impact of this section. The commissioner's report shall include information on:
(1) the providers falling below the thresholds as of January 1, 2012;
(2) the volume of services and cost of care provided to enrollees in the medical
assistance, general assistance medical care, or MinnesotaCare programs in the 12 months
prior to January 1, 2012, by providers falling below the thresholds;
(3) providers who fell below the thresholds but continued to be eligible vendors
under paragraph (c);
(4) the estimated cost savings achieved by not contracting with providers who do
not meet the performance thresholds; and
(5) recommendations for increasing the threshold levels of performance over time.

    Sec. 17. Minnesota Statutes 2008, section 256B.056, subdivision 3c, is amended to
read:
    Subd. 3c. Asset limitations for families and children. A household of two or more
persons must not own more than $20,000 in total net assets, and a household of one
person must not own more than $10,000 in total net assets. In addition to these maximum
amounts, an eligible individual or family may accrue interest on these amounts, but they
must be reduced to the maximum at the time of an eligibility redetermination. The value of
assets that are not considered in determining eligibility for medical assistance for families
and children is the value of those assets excluded under the AFDC state plan as of July 16,
1996, as required by the Personal Responsibility and Work Opportunity Reconciliation
Act of 1996 (PRWORA), Public Law 104-193, with the following exceptions:
(1) household goods and personal effects are not considered;
(2) capital and operating assets of a trade or business up to $200,000 are not
considered, except that a bank account that contains personal income or assets, or is used to
pay personal expenses, is not considered a capital or operating asset of a trade or business;
(3) one motor vehicle is excluded for each person of legal driving age who is
employed or seeking employment;
(4) one burial plot and all other burial expenses equal to the supplemental security
income program asset limit are not considered for each individual;
(5) court-ordered settlements up to $10,000 are not considered;
(6) individual retirement accounts and funds are not considered; and
(7) assets owned by children are not considered.
The assets specified in clause (2) must be disclosed to the local agency at the time of
application and at the time of an eligibility redetermination, and must be verified upon
request of the local agency.
EFFECTIVE DATE.This section is effective January 1, 2011, or upon federal
approval, whichever is later.

    Sec. 18. Minnesota Statutes 2008, section 256B.056, subdivision 3d, is amended to
read:
    Subd. 3d. Reduction of excess assets. Assets in excess of the limits in subdivisions
3 to 3c may be reduced to allowable limits as follows:
(a) Assets may be reduced in any of the three calendar months before the month
of application in which the applicant seeks coverage by:
(1) designating burial funds up to $1,500 for each applicant, spouse, and MA-eligible
dependent child; and
(2) paying health service bills for health services that are incurred in the retroactive
period for which the applicant seeks eligibility, starting with the oldest bill. After assets
are reduced to allowable limits, eligibility begins with the next dollar of MA-covered
health services incurred in the retroactive period. Applicants reducing assets under this
subdivision who also have excess income shall first spend excess assets to pay health
service bills and may meet the income spenddown on remaining bills.
(b) Assets may be reduced beginning the month of application by:
(1) paying bills for health services that are incurred during the period specified in
Minnesota Rules, part 9505.0090, subpart 2, that would otherwise be paid by medical
assistance; and. After assets are reduced to allowable limits, eligibility begins with the
next dollar of medical assistance covered health services incurred in the period. Applicants
reducing assets under this subdivision who also have excess income shall first spend excess
assets to pay health service bills and may meet the income spenddown on remaining bills.
(2) using any means other than a transfer of assets for less than fair market value as
defined in section 256B.0595, subdivision 1, paragraph (b).
EFFECTIVE DATE.This section is effective January 1, 2011.

    Sec. 19. Minnesota Statutes 2008, section 256B.057, is amended by adding a
subdivision to read:
    Subd. 11. Treatment for colorectal cancer. (a) Medical assistance shall be paid for
an individual who:
(1) has been screened for colorectal cancer by the colorectal cancer prevention
demonstration project;
(2) according to the individual's treating health professional, needs treatment for
colorectal cancer;
(3) meets income eligibility guidelines for the colorectal cancer prevention
demonstration project;
(4) is under the age of 65; and
(5) is not otherwise eligible for medical assistance or covered under creditable
coverage as defined under United States Code, title 42, section 300gg(a).
(b) Medical assistance provided under this subdivision shall be limited to services
provided during the period that the individual receives treatment for colorectal cancer.
(c) An individual meeting the criteria in paragraph (a) is eligible for medical
assistance without meeting the eligibility criteria relating to income and assets in section
256B.056, subdivisions 1a to 5b.
(d) This subdivision expires December 31, 2010.

    Sec. 20. Minnesota Statutes 2008, section 256B.0575, is amended to read:
256B.0575 AVAILABILITY OF INCOME FOR INSTITUTIONALIZED
PERSONS.
    Subdivision 1. Income deductions. When an institutionalized person is determined
eligible for medical assistance, the income that exceeds the deductions in paragraphs (a)
and (b) must be applied to the cost of institutional care.
(a) The following amounts must be deducted from the institutionalized person's
income in the following order:
(1) the personal needs allowance under section 256B.35 or, for a veteran who
does not have a spouse or child, or a surviving spouse of a veteran having no child, the
amount of an improved pension received from the veteran's administration not exceeding
$90 per month;
(2) the personal allowance for disabled individuals under section 256B.36;
(3) if the institutionalized person has a legally appointed guardian or conservator,
five percent of the recipient's gross monthly income up to $100 as reimbursement for
guardianship or conservatorship services;
(4) a monthly income allowance determined under section 256B.058, subdivision
2
, but only to the extent income of the institutionalized spouse is made available to the
community spouse;
(5) a monthly allowance for children under age 18 which, together with the net
income of the children, would provide income equal to the medical assistance standard
for families and children according to section 256B.056, subdivision 4, for a family size
that includes only the minor children. This deduction applies only if the children do not
live with the community spouse and only to the extent that the deduction is not included
in the personal needs allowance under section 256B.35, subdivision 1, as child support
garnished under a court order;
(6) a monthly family allowance for other family members, equal to one-third of the
difference between 122 percent of the federal poverty guidelines and the monthly income
for that family member;
(7) reparations payments made by the Federal Republic of Germany and reparations
payments made by the Netherlands for victims of Nazi persecution between 1940 and
1945;
(8) all other exclusions from income for institutionalized persons as mandated by
federal law; and
(9) amounts for reasonable expenses, as specified in subdivision 2, incurred for
necessary medical or remedial care for the institutionalized person that are recognized
under state law, not medical assistance covered expenses, and that are not subject to
payment by a third party.
Reasonable expenses are limited to expenses that have not been previously used as a
deduction from income and are incurred during the enrollee's current period of eligibility,
including retroactive months associated with the current period of eligibility, for medical
assistance payment of long-term care services.
For purposes of clause (6), "other family member" means a person who resides
with the community spouse and who is a minor or dependent child, dependent parent, or
dependent sibling of either spouse. "Dependent" means a person who could be claimed as
a dependent for federal income tax purposes under the Internal Revenue Code.
(b) Income shall be allocated to an institutionalized person for a period of up to three
calendar months, in an amount equal to the medical assistance standard for a family
size of one if:
(1) a physician certifies that the person is expected to reside in the long-term care
facility for three calendar months or less;
(2) if the person has expenses of maintaining a residence in the community; and
(3) if one of the following circumstances apply:
(i) the person was not living together with a spouse or a family member as defined in
paragraph (a) when the person entered a long-term care facility; or
(ii) the person and the person's spouse become institutionalized on the same date, in
which case the allocation shall be applied to the income of one of the spouses.
For purposes of this paragraph, a person is determined to be residing in a licensed nursing
home, regional treatment center, or medical institution if the person is expected to remain
for a period of one full calendar month or more.
    Subd. 2. Reasonable expenses. For the purposes of subdivision 1, paragraph (a),
clause (9), reasonable expenses are limited to expenses that have not been previously used
as a deduction from income and were not:
    (1) for long-term care expenses incurred during a period of ineligibility as defined in
section 256B.0595, subdivision 2;
    (2) incurred more than three months before the month of application associated with
the current period of eligibility;
    (3) for expenses incurred by a recipient that are duplicative of services that are
covered under chapter 256B; or
    (4) nursing facility expenses incurred without a timely assessment as required under
section 256B.0911.

    Sec. 21. Minnesota Statutes 2008, 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 an institutionalized person or the institutionalized 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, an institutionalized person, an
institutionalized 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
institutionalized person or institutionalized 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. This applies
to all transfers, including those made by a community spouse after the month in which
the institutionalized spouse is determined eligible for medical assistance. 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 requests medical assistance
payment of long-term care services, or 36 months before or any time after a medical
assistance recipient becomes an institutionalized person, 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 institutionalized
person is ineligible for long-term care services for the period of time determined under
subdivision 2, unless the institutionalized 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. In the case of payments from a trust or portions of a
trust that are considered transfers of assets under federal law, or in the case of any other
disposal of assets made on or after February 8, 2006, any transfers made within 60 months
before or any time after an institutionalized person requests medical assistance payment of
long-term care services and within 60 months before or any time after a medical assistance
recipient becomes an institutionalized person, 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
institutionalized person or the institutionalized person's spouse is entitled but does not
receive due to action by the institutionalized person, the institutionalized 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 institutionalized person or the
institutionalized 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 an institutionalized
person, an institutionalized 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 institutionalized person or the institutionalized person's spouse, transfers to any
annuity that exceeds the value of the benefit likely to be returned to the institutionalized
person or institutionalized person's spouse while alive, based on estimated life expectancy
as determined according to the current actuarial tables published by the Office of the
Chief Actuary of the Social Security Administration. The commissioner may adopt rules
reducing life expectancies based on the need for long-term care. This section applies to an
annuity purchased on or after March 1, 2002, that:
    (1) is not purchased from an insurance company or financial institution that is
subject to licensing or regulation by the Minnesota Department of Commerce or a similar
regulatory agency of another state;
    (2) does not pay out principal and interest in equal monthly installments; or
    (3) does not begin payment at the earliest possible date after annuitization.
    (f) Effective for transactions, including the purchase of an annuity, occurring on or
after February 8, 2006, by or on behalf of an institutionalized person who has applied for
or is receiving long-term care services or the institutionalized person's spouse shall be
treated as the disposal of an asset for less than fair market value unless the department is
named a preferred remainder beneficiary as described in section 256B.056, subdivision
11
. Any subsequent change to the designation of the department as a preferred remainder
beneficiary shall result in the annuity being treated as a disposal of assets for less than
fair market value. The amount of such transfer shall be the maximum amount the
institutionalized person or the institutionalized person's spouse could receive from the
annuity or similar financial instrument. Any change in the amount of the income or
principal being withdrawn from the annuity or other similar financial instrument at the
time of the most recent disclosure shall be deemed to be a transfer of assets for less than
fair market value unless the institutionalized person or the institutionalized person's spouse
demonstrates that the transaction was for fair market value. In the event a distribution
of income or principal has been improperly distributed or disbursed from an annuity or
other retirement planning instrument of an institutionalized person or the institutionalized
person's spouse, a cause of action exists against the individual receiving the improper
distribution for the cost of medical assistance services provided or the amount of the
improper distribution, whichever is less.
    (g) Effective for transactions, including the purchase of an annuity, occurring on
or after February 8, 2006, by or on behalf of an institutionalized person applying for or
receiving long-term care services shall be treated as a disposal of assets for less than fair
market value unless it is:
    (i) an annuity described in subsection (b) or (q) of section 408 of the Internal
Revenue Code of 1986; or
    (ii) purchased with proceeds from:
    (A) an account or trust described in subsection (a), (c), or (p) of section 408 of the
Internal Revenue Code;
    (B) a simplified employee pension within the meaning of section 408(k) of the
Internal Revenue Code; or
    (C) a Roth IRA described in section 408A of the Internal Revenue Code; or
    (iii) an annuity that is irrevocable and nonassignable; is actuarially sound as
determined in accordance with actuarial publications of the Office of the Chief Actuary of
the Social Security Administration; and provides for payments in equal amounts during
the term of the annuity, with no deferral and no balloon payments made.
     (h) 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
developmental disabilities, 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
developmental disabilities or who is receiving home and community-based services under
sections 256B.0915, 256B.092, and 256B.49.
    (i) This section applies to funds used to purchase a promissory note, loan, or
mortgage unless the note, loan, or mortgage:
    (1) has a repayment term that is actuarially sound;
    (2) provides for payments to be made in equal amounts during the term of the loan,
with no deferral and no balloon payments made; and
    (3) prohibits the cancellation of the balance upon the death of the lender.
    In the case of a promissory note, loan, or mortgage that does not meet an exception
in clauses (1) to (3), the value of such note, loan, or mortgage shall be the outstanding
balance due as of the date of the institutionalized person's request for medical assistance
payment of long-term care services.
    (j) This section applies to the purchase of a life estate interest in another person's
home unless the purchaser resides in the home for a period of at least one year after the
date of purchase.
(k) This section applies to transfers into a pooled trust that qualifies under United
States Code, title 42, section 1396p(d)(4)(C), by:
(1) a person age 65 or older or the person's spouse; or
(2) 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 a person age 65 or older or
the person's spouse.

    Sec. 22. Minnesota Statutes 2008, section 256B.0595, subdivision 2, is amended to
read:
    Subd. 2. Period of ineligibility for long-term care services. (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 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
first day of the month after 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 on the first day of the month after the month in which the first
uncompensated transfer was made. If the transfer was reported to the local agency after
the date that advance notice of a period of ineligibility that affects the next month could
be provided to the recipient and the recipient received medical assistance services or the
transfer was not reported to the local agency, and the applicant or recipient 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 that
portion of long-term care services provided during the period of ineligibility, or for the
uncompensated amount of the transfer, whichever is less. 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) For uncompensated transfers made on or after February 8, 2006, the period
of ineligibility:
    (1) for uncompensated transfers by or on behalf of individuals receiving medical
assistance payment of long-term care services, begins the first day of the month following
advance notice of the penalty period of ineligibility, but no later than the first day of the
month that follows three full calendar months from the date of the report or discovery
of the transfer; or
    (2) for uncompensated transfers by individuals requesting medical assistance
payment of long-term care services, begins the date on which the individual is eligible
for medical assistance under the Medicaid state plan and would otherwise be receiving
long-term care services based on an approved application for such care but for the
application of the penalty period of ineligibility resulting from the uncompensated
transfer; and
    (3) cannot begin during any other period of ineligibility.
    (d) If a calculation of a penalty period of ineligibility results in a partial month,
payments for long-term care services shall be reduced in an amount equal to the fraction.
    (e) In the case of multiple fractional transfers of assets in more than one month for
less than fair market value on or after February 8, 2006, the period of ineligibility is
calculated by treating the total, cumulative, uncompensated value of all assets transferred
during all months on or after February 8, 2006, as one transfer.
    (f) A period of ineligibility established under paragraph (c) may be eliminated if
all of the assets transferred for less than fair market value used to calculate the period of
ineligibility, or cash equal to the value of the assets at the time of the transfer, are returned
within 12 months after the date the period of ineligibility began. A period of ineligibility
must not be adjusted if less than the full amount of the transferred assets or the full cash
value of the transferred assets are returned.
EFFECTIVE DATE.This section is effective for periods of ineligibility established
on or after January 1, 2011.

    Sec. 23. Minnesota Statutes 2008, section 256B.06, subdivision 4, is amended to read:
    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited
to citizens of the United States, qualified noncitizens as defined in this subdivision, and
other persons residing lawfully in the United States. Citizens or nationals of the United
States must cooperate in obtaining satisfactory documentary evidence of citizenship or
nationality according to the requirements of the federal Deficit Reduction Act of 2005,
Public Law 109-171.
(b) "Qualified noncitizen" means a person who meets one of the following
immigration criteria:
(1) admitted for lawful permanent residence according to United States Code, title 8;
(2) admitted to the United States as a refugee according to United States Code,
title 8, section 1157;
(3) granted asylum according to United States Code, title 8, section 1158;
(4) granted withholding of deportation according to United States Code, title 8,
section 1253(h);
(5) paroled for a period of at least one year according to United States Code, title 8,
section 1182(d)(5);
(6) granted conditional entrant status according to United States Code, title 8,
section 1153(a)(7);
(7) determined to be a battered noncitizen by the United States Attorney General
according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
(8) is a child of a noncitizen determined to be a battered noncitizen by the United
States Attorney General according to the Illegal Immigration Reform and Immigrant
Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
Public Law 104-200; or
(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
Law 96-422, the Refugee Education Assistance Act of 1980.
(c) All qualified noncitizens who were residing in the United States before August
22, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
medical assistance with federal financial participation.
(d) All qualified noncitizens who entered the United States on or after August 22,
1996, and who otherwise meet the eligibility requirements of this chapter, are eligible for
medical assistance with federal financial participation through November 30, 1996.
Beginning December 1, 1996, qualified noncitizens who entered the United States
on or after August 22, 1996, and who otherwise meet the eligibility requirements of this
chapter are eligible for medical assistance with federal participation for five years if they
meet one of the following criteria:
(i) refugees admitted to the United States according to United States Code, title 8,
section 1157;
(ii) persons granted asylum according to United States Code, title 8, section 1158;
(iii) persons granted withholding of deportation according to United States Code,
title 8, section 1253(h);
(iv) veterans of the United States armed forces with an honorable discharge for
a reason other than noncitizen status, their spouses and unmarried minor dependent
children; or
(v) persons on active duty in the United States armed forces, other than for training,
their spouses and unmarried minor dependent children.
Beginning December 1, 1996, qualified noncitizens who do not meet one of the
criteria in items (i) to (v) are eligible for medical assistance without federal financial
participation as described in paragraph (j).
Notwithstanding paragraph (j), beginning July 1, 2010, children and pregnant
women who are qualified noncitizens, as described in paragraph (b), are eligible for
medical assistance with federal financial participation as provided by the federal Children's
Health Insurance Program Reauthorization Act of 2009, Public Law 111-3.
(e) Noncitizens who are not qualified noncitizens as defined in paragraph (b), who
are lawfully present in the United States, as defined in Code of Federal Regulations, title
8, section 103.12, and who otherwise meet the eligibility requirements of this chapter, are
eligible for medical assistance under clauses (1) to (3). These individuals must cooperate
with the United States Citizenship and Immigration Services to pursue any applicable
immigration status, including citizenship, that would qualify them for medical assistance
with federal financial participation.
(1) Persons who were medical assistance recipients on August 22, 1996, are eligible
for medical assistance with federal financial participation through December 31, 1996.
(2) Beginning January 1, 1997, persons described in clause (1) are eligible for
medical assistance without federal financial participation as described in paragraph (j).
(3) Beginning December 1, 1996, persons residing in the United States prior to
August 22, 1996, who were not receiving medical assistance and persons who arrived on
or after August 22, 1996, are eligible for medical assistance without federal financial
participation as described in paragraph (j).
(f) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
are eligible for the benefits as provided in paragraphs (g) to (i). For purposes of this
subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
Code, title 8, section 1101(a)(15).
(g) Payment shall also be made for care and services that are furnished to noncitizens,
regardless of immigration status, who otherwise meet the eligibility requirements of
this chapter, if such care and services are necessary for the treatment of an emergency
medical condition, except for organ transplants and related care and services and routine
prenatal care.
(h) For purposes of this subdivision, the term "emergency medical condition" means
a medical condition that meets the requirements of United States Code, title 42, section
1396b(v).
(i) Beginning July 1, 2009, pregnant noncitizens who are undocumented,
nonimmigrants, or eligible for medical assistance as described in paragraph (j), lawfully
present as designated in paragraph (e) and who are not covered by a group health plan
or health insurance coverage according to Code of Federal Regulations, title 42, section
457.310, and who otherwise meet the eligibility requirements of this chapter, are eligible
for medical assistance through the period of pregnancy, including labor and delivery,
and 60 days postpartum, to the extent federal funds are available under title XXI of the
Social Security Act, and the state children's health insurance program, followed by 60
days postpartum without federal financial participation.
(j) Qualified noncitizens as described in paragraph (d), and all other noncitizens
lawfully residing in the United States as described in paragraph (e), who are ineligible
for medical assistance with federal financial participation and who otherwise meet the
eligibility requirements of chapter 256B and of this paragraph, are eligible for medical
assistance without federal financial participation. Qualified noncitizens as described
in paragraph (d) are only eligible for medical assistance without federal financial
participation for five years from their date of entry into the United States.
(k) Beginning October 1, 2003, persons who are receiving care and rehabilitation
services from a nonprofit center established to serve victims of torture and are otherwise
ineligible for medical assistance under this chapter are eligible for medical assistance
without federal financial participation. These individuals are eligible only for the period
during which they are receiving services from the center. Individuals eligible under this
paragraph shall not be required to participate in prepaid medical assistance.
EFFECTIVE DATE.This section is effective July 1, 2009.

    Sec. 24. Minnesota Statutes 2008, section 256B.06, subdivision 5, is amended to read:
    Subd. 5. Deeming of sponsor income and resources. When determining eligibility
for any federal or state funded medical assistance under this section, the income
and resources of all noncitizens shall be deemed to include their sponsors' income
and resources as required under the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
subsequently set out in federal rules. This section is effective May 1, 1997. Beginning
July 1, 2010, sponsor deeming does not apply to pregnant women and children who are
qualified noncitizens, as described in section 256B.06, subdivision 4, paragraph (b).
EFFECTIVE DATE.This section is effective July 1, 2010.

    Sec. 25. Minnesota Statutes 2008, section 256B.0625, subdivision 3, is amended to
read:
    Subd. 3. Physicians' services. (a) Medical assistance covers physicians' services.
(b) Rates paid for anesthesiology services provided by physicians shall be according
to the formula utilized in the Medicare program and shall use a conversion factor "at
percentile of calendar year set by legislature.," except that rates paid to physicians for the
medical direction of a certified registered nurse anesthetist shall be the same as the rate
paid to the certified registered nurse anesthetist under medical direction.

    Sec. 26. Minnesota Statutes 2008, section 256B.0625, subdivision 3c, is amended to
read:
    Subd. 3c. Health Services Policy Committee. (a) The commissioner, after
receiving recommendations from professional physician associations, professional
associations representing licensed nonphysician health care professionals, and consumer
groups, shall establish a 13-member Health Services Policy Committee, which consists of
12 voting members and one nonvoting member. The Health Services Policy Committee
shall advise the commissioner regarding health services pertaining to the administration
of health care benefits covered under the medical assistance, general assistance medical
care, and MinnesotaCare programs. The Health Services Policy Committee shall meet at
least quarterly. The Health Services Policy Committee shall annually elect a physician
chair from among its members, who shall work directly with the commissioner's medical
director, to establish the agenda for each meeting. The Health Services Policy Committee
shall also recommend criteria for verifying centers of excellence for specific aspects of
medical care where a specific set of combined services, a volume of patients necessary to
maintain a high level of competency, or a specific level of technical capacity is associated
with improved health outcomes.
(b) The commissioner shall establish a dental subcommittee to operate under the
Health Services Policy Committee. The dental subcommittee consists of general dentists,
dental specialists, safety net providers, dental hygienists, health plan company and
county and public health representatives, health researchers, consumers, and a designee
of the commissioner of health. The dental subcommittee shall advise the commissioner
regarding:
(1) the critical access dental program under section 256B.76, subdivision 4, including
but not limited to criteria for designating and terminating critical access dental providers;
(2) any changes to the critical access dental provider program necessary to comply
with program expenditure limits;
(3) dental coverage policy based on evidence, quality, continuity of care, and best
practices;
(4) the development of dental delivery models; and
(5) dental services to be added or eliminated from subdivision 9, paragraph (b).
(c) The Health Services Policy Committee shall study approaches to making
provider reimbursement under the medical assistance, MinnesotaCare, and general
assistance medical care programs contingent on patient participation in a patient-centered
decision-making process, and shall evaluate the impact of these approaches on health
care quality, patient satisfaction, and health care costs. The committee shall present
findings and recommendations to the commissioner and the legislative committees with
jurisdiction over health care by January 15, 2010.
(d) The Health Services Policy Committee shall monitor and track the practice
patterns of physicians providing services to medical assistance, MinnesotaCare, and
general assistance medical care enrollees under fee-for-service, managed care, and
county-based purchasing. The committee shall focus on services or specialties for which
there is a high variation in utilization across physicians, or which are associated with
high medical costs. The commissioner, based upon the findings of the committee, shall
regularly notify physicians whose practice patterns indicate higher than average utilization
or costs. Managed care and county-based purchasing plans shall provide the committee
with utilization and cost data necessary to implement this paragraph.
    (e) The Health Services Policy Committee shall review caesarean section rates
for the fee-for-service medical assistance population. The committee may develop best
practices policies related to the minimization of caesarean sections, including but not
limited to standards and guidelines for health care providers and health care facilities.

    Sec. 27. Minnesota Statutes 2008, section 256B.0625, subdivision 9, is amended to
read:
    Subd. 9. Dental services. (a) Medical assistance covers dental services. Dental
services include, with prior authorization, fixed bridges that are cost-effective for persons
who cannot use removable dentures because of their medical condition.
(b) Medical assistance dental coverage for nonpregnant adults is limited to the
following services:
(1) comprehensive exams, limited to once every five years;
(2) periodic exams, limited to one per year;
(3) limited exams;
(4) bitewing x-rays, limited to one per year;
(5) periapical x-rays;
(6) panoramic x-rays, limited to one every five years, and only if provided in
conjunction with a posterior extraction or scheduled outpatient facility procedure, or as
medically necessary for the diagnosis and follow-up of oral and maxillofacial pathology
and trauma. Panoramic x-rays may be taken 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;
(7) prophylaxis, limited to one per year;
(8) application of fluoride varnish, limited to one per year;
(9) posterior fillings, all at the amalgam rate;
(10) anterior fillings;
(11) endodontics, limited to root canals on the anterior and premolars only;
(12) removable prostheses, each dental arch limited to one every six years;
(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
abscesses;
(14) palliative treatment and sedative fillings for relief of pain; and
(15) full-mouth debridement, limited to one every five years.
(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:
(1) periodontics, limited to periodontal scaling and root planing once every two
years;
(2) general anesthesia; and
(3) full-mouth survey once every five years.
(d) Medical assistance covers dental services for children that are medically
necessary. The following guidelines apply:
(1) posterior fillings are paid at the amalgam rate;
(2) application of sealants once every five years per permanent molar; and
(3) application of fluoride varnish once every six months.
EFFECTIVE DATE.This section is effective January 1, 2010.

    Sec. 28. Minnesota Statutes 2008, section 256B.0625, subdivision 11, is amended to
read:
    Subd. 11. Nurse anesthetist services. Medical assistance covers nurse anesthetist
services. Rates paid for anesthesiology services provided by a certified registered nurse
anesthetists anesthetist under the direction of a physician shall be according to the formula
utilized in the Medicare program and shall use the conversion factor that is used by
the Medicare program. Rates paid for anesthesiology services provided by a certified
registered nurse anesthetist who is not directed by a physician shall be the same rate as
paid under subdivision 3, paragraph (b).

    Sec. 29. Minnesota Statutes 2008, 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, physician assistant, or a nurse
practitioner employed by or under contract with a community health board as defined in
section 145A.02, subdivision 5, for the purposes of communicable disease control.
(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissioner.
(c) 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.
(d) 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.

    Sec. 30. Minnesota Statutes 2008, 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 actual acquisition costs of the drugs plus a fixed dispensing fee;
the maximum allowable cost set by the federal government or by the commissioner plus
the fixed dispensing fee; or the usual and customary price charged to the public. The
amount of payment basis must be reduced to reflect all discount amounts applied to the
charge by any 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 pharmacy dispensing fee shall be $3.65, except that the dispensing fee
for intravenous solutions which must be compounded by the pharmacist shall be $8 per
bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral
nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral
nutritional products dispensed in quantities greater than one liter. Actual acquisition
cost includes quantity and other special discounts except time and cash discounts.
Effective July 1, 2008 2009, the actual acquisition cost of a drug shall be estimated by the
commissioner, at average wholesale price minus 14 15 percent. The actual acquisition
cost of antihemophilic factor drugs shall be estimated at the average wholesale price
minus 30 percent. The maximum allowable cost of a multisource drug may be set by the
commissioner and it shall be comparable to, but no higher than, the maximum amount
paid by other third-party payors in this state who have maximum allowable cost programs.
Establishment of the amount of payment for drugs shall not be subject to the requirements
of the Administrative Procedure Act.
    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid
to pharmacists for legend drug prescriptions dispensed to residents of long-term care
facilities when a unit dose blister card system, approved by the department, is used. Under
this type of dispensing system, the pharmacist must dispense a 30-day supply of drug.
The National Drug Code (NDC) from the drug container used to fill the blister card must
be identified on the claim to the department. The unit dose blister card containing the
drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700,
that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider
will be required to credit the department for the actual acquisition cost of all unused
drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the
manufacturer's unopened package. The commissioner may permit the drug clozapine to be
dispensed in a quantity that is less than a 30-day supply.
    (c) Whenever a generically equivalent product is available, payment shall be on the
basis of the actual acquisition cost of the generic drug, or on the maximum allowable cost
established by the commissioner.
    (d) 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 or the amount established for Medicare by the United States Department of
Health and Human Services pursuant to title XVIII, section 1847a of the federal Social
Security Act.
    (e) The commissioner may negotiate lower reimbursement rates for specialty
pharmacy products than the rates 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, 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 this paragraph. 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 reimbursement rate to prevent access to care issues.

    Sec. 31. Minnesota Statutes 2008, section 256B.0625, subdivision 13h, is amended to
read:
    Subd. 13h. Medication therapy management services. (a) Medical assistance
and general assistance medical care cover medication therapy management services for
a recipient taking four or more prescriptions to treat or prevent two or more chronic
medical conditions, or a recipient with a drug therapy problem that is identified or prior
authorized by the commissioner that has resulted or is likely to result in significant
nondrug program costs. The commissioner may cover medical therapy management
services under MinnesotaCare if the commissioner determines this is cost-effective. For
purposes of this subdivision, "medication therapy management" means the provision
of the following pharmaceutical care services by a licensed pharmacist to optimize the
therapeutic outcomes of the patient's medications:
    (1) performing or obtaining necessary assessments of the patient's health status;
    (2) formulating a medication treatment plan;
    (3) monitoring and evaluating the patient's response to therapy, including safety
and effectiveness;
    (4) performing a comprehensive medication review to identify, resolve, and prevent
medication-related problems, including adverse drug events;
    (5) documenting the care delivered and communicating essential information to
the patient's other primary care providers;
    (6) providing verbal education and training designed to enhance patient
understanding and appropriate use of the patient's medications;
    (7) providing information, support services, and resources designed to enhance
patient adherence with the patient's therapeutic regimens; and
    (8) coordinating and integrating medication therapy management services within the
broader health care management services being provided to the patient.
Nothing in this subdivision shall be construed to expand or modify the scope of practice of
the pharmacist as defined in section 151.01, subdivision 27.
    (b) To be eligible for reimbursement for services under this subdivision, a pharmacist
must meet the following requirements:
    (1) have a valid license issued under chapter 151;
    (2) have graduated from an accredited college of pharmacy on or after May 1996, or
completed a structured and comprehensive education program approved by the Board of
Pharmacy and the American Council of Pharmaceutical Education for the provision and
documentation of pharmaceutical care management services that has both clinical and
didactic elements;
    (3) be practicing in an ambulatory care setting as part of a multidisciplinary team or
have developed a structured patient care process that is offered in a private or semiprivate
patient care area that is separate from the commercial business that also occurs in the
setting, or in home settings, excluding long-term care and group homes, if the service is
ordered by the provider-directed care coordination team; and
    (4) make use of an electronic patient record system that meets state standards.
    (c) For purposes of reimbursement for medication therapy management services,
the commissioner may enroll individual pharmacists as medical assistance and general
assistance medical care providers. The commissioner may also establish contact
requirements between the pharmacist and recipient, including limiting the number of
reimbursable consultations per recipient.
    (d) The commissioner, after receiving recommendations from professional medical
associations, professional pharmacy associations, and consumer groups, shall convene
an 11-member Medication Therapy Management Advisory Committee to advise
the commissioner on the implementation and administration of medication therapy
management services. The committee shall be comprised of: two licensed physicians;
two licensed pharmacists; two consumer representatives; two health plan company
representatives; and three members with expertise in the area of medication therapy
management, who may be licensed physicians or licensed pharmacists. The committee is
governed by section 15.059, except that committee members do not receive compensation
or reimbursement for expenses. The advisory committee expires on June 30, 2007.
    (e) The commissioner shall evaluate the effect of medication therapy management
on quality of care, patient outcomes, and program costs, and shall include a description
of any savings generated in the medical assistance and general assistance medical care
programs that can be attributable to this coverage. The evaluation shall be submitted to
the legislature by December 15, 2007. The commissioner may contract with a vendor
or an academic institution that has expertise in evaluating health care outcomes for the
purpose of completing the evaluation.
(d) The commissioner shall establish a pilot project for an intensive medication
therapy management program for patients identified by the commissioner with multiple
chronic conditions and a high number of medications who are at high risk of preventable
hospitalizations, emergency room use, medication complications, and suboptimal
treatment outcomes due to medication-related problems. For purposes of the pilot
project, medication therapy management services may be provided in a patient's home
or community setting, in addition to other authorized settings. The commissioner may
waive existing payment policies and establish special payment rates for the pilot project.
The pilot project must be designed to produce a net savings to the state compared to the
estimated costs that would otherwise be incurred for similar patients without the program.

    Sec. 32. Minnesota Statutes 2008, section 256B.0625, subdivision 17, is amended to
read:
    Subd. 17. Transportation costs. (a) Medical assistance covers medical
transportation costs incurred solely for obtaining emergency medical care or transportation
costs incurred by eligible persons in obtaining emergency or nonemergency medical
care when paid directly to an ambulance company, common carrier, or other recognized
providers of transportation services. Medical transportation must be provided by:
(1) an ambulance, as defined in section 144E.001, subdivision 2;
(2) special transportation; or
(3) common carrier including, but not limited to, bus, taxicab, other commercial
carrier, or private automobile.
(b) Medical assistance covers special transportation, as defined in Minnesota Rules,
part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that
would prohibit the recipient from safely accessing and using a bus, taxi, other commercial
transportation, or private automobile.
The commissioner may use an order by the recipient's attending physician to certify that
the recipient requires special transportation services. Special transportation includes
providers shall perform driver-assisted service to services for eligible individuals.
Driver-assisted service includes passenger pickup at and return to the individual's
residence or place of business, assistance with admittance of the individual to the medical
facility, and assistance in passenger securement or in securing of wheelchairs or stretchers
in the vehicle. Special transportation providers must obtain written documentation
from the health care service provider who is serving the recipient being transported,
identifying the time that the recipient arrived. Special transportation providers may not
bill for separate base rates for the continuation of a trip beyond the original destination.
Special transportation providers must take recipients to the nearest appropriate health
care provider, using the most direct route available. The maximum minimum medical
assistance reimbursement rates for special transportation services are:
(1) (i) $17 for the base rate and $1.35 per mile for special transportation services to
eligible persons who need a wheelchair-accessible van;
(2) (ii) $11.50 for the base rate and $1.30 per mile for special transportation services
to eligible persons who do not need a wheelchair-accessible van; and
(3) (iii) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip,
for special transportation services to eligible persons who need a stretcher-accessible
vehicle;
(2) the base rates for special transportation services in areas defined under RUCA
to be super rural shall be equal to the reimbursement rate established in clause (1) plus
11.3 percent; and
(3) for special transportation services in areas defined under RUCA to be rural
or super rural areas:
(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125
percent of the respective mileage rate in clause (1); and
(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to
112.5 percent of the respective mileage rate in clause (1).
(c) For purposes of reimbursement rates for special transportation services under
paragraph (b), the zip code of the recipient's place of residence shall determine whether
the urban, rural, or super rural reimbursement rate applies.
(d) For purposes of this subdivision, "rural urban commuting area" or "RUCA"
means a census-tract based classification system under which a geographical area is
determined to be urban, rural, or super rural.

    Sec. 33. Minnesota Statutes 2008, section 256B.0625, subdivision 17a, is amended to
read:
    Subd. 17a. Payment for ambulance services. Medical assistance covers
ambulance services. Providers shall bill ambulance services according to Medicare
criteria. Nonemergency ambulance services shall not be paid as emergencies. Effective
for services rendered on or after July 1, 2001, medical assistance payments for ambulance
services shall be paid at the Medicare reimbursement rate or at the medical assistance
payment rate in effect on July 1, 2000, whichever is greater.

    Sec. 34. Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:
    Subd. 18b. Broker dispatching prohibition. The commissioner shall not use a
broker or coordinator for any purpose related to transportation services under subdivision
18.

    Sec. 35. Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:
    Subd. 25a. Prior authorization of diagnostic imaging services. (a) Effective
January 1, 2010, the commissioner shall require prior authorization or decision support
for the ordering providers at the time the service is ordered for the following outpatient
diagnostic imaging services: computerized tomography (CT), magnetic resonance
imaging (MRI), magnetic resonance angiography (MRA), positive emission tomography
(PET), cardiac imaging and ultrasound diagnostic imaging.
(b) Prior authorization under this subdivision is not required for diagnostic imaging
services performed as part of a hospital emergency room visit, inpatient hospitalization, or
if concurrent with or on the same day as an urgent care facility visit.
(c) This subdivision does not apply to services provided to recipients who are
enrolled in Medicare, the prepaid medical assistance program, the prepaid general
assistance medical care program, or the MinnesotaCare program.
(d) The commissioner may contract with a private entity to provide the prior
authorization or decision support required under this subdivision. The contracting entity
must incorporate clinical guidelines that are based on evidence-based medical literature, if
available. By January 1, 2012, the contracting entity shall report to the commissioner the
results of prior authorization or decision support.

    Sec. 36. Minnesota Statutes 2008, section 256B.0625, subdivision 26, is amended to
read:
    Subd. 26. Special education services. (a) Medical assistance covers medical
services identified in a recipient's individualized education plan and covered under the
medical assistance state plan. Covered services include occupational therapy, physical
therapy, speech-language therapy, clinical psychological services, nursing services,
school psychological services, school social work services, personal care assistants
serving as management aides, assistive technology devices, transportation services,
health assessments, and other services covered under the medical assistance state plan.
Mental health services eligible for medical assistance reimbursement must be provided or
coordinated through a children's mental health collaborative where a collaborative exists if
the child is included in the collaborative operational target population. The provision or
coordination of services does not require that the individual education plan be developed
by the collaborative.
The services may be provided by a Minnesota school district that is enrolled as a
medical assistance provider or its subcontractor, and only if the services meet all the
requirements otherwise applicable if the service had been provided by a provider other
than a school district, in the following areas: medical necessity, physician's orders,
documentation, personnel qualifications, and prior authorization requirements. The
nonfederal share of costs for services provided under this subdivision is the responsibility
of the local school district as provided in section 125A.74. Services listed in a child's
individual education plan are eligible for medical assistance reimbursement only if those
services meet criteria for federal financial participation under the Medicaid program.
(b) Approval of health-related services for inclusion in the individual education plan
does not require prior authorization for purposes of reimbursement under this chapter.
The commissioner may require physician review and approval of the plan not more than
once annually or upon any modification of the individual education plan that reflects a
change in health-related services.
(c) Services of a speech-language pathologist provided under this section are covered
notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item L, if the person:
(1) holds a masters degree in speech-language pathology;
(2) is licensed by the Minnesota Board of Teaching as an educational
speech-language pathologist; and
(3) either has a certificate of clinical competence from the American Speech and
Hearing Association, has completed the equivalent educational requirements and work
experience necessary for the certificate or has completed the academic program and is
acquiring supervised work experience to qualify for the certificate.
(d) Medical assistance coverage for medically necessary services provided under
other subdivisions in this section may not be denied solely on the basis that the same or
similar services are covered under this subdivision.
(e) The commissioner shall develop and implement package rates, bundled rates, or
per diem rates for special education services under which separately covered services are
grouped together and billed as a unit in order to reduce administrative complexity.
(f) The commissioner shall develop a cost-based payment structure for payment
of these services. The commissioner shall reimburse claims submitted based on an
interim rate, and shall settle at a final rate once the department has determined it. The
commissioner shall notify the school district of the final rate. The school district has 60
days to appeal the final rate. To appeal the final rate, the school district shall file a written
appeal request to the commissioner within 60 days of the date the final rate determination
was mailed. The appeal request shall specify (1) the disputed items and (2) the name and
address of the person to contact regarding the appeal.
(g) Effective July 1, 2000, medical assistance services provided under an individual
education plan or an individual family service plan by local school districts shall not count
against medical assistance authorization thresholds for that child.
(h) Nursing services as defined in section 148.171, subdivision 15, and provided
as an individual education plan health-related service, are eligible for medical assistance
payment if they are otherwise a covered service under the medical assistance program.
Medical assistance covers the administration of prescription medications by a licensed
nurse who is employed by or under contract with a school district when the administration
of medications is identified in the child's individualized education plan. The simple
administration of medications alone is not covered under medical assistance when
administered by a provider other than a school district or when it is not identified in the
child's individualized education plan.

    Sec. 37. Minnesota Statutes 2008, section 256B.08, is amended by adding a
subdivision to read:
    Subd. 4. Data from Social Security. The commissioner shall accept data from the
Social Security Administration in accordance with United States Code, title 42, section
1396U-5(a).
EFFECTIVE DATE.This section is effective January 1, 2010.

    Sec. 38. Minnesota Statutes 2008, section 256B.15, subdivision 1, is amended to read:
    Subdivision 1. Policy and applicability. (a) It is the policy of this state that
individuals or couples, either or both of whom participate in the medical assistance
program, use their own assets to pay their share of the total cost of their care during or
after their enrollment in the program according to applicable federal law and the laws of
this state. The following provisions apply:
    (1) subdivisions 1c to 1k shall not apply to claims arising under this section which
are presented under section 525.313;
    (2) the provisions of subdivisions 1c to 1k expanding the interests included in an
estate for purposes of recovery under this section give effect to the provisions of United
States Code, title 42, section 1396p, governing recoveries, but do not give rise to any
express or implied liens in favor of any other parties not named in these provisions;
    (3) the continuation of a recipient's life estate or joint tenancy interest in real
property after the recipient's death for the purpose of recovering medical assistance under
this section modifies common law principles holding that these interests terminate on
the death of the holder;
    (4) all laws, rules, and regulations governing or involved with a recovery of medical
assistance shall be liberally construed to accomplish their intended purposes;
    (5) a deceased recipient's life estate and joint tenancy interests continued under this
section shall be owned by the remaindermen or surviving joint tenants as their interests
may appear on the date of the recipient's death. They shall not be merged into the
remainder interest or the interests of the surviving joint tenants by reason of ownership.
They shall be subject to the provisions of this section. Any conveyance, transfer, sale,
assignment, or encumbrance by a remainderman, a surviving joint tenant, or their heirs,
successors, and assigns shall be deemed to include all of their interest in the deceased
recipient's life estate or joint tenancy interest continued under this section; and
    (6) the provisions of subdivisions 1c to 1k continuing a recipient's joint tenancy
interests in real property after the recipient's death do not apply to a homestead owned
of record, on the date the recipient dies, by the recipient and the recipient's spouse as
joint tenants with a right of survivorship. Homestead means the real property occupied
by the surviving joint tenant spouse as their sole residence on the date the recipient dies
and classified and taxed to the recipient and surviving joint tenant spouse as homestead
property for property tax purposes in the calendar year in which the recipient dies. For
purposes of this exemption, real property the recipient and their surviving joint tenant
spouse purchase solely with the proceeds from the sale of their prior homestead, own
of record as joint tenants, and qualify as homestead property under section 273.124 in
the calendar year in which the recipient dies and prior to the recipient's death shall be
deemed to be real property classified and taxed to the recipient and their surviving joint
tenant spouse as homestead property in the calendar year in which the recipient dies.
The surviving spouse, or any person with personal knowledge of the facts, may provide
an affidavit describing the homestead property affected by this clause and stating facts
showing compliance with this clause. The affidavit shall be prima facie evidence of the
facts it states.
    (b) For purposes of this section, "medical assistance" includes the medical assistance
program under this chapter and the general assistance medical care program under chapter
256D and alternative care for nonmedical assistance recipients under section 256B.0913.
    (c) For purposes of this section, beginning January 1, 2010, "medical assistance"
does not include Medicare cost-sharing benefits in accordance with United States Code,
title 42, section 1396p.
    (d) All provisions in this subdivision, and subdivisions 1d, 1f, 1g, 1h, 1i, and 1j,
related to the continuation of a recipient's life estate or joint tenancy interests in real
property after the recipient's death for the purpose of recovering medical assistance, are
effective only for life estates and joint tenancy interests established on or after August 1,
2003. For purposes of this paragraph, medical assistance does not include alternative care.

    Sec. 39. Minnesota Statutes 2008, section 256B.15, subdivision 1a, is amended to read:
    Subd. 1a. Estates subject to claims. (a) If a person receives any medical assistance
hereunder, on the person's death, if single, or on the death of the survivor of a married
couple, either or both of whom received medical assistance, or as otherwise provided
for in this section, the total amount paid for medical assistance rendered for the person
and spouse shall be filed as a claim against the estate of the person or the estate of the
surviving spouse in the court having jurisdiction to probate the estate or to issue a decree
of descent according to sections 525.31 to 525.313.
(b) For the purposes of this section, the person's estate must consist of:
(1) the person's probate estate;
(2) all of the person's interests or proceeds of those interests in real property the
person owned as a life tenant or as a joint tenant with a right of survivorship at the time of
the person's death;
(3) all of the person's interests or proceeds of those interests in securities the person
owned in beneficiary form as provided under sections 524.6-301 to 524.6-311 at the time
of the person's death, to the extent the interests or proceeds of those interests become part
of the probate estate under section 524.6-307;
(4) all of the person's interests in joint accounts, multiple-party accounts, and
pay-on-death accounts, brokerage accounts, investment accounts, or the proceeds of
those accounts, as provided under sections 524.6-201 to 524.6-214 at the time of the
person's death to the extent the interests become part of the probate estate under section
524.6-207; and
(5) assets conveyed to a survivor, heir, or assign of the person through survivorship,
living trust, or other arrangements.
(c) For the purpose of this section and recovery in a surviving spouse's estate for
medical assistance paid for a predeceased spouse, the estate must consist of all of the legal
title and interests the deceased individual's predeceased spouse had in jointly owned or
marital property at the time of the spouse's death, as defined in subdivision 2b, and the
proceeds of those interests, that passed to the deceased individual or another individual, a
survivor, an heir, or an assign of the predeceased spouse through a joint tenancy, tenancy
in common, survivorship, life estate, living trust, or other arrangement. A deceased
recipient who, at death, owned the property jointly with the surviving spouse shall have
an interest in the entire property.
(d) For the purpose of recovery in a single person's estate or the estate of a survivor
of a married couple, "other arrangement" includes any other means by which title to all or
any part of the jointly owned or marital property or interest passed from the predeceased
spouse to another including, but not limited to, transfers between spouses which are
permitted, prohibited, or penalized for purposes of medical assistance.
(e) A claim shall be filed if medical assistance was rendered for either or both
persons under one of the following circumstances:
(a) (1) the person was over 55 years of age, and received services under this chapter;
(b) (2) the person resided in a medical institution for six months or longer, received
services under this chapter, and, at the time of institutionalization or application for
medical assistance, whichever is later, the person could not have reasonably been expected
to be discharged and returned home, as certified in writing by the person's treating
physician. For purposes of this section only, a "medical institution" means a skilled
nursing facility, intermediate care facility, intermediate care facility for persons with
developmental disabilities, nursing facility, or inpatient hospital; or
(c) (3) the person received general assistance medical care services under chapter
256D.
(f) The claim shall be considered an expense of the last illness of the decedent for the
purpose of section 524.3-805. Notwithstanding any law or rule to the contrary, a state or
county agency with a claim under this section must be a creditor under section 524.6-307.
Any statute of limitations that purports to limit any county agency or the state agency,
or both, to recover for medical assistance granted hereunder shall not apply to any claim
made hereunder for reimbursement for any medical assistance granted hereunder. Notice
of the claim shall be given to all heirs and devisees of the decedent whose identity can be
ascertained with reasonable diligence. The notice must include procedures and instructions
for making an application for a hardship waiver under subdivision 5; time frames for
submitting an application and determination; and information regarding appeal rights and
procedures. Counties are entitled to one-half of the nonfederal share of medical assistance
collections from estates that are directly attributable to county effort. Counties are entitled
to ten percent of the collections for alternative care directly attributable to county effort.

    Sec. 40. Minnesota Statutes 2008, section 256B.15, subdivision 1h, is amended to read:
    Subd. 1h. Estates of specific persons receiving medical assistance. (a) For
purposes of this section, paragraphs (b) to (k) (j) apply if a person received medical
assistance for which a claim may be filed under this section and died single, or the
surviving spouse of the couple and was not survived by any of the persons described
in subdivisions 3 and 4.
    (b) For purposes of this section, the person's estate consists of: (1) the person's
probate estate; (2) all of the person's interests or proceeds of those interests in real property
the person owned as a life tenant or as a joint tenant with a right of survivorship at the
time of the person's death; (3) all of the person's interests or proceeds of those interests in
securities the person owned in beneficiary form as provided under sections 524.6-301 to
524.6-311 at the time of the person's death, to the extent they become part of the probate
estate under section 524.6-307; (4) all of the person's interests in joint accounts, multiple
party accounts, and pay on death accounts, or the proceeds of those accounts, as provided
under sections 524.6-201 to 524.6-214 at the time of the person's death to the extent
they become part of the probate estate under section 524.6-207; and (5) the person's
legal title or interest at the time of the person's death in real property transferred under
a transfer on death deed under section 507.071, or in the proceeds from the subsequent
sale of the person's interest in the real property. Notwithstanding any law or rule to the
contrary, a state or county agency with a claim under this section shall be a creditor under
section 524.6-307.
    (c) (b) Notwithstanding any law or rule to the contrary, the person's life estate or joint
tenancy interest in real property not subject to a medical assistance lien under sections
514.980 to 514.985 on the date of the person's death shall not end upon the person's death
and shall continue as provided in this subdivision. The life estate in the person's estate
shall be that portion of the interest in the real property subject to the life estate that is equal
to the life estate percentage factor for the life estate as listed in the Life Estate Mortality
Table of the health care program's manual for a person who was the age of the medical
assistance recipient on the date of the person's death. The joint tenancy interest in real
property in the estate shall be equal to the fractional interest the person would have owned
in the jointly held interest in the property had they and the other owners held title to the
property as tenants in common on the date the person died.
    (d) (c) The court upon its own motion, or upon motion by the personal representative
or any interested party, may enter an order directing the remaindermen or surviving joint
tenants and their spouses, if any, to sign all documents, take all actions, and otherwise
fully cooperate with the personal representative and the court to liquidate the decedent's
life estate or joint tenancy interests in the estate and deliver the cash or the proceeds of
those interests to the personal representative and provide for any legal and equitable
sanctions as the court deems appropriate to enforce and carry out the order, including an
award of reasonable attorney fees.
    (e) (d) The personal representative may make, execute, and deliver any conveyances
or other documents necessary to convey the decedent's life estate or joint tenancy interest
in the estate that are necessary to liquidate and reduce to cash the decedent's interest or
for any other purposes.
    (f) (e) Subject to administration, all costs, including reasonable attorney fees,
directly and immediately related to liquidating the decedent's life estate or joint tenancy
interest in the decedent's estate, shall be paid from the gross proceeds of the liquidation
allocable to the decedent's interest and the net proceeds shall be turned over to the personal
representative and applied to payment of the claim presented under this section.
    (g) (f) The personal representative shall bring a motion in the district court in which
the estate is being probated to compel the remaindermen or surviving joint tenants to
account for and deliver to the personal representative all or any part of the proceeds of any
sale, mortgage, transfer, conveyance, or any disposition of real property allocable to the
decedent's life estate or joint tenancy interest in the decedent's estate, and do everything
necessary to liquidate and reduce to cash the decedent's interest and turn the proceeds of
the sale or other disposition over to the personal representative. The court may grant any
legal or equitable relief including, but not limited to, ordering a partition of real estate
under chapter 558 necessary to make the value of the decedent's life estate or joint tenancy
interest available to the estate for payment of a claim under this section.
    (h) (g) Subject to administration, the personal representative shall use all of the cash
or proceeds of interests to pay an allowable claim under this section. The remaindermen
or surviving joint tenants and their spouses, if any, may enter into a written agreement
with the personal representative or the claimant to settle and satisfy obligations imposed at
any time before or after a claim is filed.
    (i) (h) The personal representative may, at their discretion, provide any or all of the
other owners, remaindermen, or surviving joint tenants with an affidavit terminating the
decedent's estate's interest in real property the decedent owned as a life tenant or as a joint
tenant with others, if the personal representative determines in good faith that neither the
decedent nor any of the decedent's predeceased spouses received any medical assistance
for which a claim could be filed under this section, or if the personal representative has
filed an affidavit with the court that the estate has other assets sufficient to pay a claim, as
presented, or if there is a written agreement under paragraph (h) (g), or if the claim, as
allowed, has been paid in full or to the full extent of the assets the estate has available
to pay it. The affidavit may be recorded in the office of the county recorder or filed in
the Office of the Registrar of Titles for the county in which the real property is located.
Except as provided in section 514.981, subdivision 6, when recorded or filed, the affidavit
shall terminate the decedent's interest in real estate the decedent owned as a life tenant or a
joint tenant with others. The affidavit shall:
(1) be signed by the personal representative;
(2) identify the decedent and the interest being terminated;
(3) give recording information sufficient to identify the instrument that created the
interest in real property being terminated;
(4) legally describe the affected real property;
(5) state that the personal representative has determined that neither the decedent
nor any of the decedent's predeceased spouses received any medical assistance for which
a claim could be filed under this section;
(6) state that the decedent's estate has other assets sufficient to pay the claim, as
presented, or that there is a written agreement between the personal representative and
the claimant and the other owners or remaindermen or other joint tenants to satisfy the
obligations imposed under this subdivision; and
(7) state that the affidavit is being given to terminate the estate's interest under this
subdivision, and any other contents as may be appropriate.
The recorder or registrar of titles shall accept the affidavit for recording or filing. The
affidavit shall be effective as provided in this section and shall constitute notice even if it
does not include recording information sufficient to identify the instrument creating the
interest it terminates. The affidavit shall be conclusive evidence of the stated facts.
    (j) (i) The holder of a lien arising under subdivision 1c shall release the lien at
the holder's expense against an interest terminated under paragraph (h) (g) to the extent
of the termination.
    (k) (j) If a lien arising under subdivision 1c is not released under paragraph (j) (i),
prior to closing the estate, the personal representative shall deed the interest subject to the
lien to the remaindermen or surviving joint tenants as their interests may appear. Upon
recording or filing, the deed shall work a merger of the recipient's life estate or joint
tenancy interest, subject to the lien, into the remainder interest or interest the decedent and
others owned jointly. The lien shall attach to and run with the property to the extent of
the decedent's interest at the time of the decedent's death.

    Sec. 41. Minnesota Statutes 2008, section 256B.15, subdivision 2, is amended to read:
    Subd. 2. Limitations on claims. The claim shall include only the total amount
of medical assistance rendered after age 55 or during a period of institutionalization
described in subdivision 1a, clause (b) paragraph (e), and the total amount of general
assistance medical care rendered, and shall not include interest. Claims that have been
allowed but not paid shall bear interest according to section 524.3-806, paragraph (d). A
claim against the estate of a surviving spouse who did not receive medical assistance, for
medical assistance rendered for the predeceased spouse, shall be payable from the full
value of all of the predeceased spouse's assets and interests which are part of the surviving
spouse's estate under subdivisions 1a and 2b. Recovery of medical assistance expenses in
the nonrecipient surviving spouse's estate is limited to the value of the assets of the estate
that were marital property or jointly owned property at any time during the marriage. The
claim is not payable from the value of assets or proceeds of assets in the estate attributable
to a predeceased spouse whom the individual married after the death of the predeceased
recipient spouse for whom the claim is filed or from assets and the proceeds of assets in the
estate which the nonrecipient decedent spouse acquired with assets which were not marital
property or jointly owned property after the death of the predeceased recipient spouse.
Claims for alternative care shall be net of all premiums paid under section 256B.0913,
subdivision 12
, on or after July 1, 2003, and shall be limited to services provided on or
after July 1, 2003. Claims against marital property shall be limited to claims against
recipients who died on or after July 1, 2009.

    Sec. 42. Minnesota Statutes 2008, section 256B.15, is amended by adding a
subdivision to read:
    Subd. 2b. Controlling provisions. (a) For purposes of this subdivision and
subdivisions 1a and 2, paragraphs (b) to (d) apply.
(b) At the time of death of a recipient spouse and solely for purpose of recovery of
medical assistance benefits received, a predeceased recipient spouse shall have a legal
title or interest in the undivided whole of all of the property which the recipient and the
recipient's surviving spouse owned jointly or which was marital property at any time
during their marriage regardless of the form of ownership and regardless of whether
it was owned or titled in the names of one or both the recipient and the recipient's
spouse. Title and interest in the property of a predeceased recipient spouse shall not end
or extinguish upon the person's death and shall continue for the purpose of allowing
recovery of medical assistance in the estate of the surviving spouse. Upon the death of
the predeceased recipient spouse, title and interest in the predeceased spouse's property
shall vest in the surviving spouse by operation of law and without the necessity for any
probate or decree of descent proceedings and shall continue to exist after the death of the
predeceased spouse and the surviving spouse to permit recovery of medical assistance.
The recipient spouse and the surviving spouse of a deceased recipient spouse shall not
encumber, disclaim, transfer, alienate, hypothecate, or otherwise divest themselves of
these interests before or upon death.
(c) For purposes of this section, "marital property" includes any and all real or
personal property of any kind or interests in such property the predeceased recipient
spouse and their spouse, or either of them, owned at the time of their marriage to each
other or acquired during their marriage regardless of whether it was owned or titled in
the names of one or both of them. If either or both spouses of a married couple received
medical assistance, all property owned during the marriage or which either or both spouses
acquired during their marriage shall be presumed to be marital property for purposes of
recovering medical assistance unless there is clear and convincing evidence to the contrary.
(d) The agency responsible for the claim for medical assistance for a recipient spouse
may, at its discretion, release specific real and personal property from the provisions of
this section. The release shall extinguish the interest created under paragraph (b) in the
land it describes upon filing or recording. The release need not be attested, certified, or
acknowledged as a condition of filing or recording and shall be filed or recorded in the
office of the county recorder or registrar of titles, as appropriate, in the county where the
real property is located. The party to whom the release is given shall be responsible for
paying all fees and costs necessary to record and file the release. If the property described
in the release is registered property, the registrar of titles shall accept it for recording and
shall record it on the certificate of title for each parcel of property described in the release.
If the property described in the release is abstract property, the recorder shall accept it
for filing and file it in the county's grantor-grantee indexes and any tract index the county
maintains for each parcel of property described in the release.

    Sec. 43. Minnesota Statutes 2008, section 256B.15, is amended by adding a
subdivision to read:
    Subd. 9. Commissioner's intervention. The commissioner shall be permitted to
intervene as a party in any proceeding involving recovery of medical assistance upon
filing a notice of intervention and serving such notice on the other parties.

    Sec. 44. [256B.196] INTERGOVERNMENTAL TRANSFERS; HOSPITAL
PAYMENTS.
    Subdivision 1. Federal approval required. This section is contingent on federal
approval of the intergovernmental transfers and payments authorized under this section.
This section is also contingent on current payment by the government entities of the
intergovernmental transfers under this section.
    Subd. 2. Commissioner's duties. (a) For the purposes of this subdivision and
subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital
services upper payment limit for nonstate government hospitals. The commissioner shall
then determine the amount of a supplemental payment to Hennepin County Medical
Center and Regions Hospital for these services that would increase medical assistance
spending in this category to the aggregate upper payment limit for all nonstate government
hospitals in Minnesota. In making this determination, the commissioner shall allot the
available increases between Hennepin County Medical Center and Regions Hospital
based on the ratio of medical assistance fee-for-service outpatient hospital payments to
the two facilities. The commissioner shall adjust this allotment as necessary based on
federal approvals, the amount of intergovernmental transfers received from Hennepin and
Ramsey Counties, and other factors, in order to maximize the additional total payments.
The commissioner shall inform Hennepin County and Ramsey County of the periodic
intergovernmental transfers necessary to match federal Medicaid payments available
under this subdivision in order to make supplementary medical assistance payments to
Hennepin County Medical Center and Regions Hospital equal to an amount that when
combined with existing medical assistance payments to nonstate governmental hospitals
would increase total payments to hospitals in this category for outpatient services to
the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon
receipt of these periodic transfers, the commissioner shall make supplementary payments
to Hennepin County Medical Center and Regions Hospital.
(b) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians affiliated with Hennepin County Medical
Center and with Regions Hospital. The upper payment limit shall be based on the average
commercial rate or be determined using another method acceptable to the Centers for
Medicare and Medicaid Services. The commissioner shall inform Hennepin County and
Ramsey County of the periodic intergovernmental transfers necessary to match the federal
Medicaid payments available under this subdivision in order to make supplementary
payments to physicians affiliated with Hennepin County Medical Center and Regions
Hospital equal to the difference between the established medical assistance payment for
physician services and the upper payment limit. Upon receipt of these periodic transfers,
the commissioner shall make supplementary payments to physicians of Hennepin Faculty
Associates and HealthPartners.
(c) Beginning January 1, 2010, Hennepin County and Ramsey County shall make
monthly intergovernmental transfers to the commissioner in the following amounts:
$133,333 by Hennepin County and $100,000 by Ramsey County. The commissioner shall
increase the medical assistance capitation payments to Metropolitan Health Plan and
HealthPartners by an amount equal to the annual value of the monthly transfers plus
federal financial participation.
(d) The commissioner shall inform Hennepin County and Ramsey County on an
ongoing basis of the need for any changes needed in the intergovernmental transfers
in order to continue the payments under paragraphs (a) to (c), at their maximum level,
including increases in upper payment limits, changes in the federal Medicaid match, and
other factors.
(e) The payments in paragraphs (a) to (c) shall be implemented independently of
each other, subject to federal approval and to the receipt of transfers under subdivision 3.
    Subd. 3. Intergovernmental transfers. Based on the determination by the
commissioner under subdivision 2, Hennepin County and Ramsey County shall make
periodic intergovernmental transfers to the commissioner for the purposes of subdivision
2, paragraphs (a) to (c). All of the intergovernmental transfers made by Hennepin County
shall be used to match federal payments to Hennepin County Medical Center under
subdivision 2, paragraph (a); to physicians affiliated with Hennepin Faculty Associates
under subdivision 2, paragraph (b); and to Metropolitan Health Plan under subdivision
2, paragraph (c). All of the intergovernmental transfers made by Ramsey County shall
be used to match federal payments to Regions Hospital under subdivision 2, paragraph
(a); to physicians affiliated with HealthPartners under subdivision 2, paragraph (b); and to
HealthPartners under subdivision 2, paragraph (c).
    Subd. 4. Adjustments permitted. (a) The commissioner may adjust the
intergovernmental transfers under subdivision 3 and the payments under subdivision
2, based on the commissioner's determination of Medicare upper payment limits,
hospital-specific charge limits, hospital-specific limitations on disproportionate share
payments, medical inflation, actuarial certification, and cost-effectiveness for purposes
of federal waivers. Any adjustments must be made on a proportional basis. The
commissioner may make adjustments under this subdivision only after consultation
with the affected counties and hospitals. All payments under subdivision 2 and all
intergovernmental transfers under subdivision 3 are limited to amounts available after all
other base rates, adjustments, and supplemental payments in chapter 256B are calculated.
(b) The ratio of medical assistance payments specified in subdivision 2 to the
voluntary intergovernmental transfers specified in subdivision 3 shall not be reduced
except as provided under paragraph (a).
    Subd. 5. Recession period. Each type of intergovernmental transfer in subdivision
2, paragraphs (a) to (d), for payment periods from October 1, 2008, through December
31, 2010, is voluntary on the part of Hennepin and Ramsey Counties, meaning that the
transfer must be agreed to, in writing, by the counties prior to any payments being issued.
One agreement on each type of transfer shall cover the entire recession period.

    Sec. 45. Minnesota Statutes 2008, section 256B.199, is amended to read:
256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.
    (a) Effective July 1, 2007, the commissioner shall apply for federal matching funds
for the expenditures in paragraphs (b) and (c).
    (b) The commissioner shall apply for federal matching funds for certified public
expenditures as follows:
    (1) Hennepin County, Hennepin County Medical Center, Ramsey County, Regions
Hospital, the University of Minnesota, and Fairview-University Medical Center shall
report quarterly to the commissioner beginning June 1, 2007, payments made during the
second previous quarter that may qualify for reimbursement under federal law;
     (2) based on these reports, the commissioner shall apply for federal matching
funds. These funds are appropriated to the commissioner for the payments under section
256.969, subdivision 27; and
     (3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform
the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
hospital payment money expected to be available in the current federal fiscal year.
    (c) The commissioner shall apply for federal matching funds for general assistance
medical care expenditures as follows:
    (1) for hospital services occurring on or after July 1, 2007, general assistance medical
care expenditures for fee-for-service inpatient and outpatient hospital payments made by
the department shall be used to apply for federal matching funds, except as limited below:
    (i) only those general assistance medical care expenditures made to an individual
hospital that would not cause the hospital to exceed its individual hospital limits under
section 1923 of the Social Security Act may be considered; and
    (ii) general assistance medical care expenditures may be considered only to the extent
of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and
    (2) all hospitals must provide any necessary expenditure, cost, and revenue
information required by the commissioner as necessary for purposes of obtaining federal
Medicaid matching funds for general assistance medical care expenditures.
(d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall
apply for additional federal matching funds available as disproportionate share hospital
payments under the American Recovery and Reinvestment Act of 2009. These funds shall
be made available as the state share of payments under section 256.969, subdivision 28.
The entities required to report certified public expenditures under paragraph (b), clause
(1), shall report additional certified public expenditures as necessary under this paragraph.
EFFECTIVE DATE.This section is effective the day following final enactment.

    Sec. 46. Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to read:
    Subd. 5a. Managed care contracts. (a) Managed care contracts under this section
and sections 256L.12 and 256D.03, shall be entered into or renewed on a calendar year
basis beginning January 1, 1996. Managed care contracts which were in effect on June
30, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995
through December 31, 1995 at the same terms that were in effect on June 30, 1995. 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, 256D, and 256L, is responsible for complying with the terms
of its contract with the commissioner. Requirements applicable to managed care programs
under chapters 256B, 256D, and 256L, established after the effective date of a contract
with the commissioner take effect when the contract is next issued or renewed.
    (c) Effective for services rendered on or after January 1, 2003, the commissioner shall
withhold five percent of managed care plan payments under this section and county-based
purchasing plan's payment rate under section 256B.692 for the prepaid medical assistance
and general assistance medical care programs 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. The managed care 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. 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 paragraph that is reasonably expected to be returned.
    (d)(1) Effective for services rendered on or after January 1, 2009, through December
31, 2009, 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 and general assistance medical care programs. 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.
    (2) 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 paragraph. The return of the withhold under this paragraph is not subject to the
requirements of paragraph (c).
(e) Effective for services rendered on or after January 1, 2010, through December
31, 2010, the commissioner shall withhold 3.5 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.
(f) Effective for services rendered on or after January 1, 2011, through December 31,
2011, the commissioner shall withhold four 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.
(g) Effective for services rendered on or after January 1, 2012, through December
31, 2012, 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.
(h) 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.
(i) 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 and prepaid general assistance medical care programs. 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.
(j) 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.

    Sec. 47. Minnesota Statutes 2008, section 256B.69, subdivision 5c, is amended to read:
    Subd. 5c. Medical education and research fund. (a) Except as provided in
paragraph (c), the commissioner of human services shall transfer each year to the medical
education and research fund established under section 62J.692, the following:
(1) an amount equal to the reduction in the prepaid medical assistance and prepaid
general assistance medical care payments as specified in this clause. Until January 1,
2002, the county medical assistance and general assistance medical care capitation base
rate prior to plan specific adjustments and after the regional rate adjustments under section
256B.69, subdivision 5b, is reduced 6.3 percent for Hennepin County, two percent for
the remaining metropolitan counties, and no reduction for nonmetropolitan Minnesota
counties; and after January 1, 2002, the county medical assistance and general assistance
medical care capitation base rate prior to plan specific adjustments is reduced 6.3 percent
for Hennepin County, two percent for the remaining metropolitan counties, and 1.6 percent
for nonmetropolitan Minnesota counties. Nursing facility and elderly waiver payments
and demonstration project payments operating under subdivision 23 are excluded from
this reduction. The amount calculated under this clause shall not be adjusted for periods
already paid due to subsequent changes to the capitation payments;
(2) beginning July 1, 2003, $2,157,000 $4,314,000 from the capitation rates paid
under this section plus any federal matching funds on this amount;
(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates
paid under this section; and
(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid
under this section.
(b) This subdivision shall be effective upon approval of a federal waiver which
allows federal financial participation in the medical education and research fund. Effective
July 1, 2009, and thereafter, the transfers required by paragraph (a), clauses (1) to (4),
shall not exceed the total amount transferred for fiscal year 2009. Any excess shall first
reduce the amounts otherwise required to be transferred under paragraph (a), clauses
(2) to (4). Any excess following this reduction shall proportionally reduce the transfers
under paragraph (a), clause (1).
(c) Effective July 1, 2003, the amount reduced from the prepaid general assistance
medical care payments under paragraph (a), clause (1), shall be transferred to the general
fund.
(d) Beginning July 1, 2009, of the amounts in paragraph (a), the commissioner shall
transfer $21,714,000 each fiscal year to the medical education and research fund. The
balance of the transfers under paragraph (a) shall be transferred to the medical education
and research fund no earlier than July 1 of the following fiscal year.

    Sec. 48. Minnesota Statutes 2008, section 256B.69, subdivision 5f, is amended to read:
    Subd. 5f. Capitation rates. (a) Beginning July 1, 2002, the capitation rates paid
under this section are increased by $12,700,000 per year. Beginning July 1, 2003, the
capitation rates paid under this section are increased by $4,700,000 per year.
(b) Beginning July 1, 2009, the capitation rates paid under this section are increased
each year by the lesser of $21,714,000 or an amount equal to the difference between the
estimated value of the reductions described in subdivision 5c, paragraph (a), clause (1),
and the amount of the limit described in subdivision 5c, paragraph (b).

    Sec. 49. Minnesota Statutes 2008, section 256B.69, subdivision 23, is amended to read:
    Subd. 23. Alternative services; elderly and disabled persons. (a) The
commissioner may implement demonstration projects to create alternative integrated
delivery systems for acute and long-term care services to elderly persons and persons
with disabilities as defined in section 256B.77, subdivision 7a, that provide increased
coordination, improve access to quality services, and mitigate future cost increases.
The commissioner may seek federal authority to combine Medicare and Medicaid
capitation payments for the purpose of such demonstrations and may contract with
Medicare-approved special needs plans to provide Medicaid services. Medicare funds and
services shall be administered according to the terms and conditions of the federal contract
and demonstration provisions. For the purpose of administering medical assistance funds,
demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions
of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations,
with the exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1,
items B and C, which do not apply to persons enrolling in demonstrations under this
section. An initial open enrollment period may be provided. Persons who disenroll from
demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450
to 9500.1464. When a person is enrolled in a health plan under these demonstrations and
the health plan's participation is subsequently terminated for any reason, the person shall
be provided an opportunity to select a new health plan and shall have the right to change
health plans within the first 60 days of enrollment in the second health plan. Persons
required to participate in health plans under this section who fail to make a choice of
health plan shall not be randomly assigned to health plans under these demonstrations.
Notwithstanding section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220,
subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision,
the commissioner may contract with managed care organizations, including counties, to
serve only elderly persons eligible for medical assistance, elderly and disabled persons, or
disabled persons only. For persons with a primary diagnosis of developmental disability,
serious and persistent mental illness, or serious emotional disturbance, the commissioner
must ensure that the county authority has approved the demonstration and contracting
design. Enrollment in these projects for persons with disabilities shall be voluntary. The
commissioner shall not implement any demonstration project under this subdivision for
persons with a primary diagnosis of developmental disabilities, serious and persistent
mental illness, or serious emotional disturbance, without approval of the county board of
the county in which the demonstration is being implemented.
    (b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501
to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to
9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement
under this section projects for persons with developmental disabilities. The commissioner
may capitate payments for ICF/MR services, waivered services for developmental
disabilities, including case management services, day training and habilitation and
alternative active treatment services, and other services as approved by the state and by the
federal government. Case management and active treatment must be individualized and
developed in accordance with a person-centered plan. Costs under these projects may not
exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003,
and until four years after the pilot project implementation date, subcontractor participation
in the long-term care developmental disability pilot is limited to a nonprofit long-term
care system providing ICF/MR services, home and community-based waiver services,
and in-home services to no more than 120 consumers with developmental disabilities in
Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature
prior to expansion of the developmental disability pilot project. This paragraph expires
four years after the implementation date of the pilot project.
    (c) Before implementation of a demonstration project for disabled persons, the
commissioner must provide information to appropriate committees of the house of
representatives and senate and must involve representatives of affected disability groups
in the design of the demonstration projects.
    (d) A nursing facility reimbursed under the alternative reimbursement methodology
in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity
provide services under paragraph (a). The commissioner shall amend the state plan and
seek any federal waivers necessary to implement this paragraph.
    (e) The commissioner, in consultation with the commissioners of commerce and
health, may approve and implement programs for all-inclusive care for the elderly (PACE)
according to federal laws and regulations governing that program and state laws or rules
applicable to participating providers. The process for approval of these programs shall
begin only after the commissioner receives grant money in an amount sufficient to cover
the state share of the administrative and actuarial costs to implement the programs during
state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an
account in the special revenue fund and are appropriated to the commissioner to be used
solely for the purpose of PACE administrative and actuarial costs. A PACE provider is
not required to be licensed or certified as a health plan company as defined in section
62Q.01, subdivision 4. Persons age 55 and older who have been screened by the county
and found to be eligible for services under the elderly waiver or community alternatives
for disabled individuals or who are already eligible for Medicaid but meet level of
care criteria for receipt of waiver services may choose to enroll in the PACE program.
Medicare and Medicaid services will be provided according to this subdivision and
federal Medicare and Medicaid requirements governing PACE providers and programs.
PACE enrollees will receive Medicaid home and community-based services through the
PACE provider as an alternative to services for which they would otherwise be eligible
through home and community-based waiver programs and Medicaid State Plan Services.
The commissioner shall establish Medicaid rates for PACE providers that do not exceed
costs that would have been incurred under fee-for-service or other relevant managed care
programs operated by the state.
    (f) The commissioner shall seek federal approval to expand the Minnesota disability
health options (MnDHO) program established under this subdivision in stages, first to
regional population centers outside the seven-county metro area and then to all areas of
the state. Until July 1, 2009, expansion for MnDHO projects that include home and
community-based services is limited to the two projects and service areas in effect on
March 1, 2006. Enrollment in integrated MnDHO programs that include home and
community-based services shall remain voluntary. Costs for home and community-based
services included under MnDHO must not exceed costs that would have been incurred
under the fee-for-service program. Notwithstanding whether expansion occurs under
this paragraph, in determining MnDHO payment rates and risk adjustment methods for
contract years starting in 2012, the commissioner must consider the methods used to
determine county allocations for home and community-based program participants. If
necessary to reduce MnDHO rates to comply with the provision regarding MnDHO costs
for home and community-based services, the commissioner shall achieve the reduction by
maintaining the base rate for contract years 2010 and 2011 for services provided under the
community alternatives for disabled individuals waiver at the same level as for contract
year 2009. The commissioner may apply other reductions to MnDHO rates to implement
decreases in provider payment rates required by state law. In developing program
specifications for expansion of integrated programs, the commissioner shall involve and
consult the state-level stakeholder group established in subdivision 28, paragraph (d),
including consultation on whether and how to include home and community-based waiver
programs. Plans for further expansion of MnDHO projects shall be presented to the chairs
of the house of representatives and senate committees with jurisdiction over health and
human services policy and finance by February 1, 2007.
    (g) Notwithstanding section 256B.0261, health plans providing services under this
section are responsible for home care targeted case management and relocation targeted
case management. Services must be provided according to the terms of the waivers and
contracts approved by the federal government.

    Sec. 50. [256B.756] REIMBURSEMENT RATES FOR BIRTHS.
    Subdivision 1. Facility rate. (a) Notwithstanding section 256.969, effective for
services provided on or after October 1, 2009, the facility payment rate for the following
diagnosis-related groups, as they fall within the diagnostic categories: (1) 371 cesarean
section without complicating diagnosis; (2) 372 vaginal delivery with complicating
diagnosis; and (3) 373 vaginal delivery without complicating diagnosis, shall be calculated
as provided in paragraph (b).
(b) The commissioner shall calculate a single rate for all of the diagnostic related
groups specified in paragraph (a) consistent with an increase in the proportion of births
by vaginal delivery and a reduction in the percentage of births by cesarean section. The
calculated single rate must be based on an expected increase in the number of vaginal
births and expected reduction in the number of cesarean section such that the reduction
in cesarean sections is less than or equal to one standard deviation below the average in
the frequency of cesarean births for Minnesota health care program clients at hospitals
performing greater than 50 deliveries per year.
(c) The rates described in this subdivision do not include newborn care.
    Subd. 2. Provider rate. Notwithstanding section 256B.76, effective for services
provided on or after October 1, 2009, the payment rate for professional services related
to labor, delivery, and antepartum and postpartum care when provided for any of the
diagnostic categories identified in subdivision 1, paragraph (a), shall be calculated using
the methodology specified in subdivision 1, paragraph (b).
    Subd. 3. Health plans. Payments to managed care and county-based purchasing
plans under sections 256B.69, 256B.692, or 256L.12 shall be reduced for services
provided on or after October 1, 2009, to reflect the adjustments in subdivisions 1 and 2.
    Subd. 4. Prior authorization. Prior authorization shall not be required before
reimbursement is paid for a cesarean section delivery.

    Sec. 51. Minnesota Statutes 2008, section 256B.76, subdivision 1, is amended to read:
    Subdivision 1. Physician 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. If the rate on any procedure code within these categories is different than the
rate that would have been paid under the methodology in section 256B.74, subdivision 2,
then the larger rate shall be paid;
    (2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
    (3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect
on September 30, 1992.
    (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 over the rates in effect
on June 30, 2009. This reduction does not apply to office or other outpatient services
(procedure codes 99201 to 99215), preventive medicine services (procedure codes 99381
to 99412) and family planning services billed by the following primary care specialties:
general practice, internal medicine, pediatrics, geriatrics, family practice, or by an
advanced practice registered nurse or physician assistant practicing in pediatrics, geriatrics,
or family practice. This reduction does 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.

    Sec. 52. [256B.766] REIMBURSEMENT FOR BASIC CARE SERVICES.
(a) Effective for services provided on or after July 1, 2009, total payments for basic
care services, shall be reduced by three percent, prior to third-party liability and spenddown
calculation. Payments made to managed care plans and county-based purchasing plans
shall be reduced for services provided on or after October 1, 2009, to reflect this reduction.
(b) This section does not apply to physician and professional services, inpatient
hospital services, family planning services, mental health services, dental services,
prescription drugs, and medical transportation.

    Sec. 53. Minnesota Statutes 2008, section 256D.03, subdivision 4, is amended to read:
    Subd. 4. General assistance medical care; services. (a)(i) For a person who is
eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical
care covers, except as provided in paragraph (c):
    (1) inpatient hospital services;
    (2) outpatient hospital services;
    (3) services provided by Medicare certified rehabilitation agencies;
    (4) prescription drugs and other products recommended through the process
established in section 256B.0625, subdivision 13;
    (5) equipment necessary to administer insulin and diagnostic supplies and equipment
for diabetics to monitor blood sugar level;
    (6) eyeglasses and eye examinations provided by a physician or optometrist;
    (7) hearing aids;
    (8) prosthetic devices;
    (9) laboratory and X-ray services;
    (10) physician's services;
    (11) medical transportation except special transportation;
    (12) chiropractic services as covered under the medical assistance program;
    (13) podiatric services;
    (14) dental services as covered under the medical assistance program;
    (15) mental health services covered under chapter 256B;
    (16) prescribed medications for persons who have been diagnosed as mentally ill as
necessary to prevent more restrictive institutionalization;
    (17) medical supplies and equipment, and Medicare premiums, coinsurance and
deductible payments;
    (18) medical equipment not specifically listed in this paragraph when the use of
the equipment will prevent the need for costlier services that are reimbursable under
this subdivision;
    (19) services performed by a certified pediatric nurse practitioner, a certified family
nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological
nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse
practitioner in independent practice, if (1) the service is otherwise covered under this
chapter as a physician service, (2) the service provided on an inpatient basis is not included
as part of the cost for inpatient services included in the operating payment rate, and (3) the
service is within the scope of practice of the nurse practitioner's license as a registered
nurse, as defined in section 148.171;
    (20) services of a certified public health nurse or a registered nurse practicing in
a public health nursing clinic that is a department of, or that operates under the direct
authority of, a unit of government, if the service is within the scope of practice of the
public health nurse's license as a registered nurse, as defined in section 148.171;
    (21) telemedicine consultations, to the extent they are covered under section
256B.0625, subdivision 3b;
    (22) care coordination and patient education services provided by a community
health worker according to section 256B.0625, subdivision 49; and
    (23) regardless of the number of employees that an enrolled health care provider
may have, sign language interpreter services when provided by an enrolled health care
provider during the course of providing a direct, person-to-person covered health care
service to an enrolled recipient who has a hearing loss and uses interpreting services.
    (ii) Effective October 1, 2003, for a person who is eligible under subdivision 3,
paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited
to inpatient hospital services, including physician services provided during the inpatient
hospital stay. A $1,000 deductible is required for each inpatient hospitalization.
    (b) Effective August 1, 2005, sex reassignment surgery is not covered under this
subdivision.
    (c) In order to contain costs, the commissioner of human services shall select
vendors of medical care who can provide the most economical care consistent with high
medical standards and shall where possible contract with organizations on a prepaid
capitation basis to provide these services. The commissioner shall consider proposals by
counties and vendors for prepaid health plans, competitive bidding programs, block grants,
or other vendor payment mechanisms designed to provide services in an economical
manner or to control utilization, with safeguards to ensure that necessary services are
provided. Before implementing prepaid programs in counties with a county operated or
affiliated public teaching hospital or a hospital or clinic operated by the University of
Minnesota, the commissioner shall consider the risks the prepaid program creates for the
hospital and allow the county or hospital the opportunity to participate in the program in a
manner that reflects the risk of adverse selection and the nature of the patients served by
the hospital, provided the terms of participation in the program are competitive with the
terms of other participants considering the nature of the population served. Payment for
services provided pursuant to this subdivision shall be as provided to medical assistance
vendors of these services under sections 256B.02, subdivision 8, and 256B.0625. For
payments made during fiscal year 1990 and later years, the commissioner shall consult
with an independent actuary in establishing prepayment rates, but shall retain final control
over the rate methodology.
    (d) Effective January 1, 2008, drug coverage under general assistance medical
care is limited to prescription drugs that:
    (i) are covered under the medical assistance program as described in section
256B.0625, subdivisions 13 and 13d; and
    (ii) are provided by manufacturers that have fully executed general assistance
medical care rebate agreements with the commissioner and comply with the agreements.
Prescription drug coverage under general assistance medical care must conform to
coverage under the medical assistance program according to section 256B.0625,
subdivisions 13 to 13g.
     (e) Recipients eligible under subdivision 3, paragraph (a), shall pay the following
co-payments for services provided on or after October 1, 2003, and before January 1, 2009:
    (1) $25 for eyeglasses;
    (2) $25 for nonemergency visits to a hospital-based emergency room;
    (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
subject to a $12 per month maximum for prescription drug co-payments. No co-payments
shall apply to antipsychotic drugs when used for the treatment of mental illness; and
    (4) 50 percent coinsurance on restorative dental services.
    (f) Recipients eligible under subdivision 3, paragraph (a), shall include the following
co-payments for services provided on or after January 1, 2009:
    (1) $25 for nonemergency visits to a hospital-based emergency room; and
    (2) $3 per brand-name drug prescription and $1 per generic drug prescription,
subject to a $7 per month maximum for prescription drug co-payments. No co-payments
shall apply to antipsychotic drugs when used for the treatment of mental illness.
    (g) MS 2007 Supp [Expired]
    (h) Effective January 1, 2009, co-payments shall be limited to one per day per
provider for nonemergency visits to a hospital-based emergency room. Recipients of
general assistance medical care are responsible for all co-payments in this subdivision.
The general assistance medical care reimbursement to the provider shall be reduced by the
amount of the co-payment, except that reimbursement for prescription drugs shall not be
reduced once a recipient has reached the $7 per month maximum for prescription drug
co-payments. The provider collects the co-payment from the recipient. Providers may not
deny services to recipients who are unable to pay the co-payment.
    (i) General assistance medical care reimbursement to fee-for-service providers
and payments to managed care plans shall not be increased as a result of the removal of
the co-payments effective January 1, 2009.
    (j) Any county may, from its own resources, provide medical payments for which
state payments are not made.
    (k) Chemical dependency services that are reimbursed under chapter 254B must not
be reimbursed under general assistance medical care.
    (l) The maximum payment for new vendors enrolled in the general assistance
medical care program after the base year shall be determined from the average usual and
customary charge of the same vendor type enrolled in the base year.
    (m) The conditions of payment for services under this subdivision are the same
as the conditions specified in rules adopted under chapter 256B governing the medical
assistance program, unless otherwise provided by statute or rule.
     (n) Inpatient and outpatient payments shall be reduced by five percent, effective July
1, 2003. This reduction is in addition to the five percent reduction effective July 1, 2003,
and incorporated by reference in paragraph (l).
    (o) Payments for all other health services except inpatient, outpatient, and pharmacy
services shall be reduced by five percent, effective July 1, 2003.
    (p) Payments to managed care plans shall be reduced by five percent for services
provided on or after October 1, 2003.
    (q) A hospital receiving a reduced payment as a result of this section may apply the
unpaid balance toward satisfaction of the hospital's bad debts.
    (r) Fee-for-service payments for nonpreventive visits shall be reduced by $3 for
services provided on or after January 1, 2006. For purposes of this subdivision, a visit
means an episode of service which is required because of a recipient's symptoms,
diagnosis, or established illness, and which is delivered in an ambulatory setting by
a physician or physician ancillary, chiropractor, podiatrist, advance practice nurse,
audiologist, optician, or optometrist.
    (s) Payments to managed care plans shall not be increased as a result of the removal
of the $3 nonpreventive visit co-payment effective January 1, 2006.
    (t) Payments for mental health services added as covered benefits after December
31, 2007, are not subject to the reductions in paragraphs (l), (n), (o), and (p).
(u) Effective for services provided on or after July 1, 2009, total payment rates for
basic care services shall be reduced by three percent, in accordance with section 256B.766.
Payments made to managed care plans shall be reduced for services provided on or after
October 1, 2009, to reflect this reduction.
(v) Effective for services provided on or after July 1, 2009, payment rates for
physician and professional services shall be reduced as described under section 256B.76,
subdivision 1, paragraph (c). Payments made to managed care plans shall be reduced for
services provided on or after October 1, 2009, to reflect this reduction.

    Sec. 54. Minnesota Statutes 2008, section 256L.03, is amended by adding a subdivision
to read:
    Subd. 3b. Chiropractic services. MinnesotaCare covers the following chiropractic
services: medically necessary exams, manual manipulation of the spine, and x-rays.
EFFECTIVE DATE.This section is effective January 1, 2010.

    Sec. 55. Minnesota Statutes 2008, section 256L.04, subdivision 1, is amended to read:
    Subdivision 1. Families with children. (a) Families with children with family
income equal to or less than 275 percent of the federal poverty guidelines for the
applicable family size shall be eligible for MinnesotaCare according to this section. All
other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
to enrollment under section 256L.07, shall apply unless otherwise specified.
    (b) Parents who enroll in the MinnesotaCare program must also enroll their children,
if the children are eligible. Children may be enrolled separately without enrollment by
parents. However, if one parent in the household enrolls, both parents must enroll, unless
other insurance is available. If one child from a family is enrolled, all children must
be enrolled, unless other insurance is available. If one spouse in a household enrolls,
the other spouse in the household must also enroll, unless other insurance is available.
Families cannot choose to enroll only certain uninsured members.
    (c) Beginning October 1, 2003, the dependent sibling definition no longer applies
to the MinnesotaCare program. These persons are no longer counted in the parental
household and may apply as a separate household.
    (d) Beginning July 1, 2003, or upon federal approval, whichever is later, parents are
not eligible for MinnesotaCare if their gross income exceeds $57,500.
    (e) Children formerly enrolled in medical assistance and automatically deemed
eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt
from the requirements of this section until renewal.
(f) Children deemed eligible for MinnesotaCare under section 256L.07, subdivision
8, are exempt from the eligibility requirements of this subdivision.

    Sec. 56. Minnesota Statutes 2008, section 256L.04, is amended by adding a subdivision
to read:
    Subd. 1b. Children with family income greater than 275 percent of federal
poverty guidelines. Children with family income greater than 275 percent of federal
poverty guidelines for the applicable family size shall be eligible for MinnesotaCare. All
other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
to enrollment under section 256L.07, shall apply unless otherwise specified.
EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal
approval, whichever is later.

    Sec. 57. Minnesota Statutes 2008, section 256L.04, subdivision 7a, is amended to read:
    Subd. 7a. Ineligibility. Applicants Adults whose income is greater than the limits
established under this section may not enroll in the MinnesotaCare program.
EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal
approval, whichever is later.

    Sec. 58. Minnesota Statutes 2008, section 256L.04, subdivision 10a, is amended to
read:
    Subd. 10a. Sponsor's income and resources deemed available; documentation.
When determining eligibility for any federal or state benefits under sections 256L.01 to
256L.18, the income and resources of all noncitizens whose sponsor signed an affidavit of
support as defined under United States Code, title 8, section 1183a, shall be deemed to
include their sponsors' income and resources as defined in the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996, title IV, Public Law 104-193, sections
421 and 422, and subsequently set out in federal rules. To be eligible for the program,
noncitizens must provide documentation of their immigration status. Beginning July
1, 2010, or upon federal approval, whichever is later, sponsor deeming does not apply
to pregnant women and children who are qualified noncitizens, as described in section
256B.06, subdivision 4, paragraph (b).
EFFECTIVE DATE.This section is effective July 1, 2010, or upon federal
approval, whichever is later. The commissioner shall notify the revisor of statutes when
federal approval has been obtained.

    Sec. 59. Minnesota Statutes 2008, section 256L.05, subdivision 1, is amended to read:
    Subdivision 1. Application assistance and information availability. (a)
Applications and application assistance must be made available at provider offices, local
human services agencies, school districts, public and private elementary schools in which
25 percent or more of the students receive free or reduced price lunches, community health
offices, Women, Infants and Children (WIC) program sites, Head Start program sites,
public housing councils, crisis nurseries, child care centers, early childhood education
and preschool program sites, legal aid offices, and libraries. These sites may accept
applications and forward the forms to the commissioner or local county human services
agencies that choose to participate as an enrollment site. Otherwise, applicants may apply
directly to the commissioner or to participating local county human services agencies.
(b) Application assistance must be available for applicants choosing to file an
online application.

    Sec. 60. Minnesota Statutes 2008, section 256L.05, is amended by adding a subdivision
to read:
    Subd. 1c. Open enrollment and streamlined application and enrollment
process. (a) The commissioner and local agencies working in partnership must develop a
streamlined and efficient application and enrollment process for medical assistance and
MinnesotaCare enrollees that meets the criteria specified in this subdivision.
(b) The commissioners of human services and education shall provide
recommendations to the legislature by January 15, 2010, on the creation of an open
enrollment process for medical assistance and MinnesotaCare that is coordinated with
the public education system. The recommendations must:
(1) be developed in consultation with medical assistance and MinnesotaCare
enrollees and representatives from organizations that advocate on behalf of children and
families, low-income persons and minority populations, counties, school administrators
and nurses, health plans, and health care providers;
(2) be based on enrollment and renewal procedures best practices, including express
lane eligibility as required under subdivision 1d;
(3) simplify the enrollment and renewal processes wherever possible; and
(4) establish a process:
(i) to disseminate information on medical assistance and MinnesotaCare to all
children in the public education system, including prekindergarten programs; and
(ii) for the commissioner of human services to enroll children and other household
members who are eligible.
The commissioner of human services in coordination with the commissioner of
education shall implement an open enrollment process by August 1, 2010, to be effective
beginning with the 2010-2011 school year.
(c) The commissioner and local agencies shall develop an online application process
for medical assistance and MinnesotaCare.
(d) The commissioner shall develop an application that is easily understandable
and does not exceed four pages in length.
(e) The commissioner of human services shall present to the legislature, by January
15, 2010, an implementation plan for the open enrollment period and online application
process.
EFFECTIVE DATE.This section is effective July 1, 2010, or upon federal
approval, which must be requested by the commissioner, whichever is later.

    Sec. 61. Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:
    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the
first day of the month following the month in which eligibility is approved and the first
premium payment has been received. As provided in section 256B.057, coverage for
newborns is automatic from the date of birth and must be coordinated with other health
coverage. The effective date of coverage for eligible newly adoptive children added to a
family receiving covered health services is the month of placement. The effective date
of coverage for other new members added to the family is the first day of the month
following the month in which the change is reported. All eligibility criteria must be met
by the family at the time the new family member is added. The income of the new family
member is included with the family's gross income and the adjusted premium begins in
the month the new family member is added.
(b) The initial premium must be received by the last working day of the month for
coverage to begin the first day of the following month.
(c) Benefits are not available until the day following discharge if an enrollee is
hospitalized on the first day of coverage.
(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to
256L.18 are secondary to a plan of insurance or benefit program under which an eligible
person may have coverage and the commissioner shall use cost avoidance techniques to
ensure coordination of any other health coverage for eligible persons. The commissioner
shall identify eligible persons who may have coverage or benefits under other plans of
insurance or who become eligible for medical assistance.
(e) The effective date of coverage for single adults and households with no children
formerly enrolled in general assistance medical care and enrolled in MinnesotaCare
according to section 256D.03, subdivision 3, is the first day of the month following the
last day of general assistance medical care coverage.
(f) The effective date of coverage for children eligible under section 256L.07,
subdivision 8, is the first day of the month following the date of termination from foster
care or release from a juvenile residential correctional facility.
EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal
approval, whichever is later.

    Sec. 62. Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:
    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility
must be renewed every 12 months. The 12-month period begins in the month after the
month the application is approved.
    (b) Each new period of eligibility must take into account any changes in
circumstances that impact eligibility and premium amount. An enrollee must provide all
the information needed to redetermine eligibility by the first day of the month that ends
the eligibility period. If there is no change in circumstances, the enrollee may renew
eligibility at designated locations that include community clinics and health care providers'
offices. The designated sites shall forward the renewal forms to the commissioner. The
commissioner may establish criteria and timelines for sites to forward applications to the
commissioner or county agencies. The premium for the new period of eligibility must be
received as provided in section 256L.06 in order for eligibility to continue.
    (c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
subdivision 3
, the first period of eligibility begins the month the enrollee submitted the
application or renewal for general assistance medical care.
    (d) An enrollee Notwithstanding paragraph (e), an enrollee who fails to submit
renewal forms and related documentation necessary for verification of continued eligibility
in a timely manner shall remain eligible for one additional month beyond the end of the
current eligibility period before being disenrolled. The enrollee remains responsible for
MinnesotaCare premiums for the additional month.
(e) Children in families with family income equal to or below 275 percent of federal
poverty guidelines who fail to submit renewal forms and related documentation necessary
for verification of continued eligibility in a timely manner shall remain eligible for the
program. The commissioner shall use the means described in subdivision 2 or any other
means available to verify family income. If the commissioner determines that there has
been a change in income in which premium payment is required to remain enrolled, the
commissioner shall notify the family of the premium payment, and that the children
will be disenrolled if the premium payment is not received effective the first day of the
calendar month following the calendar month for which the premium is due.
(f) For children enrolled in MinnesotaCare under section 256L.07, subdivision 8, the
first period of renewal begins the month the enrollee turns 21 years of age.
EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal
approval, whichever is later.

    Sec. 63. Minnesota Statutes 2008, section 256L.07, subdivision 1, is amended to read:
    Subdivision 1. General requirements. (a) Children enrolled in the original
children's health plan as of September 30, 1992, children who enrolled in the
MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross incomes that are equal to or
less than 150 200 percent of the federal poverty guidelines are eligible without meeting
the requirements of subdivision 2 and the four-month requirement in subdivision 3, as
long as they maintain continuous coverage in the MinnesotaCare program or medical
assistance. Children who apply for MinnesotaCare on or after the implementation date
of the employer-subsidized health coverage program as described in Laws 1998, chapter
407, article 5, section 45, who have family gross incomes that are equal to or less than 150
percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
be eligible for MinnesotaCare.
    Families Parents enrolled in MinnesotaCare under section 256L.04, subdivision 1,
whose income increases above 275 percent of the federal poverty guidelines, are no longer
eligible for the program and shall be disenrolled by the commissioner. Beginning January
1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision
7
, whose income increases above 200 percent of the federal poverty guidelines or 250
percent of the federal poverty guidelines on or after July 1, 2009, are no longer eligible for
the program and shall be disenrolled by the commissioner. For persons disenrolled under
this subdivision, MinnesotaCare coverage terminates the last day of the calendar month
following the month in which the commissioner determines that the income of a family or
individual exceeds program income limits.
    (b) Notwithstanding paragraph (a), Children may remain enrolled in MinnesotaCare
if ten percent of their gross individual or gross family income as defined in section
256L.01, subdivision 4, is less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health Association. Children
who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month
notice period from the date that ineligibility is determined before disenrollment greater
than 275 percent of federal poverty guidelines. The premium for children remaining
eligible under this clause paragraph shall be the maximum premium determined under
section 256L.15, subdivision 2, paragraph (b).
    (c) Notwithstanding paragraphs paragraph (a) and (b), parents are not eligible for
MinnesotaCare if gross household income exceeds $57,500 for the 12-month period
of eligibility.
EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal
approval, whichever is later.

    Sec. 64. Minnesota Statutes 2008, section 256L.07, subdivision 2, is amended to read:
    Subd. 2. Must not have access to employer-subsidized coverage. (a) To be
eligible, a family or individual must not have access to subsidized health coverage through
an employer and must not have had access to employer-subsidized coverage through
a current employer for 18 months prior to application or reapplication. A family or
individual whose employer-subsidized coverage is lost due to an employer terminating
health care coverage as an employee benefit during the previous 18 months is not eligible.
(b) This subdivision does not apply to a family or individual who was enrolled
in MinnesotaCare within six months or less of reapplication and who no longer has
employer-subsidized coverage due to the employer terminating health care coverage as an
employee benefit. This subdivision does not apply to children with family gross incomes
that are equal to or less than 200 percent of federal poverty guidelines.
(c) For purposes of this requirement, subsidized health coverage means health
coverage for which the employer pays at least 50 percent of the cost of coverage for
the employee or dependent, or a higher percentage as specified by the commissioner.
Children are eligible for employer-subsidized coverage through either parent, including
the noncustodial parent. The commissioner must treat employer contributions to Internal
Revenue Code Section 125 plans and any other employer benefits intended to pay
health care costs as qualified employer subsidies toward the cost of health coverage for
employees for purposes of this subdivision.
EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal
approval, whichever is later.

    Sec. 65. Minnesota Statutes 2008, section 256L.07, subdivision 3, is amended to read:
    Subd. 3. Other health coverage. (a) Families and individuals enrolled in the
MinnesotaCare program must have no health coverage while enrolled or for at least four
months prior to application and renewal. Children with family gross incomes equal to or
greater than 200 percent of federal poverty guidelines, and adults, must have had no health
coverage for at least four months prior to application and renewal. Children enrolled in the
original children's health plan and children in families with income equal to or less than
150 200 percent of the federal poverty guidelines, who have other health insurance, are
eligible if the coverage:
(1) lacks two or more of the following:
(i) basic hospital insurance;
(ii) medical-surgical insurance;
(iii) prescription drug coverage;
(iv) dental coverage; or
(v) vision coverage;
(2) requires a deductible of $100 or more per person per year; or
(3) lacks coverage because the child has exceeded the maximum coverage for a
particular diagnosis or the policy excludes a particular diagnosis.
The commissioner may change this eligibility criterion for sliding scale premiums
in order to remain within the limits of available appropriations. The requirement of no
health coverage does not apply to newborns.
(b) Medical assistance, general assistance medical care, and the Civilian Health and
Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under
United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or
health coverage for purposes of the four-month requirement described in this subdivision.
(c) For purposes of this subdivision, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility
for MinnesotaCare.
(d) Applicants who were recipients of medical assistance or general assistance
medical care within one month of application must meet the provisions of this subdivision
and subdivision 2.
(e) Cost-effective health insurance that was paid for by medical assistance is not
considered health coverage for purposes of the four-month requirement under this
section, except if the insurance continued after medical assistance no longer considered it
cost-effective or after medical assistance closed.
EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal
approval, whichever is later.

    Sec. 66. Minnesota Statutes 2008, section 256L.07, is amended by adding a subdivision
to read:
    Subd. 8. Automatic eligibility for certain children. Any child who was residing
in foster care or a juvenile residential correctional facility on the child's 18th birthday is
automatically deemed eligible for MinnesotaCare upon termination or release until the
child reaches the age of 21, and is exempt from the requirements of this section and
section 256L.15. To be enrolled under this section, a child must complete an initial
application for MinnesotaCare. The commissioner shall contact individuals enrolled
under this section annually to ensure the individual continues to reside in the state and is
interested in continuing MinnesotaCare coverage.
EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal
approval, whichever is later.

    Sec. 67. Minnesota Statutes 2008, section 256L.11, subdivision 1, is amended to read:
    Subdivision 1. Medical assistance rate to be used. (a) Payment to providers under
sections 256L.01 to 256L.11 shall be at the same rates and conditions established for
medical assistance, except as provided in subdivisions 2 to 6.
(b) Effective for services provided on or after July 1, 2009, total payments for basic
care services shall be reduced by three percent, in accordance with section 256B.766.
Payments made to managed care plans shall be reduced for services provided on or after
October 1, 2009, to reflect this reduction.

    Sec. 68. Minnesota Statutes 2008, section 256L.15, subdivision 2, is amended to read:
    Subd. 2. Sliding fee scale; monthly gross individual or family income. (a) The
commissioner shall establish a sliding fee scale to determine the percentage of monthly
gross individual or family income that households at different income levels must pay to
obtain coverage through the MinnesotaCare program. The sliding fee scale must be based
on the enrollee's monthly gross individual or family income. The sliding fee scale must
contain separate tables based on enrollment of one, two, or three or more persons. Until
June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross
individual or family income for individuals or families with incomes below the limits for
the medical assistance program for families and children in effect on January 1, 1999, and
proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and
8.8 percent. These percentages are matched to evenly spaced income steps ranging from
the medical assistance income limit for families and children in effect on January 1, 1999,
to 275 percent of the federal poverty guidelines for the applicable family size, up to a
family size of five. The sliding fee scale for a family of five must be used for families of
more than five. The sliding fee scale and percentages are not subject to the provisions of
chapter 14. If a family or individual reports increased income after enrollment, premiums
shall be adjusted at the time the change in income is reported.
    (b) Children in families whose gross income is above 275 percent of the federal
poverty guidelines shall pay the maximum premium. The maximum premium is defined
as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
cases paid the maximum premium, the total revenue would equal the total cost of
MinnesotaCare medical coverage and administration. In this calculation, administrative
costs shall be assumed to equal ten percent of the total. The costs of medical coverage
for pregnant women and children under age two and the enrollees in these groups shall
be excluded from the total. The maximum premium for two enrollees shall be twice the
maximum premium for one, and the maximum premium for three or more enrollees shall
be three times the maximum premium for one.
    (c) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d) with the exception that children in families
with income at or below 150 200 percent of the federal poverty guidelines shall pay
a monthly premium of $4 no premiums. For purposes of paragraph (d), "minimum"
means a monthly premium of $4.
    (d) The following premium scale is established for individuals and families with
gross family incomes of 300 percent of the federal poverty guidelines or less:


Federal Poverty Guideline Range
Percent of Average Gross Monthly
Income

0-45%
minimum

46-54%
1.1%

55-81%
1.6%

82-109%
2.2%

110-136%
2.9%

137-164%
3.6%

165-191%
4.6%

192-219%
5.6%

220-248%
6.5%

249-274%
7.2%

275-300%
8.0%
EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal
approval, whichever is later.

    Sec. 69. Minnesota Statutes 2008, section 256L.15, subdivision 3, is amended to read:
    Subd. 3. Exceptions to sliding scale. Children in families with income at or below
150 200 percent of the federal poverty guidelines shall pay a no monthly premium of
$4 premiums.
EFFECTIVE DATE.This section is effective July 1, 2009, or upon federal
approval, whichever is later.

    Sec. 70. Minnesota Statutes 2008, section 256L.17, subdivision 3, is amended to read:
    Subd. 3. Documentation. (a) The commissioner of human services shall require
individuals and families, at the time of application or renewal, to indicate on a checkoff
form developed by the commissioner whether they satisfy the MinnesotaCare asset
requirement.
    (b) The commissioner may require individuals and families to provide any
information the commissioner determines necessary to verify compliance with the asset
requirement, if the commissioner determines that there is reason to believe that an
individual or family has assets that exceed the program limit.

    Sec. 71. Minnesota Statutes 2008, section 256L.17, subdivision 5, is amended to read:
    Subd. 5. Exemption. This section does not apply to pregnant women or children.
For purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.

    Sec. 72. Minnesota Statutes 2008, section 501B.89, is amended by adding a
subdivision to read:
    Subd. 4. Annual filing requirement for supplemental needs trusts. (a) A trustee
of a trust under subdivision 3 and United States Code, title 42, section 1396p(d)(4)(A) or
(C), shall submit to the commissioner of human services, at the time of a beneficiary's
request for medical assistance, the following information about the trust:
(1) a copy of the trust instrument; and
(2) an inventory of the beneficiary's trust account assets and the value of those assets.
(b) A trustee of a trust under subdivision 3 and United States Code, title 42, section
1396p(d)(4)(A) or (C), shall submit an accounting of the beneficiary's trust account to the
commissioner of human services at least annually until the trust, or the beneficiary's
interest in the trust, terminates. Accountings are due on the anniversary of the execution
date of the trust unless another annual date is established by the terms of the trust. The
accounting must include the following information for the accounting period:
(1) an inventory of trust assets and the value of those assets at the beginning of the
accounting period;
(2) additions to the trust during the accounting period and the source of those
additions;
(3) itemized distributions from the trust during the accounting period, including the
purpose of the distributions and to whom the distributions were made;
(4) an inventory of trust assets and the value of those assets at the end of the
accounting period; and
(5) changes to the trust instrument during the accounting period.
(c) For the purpose of paragraph (b), an accounting period is 12 months unless an
accounting period of a different length is permitted by the commissioner.
EFFECTIVE DATE.This section is effective for applications for medical
assistance and renewals of medical assistance submitted on or after July 1, 2009.

    Sec. 73. Minnesota Statutes 2008, section 519.05, is amended to read:
519.05 LIABILITY OF HUSBAND AND WIFE.
(a) A spouse is not liable to a creditor for any debts of the other spouse. Where
husband and wife are living together, they shall be jointly and severally liable for
necessary medical services that have been furnished to either spouse, including any claims
arising under section 246.53, 256B.15, 256D.16, or 261.04, and necessary household
articles and supplies furnished to and used by the family. Notwithstanding this paragraph,
in a proceeding under chapter 518 the court may apportion such debt between the spouses.
(b) Either spouse may close a credit card account or other unsecured consumer line
of credit on which both spouses are contractually liable, by giving written notice to the
creditor.

    Sec. 74. Laws 2003, First Special Session chapter 14, article 13C, section 2, subdivision
1, as amended by Laws 2004, chapter 272, article 2, section 2, is amended to read:

Subdivision 1.Total Appropriation
$
3,848,049,000
$
4,135,780,000

Summary by Fund

General
3,301,811,000
3,561,055,000


State Government
Special Revenue
534,000
534,000

Health Care Access
273,723,000
302,272,000

Federal TANF
270,425,000
270,363,000

Lottery Cash Flow
1,556,000
1,556,000
Federal Contingency Appropriation. (a)
Federal Medicaid funds made available
under title IV of the federal Jobs and Growth
Tax Relief Reconciliation Act of 2003
are appropriated to the commissioner of
human services for use in the state's medical
assistance and MinnesotaCare programs.
The commissioners of human services and
finance shall report to the legislative advisory
committee on the additional federal Medicaid
matching funds that will be available to the
state.
(b) Because of the availability of these funds,
the following policies shall become effective:
(1) medical assistance and MinnesotaCare
eligibility and local financial participation
changes provided for in this act may be
implemented prior to September 2, 2003, or
may be delayed as necessary to maximize
the use of federal funds received under
title IV of the Jobs and Growth Tax Relief
Reconciliation Act of 2003;
(2) the aggregate cap on the services
identified in Minnesota Statutes, section
256L.035, paragraph (a), clause (3), shall
be increased from $2,000 to $5,000. This
increase shall expire at the end of fiscal year
2007. Funds may be transferred from the
general fund to the health care access fund as
necessary to implement this provision; and
(3) the following payment shifts shall not be
implemented:
(i) MFIP payment shift found in subdivision
11;
(ii) the county payment shift found in
subdivision 1; and
(iii) the delay in medical assistance
and general assistance medical care
fee-for-service payments found in
subdivision 6.
(c) Notwithstanding section 14, paragraphs
(a) and (b) shall expire June 30, 2007.
Receipts for Systems Projects.
Appropriations and federal receipts for
information system projects for MAXIS,
PRISM, MMIS, and SSIS must be deposited
in the state system account authorized in
Minnesota Statutes, section 256.014. Money
appropriated for computer projects approved
by the Minnesota office of technology,
funded by the legislature, and approved
by the commissioner of finance may be
transferred from one project to another
and from development to operations as the
commissioner of human services considers
necessary. Any unexpended balance in
the appropriation for these projects does
not cancel but is available for ongoing
development and operations.
Gifts. Notwithstanding Minnesota Statutes,
chapter 7, the commissioner may accept
on behalf of the state additional funding
from sources other than state funds for the
purpose of financing the cost of assistance
program grants or nongrant administration.
All additional funding is appropriated to the
commissioner for use as designated by the
grantor of funding.
Systems Continuity. In the event of
disruption of technical systems or computer
operations, the commissioner may use
available grant appropriations to ensure
continuity of payments for maintaining the
health, safety, and well-being of clients
served by programs administered by the
department of human services. Grant funds
must be used in a manner consistent with the
original intent of the appropriation.
Nonfederal Share Transfers. The
nonfederal share of activities for which
federal administrative reimbursement is
appropriated to the commissioner may be
transferred to the special revenue fund.
TANF Funds Appropriated to Other
Entities. Any expenditures from the TANF
block grant shall be expended in accordance
with the requirements and limitations of part
A of title IV of the Social Security Act, as
amended, and any other applicable federal
requirement or limitation. Prior to any
expenditure of these funds, the commissioner
shall assure that funds are expended in
compliance with the requirements and
limitations of federal law and that any
reporting requirements of federal law are
met. It shall be the responsibility of any entity
to which these funds are appropriated to
implement a memorandum of understanding
with the commissioner that provides the
necessary assurance of compliance prior to
any expenditure of funds. The commissioner
shall receipt TANF funds appropriated
to other state agencies and coordinate all
related interagency accounting transactions
necessary to implement these appropriations.
Unexpended TANF funds appropriated to
any state, local, or nonprofit entity cancel
at the end of the state fiscal year unless
appropriating language permits otherwise.
TANF Funds Transferred to Other Federal
Grants. The commissioner must authorize
transfers from TANF to other federal block
grants so that funds are available to meet the
annual expenditure needs as appropriated.
Transfers may be authorized prior to the
expenditure year with the agreement of the
receiving entity. Transferred funds must be
expended in the year for which the funds
were appropriated unless appropriation
language permits otherwise. In accelerating
transfer authorizations, the commissioner
must aim to preserve the future potential
transfer capacity from TANF to other block
grants.
TANF Maintenance of Effort. (a) In
order to meet the basic maintenance of
effort (MOE) requirements of the TANF
block grant specified under Code of Federal
Regulations, title 45, section 263.1, the
commissioner may only report nonfederal
money expended for allowable activities
listed in the following clauses as TANF/MOE
expenditures:
(1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;
(2) the child care assistance programs
under Minnesota Statutes, sections 119B.03
and 119B.05, and county child care
administrative costs under Minnesota
Statutes, section 119B.15;
(3) state and county MFIP administrative
costs under Minnesota Statutes, chapters
256J and 256K;
(4) state, county, and tribal MFIP
employment services under Minnesota
Statutes, chapters 256J and 256K;
(5) expenditures made on behalf of
noncitizen MFIP recipients who qualify
for the medical assistance without federal
financial participation program under
Minnesota Statutes, section 256B.06,
subdivision 4
, paragraphs (d), (e), and (j);
and
(6) qualifying working family credit
expenditures under Minnesota Statutes,
section 290.0671.
(b) The commissioner shall ensure that
sufficient qualified nonfederal expenditures
are made each year to meet the state's
TANF/MOE requirements. For the activities
listed in paragraph (a), clauses (2) to
(6), the commissioner may only report
expenditures that are excluded from the
definition of assistance under Code of
Federal Regulations, title 45, section 260.31.
(c) By August 31 of each year, the
commissioner shall make a preliminary
calculation to determine the likelihood
that the state will meet its annual federal
work participation requirement under Code
of Federal Regulations, title 45, sections
261.21 and 261.23, after adjustment for any
caseload reduction credit under Code of
Federal Regulations, title 45, section 261.41.
If the commissioner determines that the
state will meet its federal work participation
rate for the federal fiscal year ending that
September, the commissioner may reduce the
expenditure under paragraph (a), clause (1),
to the extent allowed under Code of Federal
Regulations, title 45, section 263.1(a)(2).
(d) For fiscal years beginning with state
fiscal year 2003, the commissioner shall
assure that the maintenance of effort used
by the commissioner of finance for the
February and November forecasts required
under Minnesota Statutes, section 16A.103,
contains expenditures under paragraph (a),
clause (1), equal to at least 25 percent of
the total required under Code of Federal
Regulations, title 45, section 263.1.
(e) If nonfederal expenditures for the
programs and purposes listed in paragraph
(a) are insufficient to meet the state's
TANF/MOE requirements, the commissioner
shall recommend additional allowable
sources of nonfederal expenditures to the
legislature, if the legislature is or will be in
session to take action to specify additional
sources of nonfederal expenditures for
TANF/MOE before a federal penalty is
imposed. The commissioner shall otherwise
provide notice to the legislative commission
on planning and fiscal policy under paragraph
(g).
(f) If the commissioner uses authority
granted under section 11, or similar authority
granted by a subsequent legislature, to
meet the state's TANF/MOE requirement
in a reporting period, the commissioner
shall inform the chairs of the appropriate
legislative committees about all transfers
made under that authority for this purpose.
(g) If the commissioner determines that
nonfederal expenditures under paragraph
(a) are insufficient to meet TANF/MOE
expenditure requirements, and if the
legislature is not or will not be in
session to take timely action to avoid a
federal penalty, the commissioner may
report nonfederal expenditures from
other allowable sources as TANF/MOE
expenditures after the requirements of this
paragraph are met. The commissioner
may report nonfederal expenditures
in addition to those specified under
paragraph (a) as nonfederal TANF/MOE
expenditures, but only ten days after the
commissioner of finance has first submitted
the commissioner's recommendations for
additional allowable sources of nonfederal
TANF/MOE expenditures to the members of
the legislative commission on planning and
fiscal policy for their review.
(h) The commissioner of finance shall not
incorporate any changes in federal TANF
expenditures or nonfederal expenditures for
TANF/MOE that may result from reporting
additional allowable sources of nonfederal
TANF/MOE expenditures under the interim
procedures in paragraph (g) into the February
or November forecasts required under
Minnesota Statutes, section 16A.103, unless
the commissioner of finance has approved
the additional sources of expenditures under
paragraph (g).
(i) Minnesota Statutes, section 256.011,
subdivision 3
, which requires that federal
grants or aids secured or obtained under that
subdivision be used to reduce any direct
appropriations provided by law, do not apply
if the grants or aids are federal TANF funds.
(j) Notwithstanding section 14, paragraph
(a), clauses (1) to (6), and paragraphs (b) to
(j) expire June 30, 2007.
Working Family Credit Expenditures as
TANF MOE. The commissioner may claim
as TANF maintenance of effort up to the
following amounts of working family credit
expenditures for the following fiscal years:
(1) fiscal year 2004, $7,013,000;
(2) fiscal year 2005, $25,133,000;
(3) fiscal year 2006, $6,942,000; and
(4) fiscal year 2007, $6,707,000.
Fiscal Year 2003 Appropriations
Carryforward. Effective the day following
final enactment, notwithstanding Minnesota
Statutes, section 16A.28, or any other law to
the contrary, state agencies and constitutional
offices may carry forward unexpended
and unencumbered nongrant operating
balances from fiscal year 2003 general fund
appropriations into fiscal year 2004 to offset
general budget reductions.
Transfer of Grant Balances. Effective
the day following final enactment, the
commissioner of human services, with
the approval of the commissioner of
finance and after notification of the chair
of the senate health, human services and
corrections budget division and the chair
of the house of representatives health
and human services finance committee,
may transfer unencumbered appropriation
balances for the biennium ending June 30,
2003, in fiscal year 2003 among the MFIP,
MFIP child care assistance under Minnesota
Statutes, section 119B.05, general assistance,
general assistance medical care, medical
assistance, Minnesota supplemental aid,
and group residential housing programs,
and the entitlement portion of the chemical
dependency consolidated treatment fund, and
between fiscal years of the biennium.
TANF Appropriation Cancellation.
Notwithstanding the provisions of Laws
2000, chapter 488, article 1, section 16,
any prior appropriations of TANF funds
to the department of trade and economic
development or to the job skills partnership
board or any transfers of TANF funds from
another agency to the department of trade
and economic development or to the job
skills partnership board are not available
until expended, and if unobligated as of June
30, 2003, these appropriations or transfers
shall cancel to the TANF fund.
Shift County Payment. The commissioner
shall make up to 100 percent of the
calendar year 2005 payments to counties for
developmental disabilities semi-independent
living services grants, developmental
disabilities family support grants, and
adult mental health grants from fiscal year
2006 appropriations. This is a onetime
payment shift. Calendar year 2006 and future
payments for these grants are not affected by
this shift. This provision expires June 30,
2006.
Capitation Rate Increase. Of the health care
access fund appropriations to the University
of Minnesota in the higher education
omnibus appropriation bill, $2,157,000 in
fiscal year 2004 and $2,157,000 in fiscal year
2005 are to be used to increase the capitation
payments under for fiscal years beginning
July 1, 2003, and thereafter, $2,157,000 each
year shall be transferred to the commissioner
for purposes of Minnesota Statutes, section
256B.69. Notwithstanding the provisions of
section 14, this provision shall not expire.

    Sec. 75. ASTHMA COVERAGE DEMONSTRATION PROJECT.
    Subdivision 1. Medical assistance coverage. The commissioner of human services
shall establish a demonstration project to provide additional medical assistance coverage
for a maximum of 200 American Indian children in Minneapolis, St. Paul, and Duluth
who are burdened by health disparities associated with the cumulative health impact of
toxic environmental exposures. Under this demonstration project, the additional medical
assistance coverage for this population must include, but is not limited to, the following
durable medical equipment: high efficiency particulate air (HEPA) cleaners, HEPA
vacuum cleaners, allergy bed and pillow encasements, high filtration filters for forced air
gas furnaces, and dehumidifiers with medical tubing to connect the appliance to a floor
drain, if the listed item is medically necessary to reduce asthma symptoms. Provision
of these items must be preceded by a home environmental assessment for triggers of
asthma and in-home asthma education on the proper medical management of asthma by a
Certified Asthma Educator or public health nurse with asthma management training.
    Subd. 2. Report. (a) Two years following implementation of the medical assistance
coverage demonstration project established under this section, the commissioner of health,
in collaboration with the Department of Human Services, must report to the legislature
on the number of asthma-related hospital admittances that occurred in the population of
children described in subdivision 1, before and after implementation of the demonstration
project, and whether the demonstration project had an impact on asthma-related school
absenteeism for this population of children.
(b) The commissioner of health must seek nonstate funding to conduct this report.
The reporting requirement is contingent upon the availability of nonstate funds.

    Sec. 76. CLAIMS AND UTILIZATION DATA.
The commissioner of human services, in consultation with the Health Services
Policy Committee, shall develop and provide to the legislature by December 15, 2009, a
methodology and any draft legislation necessary to allow for the release, upon request, of
summary data as defined in Minnesota Statutes, section 13.02, subdivision 19, on claims
and utilization for medical assistance, general assistance medical care, and MinnesotaCare
enrollees at no charge to the University of Minnesota Medical School, the Mayo Medical
School, Northwestern Health Sciences University, the Institute for Clinical Systems
Improvement, and other research institutions, to conduct analyses of health care outcomes
and treatment effectiveness, provided the research institutions do not release private or
nonpublic data, or data for which dissemination is prohibited by law.

    Sec. 77. [256.01] [Subd. 23a.] ADMINISTRATION OF PUBLICLY FUNDED
HEALTH CARE PROGRAMS.
(a) The commissioner of human services, in cooperation with the representatives
of county human services agencies and with input from organizations that advocate on
behalf of families and children, shall develop a plan that, to the extent feasible, seeks to
align standards, income and asset methodologies, and procedures for families and children
under medical assistance and MinnesotaCare. The commissioner shall evaluate the impact
of different approaches toward alignment on the number of potential medical assistance
and MinnesotaCare enrollees who are families and children, and on administrative, health
care, and other costs to the state. The commissioner shall present recommendations to the
legislative committees with jurisdiction over health care by September 15, 2010.
(b) The commissioner shall report in detail to the chair of the Health Care and
Human Services Finance Committee of the house of representatives and to the chair of
the Health and Human Services Division of the Finance Committee of the senate, prior
to entering into any contracts involving counties for streamlined electronic enrollment
and eligibility determinations for publicly funded health care programs, if such contracts
would require payment from either the general fund, or the health care access fund, as
described in Minnesota Statutes, sections 295.58 and 297I.05.

    Sec. 78. COBRA PREMIUM STATE SUBSIDY.
    Subdivision 1. Eligibility. (a) An individual and the individual's qualified
beneficiaries shall be eligible for a state premium subsidy equal to 35 percent of the
premiums the individual is required to pay for the continuation of health care coverage
under COBRA, if the individual and the individual's qualified beneficiaries:
(1) are eligible for the 65 percent COBRA continuation premium subsidy for health
care coverage under the American Recovery and Reinvestment Act of 2009;
(2) elect COBRA continuation health care coverage; and
(3) are eligible for medical assistance under Minnesota Statutes, chapter 256B;
general assistance medical care under Minnesota Statutes, section 256D.03; or
MinnesotaCare under Minnesota Statutes, chapter 256L, except for the four-month barrier
requirement under Minnesota Statutes, section 256L.07, subdivision 3.
(b) Eligibility for the state subsidy shall continue for as long as the individual
remains eligible for the COBRA premium subsidies provided under the American
Recovery and Reinvestment Act of 2009.
    Subd. 2. Subsidy. (a) The commissioner of human services shall pay 35 percent of
the COBRA premiums that the individual must pay for continuation health care coverage
for the individual and the individual's qualified beneficiaries, if the individual and the
individual's qualified beneficiaries meet the requirements in subdivision 1.
(b) The state subsidy payment required under this section shall be made directly to
the entity to which the individual is required to make COBRA premium payments.
(c) If any eligible individual has paid either the full amount of the COBRA premiums
or 35 percent of the COBRA premiums before the date of enactment of this section, the
individual is not entitled to a reimbursement of any premium paid.
    Subd. 3. Notification. (a) All employers and plan administrators who are required to
provide notice to all qualified individuals under the American Recovery and Reinvestment
Act of 2009 must include information to qualified individuals residing in Minnesota of
the availability of the state subsidy available under this section. The notice shall include
the eligibility requirements for the state subsidy and that the individual must apply to the
commissioner of human services to receive the state subsidy.
(b) The commissioner of employment and economic development must inform an
applicant for unemployment benefits of the availability of a state subsidy if the applicant
elects COBRA continuation coverage and the applicant meets the eligibility requirements
of this section.
    Subd. 4. Exemption. Any individual who receives a state subsidy under this
section is exempt from the four-month requirement under Minnesota Statutes, section
256L.07, subdivision 3, if the individual or the individual's qualified beneficiaries apply
for MinnesotaCare after the individual no longer receives COBRA continuation coverage.
    Subd. 5. Expiration. This section expires December 31, 2010.

    Sec. 79. FEDERAL APPROVAL.
The commissioner of human services shall resubmit for federal approval the
elimination of depreciation for self-employed farmers in determining income eligibility
for MinnesotaCare passed in Laws 2007, chapter 147, article 5, section 19.

    Sec. 80. REPEALER.
Minnesota Statutes 2008, sections 256.962, subdivision 7; and 256L.17, subdivision
6, are repealed.

ARTICLE 6
TECHNICAL

    Section 1. Minnesota Statutes 2008, section 144A.46, subdivision 1, is amended to
read:
    Subdivision 1. License required. (a) A home care provider may not operate in the
state without a current license issued by the commissioner of health. A home care provider
may hold a separate license for each class of home care licensure.
    (b) Within ten days after receiving an application for a license, the commissioner
shall acknowledge receipt of the application in writing. The acknowledgment must
indicate whether the application appears to be complete or whether additional information
is required before the application will be considered complete. Within 90 days after
receiving a complete application, the commissioner shall either grant or deny the license.
If an applicant is not granted or denied a license within 90 days after submitting a
complete application, the license must be deemed granted. An applicant whose license has
been deemed granted must provide written notice to the commissioner before providing a
home care service.
    (c) Each application for a home care provider license, or for a renewal of a license,
shall be accompanied by a fee to be set by the commissioner under section 144.122.
    (d) The commissioner of health, in consultation with the commissioner of human
services, shall provide recommendations to the legislature by February 15, 2009, for
provider standards for personal care assistant services as described in section 256B.0655
256B.0659.

    Sec. 2. Minnesota Statutes 2008, section 176.011, subdivision 9, is amended to read:
    Subd. 9. Employee. "Employee" means any person who performs services for
another for hire including the following:
(1) an alien;
(2) a minor;
(3) a sheriff, deputy sheriff, police officer, firefighter, county highway engineer, and
peace officer while engaged in the enforcement of peace or in the pursuit or capture of a
person charged with or suspected of crime;
(4) a person requested or commanded to aid an officer in arresting or retaking a
person who has escaped from lawful custody, or in executing legal process, in which
cases, for purposes of calculating compensation under this chapter, the daily wage of the
person shall be the prevailing wage for similar services performed by paid employees;
(5) a county assessor;
(6) an elected or appointed official of the state, or of a county, city, town, school
district, or governmental subdivision in the state. An officer of a political subdivision
elected or appointed for a regular term of office, or to complete the unexpired portion of a
regular term, shall be included only after the governing body of the political subdivision
has adopted an ordinance or resolution to that effect;
(7) an executive officer of a corporation, except those executive officers excluded
by section 176.041;
(8) a voluntary uncompensated worker, other than an inmate, rendering services in
state institutions under the commissioners of human services and corrections similar to
those of officers and employees of the institutions, and whose services have been accepted
or contracted for by the commissioner of human services or corrections as authorized by
law. In the event of injury or death of the worker, the daily wage of the worker, for the
purpose of calculating compensation under this chapter, shall be the usual wage paid at
the time of the injury or death for similar services in institutions where the services are
performed by paid employees;
(9) a voluntary uncompensated worker engaged in emergency management as
defined in section 12.03, subdivision 4, who is:
(i) registered with the state or any political subdivision of it, according to the
procedures set forth in the state or political subdivision emergency operations plan; and
(ii) acting under the direction and control of, and within the scope of duties approved
by, the state or political subdivision.
The daily wage of the worker, for the purpose of calculating compensation under this
chapter, shall be the usual wage paid at the time of the injury or death for similar services
performed by paid employees;
(10) a voluntary uncompensated worker participating in a program established by a
local social services agency. For purposes of this clause, "local social services agency"
means any agency established under section 393.01. In the event of injury or death of the
worker, the wage of the worker, for the purpose of calculating compensation under this
chapter, shall be the usual wage paid in the county at the time of the injury or death for
similar services performed by paid employees working a normal day and week;
(11) a voluntary uncompensated worker accepted by the commissioner of natural
resources who is rendering services as a volunteer pursuant to section 84.089. The daily
wage of the worker for the purpose of calculating compensation under this chapter, shall
be the usual wage paid at the time of injury or death for similar services performed by
paid employees;
(12) a voluntary uncompensated worker in the building and construction industry
who renders services for joint labor-management nonprofit community service projects.
The daily wage of the worker for the purpose of calculating compensation under this
chapter shall be the usual wage paid at the time of injury or death for similar services
performed by paid employees;
(13) a member of the military forces, as defined in section 190.05, while in state
active service, as defined in section 190.05, subdivision 5a. The daily wage of the member
for the purpose of calculating compensation under this chapter shall be based on the
member's usual earnings in civil life. If there is no evidence of previous occupation or
earning, the trier of fact shall consider the member's earnings as a member of the military
forces;
(14) a voluntary uncompensated worker, accepted by the director of the Minnesota
Historical Society, rendering services as a volunteer, pursuant to chapter 138. The daily
wage of the worker, for the purposes of calculating compensation under this chapter,
shall be the usual wage paid at the time of injury or death for similar services performed
by paid employees;
(15) a voluntary uncompensated worker, other than a student, who renders services
at the Minnesota State Academy for the Deaf or the Minnesota State Academy for the
Blind, and whose services have been accepted or contracted for by the commissioner of
education, as authorized by law. In the event of injury or death of the worker, the daily
wage of the worker, for the purpose of calculating compensation under this chapter, shall
be the usual wage paid at the time of the injury or death for similar services performed in
institutions by paid employees;
(16) a voluntary uncompensated worker, other than a resident of the veterans home,
who renders services at a Minnesota veterans home, and whose services have been
accepted or contracted for by the commissioner of veterans affairs, as authorized by law.
In the event of injury or death of the worker, the daily wage of the worker, for the purpose
of calculating compensation under this chapter, shall be the usual wage paid at the time of
the injury or death for similar services performed in institutions by paid employees;
(17) a worker performing services under section 256B.0655 256B.0659 for a
recipient in the home of the recipient or in the community under section 256B.0625,
subdivision 19a
, who is paid from government funds through a fiscal intermediary under
section 256B.0655, subdivision 7 256B.0659, subdivision 33. For purposes of maintaining
workers' compensation insurance, the employer of the worker is as designated in law
by the commissioner of the Department of Human Services, notwithstanding any other
law to the contrary;
(18) students enrolled in and regularly attending the Medical School of the
University of Minnesota in the graduate school program or the postgraduate program. The
students shall not be considered employees for any other purpose. In the event of the
student's injury or death, the weekly wage of the student for the purpose of calculating
compensation under this chapter, shall be the annualized educational stipend awarded to
the student, divided by 52 weeks. The institution in which the student is enrolled shall
be considered the "employer" for the limited purpose of determining responsibility for
paying benefits under this chapter;
(19) a faculty member of the University of Minnesota employed for an academic
year is also an employee for the period between that academic year and the succeeding
academic year if:
(a) the member has a contract or reasonable assurance of a contract from the
University of Minnesota for the succeeding academic year; and
(b) the personal injury for which compensation is sought arises out of and in the
course of activities related to the faculty member's employment by the University of
Minnesota;
(20) a worker who performs volunteer ambulance driver or attendant services is an
employee of the political subdivision, nonprofit hospital, nonprofit corporation, or other
entity for which the worker performs the services. The daily wage of the worker for the
purpose of calculating compensation under this chapter shall be the usual wage paid at the
time of injury or death for similar services performed by paid employees;
(21) a voluntary uncompensated worker, accepted by the commissioner of
administration, rendering services as a volunteer at the Department of Administration. In
the event of injury or death of the worker, the daily wage of the worker, for the purpose of
calculating compensation under this chapter, shall be the usual wage paid at the time of the
injury or death for similar services performed in institutions by paid employees;
(22) a voluntary uncompensated worker rendering service directly to the Pollution
Control Agency. The daily wage of the worker for the purpose of calculating compensation
payable under this chapter is the usual going wage paid at the time of injury or death for
similar services if the services are performed by paid employees;
(23) a voluntary uncompensated worker while volunteering services as a first
responder or as a member of a law enforcement assistance organization while acting
under the supervision and authority of a political subdivision. The daily wage of the
worker for the purpose of calculating compensation payable under this chapter is the
usual going wage paid at the time of injury or death for similar services if the services
are performed by paid employees;
(24) a voluntary uncompensated member of the civil air patrol rendering service on
the request and under the authority of the state or any of its political subdivisions. The
daily wage of the member for the purposes of calculating compensation payable under this
chapter is the usual going wage paid at the time of injury or death for similar services if
the services are performed by paid employees; and
(25) a Minnesota Responds Medical Reserve Corps volunteer, as provided in
sections 145A.04 and 145A.06, responding at the request of or engaged in training
conducted by the commissioner of health. The daily wage of the volunteer for the purposes
of calculating compensation payable under this chapter is established in section 145A.06.
A person who qualifies under this clause and who may also qualify under another clause
of this subdivision shall receive benefits in accordance with this clause.
If it is difficult to determine the daily wage as provided in this subdivision, the trier
of fact may determine the wage upon which the compensation is payable.

    Sec. 3. Minnesota Statutes 2008, section 245C.03, subdivision 2, is amended to read:
    Subd. 2. Personal care provider organizations. The commissioner shall conduct
background studies on any individual required under sections 256B.0651 and 256B.0653
to 256B.0656 and 256B.0659 to have a background study completed under this chapter.

    Sec. 4. Minnesota Statutes 2008, section 245C.04, subdivision 3, is amended to read:
    Subd. 3. Personal care provider organizations. (a) The commissioner shall
conduct a background study of an individual required to be studied under section 245C.03,
subdivision 2
, at least upon application for initial enrollment under sections 256B.0651
and 256B.0653 to 256B.0656 and 256B.0659.
(b) Organizations required to initiate background studies under sections 256B.0651
and 256B.0653 to 256B.0656 and 256B.0659 for individuals described in section 245C.03,
subdivision 2
, must submit a completed background study form to the commissioner
before those individuals begin a position allowing direct contact with persons served
by the organization.

    Sec. 5. Minnesota Statutes 2008, section 245C.10, subdivision 3, is amended to read:
    Subd. 3. Personal care provider organizations. The commissioner shall recover
the cost of background studies initiated by a personal care provider organization under
sections 256B.0651 and 256B.0653 to 256B.0656 and 256B.0659 through a fee of no
more than $20 per study charged to the organization responsible for submitting the
background study form. The fees collected under this subdivision are appropriated to the
commissioner for the purpose of conducting background studies.

    Sec. 6. Minnesota Statutes 2008, section 256B.04, subdivision 16, is amended to read:
    Subd. 16. Personal care services. (a) Notwithstanding any contrary language in
this paragraph, the commissioner of human services and the commissioner of health shall
jointly promulgate rules to be applied to the licensure of personal care services provided
under the medical assistance program. The rules shall consider standards for personal care
services that are based on the World Institute on Disability's recommendations regarding
personal care services. These rules shall at a minimum consider the standards and
requirements adopted by the commissioner of health under section 144A.45, which the
commissioner of human services determines are applicable to the provision of personal
care services, in addition to other standards or modifications which the commissioner of
human services determines are appropriate.
The commissioner of human services shall establish an advisory group including
personal care consumers and providers to provide advice regarding which standards or
modifications should be adopted. The advisory group membership must include not less
than 15 members, of which at least 60 percent must be consumers of personal care services
and representatives of recipients with various disabilities and diagnoses and ages. At least
51 percent of the members of the advisory group must be recipients of personal care.
The commissioner of human services may contract with the commissioner of health
to enforce the jointly promulgated licensure rules for personal care service providers.
Prior to final promulgation of the joint rule the commissioner of human services
shall report preliminary findings along with any comments of the advisory group and a
plan for monitoring and enforcement by the Department of Health to the legislature by
February 15, 1992.
Limits on the extent of personal care services that may be provided to an individual
must be based on the cost-effectiveness of the services in relation to the costs of inpatient
hospital care, nursing home care, and other available types of care. The rules must
provide, at a minimum:
(1) that agencies be selected to contract with or employ and train staff to provide and
supervise the provision of personal care services;
(2) that agencies employ or contract with a qualified applicant that a qualified
recipient proposes to the agency as the recipient's choice of assistant;
(3) that agencies bill the medical assistance program for a personal care service
by a personal care assistant and supervision by a qualified professional supervising the
personal care assistant unless the recipient selects the fiscal agent option under section
256B.0655, subdivision 7 256B.0659, subdivision 33;
(4) that agencies establish a grievance mechanism; and
(5) that agencies have a quality assurance program.
(b) The commissioner may waive the requirement for the provision of personal care
services through an agency in a particular county, when there are less than two agencies
providing services in that county and shall waive the requirement for personal care
assistants required to join an agency for the first time during 1993 when personal care
services are provided under a relative hardship waiver under Minnesota Statutes 1992,
section 256B.0627, subdivision 4, paragraph (b), clause (7), and at least two agencies
providing personal care services have refused to employ or contract with the independent
personal care assistant.

    Sec. 7. Minnesota Statutes 2008, section 256B.055, subdivision 12, is amended to read:
    Subd. 12. Disabled children. (a) A person is eligible for medical assistance if the
person is under age 19 and qualifies as a disabled individual under United States Code,
title 42, section 1382c(a), and would be eligible for medical assistance under the state
plan if residing in a medical institution, and the child requires a level of care provided in
a hospital, nursing facility, or intermediate care facility for persons with developmental
disabilities, for whom home care is appropriate, provided that the cost to medical
assistance under this section is not more than the amount that medical assistance would pay
for if the child resides in an institution. After the child is determined to be eligible under
this section, the commissioner shall review the child's disability under United States Code,
title 42, section 1382c(a) and level of care defined under this section no more often than
annually and may elect, based on the recommendation of health care professionals under
contract with the state medical review team, to extend the review of disability and level of
care up to a maximum of four years. The commissioner's decision on the frequency of
continuing review of disability and level of care is not subject to administrative appeal
under section 256.045. The county agency shall send a notice of disability review to the
enrollee six months prior to the date the recertification of disability is due. Nothing in this
subdivision shall be construed as affecting other redeterminations of medical assistance
eligibility under this chapter and annual cost-effective reviews under this section.
    (b) For purposes of this subdivision, "hospital" means an institution as defined
in section 144.696, subdivision 3, 144.55, subdivision 3, or Minnesota Rules, part
4640.3600, and licensed pursuant to sections 144.50 to 144.58. For purposes of this
subdivision, a child requires a level of care provided in a hospital if the child is determined
by the commissioner to need an extensive array of health services, including mental health
services, for an undetermined period of time, whose health condition requires frequent
monitoring and treatment by a health care professional or by a person supervised by a
health care professional, who would reside in a hospital or require frequent hospitalization
if these services were not provided, and the daily care needs are more complex than
a nursing facility level of care.
    A child with serious emotional disturbance requires a level of care provided in a
hospital if the commissioner determines that the individual requires 24-hour supervision
because the person exhibits recurrent or frequent suicidal or homicidal ideation or
behavior, recurrent or frequent psychosomatic disorders or somatopsychic disorders that
may become life threatening, recurrent or frequent severe socially unacceptable behavior
associated with psychiatric disorder, ongoing and chronic psychosis or severe, ongoing
and chronic developmental problems requiring continuous skilled observation, or severe
disabling symptoms for which office-centered outpatient treatment is not adequate, and
which overall severely impact the individual's ability to function.
    (c) For purposes of this subdivision, "nursing facility" means a facility which
provides nursing care as defined in section 144A.01, subdivision 5, licensed pursuant to
sections 144A.02 to 144A.10, which is appropriate if a person is in active restorative
treatment; is in need of special treatments provided or supervised by a licensed nurse; or
has unpredictable episodes of active disease processes requiring immediate judgment
by a licensed nurse. For purposes of this subdivision, a child requires the level of care
provided in a nursing facility if the child is determined by the commissioner to meet
the requirements of the preadmission screening assessment document under section
256B.0911 and the home care independent rating document under section 256B.0655,
subdivision 4
, clause (3), adjusted to address age-appropriate standards for children age 18
and under, pursuant to section 256B.0655, subdivision 3.
    (d) For purposes of this subdivision, "intermediate care facility for persons with
developmental disabilities" or "ICF/MR" means a program licensed to provide services to
persons with developmental disabilities under section 252.28, and chapter 245A, and a
physical plant licensed as a supervised living facility under chapter 144, which together
are certified by the Minnesota Department of Health as meeting the standards in Code of
Federal Regulations, title 42, part 483, for an intermediate care facility which provides
services for persons with developmental disabilities who require 24-hour supervision
and active treatment for medical, behavioral, or habilitation needs. For purposes of this
subdivision, a child requires a level of care provided in an ICF/MR if the commissioner
finds that the child has a developmental disability in accordance with section 256B.092,
is in need of a 24-hour plan of care and active treatment similar to persons with
developmental disabilities, and there is a reasonable indication that the child will need
ICF/MR services.
    (e) For purposes of this subdivision, a person requires the level of care provided
in a nursing facility if the person requires 24-hour monitoring or supervision and a plan
of mental health treatment because of specific symptoms or functional impairments
associated with a serious mental illness or disorder diagnosis, which meet severity criteria
for mental health established by the commissioner and published in March 1997 as
the Minnesota Mental Health Level of Care for Children and Adolescents with Severe
Emotional Disorders.
    (f) The determination of the level of care needed by the child shall be made by
the commissioner based on information supplied to the commissioner by the parent or
guardian, the child's physician or physicians, and other professionals as requested by the
commissioner. The commissioner shall establish a screening team to conduct the level of
care determinations according to this subdivision.
    (g) If a child meets the conditions in paragraph (b), (c), (d), or (e), the commissioner
must assess the case to determine whether:
    (1) the child qualifies as a disabled individual under United States Code, title 42,
section 1382c(a), and would be eligible for medical assistance if residing in a medical
institution; and
    (2) the cost of medical assistance services for the child, if eligible under this
subdivision, would not be more than the cost to medical assistance if the child resides in a
medical institution to be determined as follows:
    (i) for a child who requires a level of care provided in an ICF/MR, the cost of
care for the child in an institution shall be determined using the average payment rate
established for the regional treatment centers that are certified as ICF's/MR;
    (ii) for a child who requires a level of care provided in an inpatient hospital setting
according to paragraph (b), cost-effectiveness shall be determined according to Minnesota
Rules, part 9505.3520, items F and G; and
    (iii) for a child who requires a level of care provided in a nursing facility according
to paragraph (c) or (e), cost-effectiveness shall be determined according to Minnesota
Rules, part 9505.3040, except that the nursing facility average rate shall be adjusted to
reflect rates which would be paid for children under age 16. The commissioner may
authorize an amount up to the amount medical assistance would pay for a child referred to
the commissioner by the preadmission screening team under section 256B.0911.
    (h) Children eligible for medical assistance services under section 256B.055,
subdivision 12
, as of June 30, 1995, must be screened according to the criteria in this
subdivision prior to January 1, 1996. Children found to be ineligible may not be removed
from the program until January 1, 1996.

    Sec. 8. Minnesota Statutes 2008, section 256B.0621, subdivision 2, is amended to read:
    Subd. 2. Targeted case management; definitions. For purposes of subdivisions 3
to 10, the following terms have the meanings given them:
    (1) "home care service recipients" means those individuals receiving the following
services under sections 256B.0651 to 256B.0656 and 256B.0659: skilled nursing visits,
home health aide visits, private duty nursing, personal care assistants, or therapies
provided through a home health agency;
    (2) "home care targeted case management" means the provision of targeted case
management services for the purpose of assisting home care service recipients to gain
access to needed services and supports so that they may remain in the community;
    (3) "institutions" means hospitals, consistent with Code of Federal Regulations, title
42, section 440.10; regional treatment center inpatient services, consistent with section
245.474; nursing facilities; and intermediate care facilities for persons with developmental
disabilities;
    (4) "relocation targeted case management" includes the provision of both county
targeted case management and public or private vendor service coordination services
for the purpose of assisting recipients to gain access to needed services and supports if
they choose to move from an institution to the community. Relocation targeted case
management may be provided during the lesser of:
    (i) the last 180 consecutive days of an eligible recipient's institutional stay; or
    (ii) the limits and conditions which apply to federal Medicaid funding for this
service; and
    (5) "targeted case management" means case management services provided to help
recipients gain access to needed medical, social, educational, and other services and
supports.

    Sec. 9. Minnesota Statutes 2008, section 256B.0652, subdivision 3, is amended to read:
    Subd. 3. Assessment and prior authorization process. Effective January 1, 1996,
for purposes of providing informed choice, coordinating of local planning decisions, and
streamlining administrative requirements, the assessment and prior authorization process
for persons receiving both home care and home and community-based waivered services
for persons with developmental disabilities shall meet the requirements of sections
256B.0651 and 256B.0653 to 256B.0656 and 256B.0659 with the following exceptions:
(a) Upon request for home care services and subsequent assessment by the public
health nurse under sections 256B.0651 and 256B.0653 to 256B.0656 and 256B.0659,
the public health nurse shall participate in the screening process, as appropriate, and,
if home care services are determined to be necessary, participate in the development
of a service plan coordinating the need for home care and home and community-based
waivered services with the assigned county case manager, the recipient of services, and
the recipient's legal representative, if any.
(b) The public health nurse shall give prior authorization for home care services
to the extent that home care services are:
(1) medically necessary;
(2) chosen by the recipient and their legal representative, if any, from the array of
home care and home and community-based waivered services available;
(3) coordinated with other services to be received by the recipient as described
in the service plan; and
(4) provided within the county's reimbursement limits for home care and home and
community-based waivered services for persons with developmental disabilities.
(c) If the public health agency is or may be the provider of home care services to the
recipient, the public health agency shall provide the commissioner of human services with
a written plan that specifies how the assessment and prior authorization process will be
held separate and distinct from the provision of services.

    Sec. 10. Minnesota Statutes 2008, section 256B.0657, subdivision 2, is amended to
read:
    Subd. 2. Eligibility. (a) The self-directed supports option is available to a person
who:
    (1) is a recipient of medical assistance as determined under sections 256B.055,
256B.056, and 256B.057, subdivision 9;
    (2) is eligible for personal care assistant services under section 256B.0655
256B.0659;
    (3) lives in the person's own apartment or home, which is not owned, operated, or
controlled by a provider of services not related by blood or marriage;
    (4) has the ability to hire, fire, supervise, establish staff compensation for, and
manage the individuals providing services, and to choose and obtain items, related
services, and supports as described in the participant's plan. If the recipient is not able to
carry out these functions but has a legal guardian or parent to carry them out, the guardian
or parent may fulfill these functions on behalf of the recipient; and
    (5) has not been excluded or disenrolled by the commissioner.
    (b) The commissioner may disenroll or exclude recipients, including guardians and
parents, under the following circumstances:
    (1) recipients who have been restricted by the Primary Care Utilization Review
Committee may be excluded for a specified time period;
    (2) recipients who exit the self-directed supports option during the recipient's
service plan year shall not access the self-directed supports option for the remainder of
that service plan year; and
    (3) when the department determines that the recipient cannot manage recipient
responsibilities under the program.

    Sec. 11. Minnesota Statutes 2008, section 256B.0657, subdivision 6, is amended to
read:
    Subd. 6. Services covered. (a) Services covered under the self-directed supports
option include:
    (1) personal care assistant services under section 256B.0655 256B.0659; and
    (2) items, related services, and supports, including assistive technology, that increase
independence or substitute for human assistance to the extent expenditures would
otherwise be used for human assistance.
    (b) Items, supports, and related services purchased under this option shall not be
considered home care services for the purposes of section 144A.43.

    Sec. 12. Minnesota Statutes 2008, section 256B.0657, subdivision 8, is amended to
read:
    Subd. 8. Self-directed budget requirements. The budget for the provision of the
self-directed service option shall be equal to the greater of either:
    (1) the annual amount of personal care assistant services under section 256B.0655
256B.0659 that the recipient has used in the most recent 12-month period; or
    (2) the amount determined using the consumer support grant methodology under
section 256.476, subdivision 11, except that the budget amount shall include the federal
and nonfederal share of the average service costs.

    Sec. 13. Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:
    Subd. 17. Cost of services and supports. (a) The commissioner shall ensure
that the average per capita expenditures estimated in any fiscal year for home and
community-based waiver recipients does not exceed the average per capita expenditures
that would have been made to provide institutional services for recipients in the absence
of the waiver.
(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
need-based methods for allocating to local agencies the home and community-based
waivered service resources available to support recipients with disabilities in need of
the level of care provided in a nursing facility or a hospital. The commissioner shall
allocate resources to single counties and county partnerships in a manner that reflects
consideration of:
(1) an incentive-based payment process for achieving outcomes;
(2) the need for a state-level risk pool;
(3) the need for retention of management responsibility at the state agency level; and
(4) a phase-in strategy as appropriate.
(c) Until the allocation methods described in paragraph (b) are implemented, the
annual allowable reimbursement level of home and community-based waiver services
shall be the greater of:
(1) the statewide average payment amount which the recipient is assigned under the
waiver reimbursement system in place on June 30, 2001, modified by the percentage of
any provider rate increase appropriated for home and community-based services; or
(2) an amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The
increased reimbursement level must be necessary to allow the recipient to be discharged
from an institution or to prevent imminent placement in an institution. The additional
reimbursement may be used to secure environmental modifications; assistive technology
and equipment; and increased costs for supervision, training, and support services
necessary to address the recipient's extraordinary needs. The commissioner may approve
an increased reimbursement level for up to one year of the recipient's relocation from an
institution or up to six months of a determination that a current waiver recipient is at
imminent risk of being placed in an institution.
(d) Beginning July 1, 2001, medically necessary private duty nursing services
will be authorized under this section as complex and regular care according to sections
256B.0651 and 256B.0653 to 256B.0656 and 256B.0659. The rate established by the
commissioner for registered nurse or licensed practical nurse services under any home and
community-based waiver as of January 1, 2001, shall not be reduced.

    Sec. 14. Minnesota Statutes 2008, section 256B.501, subdivision 4a, is amended to
read:
    Subd. 4a. Inclusion of home care costs in waiver rates. The commissioner
shall adjust the limits of the established average daily reimbursement rates for waivered
services to include the cost of home care services that may be provided to waivered
services recipients. This adjustment must be used to maintain or increase services and
shall not be used by county agencies for inflation increases for waivered services vendors.
Home care services referenced in this section are those listed in section 256B.0651,
subdivision 2
. The average daily reimbursement rates established in accordance with
the provisions of this subdivision apply only to the combined average, daily costs of
waivered and home care services and do not change home care limitations under sections
256B.0651 and 256B.0653 to 256B.0656 and 256B.0659. Waivered services recipients
receiving home care as of June 30, 1992, shall not have the amount of their services
reduced as a result of this section.

    Sec. 15. Minnesota Statutes 2008, section 256G.02, subdivision 6, is amended to read:
    Subd. 6. Excluded time. "Excluded time" means:
(a) any period an applicant spends in a hospital, sanitarium, nursing home, shelter
other than an emergency shelter, halfway house, foster home, semi-independent living
domicile or services program, residential facility offering care, board and lodging facility
or other institution for the hospitalization or care of human beings, as defined in section
144.50, 144A.01, or 245A.02, subdivision 14; maternity home, battered women's shelter,
or correctional facility; or any facility based on an emergency hold under sections
253B.05, subdivisions 1 and 2, and 253B.07, subdivision 6;
(b) any period an applicant spends on a placement basis in a training and habilitation
program, including a rehabilitation facility or work or employment program as defined
in section 268A.01; or receiving personal care assistant services pursuant to section
256B.0655, subdivision 2 256B.0659; semi-independent living services provided under
section 252.275, and Minnesota Rules, parts 9525.0500 to 9525.0660; day training and
habilitation programs and assisted living services; and
(c) any placement for a person with an indeterminate commitment, including
independent living.

    Sec. 16. Minnesota Statutes 2008, section 256I.05, subdivision 1a, is amended to read:
    Subd. 1a. Supplementary service rates. (a) Subject to the provisions of section
256I.04, subdivision 3, the county agency may negotiate a payment not to exceed $426.37
for other services necessary to provide room and board provided by the group residence
if the residence is licensed by or registered by the Department of Health, or licensed by
the Department of Human Services to provide services in addition to room and board,
and if the provider of services is not also concurrently receiving funding for services for
a recipient under a home and community-based waiver under title XIX of the Social
Security Act; or funding from the medical assistance program under section 256B.0655,
subdivision 2
256B.0659, for personal care services for residents in the setting; or residing
in a setting which receives funding under Minnesota Rules, parts 9535.2000 to 9535.3000.
If funding is available for other necessary services through a home and community-based
waiver, or personal care services under section 256B.0655, subdivision 2 256B.0659,
then the GRH rate is limited to the rate set in subdivision 1. Unless otherwise provided
in law, in no case may the supplementary service rate exceed $426.37. The registration
and licensure requirement does not apply to establishments which are exempt from state
licensure because they are located on Indian reservations and for which the tribe has
prescribed health and safety requirements. Service payments under this section may be
prohibited under rules to prevent the supplanting of federal funds with state funds. The
commissioner shall pursue the feasibility of obtaining the approval of the Secretary of
Health and Human Services to provide home and community-based waiver services under
title XIX of the Social Security Act for residents who are not eligible for an existing home
and community-based waiver due to a primary diagnosis of mental illness or chemical
dependency and shall apply for a waiver if it is determined to be cost-effective.
(b) The commissioner is authorized to make cost-neutral transfers from the GRH
fund for beds under this section to other funding programs administered by the department
after consultation with the county or counties in which the affected beds are located.
The commissioner may also make cost-neutral transfers from the GRH fund to county
human service agencies for beds permanently removed from the GRH census under a plan
submitted by the county agency and approved by the commissioner. The commissioner
shall report the amount of any transfers under this provision annually to the legislature.
(c) The provisions of paragraph (b) do not apply to a facility that has its
reimbursement rate established under section 256B.431, subdivision 4, paragraph (c).

    Sec. 17. Minnesota Statutes 2008, section 256J.45, subdivision 3, is amended to read:
    Subd. 3. Good cause exemptions for not attending orientation. (a) The county
agency shall not impose the sanction under section 256J.46 if it determines that the
participant has good cause for failing to attend orientation. Good cause exists when:
(1) appropriate child care is not available;
(2) the participant is ill or injured;
(3) a family member is ill and needs care by the participant that prevents the
participant from attending orientation. For a caregiver with a child or adult in the
household who meets the disability or medical criteria for home care services under
section 256B.0655, subdivision 1c 256B.0659, or a home and community-based waiver
services program under chapter 256B, or meets the criteria for severe emotional
disturbance under section 245.4871, subdivision 6, or for serious and persistent mental
illness under section 245.462, subdivision 20, paragraph (c), good cause also exists when
an interruption in the provision of those services occurs which prevents the participant
from attending orientation;
(4) the caregiver is unable to secure necessary transportation;
(5) the caregiver is in an emergency situation that prevents orientation attendance;
(6) the orientation conflicts with the caregiver's work, training, or school schedule; or
(7) the caregiver documents other verifiable impediments to orientation attendance
beyond the caregiver's control.
(b) Counties must work with clients to provide child care and transportation
necessary to ensure a caregiver has every opportunity to attend orientation.

    Sec. 18. Minnesota Statutes 2008, section 604A.33, subdivision 1, is amended to read:
    Subdivision 1. Application. This section applies to residential treatment programs
for children or group homes for children licensed under chapter 245A, residential
services and programs for juveniles licensed under section 241.021, providers licensed
pursuant to sections 144A.01 to 144A.33 or sections 144A.43 to 144A.47, personal care
provider organizations under section 256B.0655, subdivision 1g 256B.0659, providers
of day training and habilitation services under sections 252.40 to 252.46, board and
lodging facilities licensed under chapter 157, intermediate care facilities for persons with
developmental disabilities, and other facilities licensed to provide residential services to
persons with developmental disabilities.

    Sec. 19. Minnesota Statutes 2008, section 609.232, subdivision 11, is amended to read:
    Subd. 11. Vulnerable adult. "Vulnerable adult" means any person 18 years of
age or older who:
(1) is a resident inpatient of a facility;
(2) receives services at or from a facility required to be licensed to serve adults
under sections 245A.01 to 245A.15, except that a person receiving outpatient services for
treatment of chemical dependency or mental illness, or one who is committed as a sexual
psychopathic personality or as a sexually dangerous person under chapter 253B, is not
considered a vulnerable adult unless the person meets the requirements of clause (4);
(3) receives services from a home care provider required to be licensed under section
144A.46; or from a person or organization that exclusively offers, provides, or arranges
for personal care assistant services under the medical assistance program as authorized
under sections 256B.04, subdivision 16, 256B.0625, subdivision 19a, 256B.0651, and
256B.0653 to 256B.0656 and 256B.0659; or
(4) regardless of residence or whether any type of service is received, possesses a
physical or mental infirmity or other physical, mental, or emotional dysfunction:
(i) that impairs the individual's ability to provide adequately for the individual's
own care without assistance, including the provision of food, shelter, clothing, health
care, or supervision; and
(ii) because of the dysfunction or infirmity and the need for assistance, the individual
has an impaired ability to protect the individual from maltreatment.

    Sec. 20. Minnesota Statutes 2008, section 626.5572, subdivision 6, is amended to read:
    Subd. 6. Facility. (a) "Facility" means a hospital or other entity required to be
licensed under sections 144.50 to 144.58; a nursing home required to be licensed to
serve adults under section 144A.02; a residential or nonresidential facility required to
be licensed to serve adults under sections 245A.01 to 245A.16; a home care provider
licensed or required to be licensed under section 144A.46; a hospice provider licensed
under sections 144A.75 to 144A.755; or a person or organization that exclusively offers,
provides, or arranges for personal care assistant services under the medical assistance
program as authorized under sections 256B.04, subdivision 16, 256B.0625, subdivision
19a
, 256B.0651, and 256B.0653 to 256B.0656, and 256B.0659.
(b) For home care providers and personal care attendants, the term "facility" refers
to the provider or person or organization that exclusively offers, provides, or arranges for
personal care services, and does not refer to the client's home or other location at which
services are rendered.

    Sec. 21. Minnesota Statutes 2008, section 626.5572, subdivision 21, is amended to
read:
    Subd. 21. Vulnerable adult. "Vulnerable adult" means any person 18 years of
age or older who:
    (1) is a resident or inpatient of a facility;
    (2) receives services at or from a facility required to be licensed to serve adults
under sections 245A.01 to 245A.15, except that a person receiving outpatient services for
treatment of chemical dependency or mental illness, or one who is served in the Minnesota
sex offender program on a court-hold order for commitment, or is committed as a sexual
psychopathic personality or as a sexually dangerous person under chapter 253B, is not
considered a vulnerable adult unless the person meets the requirements of clause (4);
    (3) receives services from a home care provider required to be licensed under section
144A.46; or from a person or organization that exclusively offers, provides, or arranges
for personal care assistant services under the medical assistance program as authorized
under sections 256B.04, subdivision 16, 256B.0625, subdivision 19a, 256B.0651, and
256B.0653 to 256B.0656, and 256B.0659; or
    (4) regardless of residence or whether any type of service is received, possesses a
physical or mental infirmity or other physical, mental, or emotional dysfunction:
    (i) that impairs the individual's ability to provide adequately for the individual's
own care without assistance, including the provision of food, shelter, clothing, health
care, or supervision; and
    (ii) because of the dysfunction or infirmity and the need for assistance, the individual
has an impaired ability to protect the individual from maltreatment.

ARTICLE 7
CHEMICAL AND MENTAL HEALTH

    Section 1. Minnesota Statutes 2008, section 245.462, subdivision 18, is amended to
read:
    Subd. 18. Mental health professional. "Mental health professional" means a
person providing clinical services in the treatment of mental illness who is qualified in at
least one of the following ways:
    (1) in psychiatric nursing: a registered nurse who is licensed under sections 148.171
to 148.285; and:
    (i) who is certified as a clinical specialist or as a nurse practitioner in adult or family
psychiatric and mental health nursing by a national nurse certification organization; or
    (ii) who has a master's degree in nursing or one of the behavioral sciences or related
fields from an accredited college or university or its equivalent, with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness;
    (2) in clinical social work: a person licensed as an independent clinical social worker
under chapter 148D, or a person with a master's degree in social work from an accredited
college or university, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;
    (3) in psychology: an individual licensed by the Board of Psychology under sections
148.88 to 148.98 who has stated to the Board of Psychology competencies in the diagnosis
and treatment of mental illness;
    (4) in psychiatry: a physician licensed under chapter 147 and certified by the
American Board of Psychiatry and Neurology or eligible for board certification in
psychiatry;
    (5) in marriage and family therapy: the mental health professional must be a
marriage and family therapist licensed under sections 148B.29 to 148B.39 with at least
two years of post-master's supervised experience in the delivery of clinical services in
the treatment of mental illness; or
    (6) in licensed professional clinical counseling, the mental health professional
shall be a licensed professional clinical counselor under section 148B.5301 with at least
4,000 hours of postmaster's supervised experience in the delivery of clinical services in
the treatment of mental illness; or
    (7) in allied fields: a person with a master's degree from an accredited college or
university in one of the behavioral sciences or related fields, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental illness.

    Sec. 2. Minnesota Statutes 2008, section 245.470, subdivision 1, is amended to read:
    Subdivision 1. Availability of outpatient services. (a) County boards must provide
or contract for enough outpatient services within the county to meet the needs of adults
with mental illness residing in the county. Services may be provided directly by the
county through county-operated mental health centers or mental health clinics approved
by the commissioner under section 245.69, subdivision 2; by contract with privately
operated mental health centers or mental health clinics approved by the commissioner
under section 245.69, subdivision 2; by contract with hospital mental health outpatient
programs certified by the Joint Commission on Accreditation of Hospital Organizations;
or by contract with a licensed mental health professional as defined in section 245.462,
subdivision 18
, clauses (1) to (4) (6). Clients may be required to pay a fee according to
section 245.481. Outpatient services include:
    (1) conducting diagnostic assessments;
    (2) conducting psychological testing;
    (3) developing or modifying individual treatment plans;
    (4) making referrals and recommending placements as appropriate;
    (5) treating an adult's mental health needs through therapy;
    (6) prescribing and managing medication and evaluating the effectiveness of
prescribed medication; and
    (7) preventing placement in settings that are more intensive, costly, or restrictive
than necessary and appropriate to meet client needs.
    (b) County boards may request a waiver allowing outpatient services to be provided
in a nearby trade area if it is determined that the client can best be served outside the
county.

    Sec. 3. Minnesota Statutes 2008, section 245.4871, subdivision 27, is amended to read:
    Subd. 27. Mental health professional. "Mental health professional" means a
person providing clinical services in the diagnosis and treatment of children's emotional
disorders. A mental health professional must have training and experience in working with
children consistent with the age group to which the mental health professional is assigned.
A mental health professional must be qualified in at least one of the following ways:
    (1) in psychiatric nursing, the mental health professional must be a registered nurse
who is licensed under sections 148.171 to 148.285 and who is certified as a clinical
specialist in child and adolescent psychiatric or mental health nursing by a national nurse
certification organization or who has a master's degree in nursing or one of the behavioral
sciences or related fields from an accredited college or university or its equivalent, with
at least 4,000 hours of post-master's supervised experience in the delivery of clinical
services in the treatment of mental illness;
    (2) in clinical social work, the mental health professional must be a person licensed
as an independent clinical social worker under chapter 148D, or a person with a master's
degree in social work from an accredited college or university, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment
of mental disorders;
    (3) in psychology, the mental health professional must be an individual licensed by
the board of psychology under sections 148.88 to 148.98 who has stated to the board of
psychology competencies in the diagnosis and treatment of mental disorders;
    (4) in psychiatry, the mental health professional must be a physician licensed under
chapter 147 and certified by the American board of psychiatry and neurology or eligible
for board certification in psychiatry;
    (5) in marriage and family therapy, the mental health professional must be a
marriage and family therapist licensed under sections 148B.29 to 148B.39 with at least
two years of post-master's supervised experience in the delivery of clinical services in the
treatment of mental disorders or emotional disturbances; or
    (6) in licensed professional clinical counseling, the mental health professional shall
be a licensed professional clinical counselor under section 148B.5301 with at least 4,000
hours of postmaster's supervised experience in the delivery of clinical services in the
treatment of mental disorders or emotional disturbances; or
    (7) in allied fields, the mental health professional must be a person with a master's
degree from an accredited college or university in one of the behavioral sciences or related
fields, with at least 4,000 hours of post-master's supervised experience in the delivery of
clinical services in the treatment of emotional disturbances.

    Sec. 4. Minnesota Statutes 2008, section 245.488, subdivision 1, is amended to read:
    Subdivision 1. Availability of outpatient services. (a) County boards must provide
or contract for enough outpatient services within the county to meet the needs of each
child with emotional disturbance residing in the county and the child's family. Services
may be provided directly by the county through county-operated mental health centers or
mental health clinics approved by the commissioner under section 245.69, subdivision 2;
by contract with privately operated mental health centers or mental health clinics approved
by the commissioner under section 245.69, subdivision 2; by contract with hospital
mental health outpatient programs certified by the Joint Commission on Accreditation
of Hospital Organizations; or by contract with a licensed mental health professional as
defined in section 245.4871, subdivision 27, clauses (1) to (4) (6). A child or a child's
parent may be required to pay a fee based in accordance with section 245.481. Outpatient
services include:
    (1) conducting diagnostic assessments;
    (2) conducting psychological testing;
    (3) developing or modifying individual treatment plans;
    (4) making referrals and recommending placements as appropriate;
    (5) treating the child's mental health needs through therapy; and
    (6) prescribing and managing medication and evaluating the effectiveness of
prescribed medication.
    (b) County boards may request a waiver allowing outpatient services to be provided
in a nearby trade area if it is determined that the child requires necessary and appropriate
services that are only available outside the county.
    (c) Outpatient services offered by the county board to prevent placement must be at
the level of treatment appropriate to the child's diagnostic assessment.

    Sec. 5. Minnesota Statutes 2008, section 254A.02, is amended by adding a subdivision
to read:
    Subd. 8a. Placing authority. "Placing authority" means a county, prepaid health
plan, or tribal governing board governed by Minnesota Rules, parts 9530.6600 to
9530.6655.

    Sec. 6. Minnesota Statutes 2008, section 254A.16, is amended by adding a subdivision
to read:
    Subd. 6. Monitoring. The commissioner shall gather and placing authorities shall
provide information to measure compliance with Minnesota Rules, parts 9530.6600 to
9530.6655. The commissioner shall specify the format for data collection to facilitate
tracking, aggregating, and using the information.

    Sec. 7. Minnesota Statutes 2008, section 254B.03, subdivision 1, is amended to read:
    Subdivision 1. Local agency duties. (a) Every local agency shall provide chemical
dependency services to persons residing within its jurisdiction who meet criteria
established by the commissioner for placement in a chemical dependency residential or
nonresidential treatment service. Chemical dependency money must be administered
by the local agencies according to law and rules adopted by the commissioner under
sections 14.001 to 14.69.
    (b) In order to contain costs, the county board shall, with the approval of the
commissioner of human services, shall select eligible vendors of chemical dependency
services who can provide economical and appropriate treatment. Unless the local agency
is a social services department directly administered by a county or human services board,
the local agency shall not be an eligible vendor under section 254B.05. The commissioner
may approve proposals from county boards to provide services in an economical manner
or to control utilization, with safeguards to ensure that necessary services are provided.
If a county implements a demonstration or experimental medical services funding plan,
the commissioner shall transfer the money as appropriate. If a county selects a vendor
located in another state, the county shall ensure that the vendor is in compliance with the
rules governing licensure of programs located in the state.
    (c) A culturally specific vendor that provides assessments under a variance under
Minnesota Rules, part 9530.6610, shall be allowed to provide assessment services to
persons not covered by the variance.
EFFECTIVE DATE.This section is effective July 1, 2011.

    Sec. 8. Minnesota Statutes 2008, section 254B.03, subdivision 3, is amended to read:
    Subd. 3. Local agencies to pay state for county share. Local agencies shall pay
the state for the county share of the services authorized by the local agency, except when
the payment is made according to section 254B.09, subdivision 8.

    Sec. 9. Minnesota Statutes 2008, section 254B.03, is amended by adding a subdivision
to read:
    Subd. 9. Commissioner to select vendors and set rates. (a) Effective July 1, 2011,
the commissioner shall:
(1) enter into agreements with eligible vendors that:
(i) meet the standards in section 254B.05, subdivision 1;
(ii) have good standing in all applicable licensure; and
(iii) have a current approved provider agreement as a Minnesota health care program
provider; and
(2) set rates for services reimbursed under this chapter.
(b) When setting rates, the commissioner shall consider the complexity and the
acuity of the problems presented by the client.
(c) When rates set under this section and rates set under section 254B.09, subdivision
8, apply to the same treatment placement, section 254B.09, subdivision 8, supersedes.

    Sec. 10. Minnesota Statutes 2008, section 254B.05, subdivision 1, is amended to read:
    Subdivision 1. Licensure required. Programs licensed by the commissioner are
eligible vendors. Hospitals may apply for and receive licenses to be eligible vendors,
notwithstanding the provisions of section 245A.03. American Indian programs located on
federally recognized tribal lands that provide chemical dependency primary treatment,
extended care, transitional residence, or outpatient treatment services, and are licensed by
tribal government are eligible vendors. Detoxification programs are not eligible vendors.
Programs that are not licensed as a chemical dependency residential or nonresidential
treatment program by the commissioner or by tribal government are not eligible vendors.
To be eligible for payment under the Consolidated Chemical Dependency Treatment Fund,
a vendor of a chemical dependency service must participate in the Drug and Alcohol
Abuse Normative Evaluation System and the treatment accountability plan.
Effective January 1, 2000, vendors of room and board are eligible for chemical
dependency fund payment if the vendor:
(1) is certified by the county or tribal governing body as having has rules prohibiting
residents bringing chemicals into the facility or using chemicals while residing in the
facility and provide consequences for infractions of those rules;
(2) has a current contract with a county or tribal governing body;
(3) is determined to meet applicable health and safety requirements;
(4) is not a jail or prison; and
(5) is not concurrently receiving funds under chapter 256I for the recipient.
EFFECTIVE DATE.This section is effective July 1, 2011.

    Sec. 11. Minnesota Statutes 2008, section 254B.09, subdivision 2, is amended to read:
    Subd. 2. American Indian agreements. The commissioner may enter into
agreements with federally recognized tribal units to pay for chemical dependency
treatment services provided under Laws 1986, chapter 394, sections 8 to 20. The
agreements must clarify how the governing body of the tribal unit fulfills local agency
responsibilities regarding:
(1) selection of eligible vendors under section 254B.03, subdivision 1;
(2) negotiation of agreements that establish vendor services and rates for programs
located on the tribal governing body's reservation;
(3) (1) the form and manner of invoicing; and
(4) (2) provide that only invoices for eligible vendors according to section 254B.05
will be included in invoices sent to the commissioner for payment, to the extent that
money allocated under subdivisions 4 and 5 is used.
EFFECTIVE DATE.This section is effective July 1, 2011.

    Sec. 12. [254B.11] MAXIMUM RATES.
The commissioner shall publish maximum rates for vendors of the consolidated
chemical dependency treatment fund by July 1 of each year for implementation the
following January 1. Rates for calendar year 2010 must not exceed 185 percent of the
average rate on January 1, 2009, for each group of vendors with similar attributes. Unless
a new rate methodology is developed under section 254B.12, rates for services provided on
and after July 1, 2011, must not exceed 160 percent of the average rate on January 1, 2009,
for each group of vendors with similar attributes. Payment for services provided by Indian
Health Services or by agencies operated by Indian tribes for medical assistance-eligible
individuals must be governed by the applicable federal rate methodology.

    Sec. 13. [254B.12] RATE METHODOLOGY.
The commissioner shall, with broad-based stakeholder input, develop a
recommendation and present a report to the 2011 legislature, including proposed
legislation for a new rate methodology for the consolidated chemical dependency
treatment fund. The new methodology must replace county-negotiated rates with a
uniform statewide methodology that must include a graduated reimbursement scale based
on the patients' level of acuity and complexity.

    Sec. 14. Minnesota Statutes 2008, section 256B.0622, subdivision 2, is amended to
read:
    Subd. 2. Definitions. For purposes of this section, the following terms have the
meanings given them.
    (a) "Intensive nonresidential rehabilitative mental health services" means adult
rehabilitative mental health services as defined in section 256B.0623, subdivision 2,
paragraph (a), except that these services are provided by a multidisciplinary staff using
a total team approach consistent with assertive community treatment, the Fairweather
Lodge treatment model, as defined by the standards established by the National Coalition
for Community Living, and other evidence-based practices, and directed to recipients with
a serious mental illness who require intensive services.
    (b) "Intensive residential rehabilitative mental health services" means short-term,
time-limited services provided in a residential setting to recipients who are in need of
more restrictive settings and are at risk of significant functional deterioration if they do
not receive these services. Services are designed to develop and enhance psychiatric
stability, personal and emotional adjustment, self-sufficiency, and skills to live in a more
independent setting. Services must be directed toward a targeted discharge date with
specified client outcomes and must be consistent with the Fairweather Lodge treatment
model as defined in paragraph (a), and other evidence-based practices.
    (c) "Evidence-based practices" are nationally recognized mental health services that
are proven by substantial research to be effective in helping individuals with serious
mental illness obtain specific treatment goals.
    (d) "Overnight staff" means a member of the intensive residential rehabilitative
mental health treatment team who is responsible during hours when recipients are
typically asleep.
    (e) "Treatment team" means all staff who provide services under this section to
recipients. At a minimum, this includes the clinical supervisor, mental health professionals
as defined in section 245.462, subdivision 18, clauses (1) to (5) (6); mental health
practitioners as defined in section 245.462, subdivision 17; mental health rehabilitation
workers under section 256B.0623, subdivision 5, clause (3); and certified peer specialists
under section 256B.0615.

    Sec. 15. Minnesota Statutes 2008, section 256B.0623, subdivision 5, is amended to
read:
    Subd. 5. Qualifications of provider staff. Adult rehabilitative mental health
services must be provided by qualified individual provider staff of a certified provider
entity. Individual provider staff must be qualified under one of the following criteria:
    (1) a mental health professional as defined in section 245.462, subdivision 18,
clauses (1) to (5) (6). If the recipient has a current diagnostic assessment by a licensed
mental health professional as defined in section 245.462, subdivision 18, clauses (1) to (5)
(6), recommending receipt of adult mental health rehabilitative services, the definition of
mental health professional for purposes of this section includes a person who is qualified
under section 245.462, subdivision 18, clause (6) (7), and who holds a current and valid
national certification as a certified rehabilitation counselor or certified psychosocial
rehabilitation practitioner;
    (2) a mental health practitioner as defined in section 245.462, subdivision 17. The
mental health practitioner must work under the clinical supervision of a mental health
professional;
    (3) a certified peer specialist under section 256B.0615. The certified peer specialist
must work under the clinical supervision of a mental health professional; or
    (4) a mental health rehabilitation worker. A mental health rehabilitation worker
means a staff person working under the direction of a mental health practitioner or mental
health professional and under the clinical supervision of a mental health professional in
the implementation of rehabilitative mental health services as identified in the recipient's
individual treatment plan who:
    (i) is at least 21 years of age;
    (ii) has a high school diploma or equivalent;
    (iii) has successfully completed 30 hours of training during the past two years in all
of the following areas: recipient rights, recipient-centered individual treatment planning,
behavioral terminology, mental illness, co-occurring mental illness and substance abuse,
psychotropic medications and side effects, functional assessment, local community
resources, adult vulnerability, recipient confidentiality; and
    (iv) meets the qualifications in subitem (A) or (B):
    (A) has an associate of arts degree in one of the behavioral sciences or human
services, or is a registered nurse without a bachelor's degree, or who within the previous
ten years has:
    (1) three years of personal life experience with serious and persistent mental illness;
    (2) three years of life experience as a primary caregiver to an adult with a serious
mental illness or traumatic brain injury; or
    (3) 4,000 hours of supervised paid work experience in the delivery of mental health
services to adults with a serious mental illness or traumatic brain injury; or
    (B)(1) is fluent in the non-English language or competent in the culture of the
ethnic group to which at least 20 percent of the mental health rehabilitation worker's
clients belong;
    (2) receives during the first 2,000 hours of work, monthly documented individual
clinical supervision by a mental health professional;
    (3) has 18 hours of documented field supervision by a mental health professional
or practitioner during the first 160 hours of contact work with recipients, and at least six
hours of field supervision quarterly during the following year;
    (4) has review and cosignature of charting of recipient contacts during field
supervision by a mental health professional or practitioner; and
    (5) has 40 hours of additional continuing education on mental health topics during
the first year of employment.

    Sec. 16. Minnesota Statutes 2008, section 256B.0624, subdivision 5, is amended to
read:
    Subd. 5. Mobile crisis intervention staff qualifications. For provision of adult
mental health mobile crisis intervention services, a mobile crisis intervention team is
comprised of at least two mental health professionals as defined in section 245.462,
subdivision 18
, clauses (1) to (5) (6), or a combination of at least one mental health
professional and one mental health practitioner as defined in section 245.462, subdivision
17
, with the required mental health crisis training and under the clinical supervision of
a mental health professional on the team. The team must have at least two people with
at least one member providing on-site crisis intervention services when needed. Team
members must be experienced in mental health assessment, crisis intervention techniques,
and clinical decision-making under emergency conditions and have knowledge of local
services and resources. The team must recommend and coordinate the team's services
with appropriate local resources such as the county social services agency, mental health
services, and local law enforcement when necessary.

    Sec. 17. Minnesota Statutes 2008, section 256B.0624, subdivision 8, is amended to
read:
    Subd. 8. Adult crisis stabilization staff qualifications. (a) Adult mental health
crisis stabilization services must be provided by qualified individual staff of a qualified
provider entity. Individual provider staff must have the following qualifications:
    (1) be a mental health professional as defined in section 245.462, subdivision 18,
clauses (1) to (5) (6);
    (2) be a mental health practitioner as defined in section 245.462, subdivision 17.
The mental health practitioner must work under the clinical supervision of a mental health
professional; or
    (3) be a mental health rehabilitation worker who meets the criteria in section
256B.0623, subdivision 5, clause (3); works under the direction of a mental health
practitioner as defined in section 245.462, subdivision 17, or under direction of a
mental health professional; and works under the clinical supervision of a mental health
professional.
    (b) Mental health practitioners and mental health rehabilitation workers must have
completed at least 30 hours of training in crisis intervention and stabilization during
the past two years.

    Sec. 18. Minnesota Statutes 2008, section 256B.0625, subdivision 42, is amended to
read:
    Subd. 42. Mental health professional. Notwithstanding Minnesota Rules, part
9505.0175, subpart 28, the definition of a mental health professional shall include a person
who is qualified as specified in section 245.462, subdivision 18, clause clauses (5) and (6);
or 245.4871, subdivision 27, clause clauses (5) and (6), for the purpose of this section and
Minnesota Rules, parts 9505.0170 to 9505.0475.

    Sec. 19. Minnesota Statutes 2008, section 256B.0943, subdivision 1, is amended to
read:
    Subdivision 1. Definitions. For purposes of this section, the following terms have
the meanings given them.
    (a) "Children's therapeutic services and supports" means the flexible package of
mental health services for children who require varying therapeutic and rehabilitative
levels of intervention. The services are time-limited interventions that are delivered using
various treatment modalities and combinations of services designed to reach treatment
outcomes identified in the individual treatment plan.
    (b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.
    (c) "County board" means the county board of commissioners or board established
under sections 402.01 to 402.10 or 471.59.
    (d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a.
    (e) "Culturally competent provider" means a provider who understands and can
utilize to a client's benefit the client's culture when providing services to the client. A
provider may be culturally competent because the provider is of the same cultural or
ethnic group as the client or the provider has developed the knowledge and skills through
training and experience to provide services to culturally diverse clients.
    (f) "Day treatment program" for children means a site-based structured program
consisting of group psychotherapy for more than three individuals and other intensive
therapeutic services provided by a multidisciplinary team, under the clinical supervision
of a mental health professional.
    (g) "Diagnostic assessment" has the meaning given in section 245.4871, subdivision
11
.
    (h) "Direct service time" means the time that a mental health professional, mental
health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family. Direct service time includes time in which the provider obtains
a client's history or provides service components of children's therapeutic services and
supports. Direct service time does not include time doing work before and after providing
direct services, including scheduling, maintaining clinical records, consulting with others
about the client's mental health status, preparing reports, receiving clinical supervision
directly related to the client's psychotherapy session, and revising the client's individual
treatment plan.
    (i) "Direction of mental health behavioral aide" means the activities of a mental
health professional or mental health practitioner in guiding the mental health behavioral
aide in providing services to a client. The direction of a mental health behavioral aide
must be based on the client's individualized treatment plan and meet the requirements in
subdivision 6, paragraph (b), clause (5).
    (j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15
. For persons at least age 18 but under age 21, mental illness has the meaning given in
section 245.462, subdivision 20, paragraph (a).
    (k) "Individual behavioral plan" means a plan of intervention, treatment, and
services for a child written by a mental health professional or mental health practitioner,
under the clinical supervision of a mental health professional, to guide the work of the
mental health behavioral aide.
    (l) "Individual treatment plan" has the meaning given in section 245.4871,
subdivision 21
.
    (m) "Mental health professional" means an individual as defined in section 245.4871,
subdivision 27
, clauses (1) to (5) (6), or tribal vendor as defined in section 256B.02,
subdivision 7
, paragraph (b).
    (n) "Preschool program" means a day program licensed under Minnesota Rules,
parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and
supports provider to provide a structured treatment program to a child who is at least 33
months old but who has not yet attended the first day of kindergarten.
    (o) "Skills training" means individual, family, or group training designed to improve
the basic functioning of the child with emotional disturbance and the child's family in the
activities of daily living and community living, and to improve the social functioning of the
child and the child's family in areas important to the child's maintaining or reestablishing
residency in the community. Individual, family, and group skills training must:
    (1) consist of activities designed to promote skill development of the child and the
child's family in the use of age-appropriate daily living skills, interpersonal and family
relationships, and leisure and recreational services;
    (2) consist of activities that will assist the family's understanding of normal child
development and to use parenting skills that will help the child with emotional disturbance
achieve the goals outlined in the child's individual treatment plan; and
    (3) promote family preservation and unification, promote the family's integration
with the community, and reduce the use of unnecessary out-of-home placement or
institutionalization of children with emotional disturbance.

    Sec. 20. Minnesota Statutes 2008, section 256B.0625, subdivision 47, is amended to
read:
    Subd. 47. Treatment foster care services. Effective July 1, 2007 2011, and subject
to federal approval, medical assistance covers treatment foster care services according to
section 256B.0946.

    Sec. 21. Minnesota Statutes 2008, section 256B.0943, subdivision 12, is amended to
read:
    Subd. 12. Excluded services. The following services are not eligible for medical
assistance payment as children's therapeutic services and supports:
    (1) service components of children's therapeutic services and supports
simultaneously provided by more than one provider entity unless prior authorization is
obtained;
    (2) treatment by multiple providers within the same agency at the same clock time;
(3) children's therapeutic services and supports provided in violation of medical
assistance policy in Minnesota Rules, part 9505.0220;
    (3) (4) mental health behavioral aide services provided by a personal care assistant
who is not qualified as a mental health behavioral aide and employed by a certified
children's therapeutic services and supports provider entity;
    (4) (5) service components of CTSS that are the responsibility of a residential or
program license holder, including foster care providers under the terms of a service
agreement or administrative rules governing licensure;
    (5) (6) adjunctive activities that may be offered by a provider entity but are not
otherwise covered by medical assistance, including:
    (i) a service that is primarily recreation oriented or that is provided in a setting that
is not medically supervised. This includes sports activities, exercise groups, activities
such as craft hours, leisure time, social hours, meal or snack time, trips to community
activities, and tours;
    (ii) a social or educational service that does not have or cannot reasonably be
expected to have a therapeutic outcome related to the client's emotional disturbance;
    (iii) consultation with other providers or service agency staff about the care or
progress of a client;
    (iv) prevention or education programs provided to the community; and
    (v) treatment for clients with primary diagnoses of alcohol or other drug abuse; and
    (6) (7) activities that are not direct service time.

    Sec. 22. Minnesota Statutes 2008, section 256B.0944, is amended by adding a
subdivision to read:
    Subd. 4a. Alternative provider standards. If a provider entity demonstrates that,
due to geographic or other barriers, it is not feasible to provide mobile crisis intervention
services 24 hours a day, seven days a week, according to the standards in subdivision 4,
paragraph (b), clause (1), the commissioner may approve a crisis response provider based
on an alternative plan proposed by a provider entity. The alternative plan must:
(1) result in increased access and a reduction in disparities in the availability of
crisis services; and
(2) provide mobile services outside of the usual nine-to-five office hours and on
weekends and holidays.

    Sec. 23. Minnesota Statutes 2008, section 256B.0947, subdivision 1, is amended to
read:
    Subdivision 1. Scope. Subject to federal approval Effective November 1, 2010, and
subject to federal approval, medical assistance covers medically necessary, intensive
nonresidential rehabilitative mental health services as defined in subdivision 2, for
recipients as defined in subdivision 3, when the services are provided by an entity meeting
the standards in this section.

    Sec. 24. Minnesota Statutes 2008, section 256J.08, subdivision 73a, is amended to read:
    Subd. 73a. Qualified professional. (a) For physical illness, injury, or incapacity,
a "qualified professional" means a licensed physician, a physician's assistant, a nurse
practitioner, or a licensed chiropractor.
    (b) For developmental disability and intelligence testing, a "qualified professional"
means an individual qualified by training and experience to administer the tests necessary
to make determinations, such as tests of intellectual functioning, assessments of adaptive
behavior, adaptive skills, and developmental functioning. These professionals include
licensed psychologists, certified school psychologists, or certified psychometrists working
under the supervision of a licensed psychologist.
    (c) For learning disabilities, a "qualified professional" means a licensed psychologist
or school psychologist with experience determining learning disabilities.
    (d) For mental health, a "qualified professional" means a licensed physician or a
qualified mental health professional. A "qualified mental health professional" means:
    (1) for children, in psychiatric nursing, a registered nurse who is licensed under
sections 148.171 to 148.285, and who is certified as a clinical specialist in child
and adolescent psychiatric or mental health nursing by a national nurse certification
organization or who has a master's degree in nursing or one of the behavioral sciences
or related fields from an accredited college or university or its equivalent, with at least
4,000 hours of post-master's supervised experience in the delivery of clinical services in
the treatment of mental illness;
    (2) for adults, in psychiatric nursing, a registered nurse who is licensed under
sections 148.171 to 148.285, and who is certified as a clinical specialist in adult psychiatric
and mental health nursing by a national nurse certification organization or who has a
master's degree in nursing or one of the behavioral sciences or related fields from an
accredited college or university or its equivalent, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services in the treatment of mental illness;
    (3) in clinical social work, a person licensed as an independent clinical social worker
under chapter 148D, or a person with a master's degree in social work from an accredited
college or university, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;
    (4) in psychology, an individual licensed by the Board of Psychology under sections
148.88 to 148.98, who has stated to the Board of Psychology competencies in the
diagnosis and treatment of mental illness;
    (5) in psychiatry, a physician licensed under chapter 147 and certified by the
American Board of Psychiatry and Neurology or eligible for board certification in
psychiatry; and
    (6) in marriage and family therapy, the mental health professional must be a
marriage and family therapist licensed under sections 148B.29 to 148B.39, with at least
two years of post-master's supervised experience in the delivery of clinical services in the
treatment of mental illness; and
    (7) in licensed professional clinical counseling, the mental health professional
shall be a licensed professional clinical counselor under section 148B.5301 with at least
4,000 hours of postmaster's supervised experience in the delivery of clinical services in
the treatment of mental illness.

    Sec. 25. AUTISM SPECTRUM DISORDER TASK FORCE.
(a) The Autism Spectrum Disorder Task Force is composed of 15 members,
appointed as follows:
(1) two members of the senate appointed by the Subcommittee on Committees of the
Committee on Rules and Administration, one of whom must be a member of the minority;
(2) two members of the house of representatives, one from the majority party,
appointed by the speaker of the house, and one from the minority party, appointed by
the minority leader;
    (3) two members appointed by the legislature, with regard to geographic diversity in
the state, who are parents of children with autism spectrum disorder (ASD); one member
shall be appointed by the senate Subcommittee on Committees of the Committee on
Rules and Administration making appointments for the senate; and one member shall be
appointed by the speaker of the house making the appointments for the house;
(4) one member appointed by the Minnesota chapter of the American Academy of
Pediatrics who is a general primary care pediatrician;
(5) one member appointed by the Minnesota Academy of Family Physicians who is
a family practice physician;
(6) one member appointed by the Minnesota Psychological Association who is a
neuropsychologist;
(7) one member appointed by the directors of public school student support services;
(8) one member appointed by the Somali American Autism Foundation;
(9) one member appointed by the ARC of Minnesota;
(10) one member appointed by the Autism Society of Minnesota;
(11) one member appointed by the Parent Advocacy Coalition for Educational
Rights; and
(12) one member appointed by the Minnesota Council of Health Plans.
Appointments must be made by September 1, 2009. The Legislative Coordinating
Commission shall provide meeting space for the task force. The senate member appointed
by the minority leader of the senate shall convene the first meeting of the task force no
later than October 1, 2009. The task force shall elect a chair at the first meeting.
(b) If federal or state funding is available, the commissioners of education,
employment and economic development, health, and human services shall provide
assistance to the task force.
(c) The task force shall develop recommendations and report on the following topics:
(1) ways to improve services provided by all state and political subdivisions;
(2) sources of public and private funding available for treatment and ways to
improve efficiency in the use of these funds;
(3) methods to improve coordination in the delivery of service between public
and private agencies, health providers, and schools, and to address any geographic
discrepancies in the delivery of services;
(4) increasing the availability of and the training for medical providers and educators
who identify and provide services to individuals with ASD; and
(5) treatment options supported by peer-reviewed, established scientific research
for individuals with ASD.
(d) The task force shall coordinate with existing efforts at the Departments of
Education, Health, Human Services, and Employment and Economic Development
related to ASD.
(e) By January 15 of each year, the task force shall provide a report regarding its
findings and consideration of the topics listed under paragraph (c), and the action taken
under paragraph (d), including draft legislation if necessary, to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services.
(f) This section expires June 30, 2011.

    Sec. 26. STATE-COUNTY CHEMICAL HEALTH CARE HOME PILOT
PROJECT.
    Subdivision 1. Establishment; purpose. There is established a state-county
chemical health care home pilot project. The purpose of the pilot project is for the
Department of Human Services and counties to authentically and creatively work in
partnership to redesign the current chemical health service delivery system in a way
that promotes greater accountability, productivity, and results in the delivery of state
chemical dependency services. The pilot project or projects must look to provide
appropriate flexibility in a way that ensures timely access to needed services as well
as better aligning systems and services to offer the most appropriate level of chemical
health care services to the client. This may include, but is not limited to, looking into new
governance agreements, performance agreements, or service level agreements. Pilot
projects must maintain eligibility requirements for the consolidated chemical dependency
treatment fund, continue to meet the requirements of Minnesota Rules, parts 9530.6600 to
9530.6655 (also known as Rule 25) and Minnesota Rules, parts 9530.6405 to 9530.6505
(also known as Rule 31), and must not put at risk current and future federal funding toward
chemical health-related services in the state of Minnesota.
    Subd. 2. Workgroup; report. A workgroup must be convened on or before July
15, 2009, consisting of representatives from the Department of Human Services and
potential participating counties to develop draft proposals for pilot projects meeting the
requirements of this section. The workgroup shall report back to the legislative committees
with jurisdiction over chemical health by January 15, 2010, for potential approval of one
metro and one nonmetro county pilot project to be implemented beginning July 10, 2010.
    Subd. 3. Report. The Department of Human Services shall evaluate the efficacy and
feasibility of the pilot projects and report the results of that evaluation to the legislative
committees having jurisdiction over chemical health by June 30, 2011. Expansion of pilot
projects may occur only if the department's report finds the pilot projects effective.
    Subd. 4. Expiration. This section expires June 30, 2012.
EFFECTIVE DATE.This section is effective the day following final enactment.

ARTICLE 8
CONTINUING CARE

    Section 1. Minnesota Statutes 2008, section 144.0724, subdivision 2, is amended to
read:
    Subd. 2. Definitions. For purposes of this section, the following terms have the
meanings given.
(a) "Assessment reference date" means the last day of the minimum data set
observation period. The date sets the designated endpoint of the common observation
period, and all minimum data set items refer back in time from that point.
(b) "Case mix index" means the weighting factors assigned to the RUG-III
classifications.
(c) "Index maximization" means classifying a resident who could be assigned to
more than one category, to the category with the highest case mix index.
(d) "Minimum data set" means the assessment instrument specified by the Centers for
Medicare and Medicaid Services and designated by the Minnesota Department of Health.
(e) "Representative" means a person who is the resident's guardian or conservator,
the person authorized to pay the nursing home expenses of the resident, a representative
of the nursing home ombudsman's office whose assistance has been requested, or any
other individual designated by the resident.
(f) "Resource utilization groups" or "RUG" means the system for grouping a nursing
facility's residents according to their clinical and functional status identified in data
supplied by the facility's minimum data set.
(g) "Activities of daily living" means grooming, dressing, bathing, transferring,
mobility, positioning, eating, and toileting.
(h) "Nursing facility level of care determination" means the assessment process
that results in a determination of a resident's or prospective resident's need for nursing
facility level of care as established in subdivision 11 for purposes of medical assistance
payment of long-term care services for:
(1) nursing facility services under section 256B.434 or 256B.441;
(2) elderly waiver services under section 256B.0915;
(3) CADI and TBI waiver services under section 256B.49; and
(4) state payment of alternative care services under section 256B.0913.
EFFECTIVE DATE.The section is effective January 1, 2011.

    Sec. 2. Minnesota Statutes 2008, section 144.0724, subdivision 4, is amended to read:
    Subd. 4. Resident assessment schedule. (a) A facility must conduct and
electronically submit to the commissioner of health case mix assessments that conform
with the assessment schedule defined by Code of Federal Regulations, title 42, section
483.20, and published by the United States Department of Health and Human Services,
Centers for Medicare and Medicaid Services, in the Long Term Care Assessment
Instrument User's Manual, version 2.0, October 1995, and subsequent clarifications made
in the Long-Term Care Assessment Instrument Questions and Answers, version 2.0,
August 1996. The commissioner of health may substitute successor manuals or question
and answer documents published by the United States Department of Health and Human
Services, Centers for Medicare and Medicaid Services, to replace or supplement the
current version of the manual or document.
(b) The assessments used to determine a case mix classification for reimbursement
include the following:
(1) a new admission assessment must be completed by day 14 following admission;
(2) an annual assessment must be completed within 366 days of the last
comprehensive assessment;
(3) a significant change assessment must be completed within 14 days of the
identification of a significant change; and
(4) the second quarterly assessment following either a new admission assessment,
an annual assessment, or a significant change assessment, and all quarterly assessments
beginning October 1, 2006. Each quarterly assessment must be completed within 92
days of the previous assessment.
(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:
(1) preadmission screening completed under section 256B.0911, subdivision 4a,
by a county, tribe, or managed care organization under contract with the Department
of Human Services; and
(2) a face-to-face long-term care consultation assessment completed under section
256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care organization
under contract with the Department of Human Services.
EFFECTIVE DATE.The section is effective January 1, 2011.

    Sec. 3. Minnesota Statutes 2008, section 144.0724, subdivision 8, is amended to read:
    Subd. 8. Request for reconsideration of resident classifications. (a) The resident,
or resident's representative, or the nursing facility or boarding care home may request that
the commissioner of health reconsider the assigned reimbursement classification. The
request for reconsideration must be submitted in writing to the commissioner within
30 days of the day the resident or the resident's representative receives the resident
classification notice. The request for reconsideration must include the name of the
resident, the name and address of the facility in which the resident resides, the reasons for
the reconsideration, the requested classification changes, and documentation supporting
the requested classification. The documentation accompanying the reconsideration request
is limited to documentation which establishes that the needs of the resident at the time of
the assessment justify a classification which is different than the classification established
by the commissioner of health.
(b) Upon request, the nursing facility must give the resident or the resident's
representative a copy of the assessment form and the other documentation that was given
to the commissioner of health to support the assessment findings. The nursing facility
shall also provide access to and a copy of other information from the resident's record that
has been requested by or on behalf of the resident to support a resident's reconsideration
request. A copy of any requested material must be provided within three working days of
receipt of a written request for the information. If a facility fails to provide the material
within this time, it is subject to the issuance of a correction order and penalty assessment
under sections 144.653 and 144A.10. Notwithstanding those sections, any correction order
issued under this subdivision must require that the nursing facility immediately comply
with the request for information and that as of the date of the issuance of the correction
order, the facility shall forfeit to the state a $100 fine for the first day of noncompliance, and
an increase in the $100 fine by $50 increments for each day the noncompliance continues.
(c) In addition to the information required under paragraphs (a) and (b), a
reconsideration request from a nursing facility must contain the following information: (i)
the date the reimbursement classification notices were received by the facility; (ii) the date
the classification notices were distributed to the resident or the resident's representative;
and (iii) a copy of a notice sent to the resident or to the resident's representative. This
notice must inform the resident or the resident's representative that a reconsideration of the
resident's classification is being requested, the reason for the request, that the resident's
rate will change if the request is approved by the commissioner, the extent of the change,
that copies of the facility's request and supporting documentation are available for review,
and that the resident also has the right to request a reconsideration. If the facility fails to
provide the required information with the reconsideration request, the request must be
denied, and the facility may not make further reconsideration requests on that specific
reimbursement classification.
(d) Reconsideration by the commissioner must be made by individuals not involved
in reviewing the assessment, audit, or reconsideration that established the disputed
classification. The reconsideration must be based upon the initial assessment and upon the
information provided to the commissioner under paragraphs (a) and (b). If necessary for
evaluating the reconsideration request, the commissioner may conduct on-site reviews.
Within 15 working days of receiving the request for reconsideration, the commissioner
shall affirm or modify the original resident classification. The original classification
must be modified if the commissioner determines that the assessment resulting in the
classification did not accurately reflect the needs or assessment characteristics of the
resident at the time of the assessment. The resident and the nursing facility or boarding
care home shall be notified within five working days after the decision is made. A decision
by the commissioner under this subdivision is the final administrative decision of the
agency for the party requesting reconsideration.
(e) The resident classification established by the commissioner shall be the
classification that applies to the resident while the request for reconsideration is pending.
If a request for reconsideration applies to an assessment used to determine nursing facility
level of care under subdivision 4, paragraph (c), the resident shall continue to be eligible
for nursing facility level of care while the request for reconsideration is pending.
(f) The commissioner may request additional documentation regarding a
reconsideration necessary to make an accurate reconsideration determination.
EFFECTIVE DATE.The section is effective January 1, 2011.

    Sec. 4. Minnesota Statutes 2008, section 144.0724, is amended by adding a subdivision
to read:
    Subd. 11. Nursing facility level of care. (a) For purposes of medical assistance
payment of long-term care services, a recipient must be determined, using assessments
defined in subdivision 4, to meet one of the following nursing facility level of care criteria:
(1) the person needs the assistance of another person or constant supervision to begin
and complete at least four of the following activities of living: bathing, bed mobility,
dressing, eating, grooming, toileting, transferring, and walking;
(2) the person needs the assistance of another person or constant supervision to begin
and complete toileting, transferring, or positioning and the assistance cannot be scheduled;
(3) the person has significant difficulty with memory, using information, daily
decision making, or behavioral needs that require intervention;
(4) the person has had a qualifying nursing facility stay of at least 90 days; or
(5) the person is determined to be at risk for nursing facility admission or
readmission through a face-to-face long-term care consultation assessment as specified
in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care
organization under contract with the Department of Human Services. The person is
considered at risk under this clause if the person currently lives alone or will live alone
upon discharge and also meets one of the following criteria:
(i) the person has experienced a fall resulting in a fracture;
(ii) the person has been determined to be at risk of maltreatment or neglect,
including self-neglect; or
(iii) the person has a sensory impairment that substantially impacts functional ability
and maintenance of a community residence.
(b) The assessment used to establish medical assistance payment for nursing facility
services must be the most recent assessment performed under subdivision 4, paragraph
(b), that occurred no more than 90 calendar days before the effective date of medical
assistance eligibility for payment of long-term care services. In no case shall medical
assistance payment for long-term care services occur prior to the date of the determination
of nursing facility level of care.
(c) The assessment used to establish medical assistance payment for long-term care
services provided under sections 256B.0915 and 256B.49 and alternative care payment
for services provided under section 256B.0913 must be the most recent face-to-face
assessment performed under section 256B.0911, subdivision 3a, that occurred no more
than 60 calendar days before the effective date of medical assistance eligibility for
payment of long-term care services.
EFFECTIVE DATE.The section is effective January 1, 2011.

    Sec. 5. Minnesota Statutes 2008, section 144.0724, is amended by adding a subdivision
to read:
    Subd. 12. Appeal of nursing facility level of care determination. A resident or
prospective resident whose level of care determination results in a denial of long-term care
services can appeal the determination as outlined in section 256B.0911, subdivision 3a,
paragraph (h), clause (7).
EFFECTIVE DATE.The section is effective January 1, 2011.

    Sec. 6. Minnesota Statutes 2008, section 144A.073, is amended by adding a
subdivision to read:
    Subd. 12. Extension of approval of moratorium exception projects.
Notwithstanding subdivision 3, the commissioner of health shall extend project approval
by an additional 18 months for an approved proposal for an exception to the nursing home
licensure and certification moratorium if the proposal was approved under this section
between July 1, 2007, and June 30, 2009.

    Sec. 7. Minnesota Statutes 2008, section 144A.44, subdivision 2, is amended to read:
    Subd. 2. Interpretation and enforcement of rights. These rights are established
for the benefit of persons who receive home care services. "Home care services" means
home care services as defined in section 144A.43, subdivision 3, and unlicensed personal
care assistance services, including services covered by medical assistance under section
256B.0625, subdivision 19a. A home care provider may not require a person to surrender
these rights as a condition of receiving services. A guardian or conservator or, when there
is no guardian or conservator, a designated person, may seek to enforce these rights. This
statement of rights does not replace or diminish other rights and liberties that may exist
relative to persons receiving home care services, persons providing home care services, or
providers licensed under Laws 1987, chapter 378. A copy of these rights must be provided
to an individual at the time home care services, including personal care assistance
services, are initiated. The copy shall also contain the address and phone number of the
Office of Health Facility Complaints and the Office of Ombudsman for Long-Term Care
and a brief statement describing how to file a complaint with these offices. Information
about how to contact the Office of Ombudsman for Long-Term Care shall be included in
notices of change in client fees and in notices where home care providers initiate transfer
or discontinuation of services.

    Sec. 8. Minnesota Statutes 2008, section 245A.03, is amended by adding a subdivision
to read:
    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an
initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
9555.6265, under this chapter for a physical location that will not be the primary residence
of the license holder for the entire period of licensure. If a license is issued during this
moratorium, and the license holder changes the license holder's primary residence away
from the physical location of the foster care license, the commissioner shall revoke the
license according to section 245A.07. Exceptions to the moratorium include:
(1) foster care settings that are required to be registered under chapter 144D;
(2) foster care licenses replacing foster care licenses in existence on the effective
date of this section and determined to be needed by the commissioner under paragraph (b);
(3) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center;
(4) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for persons requiring hospital level care; or
(5) new foster care licenses determined to be needed by the commissioner for the
transition of people from personal care assistance to the home and community-based
services.
(b) The commissioner shall determine the need for newly licensed foster care homes
as defined under this subdivision. As part of the determination, the commissioner shall
consider the availability of foster care capacity in the area which the licensee seeks to
operate, and the recommendation of the local county board. The determination by the
commissioner must be final. A determination of need is not required for a change in
ownership at the same address.
    (c) Residential settings that would otherwise be subject to the moratorium established
in paragraph (a), that are in the process of receiving an adult or child foster care license as
of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult
or child foster care license. For this paragraph, all of the following conditions must be met
to be considered in process of receiving an adult or child foster care license:
    (1) participants have made decisions to move into the residential setting, including
documentation in each participant's care plan;
    (2) the provider has purchased housing or has made a financial investment in the
property;
    (3) the lead agency has approved the plans, including costs for the residential setting
for each individual;
    (4) the completion of the licensing process, including all necessary inspections, is
the only remaining component prior to being able to provide services; and
    (5) the needs of the individuals cannot be met within the existing capacity in that
county.
To qualify for the process under this paragraph, the lead agency must submit
documentation to the commissioner by August 1, 2009, that all of the above criteria are
met.
(d) The commissioner shall study the effects of the license moratorium under this
subdivision and shall report back to the legislature by January 15, 2011.
EFFECTIVE DATE.This section is effective the day following final enactment.

    Sec. 9. Minnesota Statutes 2008, section 245A.11, is amended by adding a subdivision
to read:
    Subd. 8. Community residential setting license. (a) The commissioner shall
establish provider standards for residential support services that integrate service standards
and the residential setting under one license. The commissioner shall propose statutory
language and an implementation plan for licensing requirements for residential support
services to the legislature by January 15, 2011.
(b) Providers licensed under chapter 245B, and providing, contracting, or arranging
for services in settings licensed as adult foster care under Minnesota Rules, parts
9555.5105 to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to
2960.3340; and meeting the provisions of section 256B.092, subdivision 11, paragraph
(b), must be required to obtain a community residential setting license.

    Sec. 10. Minnesota Statutes 2008, section 252.46, is amended by adding a subdivision
to read:
    Subd. 1a. Day training and habilitation rates. The commissioner shall establish
a statewide rate-setting methodology for all day training and habilitation services. The
rate-setting methodology must abide by the principles of transparency and equitability
across the state. The methodology must involve a uniform process of structuring rates for
each service and must promote quality and participant choice.

    Sec. 11. Minnesota Statutes 2008, section 252.50, subdivision 1, is amended to read:
    Subdivision 1. Community-based programs established. The commissioner
shall establish a system of state-operated, community-based programs for persons with
developmental disabilities. For purposes of this section, "state-operated, community-based
program" means a program administered by the state to provide treatment and habilitation
in noninstitutional community settings to persons with developmental disabilities.
Employees of the programs, except clients who work within and benefit from these
treatment and habilitation programs, must be state employees under chapters 43A and
179A. Although any clients who work within and benefit from these treatment and
habilitation programs are not employees under chapters 43A and 179A, the Department
of Human Services may consider clients who work within and benefit from these
programs employees for federal tax purposes. The establishment of state-operated,
community-based programs must be within the context of a comprehensive definition of
the role of state-operated services in the state. The role of state-operated services must
be defined within the context of a comprehensive system of services for persons with
developmental disabilities. State-operated, community-based programs may include, but
are not limited to, community group homes, foster care, supportive living services, day
training and habilitation programs, and respite care arrangements. The commissioner
may operate the pilot projects established under Laws 1985, First Special Session
chapter 9, article 1, section 2, subdivision 6, and shall, within the limits of available
appropriations, establish additional state-operated, community-based programs for
persons with developmental disabilities. State-operated, community-based programs may
accept admissions from regional treatment centers, from the person's own home, or from
community programs. State-operated, community-based programs offering day program
services may be provided for persons with developmental disabilities who are living in
state-operated, community-based residential programs until July 1, 2000. No later than
1994, the commissioner, together with family members, counties, advocates, employee
representatives, and other interested parties, shall begin planning so that by July 1, 2000,
state-operated, community-based residential facilities will be in compliance with section
252.41, subdivision 9.

    Sec. 12. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision
to read:
    Subd. 29. State medical review team. (a) To ensure the timely processing of
determinations of disability by the commissioner's state medical review team under
sections 256B.055, subdivision 7, paragraph (b), 256B.057, subdivision 9, paragraph
(j), and 256B.055, subdivision 12, the commissioner shall review all medical evidence
submitted by county agencies with a referral and seek additional information from
providers, applicants, and enrollees to support the determination of disability where
necessary. Disability shall be determined according to the rules of title XVI and title
XIX of the Social Security Act and pertinent rules and policies of the Social Security
Administration.
    (b) Prior to a denial or withdrawal of a requested determination of disability due
to insufficient evidence, the commissioner shall (1) ensure that the missing evidence is
necessary and appropriate to a determination of disability, and (2) assist applicants and
enrollees to obtain the evidence, including, but not limited to, medical examinations
and electronic medical records.
(c) The commissioner shall provide the chairs of the legislative committees with
jurisdiction over health and human services finance and budget the following information
on the activities of the state medical review team by February 1, 2010, and annually
thereafter:
(1) the number of applications to the state medical review team that were denied,
approved, or withdrawn;
(2) the average length of time from receipt of the application to a decision;
(3) the number of appeals and appeal results;
(4) for applicants, their age, health coverage at the time of application, hospitalization
history within three months of application, and whether an application for Social Security
or Supplemental Security Income benefits is pending; and
(5) specific information on the medical certification, licensure, or other credentials
of the person or persons performing the medical review determinations and length of
time in that position.

    Sec. 13. [256.0281] INTERAGENCY DATA EXCHANGE.
The Department of Human Services, the Department of Health, and the Office of the
Ombudsman for Mental Health and Developmental Disabilities may establish interagency
agreements governing the electronic exchange of data on providers and individuals
collected, maintained, or used by each agency when such exchange is outlined by each
agency in an interagency agreement to accomplish the purposes in clauses (1) to (4):
(1) to improve provider enrollment processes for home and community-based
services and state plan home care services;
(2) to improve quality management of providers between state agencies;
(3) to establish and maintain provider eligibility to participate as providers under
Minnesota health care programs; or
(4) to meet the quality assurance reporting requirements under federal law under
section 1915(c) of the Social Security Act related to home and community-based waiver
programs.
Each interagency agreement must include provisions to ensure anonymity of individuals,
including mandated reporters, and must outline the specific uses of and access to shared
data within each agency. Electronic interfaces between source data systems developed
under these interagency agreements must incorporate these provisions as well as other
HIPPA provisions related to individual data.

    Sec. 14. Minnesota Statutes 2008, section 256.476, subdivision 5, is amended to read:
    Subd. 5. Reimbursement, allocations, and reporting. (a) For the purpose of
transferring persons to the consumer support grant program from the family support
program and personal care assistant services, home health aide services, or private duty
nursing services, the amount of funds transferred by the commissioner between the
family support program account, the medical assistance account, or the consumer support
grant account shall be based on each county's participation in transferring persons to the
consumer support grant program from those programs and services.
    (b) At the beginning of each fiscal year, county allocations for consumer support
grants shall be based on:
    (1) the number of persons to whom the county board expects to provide consumer
supports grants;
    (2) their eligibility for current program and services;
    (3) the amount of nonfederal dollars monthly grant levels allowed under subdivision
11; and
    (4) projected dates when persons will start receiving grants. County allocations shall
be adjusted periodically by the commissioner based on the actual transfer of persons or
service openings, and the nonfederal dollars monthly grant levels associated with those
persons or service openings, to the consumer support grant program.
    (c) The amount of funds transferred by the commissioner from the medical
assistance account for an individual may be changed if it is determined by the county or its
agent that the individual's need for support has changed.
    (d) The authority to utilize funds transferred to the consumer support grant account
for the purposes of implementing and administering the consumer support grant program
will not be limited or constrained by the spending authority provided to the program
of origination.
    (e) The commissioner may use up to five percent of each county's allocation, as
adjusted, for payments for administrative expenses, to be paid as a proportionate addition
to reported direct service expenditures.
    (f) The county allocation for each person or the person's legal representative or other
authorized representative cannot exceed the amount allowed under subdivision 11.
    (g) The commissioner may recover, suspend, or withhold payments if the county
board, local agency, or grantee does not comply with the requirements of this section.
    (h) Grant funds unexpended by consumers shall return to the state once a year. The
annual return of unexpended grant funds shall occur in the quarter following the end of
the state fiscal year.

    Sec. 15. Minnesota Statutes 2008, section 256.476, subdivision 11, is amended to read:
    Subd. 11. Consumer support grant program after July 1, 2001. (a) Effective
July 1, 2001, the commissioner shall allocate consumer support grant resources to
serve additional individuals based on a review of Medicaid authorization and payment
information of persons eligible for a consumer support grant from the most recent fiscal
year. The commissioner shall use the following methodology to calculate maximum
allowable monthly consumer support grant levels:
    (1) For individuals whose program of origination is medical assistance home care
under sections 256B.0651 and 256B.0653 to 256B.0656, the maximum allowable monthly
grant levels are calculated by:
    (i) determining the nonfederal share 50 percent of the average service authorization
for each home care rating;
    (ii) calculating the overall ratio of actual payments to service authorizations by
program;
    (iii) applying the overall ratio to the average service authorization level of each
home care rating;
    (iv) adjusting the result for any authorized rate increases provided by the legislature;
and
    (v) adjusting the result for the average monthly utilization per recipient.
    (2) The commissioner may review and evaluate the methodology to reflect changes
in the home care program's overall ratio of actual payments to service authorizations
programs.
    (b) Effective January 1, 2004, persons previously receiving exception grants will
have their grants calculated using the methodology in paragraph (a), clause (1). If a person
currently receiving an exception grant wishes to have their home care rating reevaluated,
they may request an assessment as defined in section 256B.0651, subdivision 1, paragraph
(b).

    Sec. 16. Minnesota Statutes 2008, section 256.975, subdivision 7, is amended to read:
    Subd. 7. Consumer information and assistance and long-term care options
counseling; senior linkage Senior LinkAge Line. (a) The Minnesota Board on Aging
shall operate a statewide information and assistance service to aid older Minnesotans and
their families in making informed choices about long-term care options and health care
benefits. Language services to persons with limited English language skills may be made
available. The service, known as Senior LinkAge Line, must be available during business
hours through a statewide toll-free number and must also be available through the Internet.
    (b) The service must assist provide long-term care options counseling by assisting
older adults, caregivers, and providers in accessing information and options counseling
about choices in long-term care services that are purchased through private providers or
available through public options. The service must:
    (1) develop a comprehensive database that includes detailed listings in both
consumer- and provider-oriented formats;
    (2) make the database accessible on the Internet and through other telecommunication
and media-related tools;
    (3) link callers to interactive long-term care screening tools and make these tools
available through the Internet by integrating the tools with the database;
    (4) develop community education materials with a focus on planning for long-term
care and evaluating independent living, housing, and service options;
    (5) conduct an outreach campaign to assist older adults and their caregivers in
finding information on the Internet and through other means of communication;
    (6) implement a messaging system for overflow callers and respond to these callers
by the next business day;
    (7) link callers with county human services and other providers to receive more
in-depth assistance and consultation related to long-term care options;
    (8) link callers with quality profiles for nursing facilities and other providers
developed by the commissioner of health; and
    (9) incorporate information about housing with services and consumer rights
within the MinnesotaHelp.info network long-term care database to facilitate consumer
comparison of services and costs among housing with services establishments and with
other in-home services and to support financial self-sufficiency as long as possible.
Housing with services establishments and their arranged home care providers shall provide
information to the commissioner of human services that is consistent with information
required by the commissioner of health under section 144G.06, the Uniform Consumer
Information Guide. The commissioner of human services shall provide the data to the
Minnesota Board on Aging for inclusion in the MinnesotaHelp.info network long-term
care database.;
(10) provide long-term care options counseling. Long-term care options counselors
shall:
(i) for individuals not eligible for case management under a public program or public
funding source, provide interactive decision support under which consumers, family
members, or other helpers are supported in their deliberations to determine appropriate
long-term care choices in the context of the consumer's needs, preferences, values, and
individual circumstances, including implementing a community support plan;
(ii) provide Web-based educational information and collateral written materials to
familiarize consumers, family members, or other helpers with the long-term care basics,
issues to be considered, and the range of options available in the community;
(iii) provide long-term care futures planning, which means providing assistance to
individuals who anticipate having long-term care needs to develop a plan for the more
distant future; and
(iv) provide expertise in benefits and financing options for long-term care, including
Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages,
private pay options, and ways to access low or no-cost services or benefits through
volunteer-based or charitable programs; and
(11) using risk management and support planning protocols, provide long-term care
options counseling to current residents of nursing homes deemed appropriate for discharge
by the commissioner. In order to meet this requirement, the commissioner shall provide
designated Senior LinkAge Line contact centers with a list of nursing home residents
appropriate for discharge planning via a secure Web portal. Senior LinkAge Line shall
provide these residents, if they indicate a preference to receive long-term care options
counseling, with initial assessment, review of risk factors, independent living support
consultation, or referral to:
(i) services under section 256B.0911, subdivision 3;
(ii) designated care coordinators of contracted entities under section 256B.035 for
persons who are enrolled in a managed care plan; or
(iii) the long-term care consultation team for those who are appropriate for relocation
service coordination due to high-risk factors or psychological or physical disability.
    (c) The Minnesota Board on Aging shall conduct an evaluation of the effectiveness
of the statewide information and assistance, and submit this evaluation to the legislature
by December 1, 2002. The evaluation must include an analysis of funding adequacy, gaps
in service delivery, continuity in information between the service and identified linkages,
and potential use of private funding to enhance the service.

    Sec. 17. Minnesota Statutes 2008, section 256B.055, subdivision 7, is amended to read:
    Subd. 7. Aged, blind, or disabled persons. (a) Medical assistance may be paid for
a person who meets the categorical eligibility requirements of the supplemental security
income program or, who would meet those requirements except for excess income or
assets, and who meets the other eligibility requirements of this section.
(b) Following a determination that the applicant is not aged or blind and does not
meet any other category of eligibility for medical assistance and has not been determined
disabled by the Social Security Administration, applicants under this subdivision shall be
referred to the commissioner's state medical review team for a determination of disability.

    Sec. 18. Minnesota Statutes 2008, section 256B.0625, subdivision 6a, is amended to
read:
    Subd. 6a. Home health services. Home health services are those services specified
in Minnesota Rules, part 9505.0295 and sections 256B.0651 and 256B.0653. Medical
assistance covers home health services at a recipient's home residence. Medical assistance
does not cover home health services for residents of a hospital, nursing facility, or
intermediate care facility, unless the commissioner of human services has prior authorized
skilled nurse visits for less than 90 days for a resident at an intermediate care facility for
persons with developmental disabilities, to prevent an admission to a hospital or nursing
facility or unless a resident who is otherwise eligible is on leave from the facility and the
facility either pays for the home health services or forgoes the facility per diem for the
leave days that home health services are used. Home health services must be provided by
a Medicare certified home health agency. All nursing and home health aide services must
be provided according to sections 256B.0651 to 256B.0656 256B.0653.

    Sec. 19. Minnesota Statutes 2008, section 256B.0625, subdivision 7, is amended to
read:
    Subd. 7. Private duty nursing. Medical assistance covers private duty nursing
services in a recipient's home. Recipients who are authorized to receive private duty
nursing services in their home may use approved hours outside of the home during hours
when normal life activities take them outside of their home. To use private duty nursing
services at school, the recipient or responsible party must provide written authorization in
the care plan identifying the chosen provider and the daily amount of services to be used at
school. Medical assistance does not cover private duty nursing services for residents of a
hospital, nursing facility, intermediate care facility, or a health care facility licensed by the
commissioner of health, except as authorized in section 256B.64 for ventilator-dependent
recipients in hospitals or unless a resident who is otherwise eligible is on leave from the
facility and the facility either pays for the private duty nursing services or forgoes the
facility per diem for the leave days that private duty nursing services are used. Total hours
of service and payment allowed for services outside the home cannot exceed that which is
otherwise allowed in an in-home setting according to sections 256B.0651 and 256B.0653
256B.0654 to 256B.0656. All private duty nursing services must be provided according to
the limits established under sections 256B.0651 and 256B.0653 to 256B.0656. Private
duty nursing services may not be reimbursed if the nurse is the family foster care provider
of a recipient who is under age 18, unless allowed under section 256B.0654, subdivision 4.

    Sec. 20. Minnesota Statutes 2008, section 256B.0625, subdivision 19a, is amended to
read:
    Subd. 19a. Personal care assistant assistance services. Medical assistance covers
personal care assistant assistance services in a recipient's home. Effective January 1,
2010, to qualify for personal care assistant assistance services, a recipient must require
assistance and be determined dependent in one activity of daily living as defined in section
256B.0659, subdivision 1, paragraph (b), or in a Level I behavior as defined in section
256B.0659, subdivision 1, paragraph (c). Beginning July 1, 2011, to qualify for personal
care assistance services, a recipient must require assistance and be determined dependent
in at least two activities of daily living as defined in section 256B.0659. Recipients or
responsible parties must be able to identify the recipient's needs, direct and evaluate task
accomplishment, and provide for health and safety. Approved hours may be used outside
the home when normal life activities take them outside the home. To use personal care
assistant assistance services at school, the recipient or responsible party must provide
written authorization in the care plan identifying the chosen provider and the daily amount
of services to be used at school. Total hours for services, whether actually performed
inside or outside the recipient's home, cannot exceed that which is otherwise allowed for
personal care assistant assistance services in an in-home setting according to sections
256B.0651 and 256B.0653 to 256B.0656. Medical assistance does not cover personal care
assistant assistance services for residents of a hospital, nursing facility, intermediate care
facility, health care facility licensed by the commissioner of health, or unless a resident
who is otherwise eligible is on leave from the facility and the facility either pays for the
personal care assistant assistance services or forgoes the facility per diem for the leave
days that personal care assistant assistance services are used. All personal care assistant
assistance services must be provided according to sections 256B.0651 and 256B.0653
to 256B.0656. Personal care assistant assistance services may not be reimbursed if the
personal care assistant is the spouse or legal paid guardian of the recipient or the parent of
a recipient under age 18, or the responsible party or the family foster care provider of a
recipient who cannot direct the recipient's own care unless, in the case of a foster care
provider, a county or state case manager visits the recipient as needed, but not less than
every six months, to monitor the health and safety of the recipient and to ensure the goals
of the care plan are met. Parents of adult recipients, adult children of the recipient or
adult siblings of the recipient may be reimbursed for personal care assistant services,
if they are granted a waiver under sections 256B.0651 and 256B.0653 to 256B.0656.
Notwithstanding the provisions of section 256B.0655, subdivision 2, paragraph (b), clause
(4) 256B.0659, the noncorporate legal unpaid guardian or conservator of an adult, who is
not the responsible party and not the personal care provider organization, may be granted a
hardship waiver under sections 256B.0651 and 256B.0653 to 256B.0656, to be reimbursed
to provide personal care assistant assistance services to the recipient if the guardian or
conservator meets all criteria for a personal care assistant according to section 256B.0659,
and shall not be considered to have a service provider interest for purposes of participation
on the screening team under section 256B.092, subdivision 7.

    Sec. 21. Minnesota Statutes 2008, section 256B.0625, subdivision 19c, is amended to
read:
    Subd. 19c. Personal care. Medical assistance covers personal care assistant
assistance services provided by an individual who is qualified to provide the services
according to subdivision 19a and sections 256B.0651 and 256B.0653 to 256B.0656,
where the services have a statement of need by a physician, provided in accordance with
a plan, and are supervised by the recipient or a qualified professional. The physician's
statement of need for personal care assistant services shall be documented on a form
approved by the commissioner and include the diagnosis or condition of the person that
results in a need for personal care assistant services and be updated when the person's
medical condition requires a change, but at least annually if the need for personal care
assistant services is ongoing.
"Qualified professional" means a mental health professional as defined in section 245.462,
subdivision 18
, or 245.4871, subdivision 27; or a registered nurse as defined in sections
148.171 to 148.285, or a licensed social worker as defined in section 148B.21, or a
qualified developmental disabilities specialist under section 245B.07, subdivision 4.
As part of the assessment, the county public health nurse will assist the recipient or
responsible party to identify the most appropriate person to provide supervision of the
personal care assistant. The qualified professional shall perform the duties described
required in Minnesota Rules, part 9505.0335, subpart 4 section 256B.0659.

    Sec. 22. Minnesota Statutes 2008, section 256B.0641, subdivision 3, is amended to
read:
    Subd. 3. Facility in receivership. Subdivision 2 does not apply to the change of
ownership of a facility to a nonrelated organization while the facility to be sold, transferred
or reorganized is in receivership under section 144A.14, 144A.15, 245A.12, or 245A.13,
and the commissioner during the receivership has not determined the need to place
residents of the facility into a newly constructed or newly established facility. Nothing
in this subdivision limits the liability of a former owner.

    Sec. 23. Minnesota Statutes 2008, section 256B.0651, is amended to read:
256B.0651 HOME CARE SERVICES.
    Subdivision 1. Definitions. (a) "Activities of daily living" includes eating, toileting,
grooming, dressing, bathing, transferring, mobility, and positioning For the purposes of
sections 256B.0651 to 256B.0656 and 256B.0659, the terms in paragraphs (b) to (g)
have the meanings given.
(b) "Activities of daily living" has the meaning given in section 256B.0659,
subdivision 1, paragraph (b).
(c) "Assessment" means a review and evaluation of a recipient's need for home care
services conducted in person. Assessments for home health agency services shall be
conducted by a home health agency nurse. Assessments for medical assistance home care
services for developmental disability and alternative care services for developmentally
disabled home and community-based waivered recipients may be conducted by the county
public health nurse to ensure coordination and avoid duplication. Assessments must be
completed on forms provided by the commissioner within 30 days of a request for home
care services by a recipient or responsible party.
(c) (d) "Home care services" means a health service, determined by the commissioner
as medically necessary, that is ordered by a physician and documented in a service plan
that is reviewed by the physician at least once every 60 days for the provision of home
health services, or private duty nursing, or at least once every 365 days for personal care.
Home care services are provided to the recipient at the recipient's residence that is a
place other than a hospital or long-term care facility or as specified in section 256B.0625
means medical assistance covered services that are home health agency services, including
skilled nurse visits; home health aide visits; physical therapy, occupational therapy,
respiratory therapy, and language-speech pathology therapy; private duty nursing; and
personal care assistance.
(e) "Home residence," effective January 1, 2010, means a residence owned or rented
by the recipient either alone, with roommates of the recipient's choosing, or with an unpaid
responsible party or legal representative; or a family foster home where the license holder
lives with the recipient and is not paid to provide home care services for the recipient
except as allowed under sections 256B.0651, subdivision 9, and 256B.0654, subdivision 4.
(d) (f) "Medically necessary" has the meaning given in Minnesota Rules, parts
9505.0170 to 9505.0475.
(e) "Telehomecare" means the use of telecommunications technology by a home
health care professional to deliver home health care services, within the professional's
scope of practice, to a patient located at a site other than the site where the practitioner
is located.
(g) "Ventilator-dependent" means an individual who receives mechanical ventilation
for life support at least six hours per day and is expected to be or has been dependent on a
ventilator for at least 30 consecutive days.
    Subd. 2. Services covered. Home care services covered under this section and
sections 256B.0653 256B.0652 to 256B.0656 and 256B.0659 include:
(1) nursing services under section sections 256B.0625, subdivision 6a, and
256B.0653
;
(2) private duty nursing services under section sections 256B.0625, subdivision
7
, and 256B.0654;
(3) home health services under section sections 256B.0625, subdivision 6a, and
256B.0653
;
(4) personal care assistant assistance services under section sections 256B.0625,
subdivision 19a
, and 256B.0659;
(5) supervision of personal care assistant assistance services provided by a qualified
professional under section sections 256B.0625, subdivision 19a, and 256B.0659;
(6) qualified professional of personal care assistant services under the fiscal
intermediary option as specified in section 256B.0655, subdivision 7;
(7) face-to-face assessments by county public health nurses for services under
section sections 256B.0625, subdivision 19a, 256B.0655, and 256B.0659; and
(8) (7) service updates and review of temporary increases for personal care assistant
assistance services by the county public health nurse for services under section sections
256B.0625, subdivision 19a, and 256B.0659.
    Subd. 3. Noncovered home care services. The following home care services are
not eligible for payment under medical assistance:
(1) skilled nurse visits for the sole purpose of supervision of the home health aide;
(2) a skilled nursing visit:
(i) only for the purpose of monitoring medication compliance with an established
medication program for a recipient; or
(ii) to administer or assist with medication administration, including injections,
prefilling syringes for injections, or oral medication set-up of an adult recipient, when as
determined and documented by the registered nurse, the need can be met by an available
pharmacy or the recipient is physically and mentally able to self-administer or prefill
a medication;
(3) home care services to a recipient who is eligible for covered services under the
Medicare program or any other insurance held by the recipient;
(4) services to other members of the recipient's household;
(5) a visit made by a skilled nurse solely to train other home health agency workers;
(6) any home care service included in the daily rate of the community-based
residential facility where the recipient is residing;
(7) nursing and rehabilitation therapy services that are reasonably accessible to a
recipient outside the recipient's place of residence, excluding the assessment, counseling
and education, and personal assistant care;
(8) any home health agency service, excluding personal care assistant services and
private duty nursing services, which are performed in a place other than the recipient's
residence; and
(9) Medicare evaluation or administrative nursing visits on dual-eligible recipients
that do not qualify for Medicare visit billing.
(1) services provided in a nursing facility, hospital, or intermediate care facility with
exceptions in section 256B.0653;
(2) services for the sole purpose of monitoring medication compliance with an
established medication program for a recipient;
(3) home care services for covered services under the Medicare program or any other
insurance held by the recipient;
(4) services to other members of the recipient's household;
(5) any home care service included in the daily rate of the community-based
residential facility where the recipient is residing;
(6) nursing and rehabilitation therapy services that are reasonably accessible to a
recipient outside the recipient's place of residence, excluding the assessment, counseling
and education, and personal assistance care; or
(7) Medicare evaluation or administrative nursing visits on dual-eligible recipients
that do not qualify for Medicare visit billing.
    Subd. 4. Prior Authorization; exceptions. All home care services above the limits
in subdivision 11 must receive the commissioner's prior authorization before services
begin, except when:
(1) the home care services were required to treat an emergency medical condition
that if not immediately treated could cause a recipient serious physical or mental disability,
continuation of severe pain, or death. The provider must request retroactive authorization
no later than five working days after giving the initial service. The provider must be able
to substantiate the emergency by documentation such as reports, notes, and admission or
discharge histories;
(2) the home care services were provided on or after the date on which the recipient's
eligibility began, but before the date on which the recipient was notified that the case was
opened. Authorization will be considered if the request is submitted by the provider
within 20 working days of the date the recipient was notified that the case was opened;
a recipient's medical assistance eligibility has lapsed, is then retroactively reinstated,
and an authorization for home care services is completed based on the date of a current
assessment, eligibility, and request for authorization;
(3) a third-party payor for home care services has denied or adjusted a payment.
Authorization requests must be submitted by the provider within 20 working days of the
notice of denial or adjustment. A copy of the notice must be included with the request;
(4) the commissioner has determined that a county or state human services agency
has made an error; or
(5) the professional nurse determines an immediate need for up to 40 skilled nursing
or home health aide visits per calendar year and submits a request for authorization within
20 working days of the initial service date, and medical assistance is determined to be
the appropriate payer. if a recipient enrolled in managed care experiences a temporary
disenrollment from a health plan, the commissioner shall accept the current health plan
authorization for personal care assistance services for up to 60 days. The request must
be received within the first 30 days of the disenrollment. If the recipient's reenrollment
in managed care is after the 60 days and before 90 days, the provider shall request an
additional 30-day extension of the current health plan authorization, for a total limit of
90 days from the time of disenrollment.
    Subd. 5. Retroactive authorization. A request for retroactive authorization will be
evaluated according to the same criteria applied to prior authorization requests.
    Subd. 6. Prior Authorization. (a) The commissioner, or the commissioner's
designee, shall review the assessment, service update, request for temporary services,
request for flexible use option, service plan, and any additional information that is
submitted. The commissioner shall, within 30 days after receiving a complete request,
assessment, and service plan, authorize home care services as follows: provided in this
section.
(a) Home health services. (b) All Home health services provided by a home health
aide including skilled nurse visits and home health aide visits must be prior authorized
by the commissioner or the commissioner's designee. Prior Authorization must be based
on medical necessity and cost-effectiveness when compared with other care options.
The commissioner must receive the request for authorization of skilled nurse visits and
home health aide visits within 20 working days of the start of service. When home health
services are used in combination with personal care and private duty nursing, the cost of
all home care services shall be considered for cost-effectiveness. The commissioner shall
limit home health aide visits to no more than one visit each per day. The commissioner, or
the commissioner's designee, may authorize up to two skilled nurse visits per day.
(b) Ventilator-dependent recipients. (c) If the recipient is ventilator-dependent, the
monthly medical assistance authorization for home care services shall not exceed what the
commissioner would pay for care at the highest cost hospital designated as a long-term
hospital under the Medicare program. For purposes of this paragraph, home care services
means all direct care services provided in the home that would be included in the payment
for care at the long-term hospital. "Ventilator-dependent" means an individual who
receives mechanical ventilation for life support at least six hours per day and is expected
to be or has been dependent for at least 30 consecutive days. Recipients who meet the
definition of ventilator dependent and the EN home care rating and utilize a combination
of home care services are limited up to a total of 24 hours of home care services per day.
Additional hours may be authorized when a recipient's assessment indicates a need for two
staff to perform activities. Additional time is limited to four hours per day.
    Subd. 7. Prior Authorization; time limits. (a) The commissioner or the
commissioner's designee shall determine the time period for which a prior an authorization
shall be effective and, if flexible use has been requested, whether to allow the flexible use
option. If the recipient continues to require home care services beyond the duration of
the prior authorization, the home care provider must request a new prior authorization.
A personal care provider agency must request a new personal care assistant assistance
services assessment, or service update if allowed, at least 60 days prior to the end of
the current prior authorization time period. The request for the assessment must be
made on a form approved by the commissioner. Under no circumstances, other than the
exceptions in subdivision 4, shall a prior An authorization must be valid prior to the date
the commissioner receives the request or for no more than 12 months.
(b) The amount and type of personal care assistance services authorized based
upon the assessment and service plan must remain in effect for the recipient whether
the recipient chooses a different provider or enrolls or disenrolls from a managed care
plan under section 256B.0659, unless the service needs of the recipient change and new
assessment is warranted under section 256B.0655, subdivision 1b.
(c) A recipient who appeals a reduction in previously authorized home care
services may continue previously authorized services, other than temporary services
under subdivision 8, pending an appeal under section 256.045. The commissioner must
provide ensure that the recipient has a copy of the most recent service plan that contains
a detailed explanation of why the authorized services which areas of covered personal
care assistance tasks are reduced in amount from those requested by the home care
provider, and provide notice of the amount of time per day reduced, and the reasons for
the reduction in the recipient's notice of denial, termination, or reduction.
    Subd. 8. Prior Authorization requests; temporary services. The agency nurse,
the independently enrolled private duty nurse, or county public health nurse may request
a temporary authorization for home care services by telephone. The commissioner may
approve a temporary level of home care services based on the assessment, and service
or care plan information, and primary payer coverage determination information as
required. Authorization for a temporary level of home care services including nurse
supervision is limited to the time specified by the commissioner, but shall not exceed
45 days, unless extended because the county public health nurse has not completed the
required assessment and service plan, or the commissioner's determination has not been
made. The level of services authorized under this provision shall have no bearing on a
future prior authorization.
    Subd. 9. Prior Authorization for foster care setting. (a) Home care services
provided in an adult or child foster care setting must receive prior authorization by the
department commissioner according to the limits established in subdivision 11.
(b) The commissioner may not authorize:
(1) home care services that are the responsibility of the foster care provider under
the terms of the foster care placement agreement, difficulty of care rate as of January 1,
2010, and administrative rules;
(2) personal care assistant assistance services when the foster care license holder is
also the personal care provider or personal care assistant unless the recipient can direct the
recipient's own care, or case management is provided as required in section 256B.0625,
subdivision 19a
, unless the foster home is the licensed provider's primary residence as
defined in section 256B.0625, subdivision 19a; or
(3) personal care assistant services when the responsible party is an employee of, or
under contract with, or has any direct or indirect financial relationship with the personal
care provider or personal care assistant, unless case management is provided as required
in section 256B.0625, subdivision 19a; or
(4) (3) personal care assistant and private duty nursing services when the number
of foster care residents licensed capacity is greater than four unless the county responsible
for the recipient's foster placement made the placement prior to April 1, 1992, requests
that personal care assistant and private duty nursing services be provided, and case
management is provided as required in section 256B.0625, subdivision 19a.
    Subd. 10. Limitation on payments. Medical assistance payments for home care
services shall be limited according to subdivisions 4 to 12 and sections 256B.0654,
subdivision 2
, and 256B.0655, subdivisions 3 and 4.
    Subd. 11. Limits on services without prior authorization. A recipient may receive
the following home care services during a calendar year:
(1) up to two face-to-face assessments to determine a recipient's need for personal
care assistant assistance services;
(2) one service update done to determine a recipient's need for personal care assistant
assistance services; and
(3) up to nine face-to-face skilled nurse visits.
    Subd. 12. Approval of home care services. The commissioner or the
commissioner's designee shall determine the medical necessity of home care services,
the level of caregiver according to subdivision 2, and the institutional comparison
according to subdivisions 4 to 12 and sections 256B.0654, subdivision 2, and 256B.0655,
subdivisions 3 and 4
, and 256B.0659, the cost-effectiveness of services, and the amount,
scope, and duration of home care services reimbursable by medical assistance, based
on the assessment, primary payer coverage determination information as required, the
service plan, the recipient's age, the cost of services, the recipient's medical condition, and
diagnosis or disability. The commissioner may publish additional criteria for determining
medical necessity according to section 256B.04.
    Subd. 13. Recovery of excessive payments. The commissioner shall seek
monetary recovery from providers of payments made for services which exceed the limits
established in this section and sections 256B.0653 to 256B.0656, and 256B.0659. This
subdivision does not apply to services provided to a recipient at the previously authorized
level pending an appeal under section 256.045, subdivision 10.
    Subd. 14. Referrals to Medicare providers required. Home care providers that
do not participate in or accept Medicare assignment must refer and document the referral
of dual-eligible recipients to Medicare providers when Medicare is determined to be the
appropriate payer for services and supplies and equipment. Providers must be terminated
from participation in the medical assistance program for failure to make these referrals.
    Subd. 15. Quality assurance for program integrity. The commissioner shall
establish an ongoing quality assurance process for home care services to monitor program
integrity, including provider standards and training, consumer surveys, and random
reviews of documentation.
    Subd. 16. Oversight of enrolled providers. The commissioner has the authority to
request proof of documentation of meeting provider standards, quality standards of care,
correct billing practices, and other information. Failure to comply with or to provide access
and information to demonstrate compliance with laws, rules, or policies may result in
suspension, denial, or termination of the provider agency's enrollment with the department.

    Sec. 24. Minnesota Statutes 2008, section 256B.0652, is amended to read:
256B.0652 PRIOR AUTHORIZATION AND REVIEW OF HOME CARE
SERVICES.
    Subdivision 1. State coordination. The commissioner shall supervise the
coordination of the prior authorization and review of home care services that are
reimbursed by medical assistance.
    Subd. 2. Duties. (a) The commissioner may contract with or employ qualified
registered nurses and necessary support staff, or contract with qualified agencies, to
provide home care prior authorization and review services for medical assistance
recipients who are receiving home care services.
(b) Reimbursement for the prior authorization function shall be made through the
medical assistance administrative authority. The state shall pay the nonfederal share.
The functions will be to:
(1) assess the recipient's individual need for services required to be cared for safely
in the community;
(2) ensure that a service care plan that meets the recipient's needs is developed
by the appropriate agency or individual;
(3) ensure cost-effectiveness and nonduplication of medical assistance home care
services;
(4) recommend the approval or denial of the use of medical assistance funds to pay
for home care services;
(5) reassess the recipient's need for and level of home care services at a frequency
determined by the commissioner; and
(6) conduct on-site assessments when determined necessary by the commissioner
and recommend changes to care plans that will provide more efficient and appropriate
home care; and
(7) on the department's Web site:
(i) provide a link to MinnesotaHelp.info for a list of enrolled home care agencies
with the following information: main office address, contact information for the agency,
counties in which services are provided, type of home care services provided, whether
the personal care assistance choice option is offered, types of qualified professionals
employed, number of personal care assistants employed, and data on staff turnover; and
(ii) post data on home care services including information from both fee-for-service
and managed care plans on recipients as available.
(c) In addition, the commissioner or the commissioner's designee may:
(1) review care plans, service plans, and reimbursement data for utilization of
services that exceed community-based standards for home care, inappropriate home care
services, medical necessity, home care services that do not meet quality of care standards,
or unauthorized services and make appropriate referrals within the department or to other
appropriate entities based on the findings;
(2) assist the recipient in obtaining services necessary to allow the recipient to
remain safely in or return to the community;
(3) coordinate home care services with other medical assistance services under
section 256B.0625;
(4) assist the recipient with problems related to the provision of home care services;
(5) assure the quality of home care services; and
(6) assure that all liable third-party payers including, but not limited to, Medicare
have been used prior to medical assistance for home care services, including but not
limited to, home health agency, elected hospice benefit, waivered services, alternative care
program services, and personal care services.
(d) For the purposes of this section, "home care services" means medical assistance
services defined under section 256B.0625, subdivisions 6a, 7, and 19a.
    Subd. 3. Assessment and prior authorization process for persons receiving
personal care assistance and developmental disabilities services. Effective January 1,
1996, For purposes of providing informed choice, coordinating of local planning decisions,
and streamlining administrative requirements, the assessment and prior authorization
process for persons receiving both home care and home and community-based waivered
services for persons with developmental disabilities shall meet the requirements of
sections 256B.0651 and 256B.0653 to 256B.0656 with the following exceptions:
(a) Upon request for home care services and subsequent assessment by the public
health nurse under sections 256B.0651 and 256B.0653 to 256B.0656, the public health
nurse shall participate in the screening process, as appropriate, and, if home care
services are determined to be necessary, participate in the development of a service plan
coordinating the need for home care and home and community-based waivered services
with the assigned county case manager, the recipient of services, and the recipient's legal
representative, if any.
(b) The public health nurse shall give prior authorization for home care services
to the extent that home care services are:
(1) medically necessary;
(2) chosen by the recipient and their legal representative, if any, from the array of
home care and home and community-based waivered services available;
(3) coordinated with other services to be received by the recipient as described
in the service plan; and
(4) provided within the county's reimbursement limits for home care and home and
community-based waivered services for persons with developmental disabilities.
(c) If the public health agency is or may be the provider of home care services to the
recipient, the public health agency shall provide the commissioner of human services with
a written plan that specifies how the assessment and prior authorization process will be
held separate and distinct from the provision of services.

    Sec. 25. Minnesota Statutes 2008, section 256B.0653, is amended to read:
256B.0653 HOME HEALTH AGENCY COVERED SERVICES.
    Subdivision 1. Homecare; skilled nurse visits Scope. "Skilled nurse visits" are
provided in a recipient's residence under a plan of care or service plan that specifies a level
of care which the nurse is qualified to provide. These services are:
(1) nursing services according to the written plan of care or service plan and accepted
standards of medical and nursing practice in accordance with chapter 148;
(2) services which due to the recipient's medical condition may only be safely and
effectively provided by a registered nurse or a licensed practical nurse;
(3) assessments performed only by a registered nurse; and
(4) teaching and training the recipient, the recipient's family, or other caregivers
requiring the skills of a registered nurse or licensed practical nurse. This section applies to
home health agency services including, home health aide, skilled nursing visits, physical
therapy, occupational therapy, respiratory therapy, and speech language pathology therapy.
    Subd. 2. Telehomecare; skilled nurse visits Definitions. Medical assistance
covers skilled nurse visits according to section 256B.0625, subdivision 6a, provided via
telehomecare, for services which do not require hands-on care between the home care
nurse and recipient. The provision of telehomecare must be made via live, two-way
interactive audiovisual technology and may be augmented by utilizing store-and-forward
technologies. Store-and-forward technology includes telehomecare services that do not
occur in real time via synchronous transmissions, and that do not require a face-to-face
encounter with the recipient for all or any part of any such telehomecare visit. Individually
identifiable patient data obtained through real-time or store-and-forward technology must
be maintained as health records according to sections 144.291 to 144.298. If the video
is used for research, training, or other purposes unrelated to the care of the patient, the
identity of the patient must be concealed. A communication between the home care nurse
and recipient that consists solely of a telephone conversation, facsimile, electronic mail, or
a consultation between two health care practitioners, is not to be considered a telehomecare
visit. Multiple daily skilled nurse visits provided via telehomecare are allowed. Coverage
of telehomecare is limited to two visits per day. All skilled nurse visits provided via
telehomecare must be prior authorized by the commissioner or the commissioner's
designee and will be covered at the same allowable rate as skilled nurse visits provided
in-person. For the purposes of this section, the following terms have the meanings given.
(a) "Assessment" means an evaluation of the recipient's medical need for home
health agency services by a registered nurse or appropriate therapist that is conducted
within 30 days of a request.
(b) "Home care therapies" means occupational, physical, and respiratory therapy
and speech-language pathology services provided in the home by a Medicare certified
home health agency.
(c) "Home health agency services" means services delivered in the recipient's home
residence, except as specified in section 256B.0625, by a home health agency to a recipient
with medical needs due to illness, disability, or physical conditions.
(d) "Home health aide" means an employee of a home health agency who completes
medically oriented tasks written in the plan of care for a recipient.
(e) "Home health agency" means a home care provider agency that is
Medicare-certified.
(f) "Occupational therapy services" mean the services defined in Minnesota Rules,
part 9505.0390.
(g) "Physical therapy services" mean the services defined in Minnesota Rules, part
9505.0390.
(h) "Respiratory therapy services" mean the services defined in chapter 147C and
Minnesota Rules, part 4668.0003, subpart 37.
(i) "Speech-language pathology services" mean the services defined in Minnesota
Rules, part 9505.0390.
(j) "Skilled nurse visit" means a professional nursing visit to complete nursing tasks
required due to a recipient's medical condition that can only be safely provided by a
professional nurse to restore and maintain optimal health.
(k) "Store-and-forward technology" means telehomecare services that do not occur
in real time via synchronous transmissions such as diabetic and vital sign monitoring.
(l) "Telehomecare" means the use of telecommunications technology via
live, two-way interactive audiovisual technology which may be augmented by
store-and-forward technology.
(m) "Telehomecare skilled nurse visit" means a visit by a professional nurse to
deliver a skilled nurse visit to a recipient located at a site other than the site where the
nurse is located and is used in combination with face-to-face skilled nurse visits to
adequately meet the recipient's needs.
    Subd. 3. Therapies through home health agencies Home health aide visits.
(a) Medical assistance covers physical therapy and related services, including specialized
maintenance therapy. Services provided by a physical therapy assistant shall be
reimbursed at the same rate as services performed by a physical therapist when the
services of the physical therapy assistant are provided under the direction of a physical
therapist who is on the premises. Services provided by a physical therapy assistant that are
provided under the direction of a physical therapist who is not on the premises shall be
reimbursed at 65 percent of the physical therapist rate. Direction of the physical therapy
assistant must be provided by the physical therapist as described in Minnesota Rules, part
9505.0390, subpart 1, item B. The physical therapist and physical therapist assistant may
not both bill for services provided to a recipient on the same day.
(b) Medical assistance covers occupational therapy and related services, including
specialized maintenance therapy. Services provided by an occupational therapy assistant
shall be reimbursed at the same rate as services performed by an occupational therapist
when the services of the occupational therapy assistant are provided under the direction of
the occupational therapist who is on the premises. Services provided by an occupational
therapy assistant under the direction of an occupational therapist who is not on the
premises shall be reimbursed at 65 percent of the occupational therapist rate. Direction
of the occupational therapy assistant must be provided by the occupational therapist as
described in Minnesota Rules, part 9505.0390, subpart 1, item B. The occupational
therapist and occupational therapist assistant may not both bill for services provided
to a recipient on the same day.
(a) Home health aide visits must be provided by a certified home health aide
using a written plan of care that is updated in compliance with Medicare regulations.
A home health aide shall provide hands-on personal care, perform simple procedures
as an extension of therapy or nursing services, and assist in instrumental activities of
daily living as defined in section 256B.0659. Home health aide visits must be provided
in the recipient's home.
(b) All home health aide visits must have authorization under section 256B.0652.
The commissioner shall limit home health aide visits to no more than one visit per day
per recipient.
(c) Home health aides must be supervised by a registered nurse or an appropriate
therapist when providing services that are an extension of therapy.
    Subd. 4. Skilled nurse visit services. (a) Skilled nurse visit services must be
provided by a registered nurse or a licensed practical nurse under the supervision of a
registered nurse, according to the written plan of care and accepted standards of medical
and nursing practice according to chapter 148. Skilled nurse visit services must be ordered
by a physician and documented in a plan of care that is reviewed and approved by the
ordering physician at least once every 60 days. All skilled nurse visits must be medically
necessary and provided in the recipient's home residence except as allowed under section
256B.0625, subdivision 6a.
(b) Skilled nurse visits include face-to-face and telehomecare visits with a limit of
up to two visits per day per recipient. All visits must be based on assessed needs.
(c) Telehomecare skilled nurse visits are allowed when the recipient's health status
can be accurately measured and assessed without a need for a face-to-face, hands-on
encounter. All telehomecare skilled nurse visits must have authorization and are paid at
the same allowable rates as face-to-face skilled nurse visits.
(d) The provision of telehomecare must be made via live, two-way interactive
audiovisual technology and may be augmented by utilizing store-and-forward
technologies. Individually identifiable patient data obtained through real-time or
store-and-forward technology must be maintained as health records according to sections
144.291 to 144.298. If the video is used for research, training, or other purposes unrelated
to the care of the patient, the identity of the patient must be concealed.
(e) Authorization for skilled nurse visits must be completed under section
256B.0652. A total of nine face-to-face skilled nurses visits per calendar year do not
require authorization. All telehomecare skilled nurse visits require authorization.
    Subd. 5. Home care therapies. (a) Home care therapies include the following:
physical therapy, occupational therapy, respiratory therapy, and speech and language
pathology therapy services.
(b) Home care therapies must be:
(1) provided in the recipient's residence after it has been determined the recipient is
unable to access outpatient therapy;
(2) prescribed, ordered, or referred by a physician and documented in a plan of care
and reviewed, according to Minnesota Rules, part 9505.0390;
(3) assessed by an appropriate therapist; and
(4) provided by a Medicare-certified home health agency enrolled as a Medicaid
provider agency.
(c) Restorative and specialized maintenance therapies must be provided according to
Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be
used as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.
(d) For both physical and occupational therapies, the therapist and the therapist's
assistant may not both bill for services provided to a recipient on the same day.
    Subd. 6. Noncovered home health agency services. The following are not eligible
for payment under medical assistance as a home health agency service:
(1) telehomecare skilled nurses services that is communication between the home
care nurse and recipient that consists solely of a telephone conversation, facsimile,
electronic mail, or a consultation between two health care practitioners;
(2) the following skilled nurse visits:
(i) for the purpose of monitoring medication compliance with an established
medication program for a recipient;
(ii) administering or assisting with medication administration, including injections,
prefilling syringes for injections, or oral medication setup of an adult recipient, when,
as determined and documented by the registered nurse, the need can be met by an
available pharmacy or the recipient or a family member is physically and mentally able
to self-administer or prefill a medication;
(iii) services done for the sole purpose of supervision of the home health aide or
personal care assistant;
(iv) services done for the sole purpose to train other home health agency workers;
(v) services done for the sole purpose of blood samples or lab draw when the
recipient is able to access these services outside the home; and
(vi) Medicare evaluation or administrative nursing visits required by Medicare;
(3) home health aide visits when the following activities are the sole purpose for the
visit: companionship, socialization, household tasks, transportation, and education; and
(4) home care therapies provided in other settings such as a clinic, day program, or as
an inpatient or when the recipient can access therapy outside of the recipient's residence.

    Sec. 26. Minnesota Statutes 2008, section 256B.0654, is amended to read:
256B.0654 PRIVATE DUTY NURSING.
    Subdivision 1. Definitions. (a) "Assessment" means a review and evaluation of a
recipient's need for home care services conducted in person. Assessments for private duty
nursing shall be conducted by a registered private duty nurse. Assessments for medical
assistance home care services for developmental disabilities and alternative care services
for developmentally disabled home and community-based waivered recipients may be
conducted by the county public health nurse to ensure coordination and avoid duplication.
(b) (a) "Complex and regular private duty nursing care" means:
(1) complex care is private duty nursing services provided to recipients who are
ventilator dependent or for whom a physician has certified that were it not for private duty
nursing the recipient would meet the criteria for inpatient hospital intensive care unit
(ICU) level of care; and
(2) regular care is private duty nursing provided to all other recipients.
(b) "Private duty nursing" means ongoing professional nursing services by a
registered or licensed practical nurse including assessment, professional nursing tasks, and
education, based on an assessment and physician orders to maintain or restore optimal
health of the recipient.
(c) "Private duty nursing agency" means a medical assistance enrolled provider
licensed under chapter 144A to provide private duty nursing services.
(d) "Regular private duty nursing" means nursing services provided to a recipient
who is considered stable and not at an inpatient hospital intensive care unit level of care,
but may have episodes of instability that are not life threatening.
(e) "Shared private duty nursing" means the provision of nursing services by a
private duty nurse to two recipients at the same time and in the same setting.
    Subd. 2. Authorization; private duty nursing services. (a) All private duty
nursing services shall be prior authorized by the commissioner or the commissioner's
designee. Prior Authorization for private duty nursing services shall be based on
medical necessity and cost-effectiveness when compared with alternative care options.
The commissioner may authorize medically necessary private duty nursing services in
quarter-hour units when:
(1) the recipient requires more individual and continuous care than can be provided
during a skilled nurse visit; or
(2) the cares are outside of the scope of services that can be provided by a home
health aide or personal care assistant.
(b) The commissioner may authorize:
(1) up to two times the average amount of direct care hours provided in nursing
facilities statewide for case mix classification "K" as established by the annual cost report
submitted to the department by nursing facilities in May 1992;
(2) private duty nursing in combination with other home care services up to the total
cost allowed under section 256B.0655, subdivision 4;
(3) up to 16 hours per day if the recipient requires more nursing than the maximum
number of direct care hours as established in clause (1) and the recipient meets the hospital
admission criteria established under Minnesota Rules, parts 9505.0501 to 9505.0540.
(c) The commissioner may authorize up to 16 hours per day of medically necessary
private duty nursing services or up to 24 hours per day of medically necessary private duty
nursing services until such time as the commissioner is able to make a determination of
eligibility for recipients who are cooperatively applying for home care services under
the community alternative care program developed under section 256B.49, or until it is
determined by the appropriate regulatory agency that a health benefit plan is or is not
required to pay for appropriate medically necessary health care services. Recipients
or their representatives must cooperatively assist the commissioner in obtaining this
determination. Recipients who are eligible for the community alternative care program
may not receive more hours of nursing under this section and sections 256B.0651,
256B.0653, 256B.0655, and 256B.0656, and 256B.0659 than would otherwise be
authorized under section 256B.49.
    Subd. 2a. Private duty nursing services. (a) Private duty nursing services must
be used:
(1) in the recipient's home or outside the home when normal life activities require;
(2) when the recipient requires more individual and continuous care than can be
provided during a skilled nurse visit; and
(3) when the care required is outside of the scope of services that can be provided by
a home health aide or personal care assistant.
(b) Private duty nursing services must be:
(1) assessed by a registered nurse on a form approved by the commissioner;
(2) ordered by a physician and documented in a plan of care that is reviewed by the
physician at least once every 60 days; and
(3) authorized by the commissioner under section 256B.0652.
    Subd. 2b. Noncovered private duty nursing services. Private duty nursing
services do not cover the following:
(1) nursing services by a nurse who is the family foster care provider of a person
who has not reached 18 years of age unless allowed under subdivision 4;
(2) nursing services to more than two persons receiving shared private duty nursing
services from a private duty nurse in a single setting; and
(3) nursing services provided by a registered nurse or licensed practical nurse who is
the recipient's legal guardian or related to the recipient as spouse, parent, or family foster
parent whether by blood, marriage, or adoption except as specified in section 256B.0652,
subdivision 4.
    Subd. 3. Shared private duty nursing care option. (a) Medical assistance
payments for shared private duty nursing services by a private duty nurse shall be limited
according to this subdivision. For the purposes of this section and sections 256B.0651,
256B.0653, 256B.0655, and 256B.0656, "private duty nursing agency" means an agency
licensed under chapter 144A to provide private duty nursing services. Unless otherwise
provided in this subdivision, all other statutory and regulatory provisions relating to
private duty nursing services apply to shared private duty nursing services. Nothing in
this subdivision shall be construed to reduce the total number of private duty nursing
hours authorized for an individual recipient.
(b) Recipients of private duty nursing services may share nursing staff and the
commissioner shall provide a rate methodology for shared private duty nursing. For two
persons sharing nursing care, the rate paid to a provider shall not exceed 1.5 times the
regular private duty nursing rates paid for serving a single individual by a registered nurse
or licensed practical nurse. These rates apply only to situations in which both recipients
are present and receive shared private duty nursing care on the date for which the service
is billed. No more than two persons may receive shared private duty nursing services
from a private duty nurse in a single setting.
(c) (b) Shared private duty nursing care is the provision of nursing services by a
private duty nurse to two medical assistance eligible recipients at the same time and in
the same setting. This subdivision does not apply when a private duty nurse is caring for
multiple recipients in more than one setting.
(c) For the purposes of this subdivision, "setting" means:
(1) the home residence or foster care home of one of the individual recipients as
defined in section 256B.0651; or
(2) a child care program licensed under chapter 245A or operated by a local school
district or private school; or
(3) an adult day care service licensed under chapter 245A; or
(4) outside the home residence or foster care home of one of the recipients when
normal life activities take the recipients outside the home.
This subdivision does not apply when a private duty nurse is caring for multiple
recipients in more than one setting.
(d) The private duty nursing agency must offer the recipient the option of shared or
one-on-one private duty nursing services. The recipient may withdraw from participating
in a shared service arrangement at any time.
(d) (e) The recipient or the recipient's legal representative, and the recipient's
physician, in conjunction with the home health care private duty nursing agency, shall
determine:
(1) whether shared private duty nursing care is an appropriate option based on the
individual needs and preferences of the recipient; and
(2) the amount of shared private duty nursing services authorized as part of the
overall authorization of nursing services.
(e) (f) The recipient or the recipient's legal representative, in conjunction with the
private duty nursing agency, shall approve the setting, grouping, and arrangement of
shared private duty nursing care based on the individual needs and preferences of the
recipients. Decisions on the selection of recipients to share services must be based on the
ages of the recipients, compatibility, and coordination of their care needs.
(f) (g) The following items must be considered by the recipient or the recipient's
legal representative and the private duty nursing agency, and documented in the recipient's
health service record:
(1) the additional training needed by the private duty nurse to provide care to
two recipients in the same setting and to ensure that the needs of the recipients are met
appropriately and safely;
(2) the setting in which the shared private duty nursing care will be provided;
(3) the ongoing monitoring and evaluation of the effectiveness and appropriateness
of the service and process used to make changes in service or setting;
(4) a contingency plan which accounts for absence of the recipient in a shared private
duty nursing setting due to illness or other circumstances;
(5) staffing backup contingencies in the event of employee illness or absence; and
(6) arrangements for additional assistance to respond to urgent or emergency care
needs of the recipients.
(g) The provider must offer the recipient or responsible party the option of shared or
one-on-one private duty nursing services. The recipient or responsible party can withdraw
from participating in a shared service arrangement at any time.
(h) The private duty nursing agency must document the following in the
health service record for each individual recipient sharing private duty nursing care
The documentation for shared private duty nursing must be on a form approved by
the commissioner for each individual recipient sharing private duty nursing. The
documentation must be part of the recipient's health service record and include:
(1) permission by the recipient or the recipient's legal representative for the
maximum number of shared nursing care hours per week chosen by the recipient and
permission for shared private duty nursing services provided in and outside the recipient's
home residence;
(2) permission by the recipient or the recipient's legal representative for shared
private duty nursing services provided outside the recipient's residence;
(3) permission by the recipient or the recipient's legal representative for others to
receive shared private duty nursing services in the recipient's residence;
(4) revocation by the recipient or the recipient's legal representative of for the shared
private duty nursing care authorization, or the shared care to be provided to others in the
recipient's residence, or the shared private duty nursing services to be provided outside
permission, or services provided to others in and outside the recipient's residence; and
(5) (3) daily documentation of the shared private duty nursing services provided by
each identified private duty nurse, including:
(i) the names of each recipient receiving shared private duty nursing services
together;
(ii) the setting for the shared services, including the starting and ending times that
the recipient received shared private duty nursing care; and
(iii) notes by the private duty nurse regarding changes in the recipient's condition,
problems that may arise from the sharing of private duty nursing services, and scheduling
and care issues.
(i) Unless otherwise provided in this subdivision, all other statutory and regulatory
provisions relating to private duty nursing services apply to shared private duty nursing
services.
Nothing in this subdivision shall be construed to reduce the total number of private
duty nursing hours authorized for an individual recipient under subdivision 2.
(i) The commissioner shall provide a rate methodology for shared private duty
nursing. For two persons sharing nursing care, the rate paid to a provider must not exceed
1.5 times the regular private duty nursing rates paid for serving a single individual by a
registered nurse or licensed practical nurse. These rates apply only to situations in which
both recipients are present and receive shared private duty nursing care on the date for
which the service is billed.
    Subd. 4. Hardship criteria; private duty nursing. (a) Payment is allowed for
extraordinary services that require specialized nursing skills and are provided by parents
of minor children, family foster parents, spouses, and legal guardians who are providing
private duty nursing care under the following conditions:
(1) the provision of these services is not legally required of the parents, spouses,
or legal guardians;
(2) the services are necessary to prevent hospitalization of the recipient; and
(3) the recipient is eligible for state plan home care or a home and community-based
waiver and one of the following hardship criteria are met:
(i) the parent, spouse, or legal guardian resigns from a part-time or full-time job to
provide nursing care for the recipient; or
(ii) the parent, spouse, or legal guardian goes from a full-time to a part-time job with
less compensation to provide nursing care for the recipient; or
(iii) the parent, spouse, or legal guardian takes a leave of absence without pay to
provide nursing care for the recipient; or
(iv) because of labor conditions, special language needs, or intermittent hours of
care needed, the parent, spouse, or legal guardian is needed in order to provide adequate
private duty nursing services to meet the medical needs of the recipient.
(b) Private duty nursing may be provided by a parent, spouse, family foster parent,
or legal guardian who is a nurse licensed in Minnesota. Private duty nursing services
provided by a parent, spouse, family foster parent, or legal guardian cannot be used in
lieu of nursing services covered and available under liable third-party payors, including
Medicare. The private duty nursing provided by a parent, spouse, family foster parent, or
legal guardian must be included in the service plan agreement. Authorized skilled nursing
services for a single recipient or recipients with the same residence and provided by the
parent, spouse, family foster parent, or legal guardian may not exceed 50 percent of the
total approved nursing hours, or eight hours per day, whichever is less, up to a maximum
of 40 hours per week. A parent or parents, spouse, family foster parent, or legal guardian
shall not provide more than 40 hours of services in a seven-day period. For parents, family
foster parents, and legal guardians, 40 hours is the total amount allowed regardless of the
number of children or adults who receive services. Nothing in this subdivision precludes
the parent's, spouse's, or legal guardian's obligation of assuming the nonreimbursed family
responsibilities of emergency backup caregiver and primary caregiver.
(c) A parent, family foster parent, or a spouse may not be paid to provide private
duty nursing care if:
(1) the parent or spouse fails to pass a criminal background check according to
chapter 245C, or if;
(2) it has been determined by the home health private duty nursing agency, the
case manager, or the physician that the private duty nursing care provided by the parent,
family foster parent, spouse, or legal guardian is unsafe; or
(3) the parent, family foster parent, spouse, or legal guardian do not follow physician
orders.
(d) For purposes of this section, "assessment" means a review and evaluation of a
recipient's need for home care services conducted in person. Assessments for private duty
nursing must be conducted by a registered nurse.

    Sec. 27. Minnesota Statutes 2008, section 256B.0655, subdivision 1b, is amended to
read:
    Subd. 1b. Assessment. "Assessment" means a review and evaluation of a recipient's
need for home care services conducted in person. Assessments for personal care assistant
services shall be conducted by the county public health nurse or a certified public
health nurse under contract with the county. A face-to-face An in-person assessment
must include: documentation of health status, determination of need, evaluation of
service effectiveness, identification of appropriate services, service plan development
or modification, coordination of services, referrals and follow-up to appropriate payers
and community resources, completion of required reports, recommendation of service
authorization, and consumer education. Once the need for personal care assistant
services is determined under this section or sections 256B.0651, 256B.0653, 256B.0654,
and 256B.0656, the county public health nurse or certified public health nurse under
contract with the county is responsible for communicating this recommendation to the
commissioner and the recipient. A face-to-face assessment for personal care assistant
services is conducted on those recipients who have never had a county public health
nurse assessment. A face-to-face An in-person assessment must occur at least annually or
when there is a significant change in the recipient's condition or when there is a change
in the need for personal care assistant services. A service update may substitute for
the annual face-to-face assessment when there is not a significant change in recipient
condition or a change in the need for personal care assistant service. A service update
may be completed by telephone, used when there is no need for an increase in personal
care assistant services, and used for two consecutive assessments if followed by a
face-to-face assessment. A service update must be completed on a form approved by the
commissioner. A service update or review for temporary increase includes a review of
initial baseline data, evaluation of service effectiveness, redetermination of service need,
modification of service plan and appropriate referrals, update of initial forms, obtaining
service authorization, and on going consumer education. Assessments must be completed
on forms provided by the commissioner within 30 days of a request for home care services
by a recipient or responsible party or personal care provider agency.

    Sec. 28. Minnesota Statutes 2008, section 256B.0655, subdivision 4, is amended to
read:
    Subd. 4. Prior Authorization; personal care assistance and qualified
professional. The commissioner, or the commissioner's designee, shall review the
assessment, service update, request for temporary services, request for flexible use option,
service plan, and any additional information that is submitted. The commissioner shall,
within 30 days after receiving a complete request, assessment, and service plan, authorize
home care services as follows:
(1) (a) All personal care assistant assistance services and, supervision by a
qualified professional, if requested by the recipient, and additional services beyond the
limits established in section 256B.0651, subdivision 11, must be prior authorized by
the commissioner or the commissioner's designee before services begin except for the
assessments established in section sections 256B.0651, subdivision 11, and 256B.0911.
The authorization for personal care assistance and qualified professional services under
section 256B.0659 must be completed within 30 days after receiving a complete request.
(b) The amount of personal care assistant assistance services authorized must be
based on the recipient's home care rating. The home care rating shall be determined by
the commissioner or the commissioner's designee based on information submitted to the
commissioner identifying the following:
(1) total number of dependencies of activities of daily living as defined in section
256B.0659;
(2) number of complex health-related functions as defined in section 256B.0659; and
(3) number of behavior descriptions as defined in section 256B.0659.
(c) The methodology to determine total time for personal care assistance services for
each home care rating is based on the median paid units per day for each home care rating
from fiscal year 2007 data for the personal care assistance program. Each home care rating
has a base level of hours assigned. Additional time is added through the assessment and
identification of the following:
(1) 30 additional minutes per day for a dependency in each critical activity of daily
living as defined in section 256B.0659;
(2) 30 additional minutes per day for each complex health-related function as
defined in section 256B.0659; and
(3) 30 additional minutes per day for each behavior issue as defined in section
256B.0659.
(d) A limit of 96 units of qualified professional supervision may be authorized for
each recipient receiving personal care assistance services. A request to the commissioner
to exceed this total in a calendar year must be requested by the personal care provider
agency on a form approved by the commissioner.
A child may not be found to be dependent in an activity of daily living if because
of the child's age an adult would either perform the activity for the child or assist the
child with the activity and the amount of assistance needed is similar to the assistance
appropriate for a typical child of the same age. Based on medical necessity, the
commissioner may authorize:
(A) up to two times the average number of direct care hours provided in nursing
facilities for the recipient's comparable case mix level; or
(B) up to three times the average number of direct care hours provided in nursing
facilities for recipients who have complex medical needs or are dependent in at least seven
activities of daily living and need physical assistance with eating or have a neurological
diagnosis; or
(C) up to 60 percent of the average reimbursement rate, as of July 1, 1991, for care
provided in a regional treatment center for recipients who have Level I behavior, plus any
inflation adjustment as provided by the legislature for personal care service; or
(D) up to the amount the commissioner would pay, as of July 1, 1991, plus any
inflation adjustment provided for home care services, for care provided in a regional
treatment center for recipients referred to the commissioner by a regional treatment center
preadmission evaluation team. For purposes of this clause, home care services means
all services provided in the home or community that would be included in the payment
to a regional treatment center; or
(E) up to the amount medical assistance would reimburse for facility care for
recipients referred to the commissioner by a preadmission screening team established
under section 256B.0911 or 256B.092; and
(F) a reasonable amount of time for the provision of supervision by a qualified
professional of personal care assistant services, if a qualified professional is requested by
the recipient or responsible party.
(2) The number of direct care hours shall be determined according to the annual cost
report submitted to the department by nursing facilities. The average number of direct care
hours, as established by May 1, 1992, shall be calculated and incorporated into the home
care limits on July 1, 1992. These limits shall be calculated to the nearest quarter hour.
(3) The home care rating shall be determined by the commissioner or the
commissioner's designee based on information submitted to the commissioner by the
county public health nurse on forms specified by the commissioner. The home care rating
shall be a combination of current assessment tools developed under sections 256B.0911
and 256B.501 with an addition for seizure activity that will assess the frequency and
severity of seizure activity and with adjustments, additions, and clarifications that are
necessary to reflect the needs and conditions of recipients who need home care including
children and adults under 65 years of age. The commissioner shall establish these forms
and protocols under this section and sections 256B.0651, 256B.0653, 256B.0654, and
256B.0656 and shall use an advisory group, including representatives of recipients,
providers, and counties, for consultation in establishing and revising the forms and
protocols.
(4) A recipient shall qualify as having complex medical needs if the care required is
difficult to perform and because of recipient's medical condition requires more time than
community-based standards allow or requires more skill than would ordinarily be required
and the recipient needs or has one or more of the following:
(A) daily tube feedings;
(B) daily parenteral therapy;
(C) wound or decubiti care;
(D) postural drainage, percussion, nebulizer treatments, suctioning, tracheotomy
care, oxygen, mechanical ventilation;
(E) catheterization;
(F) ostomy care;
(G) quadriplegia; or
(H) other comparable medical conditions or treatments the commissioner determines
would otherwise require institutional care.
(5) A recipient shall qualify as having Level I behavior if there is reasonable
supporting evidence that the recipient exhibits, or that without supervision, observation, or
redirection would exhibit, one or more of the following behaviors that cause, or have the
potential to cause:
(A) injury to the recipient's own body;
(B) physical injury to other people; or
(C) destruction of property.
(6) Time authorized for personal care relating to Level I behavior in paragraph
(5), clauses (A) to (C), shall be based on the predictability, frequency, and amount of
intervention required.
(7) A recipient shall qualify as having Level II behavior if the recipient exhibits on a
daily basis one or more of the following behaviors that interfere with the completion of
personal care assistant services under subdivision 2, paragraph (a):
(A) unusual or repetitive habits;
(B) withdrawn behavior; or
(C) offensive behavior.
(8) A recipient with a home care rating of Level II behavior in paragraph (7), clauses
(A) to (C), shall be rated as comparable to a recipient with complex medical needs under
paragraph (4). If a recipient has both complex medical needs and Level II behavior, the
home care rating shall be the next complex category up to the maximum rating under
paragraph (1), clause (B).
EFFECTIVE DATE.The amendments to paragraphs (a) and (b) are effective
January 1, 2010.

    Sec. 29. Minnesota Statutes 2008, section 256B.0657, subdivision 8, is amended to
read:
    Subd. 8. Self-directed budget requirements. The budget for the provision of the
self-directed service option shall be equal to the greater of either established based on:
    (1) the annual amount of personal care assistant services under section 256B.0655
that the recipient has used in the most recent 12-month period assessed personal care
assistance units, not to exceed the maximum number of personal care assistance units
available, as determined by section 256B.0655; or and
    (2) the amount determined using the consumer support grant methodology under
section 256.476, subdivision 11, except that the budget amount shall include the federal
and nonfederal share of the average service costs. the personal care assistance unit rate:
    (i) with a reduction to the unit rate to pay for a program administrator as defined in
subdivision 10; and
    (ii) an additional adjustment to the unit rate as needed to ensure cost neutrality for
the state.

    Sec. 30. Minnesota Statutes 2008, section 256B.0657, is amended by adding a
subdivision to read:
    Subd. 12. Enrollment and evaluation. Enrollment in the self-directed supports
option is available to current personal care assistance recipients upon annual personal care
assistance reassessment, with a maximum enrollment of 1,000 people in the first fiscal
year of implementation and an additional 1,000 people in the second fiscal year. The
commissioner shall evaluate the self-directed supports option during the first two years of
implementation and make any necessary changes prior to the option becoming available
statewide.

    Sec. 31. [256B.0659] PERSONAL CARE ASSISTANCE PROGRAM.
    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in
paragraphs (b) to (p) have the meanings given unless otherwise provided in text.
(b) "Activities of daily living" means grooming, dressing, bathing, transferring,
mobility, positioning, eating, and toileting.
(c) "Behavior," effective January 1, 2010, means a category to determine the home
care rating and is based on the criteria found in this section. "Level I behavior" means
physical aggression towards self, others, or destruction of property that requires the
immediate response of another person.
(d) "Complex health-related needs," effective January 1, 2010, means a category to
determine the home care rating and is based on the criteria found in this section.
(e) "Critical activities of daily living," effective January 1, 2010, means transferring,
mobility, eating, and toileting.
(f) "Dependency in activities of daily living" means a person requires assistance to
begin and complete one or more of the activities of daily living.
(g) "Health-related procedures and tasks" means procedures and tasks that can
be delegated or assigned by a licensed health care professional under state law to be
performed by a personal care assistant.
(h) "Instrumental activities of daily living" means activities to include meal planning
and preparation; basic assistance with paying bills; shopping for food, clothing, and
other essential items; performing household tasks integral to the personal care assistance
services; communication by telephone and other media; and traveling, including to
medical appointments and to participate in the community.
(i) "Managing employee" has the same definition as Code of Federal Regulations,
title 42, section 455.
(j) "Qualified professional" means a professional providing supervision of personal
care assistance services and staff as defined in section 256B.0625, subdivision 19c.
(k) "Personal care assistance provider agency" means a medical assistance enrolled
provider that provides or assists with providing personal care assistance services and
includes personal care assistance provider organizations, personal care assistance choice
agency, class A licensed nursing agency, and Medicare-certified home health agency.
(l) "Personal care assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.
(m) "Personal care assistance care plan" means a written description of personal
care assistance services developed by the personal care assistance provider according
to the service plan.
(n) "Responsible party" means an individual who is capable of providing the support
necessary to assist the recipient to live in the community.
(o) "Self-administered medication" means medication taken orally, by injection or
insertion, or applied topically without the need for assistance.
(p) "Service plan" means a written summary of the assessment and description of the
services needed by the recipient.
    Subd. 2. Personal care assistance services; covered services. (a) The personal
care assistance services eligible for payment include services and supports furnished
to an individual, as needed, to assist in:
(1) activities of daily living;
(2) health-related procedures and tasks;
(3) observation and redirection of behaviors; and
(4) instrumental activities of daily living.
(b) Activities of daily living include the following covered services:
(1) dressing, including assistance with choosing, application, and changing of
clothing and application of special appliances, wraps, or clothing;
(2) grooming, including assistance with basic hair care, oral care, shaving, applying
cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included,
except for recipients who are diabetic or have poor circulation;
(3) bathing, including assistance with basic personal hygiene and skin care;
(4) eating, including assistance with hand washing and application of orthotics
required for eating, transfers, and feeding;
(5) transfers, including assistance with transferring the recipient from one seating or
reclining area to another;
(6) mobility, including assistance with ambulation, including use of a wheelchair.
Mobility does not include providing transportation for a recipient;
(7) positioning, including assistance with positioning or turning a recipient for
necessary care and comfort; and
(8) toileting, including assistance with helping recipient with bowel or bladder
elimination and care including transfers, mobility, positioning, feminine hygiene, use of
toileting equipment or supplies, cleansing the perineal area, inspection of the skin, and
adjusting clothing.
(c) Health-related procedures and tasks include the following covered services:
(1) range of motion and passive exercise to maintain a recipient's strength and
muscle functioning;
(2) assistance with self-administered medication as defined by this section, including
reminders to take medication, bringing medication to the recipient, and assistance with
opening medication under the direction of the recipient or responsible party;
(3) interventions for seizure disorders, including monitoring and observation; and
(4) other activities considered within the scope of the personal care service and
meeting the definition of health-related procedures and tasks under this section.
(d) A personal care assistant may provide health-related procedures and tasks
associated with the complex health-related needs of a recipient if the procedures and
tasks meet the definition of health-related procedures and tasks under this section and the
personal care assistant is trained by a qualified professional and demonstrates competency
to safely complete the procedures and tasks. Delegation of health-related procedures and
tasks and all training must be documented in the personal care assistance care plan and the
recipient's and personal care assistant's files.
(e) Effective January 1, 2010, for a personal care assistant to provide the
health-related procedures and tasks of tracheostomy suctioning and services to recipients
on ventilator support there must be:
(1) delegation and training by a registered nurse, certified or licensed respiratory
therapist, or a physician;
(2) utilization of clean rather than sterile procedure;
(3) specialized training about the health-related procedures and tasks and equipment,
including ventilator operation and maintenance;
(4) individualized training regarding the needs of the recipient; and
(5) supervision by a qualified professional who is a registered nurse.
(f) Effective January 1, 2010, a personal care assistant may observe and redirect the
recipient for episodes where there is a need for redirection due to behaviors. Training of
the personal care assistant must occur based on the needs of the recipient, the personal
care assistance care plan, and any other support services provided.
(g) Instrumental activities of daily living under subdivision 1, paragraph (h).
    Subd. 3. Noncovered personal care assistance services. (a) Personal care
assistance services are not eligible for medical assistance payment under this section
when provided:
(1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal
guardian, licensed foster provider, except as allowed under section 256B.0651, subdivision
9a, or responsible party;
(2) in lieu of other staffing options in a residential or child care setting;
(3) solely as a child care or babysitting service; or
(4) without authorization by the commissioner or the commissioner's designee.
(b) The following personal care services are not eligible for medical assistance
payment under this section when provided in residential settings:
(1) effective January 1, 2010, when the provider of home care services who is not
related by blood, marriage, or adoption owns or otherwise controls the living arrangement,
including licensed or unlicensed services; or
(2) when personal care assistance services are the responsibility of a residential or
program license holder under the terms of a service agreement and administrative rules.
(c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible
for medical assistance reimbursement for personal care assistance services under this
section include:
(1) sterile procedures;
(2) injections of fluids and medications into veins, muscles, or skin;
(3) home maintenance or chore services;
(4) homemaker services not an integral part of assessed personal care assistance
services needed by a recipient;
(5) application of restraints or implementation of procedures under section 245.825;
(6) instrumental activities of daily living for children under the age of 18; and
(7) assessments for personal care assistance services by personal care assistance
provider agencies or by independently enrolled registered nurses.
    Subd. 4. Assessment for personal care assistance services. (a) An assessment
as defined in section 256B.0655, subdivision 1b, must be completed for personal care
assistance services.
(b) The following limitations apply to the assessment:
(1) a person must be assessed as dependent in an activity of daily living based
on the person's need, on a daily basis, for:
(i) cueing and constant supervision to complete the task; or
(ii) hands-on assistance to complete the task; and
(2) a child may not be found to be dependent in an activity of daily living if because
of the child's age an adult would either perform the activity for the child or assist the child
with the activity. Assistance needed is the assistance appropriate for a typical child of
the same age.
(c) Assessment for complex health-related needs must meet the criteria in this
paragraph. During the assessment process, a recipient qualifies as having complex
health-related needs if the recipient has one or more of the interventions that are ordered by
a physician, specified in a personal care assistance care plan, and found in the following:
(1) tube feedings requiring:
(i) a gastro/jejunostomy tube; or
(ii) continuous tube feeding lasting longer than 12 hours per day;
(2) wounds described as:
    (i) stage III or stage IV;
    (ii) multiple wounds;
    (iii) requiring sterile or clean dressing changes or a wound vac; or
    (iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require
specialized care;
    (3) parenteral therapy described as:
    (i) IV therapy more than two times per week lasting longer than four hours for
each treatment; or
    (ii) total parenteral nutrition (TPN) daily;
    (4) respiratory interventions including:
    (i) oxygen required more than eight hours per day;
    (ii) respiratory vest more than one time per day;
    (iii) bronchial drainage treatments more than two times per day;
    (iv) sterile or clean suctioning more than six times per day;
    (v) dependence on another to apply respiratory ventilation augmentation devices
such as BiPAP and CPAP; and
    (vi) ventilator dependence under section 256B.0652;
    (5) insertion and maintenance of catheter including:
(i) sterile catheter changes more than one time per month;
(ii) clean self-catheterization more than six times per day; or
(iii) bladder irrigations;
(6) bowel program more than two times per week requiring more than 30 minutes to
perform each time;
(7) neurological intervention including:
(i) seizures more than two times per week and requiring significant physical
assistance to maintain safety; or
(ii) swallowing disorders diagnosed by a physician and requiring specialized
assistance from another on a daily basis; and
(8) other congenital or acquired diseases creating a need for significantly increased
direct hands-on assistance and interventions in six to eight activities of daily living.
(d) An assessment of behaviors must meet the criteria in this paragraph. A recipient
qualifies as having a need for assistance due to behaviors if the recipient's behavior requires
assistance at least four times per week and shows one or more of the following behaviors:
(1) physical aggression towards self or others, or destruction of property that requires
the immediate response of another person;
(2) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or
(3) verbally aggressive and resistive to care.
    Subd. 5. Service, support planning, and referral. (a) The assessor, with the
recipient or responsible party, shall review the assessment information and determine
referrals for other payers, services, and community supports as appropriate.
(b) The recipient must be referred for evaluation, services, or supports that are
appropriate to help meet the recipient's needs including, but not limited to, the following
circumstances:
(1) when there is another payer who is responsible to provide the service to meet
the recipient's needs;
(2) when the recipient qualifies for assistance due to mental illness or behaviors
under this section, a referral for a mental health diagnostic and functional assessment
must be completed, or referral must be made for other specific mental health services or
other community services;
(3) when the recipient is eligible for medical assistance and meets medical assistance
eligibility for a home health aide or skilled nurse visit;
(4) when the recipient would benefit from an evaluation for another service; and
(5) when there is a more appropriate service to meet the assessed needs.
    (c) The reimbursement rates for public health nurse visits that relate to the provision
of personal care assistance services under this section and section 256B.0625, subdivision
19a
, are:
    (1) $210.50 for a face-to-face assessment visit;
    (2) $105.25 for each service update; and
    (3) $105.25 for each request for a temporary service increase.
    (d) The rates specified in paragraph (c) must be adjusted to reflect provider rate
increases for personal care assistance services that are approved by the legislature for the
fiscal year ending June 30, 2000, and subsequent fiscal years. Any requirements applied
by the legislature to provider rate increases for personal care assistance services also
apply to adjustments under this paragraph.
    (e) Effective July 1, 2008, the payment rate for an assessment under this section and
section 256B.0651 shall be reduced by 25 percent when the assessment is not completed
on time and the service agreement documentation is not submitted in time to continue
services. The commissioner shall reduce the amount of the claim for those assessments
that are not submitted on time.
    Subd. 6. Service plan. The service plan must be completed by the assessor with the
recipient and responsible party on a form determined by the commissioner and include
a summary of the assessment with a description of the need, authorized amount, and
expected outcomes and goals of personal care assistance services. The recipient and
the provider chosen by the recipient or responsible party must be given a copy of the
completed service plan within ten working days of the assessment. The recipient or
responsible party must be given information by the assessor about the options in the
personal care assistance program to allow for review and decision making.
    Subd. 7. Personal care assistance care plan. (a) Each recipient must have a
current personal care assistance care plan based on the service plan in subdivision 6 that is
developed by the qualified professional with the recipient and responsible party. A copy of
the most current personal care assistance care plan is required to be in the recipient's home
and in the recipient's file at the provider agency.
(b) The personal care assistance care plan must have the following components:
(1) start and end date of the care plan;
(2) recipient demographic information, including name and telephone number;
(3) emergency numbers, procedures, and a description of measures to address
identified safety and vulnerability issues, including a backup staffing plan;
(4) name of responsible party and instructions for contact;
(5) description of the recipient's individualized needs for assistance with activities of
daily living, instrumental activities of daily living, health-related tasks, and behaviors; and
(6) dated signatures of recipient or responsible party and qualified professional.
(c) The personal care assistance care plan must have instructions and comments
about the recipient's needs for assistance and any special instructions or procedures
required. The month-to-month plan for the use of personal care assistance services is part
of the personal care assistance care plan. The personal care assistance care plan must
be completed within the first week after start of services with a personal care provider
agency and must be updated as needed when there is a change in need for personal care
assistance services. A new personal care assistance care plan is required annually at the
time of the reassessment.
    Subd. 8. Communication with recipient's physician. The personal care assistance
program requires communication with the recipient's physician about a recipient's assessed
needs for personal care assistance services. The commissioner shall work with the state
medical director to develop options for communication with the recipient's physician.
    Subd. 9. Responsible party; generally. (a) "Responsible party," effective January
1, 2010, means an individual who is capable of providing the support necessary to assist
the recipient to live in the community.
(b) A responsible party must be 18 years of age, actively participate in planning and
directing of personal care assistance services, and attend all assessments for the recipient.
(c) A responsible party must not be the:
(1) personal care assistant;
(2) home care provider agency owner or staff; or
(3) county staff acting as part of employment.
(d) A licensed family foster parent who lives with the recipient may be the
responsible party as long as the family foster parent meets the other responsible party
requirements.
(e) A responsible party is required when:
(1) the person is a minor according to section 524.5-102, subdivision 10;
(2) the person is an incapacitated adult according to section 524.5-102, subdivision
6, resulting in a court-appointed guardian; or
(3) the assessment according to section 256B.0655, subdivision 1b, determines that
the recipient is in need of a responsible party to direct the recipient's care.
(f) There may be two persons designated as the responsible party for reasons such
as divided households and court-ordered custodies. Each person named as responsible
party must meet the program criteria and responsibilities.
(g) The recipient or the recipient's legal representative shall appoint a responsible
party if necessary to direct and supervise the care provided to the recipient. The
responsible party must be identified at the time of assessment and listed on the recipient's
service agreement and personal care assistance care plan.
    Subd. 10. Responsible party; duties; delegation. (a) A responsible party shall
enter into a written agreement with a personal care assistance provider agency, on a form
determined by the commissioner, to perform the following duties:
(1) be available while care is provided in a method agreed upon by the individual
or the individual's legal representative and documented in the recipient's personal care
assistance care plan;
(2) monitor personal care assistance services to ensure the recipient's personal care
assistance care plan is being followed; and
(3) review and sign personal care assistance time sheets after services are provided
to provide verification of the personal care assistance services.
Failure to provide the support required by the recipient must result in a referral to the
county common entry point.
(b) Responsible parties who are parents of minors or guardians of minors or
incapacitated persons may delegate the responsibility to another adult who is not the
personal care assistant during a temporary absence of at least 24 hours but not more
than six months. The person delegated as a responsible party must be able to meet the
definition of the responsible party, except that the delegated responsible party is required
to reside with the recipient only while serving as the responsible party. The responsible
party must ensure that the delegate performs the functions of the responsible party, is
identified at the time of the assessment, and is listed on the personal care assistance
care plan. The responsible party must communicate to the personal care assistance
provider agency about the need for a delegate responsible party, including the name of the
delegated responsible party, dates the delegated responsible party will be living with the
recipient, and contact numbers.
    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant
must meet the following requirements:
(1) be at least 18 years of age with the exception of persons who are 16 or 17 years
of age with these additional requirements:
(i) supervision by a qualified professional every 60 days; and
(ii) employment by only one personal care assistance provider agency responsible
for compliance with current labor laws;
(2) be employed by a personal care assistance provider agency;
(3) enroll with the department as a personal care assistant after clearing a background
study. Before a personal care assistant provides services, the personal care assistance
provider agency must initiate a background study on the personal care assistant under
chapter 245C, and the personal care assistance provider agency must have received a
notice from the commissioner that the personal care assistant is:
(i) not disqualified under section 245C.14; or
(ii) is disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;
(4) be able to effectively communicate with the recipient and personal care
assistance provider agency;
(5) be able to provide covered personal care assistance services according to the
recipient's personal care assistance care plan, respond appropriately to recipient needs,
and report changes in the recipient's condition to the supervising qualified professional
or physician;
(6) not be a consumer of personal care assistance services;
(7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;
(8) effective January 1, 2010, complete standardized training as determined by the
commissioner before completing enrollment. Personal care assistant training must include
successful completion of the following training components: basic first aid, vulnerable
adult, child maltreatment, OSHA universal precautions, basic roles and responsibilities of
personal care assistants including information about assistance with lifting and transfers
for recipients, emergency preparedness, orientation to positive behavioral practices, fraud
issues, and completion of time sheets. Upon completion of the training components,
the personal care assistant must demonstrate the competency to provide assistance to
recipients;
(9) complete training and orientation on the needs of the recipient within the first
seven days after the services begin; and
(10) be limited to providing and being paid for up to 310 hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with.
(b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).
(c) Effective January 1, 2010, persons who do not qualify as a personal care assistant
include parents and stepparents of minors, spouses, paid legal guardians, family foster
care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or
staff of a residential setting.
    Subd. 12. Documentation of personal care assistance services provided. (a)
Personal care assistance services for a recipient must be documented daily by each personal
care assistant, on a time sheet form approved by the commissioner. All documentation
may be Web-based, electronic, or paper documentation. The completed form must be
submitted on a monthly basis to the provider and kept in the recipient's health record.
(b) The activity documentation must correspond to the personal care assistance care
plan and be reviewed by the qualified professional.
(c) The personal care assistant time sheet must be on a form approved by the
commissioner documenting time the personal care assistant provides services in the home.
The following criteria must be included in the time sheet:
(1) full name of personal care assistant and individual provider number;
(2) provider name and telephone numbers;
(3) full name of recipient;
(4) consecutive dates, including month, day, and year, and arrival and departure
time with a.m. or p.m. notations;
(5) signatures of recipient or the responsible party;
(6) personal signature of the personal care assistant;
(7) any shared care provided, if applicable;
(8) a statement that it is a federal crime to provide false information on personal
care service billings for medical assistance payments; and
(9) dates and location of recipient stays in a hospital, care facility, or incarceration.
    Subd. 13. Qualified professional; qualifications. (a) The qualified professional
must be employed by a personal care assistance provider agency and meet the definition
under section 256B.0625, subdivision 19c. Before a qualified professional provides
services, the personal care assistance provider agency must initiate a background study on
the qualified professional under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the qualified professional:
(1) is not disqualified under section 245C.14; or
(2) is disqualified, but the qualified professional has received a set aside of the
disqualification under section 245C.22.
(b) The qualified professional shall perform the duties of training, supervision, and
evaluation of the personal care assistance staff and evaluation of the effectiveness of
personal care assistance services. The qualified professional shall:
(1) develop and monitor with the recipient a personal care assistance care plan based
on the service plan and individualized needs of the recipient;
(2) develop and monitor with the recipient a monthly plan for the use of personal
care assistance services;
(3) review documentation of personal care assistance services provided;
(4) provide training and ensure competency for the personal care assistant in the
individual needs of the recipient; and
(5) document all training, communication, evaluations, and needed actions to
improve performance of the personal care assistants.
(c) The qualified professional shall complete the provider training with basic
information about the personal care assistance program approved by the commissioner
within six months of the date hired by a personal care assistance provider agency.
Qualified professionals who have completed the required trainings as an employee with a
personal care assistance provider agency do not need to repeat the required trainings if they
are hired by another agency, if they have completed the training within the last three years.
    Subd. 14. Qualified professional; duties. (a) Effective January 1, 2010, all personal
care assistants must be supervised by a qualified professional.
(b) Through direct training, observation, return demonstrations, and consultation
with the staff and the recipient, the qualified professional must ensure and document
that the personal care assistant is:
(1) capable of providing the required personal care assistance services;
(2) knowledgeable about the plan of personal care assistance services before services
are performed; and
(3) able to identify conditions that should be immediately brought to the attention of
the qualified professional.
(c) The qualified professional shall evaluate the personal care assistant within the
first 14 days of starting to provide services for a recipient except for the personal care
assistance choice option under subdivision 19, paragraph (a), clause (4). The qualified
professional shall evaluate the personal care assistance services for a recipient through
direct observation of a personal care assistant's work:
(1) at least every 90 days thereafter for the first year of a recipient's services; and
(2) every 120 days after the first year of a recipient's service or whenever needed for
response to a recipient's request for increased supervision of the personal care assistance
staff.
(d) Communication with the recipient is a part of the evaluation process of the
personal care assistance staff.
(e) At each supervisory visit, the qualified professional shall evaluate personal care
assistance services including the following information:
(1) satisfaction level of the recipient with personal care assistance services;
(2) review of the month-to-month plan for use of personal care assistance services;
(3) review of documentation of personal care assistance services provided;
(4) whether the personal care assistance services are meeting the goals of the service
as stated in the personal care assistance care plan and service plan;
(5) a written record of the results of the evaluation and actions taken to correct any
deficiencies in the work of a personal care assistant; and
(6) revision of the personal care assistance care plan as necessary in consultation
with the recipient or responsible party, to meet the needs of the recipient.
(f) The qualified professional shall complete the required documentation in the
agency recipient and employee files and the recipient's home, including the following
documentation:
(1) the personal care assistance care plan based on the service plan and individualized
needs of the recipient;
(2) a month-to-month plan for use of personal care assistance services;
(3) changes in need of the recipient requiring a change to the level of service and the
personal care assistance care plan;
(4) evaluation results of supervision visits and identified issues with personal care
assistance staff with actions taken;
(5) all communication with the recipient and personal care assistance staff; and
(6) hands-on training or individualized training for the care of the recipient.
(g) The documentation in paragraph (f) must be done on agency forms.
(h) The services that are not eligible for payment as qualified professional services
include:
(1) direct professional nursing tasks that could be assessed and authorized as skilled
nursing tasks;
(2) supervision of personal care assistance completed by telephone;
(3) agency administrative activities;
(4) training other than the individualized training required to provide care for a
recipient; and
(5) any other activity that is not described in this section.
    Subd. 15. Flexible use. (a) "Flexible use" means the scheduled use of authorized
hours of personal care assistance services, which vary within a service authorization
period covering no more than six months, in order to more effectively meet the needs and
schedule of the recipient. Each 12-month service agreement is divided into two six-month
authorization date spans. No more than 75 percent of the total authorized units for a
12-month service agreement may be used in a six-month date span.
(b) Authorization of flexible use occurs during the authorization process under
section 256B.0652. The flexible use of authorized hours does not increase the total
amount of authorized hours available to a recipient. The commissioner shall not authorize
additional personal care assistance services to supplement a service authorization that
is exhausted before the end date under a flexible service use plan, unless the assessor
determines a change in condition and a need for increased services is established.
Authorized hours not used within the six-month period must not be carried over to another
time period.
(c) A recipient who has terminated personal care assistance services before the end
of the 12-month authorization period must not receive additional hours upon reapplying
during the same 12-month authorization period, except if a change in condition is
documented. Services must be prorated for the remainder of the 12-month authorization
period based on the first six-month assessment.
(d) The recipient, responsible party, and qualified professional must develop a
written month-to-month plan of the projected use of personal care assistance services that
is part of the personal care assistance care plan and ensures:
(1) that the health and safety needs of the recipient are met throughout both date
spans of the authorization period; and
(2) that the total authorized amount of personal care assistance services for each date
span must not be used before the end of each date span in the authorization period.
(e) The personal care assistance provider agency shall monitor the use of personal
care assistance services to ensure health and safety needs of the recipient are met
throughout both date spans of the authorization period. The commissioner or the
commissioner's designee shall provide written notice to the provider and the recipient or
responsible party when a recipient is at risk of exceeding the personal care assistance
services prior to the end of the six-month period.
(f) Misuse and abuse of the flexible use of personal care assistance services resulting
in the overuse of units in a manner where the recipient will not have enough units to meet
their needs for assistance and ensure health and safety for the entire six-month date span
may lead to an action by the commissioner. The commissioner may take action including,
but not limited to: (1) restricting recipients to service authorizations of no more than one
month in duration; (2) requiring the recipient to have a responsible party; and (3) requiring
a qualified professional to monitor and report services on a monthly basis.
    Subd. 16. Shared services. (a) Medical assistance payments for shared personal
care assistance services are limited according to this subdivision.
(b) Shared service is the provision of personal care assistance services by a personal
care assistant to two or three recipients, eligible for medical assistance, who voluntarily
enter into an agreement to receive services at the same time and in the same setting.
(c) For the purposes of this subdivision, "setting" means:
(1) the home residence or family foster care home of one or more of the individual
recipients; or
(2) a child care program licensed under chapter 245A or operated by a local school
district or private school.
(d) Shared personal care assistance services follow the same criteria for covered
services as subdivision 2.
(e) Noncovered shared personal care assistance services include the following:
(1) services for more than three recipients by one personal care assistant at one time;
(2) staff requirements for child care programs under chapter 245C;
(3) caring for multiple recipients in more than one setting;
(4) additional units of personal care assistance based on the selection of the option;
and
(5) use of more than one personal care assistance provider agency for the shared
care services.
(f) The option of shared personal care assistance is elected by the recipient or the
responsible party with the assistance of the assessor. The option must be determined
appropriate based on the ages of the recipients, compatibility, and coordination of their
assessed care needs. The recipient or the responsible party, in conjunction with the
qualified professional, shall arrange the setting and grouping of shared services based
on the individual needs and preferences of the recipients. The personal care assistance
provider agency shall offer the recipient or the responsible party the option of shared or
one-on-one personal care assistance services or a combination of both. The recipient or
the responsible party may withdraw from participating in a shared services arrangement at
any time.
(g) Authorization for the shared service option must be determined by the
commissioner based on the criteria that the shared service is appropriate to meet all of the
recipients' needs and their health and safety is maintained. The authorization of shared
services is part of the overall authorization of personal care assistance services. Nothing
in this subdivision must be construed to reduce the total number of hours authorized for
an individual recipient.
(h) A personal care assistant providing shared personal care assistance services must:
(1) receive training specific for each recipient served; and
(2) follow all required documentation requirements for time and services provided.
(i) A qualified professional shall:
(1) evaluate the ability of the personal care assistant to provide services for all of
the recipients in a shared setting;
(2) visit the shared setting as services are being provided at least once every six
months or whenever needed for response to a recipient's request for increased supervision
of the personal care assistance staff;
(3) provide ongoing monitoring and evaluation of the effectiveness and
appropriateness of the shared services;
(4) develop a contingency plan with each of the recipients which accounts for
absence of the recipient in a share services setting due to illness or other circumstances;
(5) obtain permission from each of the recipients who are sharing a personal care
assistant for number of shared hours for services provided inside and outside the home
residence; and
(6) document the training completed by the personal care assistants specific to the
shared setting and recipients sharing services.
    Subd. 17. Shared services; rates. The commissioner shall provide a rate system for
shared personal care assistance services. For two persons sharing services, the rate paid
to a provider must not exceed one and one-half times the rate paid for serving a single
individual, and for three persons sharing services, the rate paid to a provider must not
exceed twice the rate paid for serving a single individual. These rates apply only when all
of the criteria for the shared care personal care assistance service have been met.
    Subd. 18. Personal care assistance choice option; generally. (a) The
commissioner may allow a recipient of personal care assistance services to use a fiscal
intermediary to assist the recipient in paying and accounting for medically necessary
covered personal care assistance services. Unless otherwise provided in this section, all
other statutory and regulatory provisions relating to personal care assistance services apply
to a recipient using the personal care assistance choice option.
(b) Personal care assistance choice is an option of the personal care assistance
program that allows the recipient who receives personal care assistance services to be
responsible for the hiring, training, scheduling, and firing of personal care assistants. This
program offers greater control and choice for the recipient in who provides the personal
care assistance service and when the service is scheduled. The recipient or the recipient's
responsible party must choose a personal care assistance choice provider agency as
a fiscal intermediary. This personal care assistance choice provider agency manages
payroll, invoices the state, is responsible for all payroll related taxes and insurance, and is
responsible for providing the consumer training and support in managing the recipient's
personal care assistance services.
    Subd. 19. Personal care assistance choice option; qualifications; duties. (a)
Under personal care assistance choice, the recipient or responsible party shall:
(1) recruit, hire, schedule, and terminate personal care assistants and a qualified
professional;
(2) develop a personal care assistance care plan based on the assessed needs
and addressing the health and safety of the recipient with the assistance of a qualified
professional as needed;
(3) orient and train the personal care assistant with assistance as needed from the
qualified professional;
(4) effective January 1, 2010, supervise and evaluate the personal care assistant with
the qualified professional, who is required to visit the recipient at least every 180 days;
(5) monitor and verify in writing and report to the personal care assistance choice
agency the number of hours worked by the personal care assistant and the qualified
professional;
(6) engage in an annual face-to-face reassessment to determine continuing eligibility
and service authorization; and
(7) use the same personal care assistance choice provider agency if shared personal
assistance care is being used.
(b) The personal care assistance choice provider agency shall:
(1) meet all personal care assistance provider agency standards;
(2) enter into a written agreement with the recipient, responsible party, and personal
care assistants;
(3) not be related as a parent, child, sibling, or spouse to the recipient, qualified
professional, or the personal care assistant; and
(4) ensure arm's-length transactions without undue influence or coercion with the
recipient and personal care assistant.
(c) The duties of the personal care assistance choice provider agency are to:
(1) be the employer of the personal care assistant and the qualified professional for
employment law and related regulations including, but not limited to, purchasing and
maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
and liability insurance, and submit any or all necessary documentation including, but not
limited to, workers' compensation and unemployment insurance;
(2) bill the medical assistance program for personal care assistance services and
qualified professional services;
(3) request and complete background studies that comply with the requirements for
personal care assistants and qualified professionals;
(4) pay the personal care assistant and qualified professional based on actual hours
of services provided;
(5) withhold and pay all applicable federal and state taxes;
(6) verify and keep records of hours worked by the personal care assistant and
qualified professional;
(7) make the arrangements and pay taxes and other benefits, if any; and comply with
any legal requirements for a Minnesota employer;
(8) enroll in the medical assistance program as a personal care assistance choice
agency; and
(9) enter into a written agreement as specified in subdivision 20 before services
are provided.
    Subd. 20. Personal care assistance choice option; administration. (a) Before
services commence under the personal care assistance choice option, and annually
thereafter, the personal care assistance choice provider agency, recipient, or responsible
party, each personal care assistant, and the qualified professional shall enter into a written
agreement. The agreement must include at a minimum:
(1) duties of the recipient, qualified professional, personal care assistant, and
personal care assistance choice provider agency;
(2) salary and benefits for the personal care assistant and the qualified professional;
(3) administrative fee of the personal care assistance choice provider agency and
services paid for with that fee, including background study fees;
(4) grievance procedures to respond to complaints;
(5) procedures for hiring and terminating the personal care assistant; and
(6) documentation requirements including, but not limited to, time sheets, activity
records, and the personal care assistance care plan.
(b) Effective January 1, 2010, except for the administrative fee of the personal care
assistance choice provider agency as reported on the written agreement, the remainder
of the rates paid to the personal care assistance choice provider agency must be used to
pay for the salary and benefits for the personal care assistant or the qualified professional.
The provider agency must use a minimum of 72.5 percent of the revenue generated by
the medical assistance rate for personal care assistance services for employee personal
care assistant wages and benefits.
(c) The commissioner shall deny, revoke, or suspend the authorization to use the
personal care assistance choice option if:
(1) it has been determined by the qualified professional or public health nurse that
the use of this option jeopardizes the recipient's health and safety;
(2) the parties have failed to comply with the written agreement specified in this
subdivision;
(3) the use of the option has led to abusive or fraudulent billing for personal care
assistance services; or
(4) the department terminates the personal care assistance choice option.
(d) The recipient or responsible party may appeal the commissioner's decision in
paragraph (c) according to section 256.045. The denial, revocation, or suspension to
use the personal care assistance choice option must not affect the recipient's authorized
level of personal care assistance services.
    Subd. 21. Requirements for initial enrollment of personal care assistance
provider agencies. (a) All personal care assistance provider agencies must provide, at the
time of enrollment as a personal care assistance provider agency in a format determined
by the commissioner, information and documentation that includes, but is not limited to,
the following:
(1) the personal care assistance provider agency's current contact information
including address, telephone number, and e-mail address;
(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
provider's payments from Medicaid in the previous year, whichever is less;
(3) proof of fidelity bond coverage in the amount of $20,000;
(4) proof of workers' compensation insurance coverage;
(5) a description of the personal care assistance provider agency's organization
identifying the names of all owners, managing employees, staff, board of directors, and
the affiliations of the directors, owners, or staff to other service providers;
(6) a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery;
and employee and consumer safety including process for notification and resolution
of consumer grievances, identification and prevention of communicable diseases, and
employee misconduct;
(7) copies of all other forms the personal care assistance provider agency uses in
the course of daily business including, but not limited to:
(i) a copy of the personal care assistance provider agency's time sheet if the time
sheet varies from the standard time sheet for personal care assistance services approved
by the commissioner, and a letter requesting approval of the personal care assistance
provider agency's nonstandard time sheet;
(ii) the personal care assistance provider agency's template for the personal care
assistance care plan; and
(iii) the personal care assistance provider agency's template and the written
agreement in subdivision 20 for recipients using the personal care assistance choice
option, if applicable;
(8) a list of all trainings and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;
(9) documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section;
(10) documentation of the agency's marketing practices;
(11) disclosure of ownership, leasing, or management of all residential properties
that is used or could be used for providing home care services; and
(12) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance services
for employee personal care assistant wages and benefits: 72.5 percent of revenue in the
personal care assistance choice option and 72.5 percent of revenue from other personal
care assistance providers.
(b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider
agency enrolls as a vendor or upon request from the commissioner. The commissioner
shall collect the information specified in paragraph (a) from all personal care assistance
providers beginning upon enactment of this section.
(c) All personal care assistance provider agencies shall complete mandatory training
as determined by the commissioner before enrollment as a provider. Personal care
assistance provider agencies are required to send all owners, qualified professionals
employed by the agency, and all other managing employees to the initial and subsequent
trainings. Personal care assistance provider agency billing staff shall complete training
about personal care assistance program financial management. This training is effective
upon enactment of this section. Any personal care assistance provider agency enrolled
before that date shall, if it has not already, complete the provider training within 18 months
of the effective date of this section. Any new owners, new qualified professionals, and new
managing employees are required to complete mandatory training as a requisite of hiring.
    Subd. 22. Annual review for personal care providers. (a) All personal care
assistance provider agencies shall resubmit, on an annual basis, the information specified
in subdivision 21, in a format determined by the commissioner, and provide a copy of the
personal care assistance provider agency's most current version of its grievance policies
and procedures along with a written record of grievances and resolutions of the grievances
that the personal care assistance provider agency has received in the previous year and any
other information requested by the commissioner.
(b) The commissioner shall send annual review notification to personal care
assistance provider agencies 30 days prior to renewal. The notification must:
(1) list the materials and information the personal care assistance provider agency is
required to submit;
(2) provide instructions on submitting information to the commissioner; and
(3) provide a due date by which the commissioner must receive the requested
information.
Personal care assistance provider agencies shall submit required documentation for
annual review within 30 days of notification from the commissioner. If no documentation
is submitted, the personal care assistance provider agency enrollment number must be
terminated or suspended.
(c) Personal care assistance provider agencies also currently licensed under
Minnesota Rules, part 4668.0012, as a class A provider or currently certified for
participation in Medicare as a home health agency are deemed in compliance with
the personal care assistance requirements for enrollment, annual review process, and
documentation.
    Subd. 23. Enrollment requirements following termination. (a) A terminated
personal care assistance provider agency, including all named individuals on the current
enrollment disclosure form and known or discovered affiliates of the personal care
assistance provider agency, is not eligible to enroll as a personal care assistance provider
agency for two years following the termination.
(b) After the two-year period in paragraph (a), if the provider seeks to reenroll
as a personal care assistance provider agency, the personal care assistance provider
agency must be placed on a one-year probation period, beginning after completion of
the following:
(1) the department's provider trainings under this section; and
(2) initial enrollment requirements under subdivision 21.
(c) During the probationary period the commissioner shall complete site visits and
request submission of documentation to review compliance with program policy.
    Subd. 24. Personal care assistance provider agency; general duties. A personal
care assistance provider agency shall:
(1) enroll as a Medicaid provider meeting all provider standards, including
completion of the required provider training;
(2) comply with general medical assistance coverage requirements;
(3) demonstrate compliance with law and policies of the personal care assistance
program to be determined by the commissioner;
(4) comply with background study requirements;
(5) verify and keep records of hours worked by the personal care assistant and
qualified professional;
(6) market agency services only through printed information in brochures and on
Web sites and not engage in any agency-initiated direct contact or marketing in person, by
phone, or other electronic means to potential recipients, guardians, or family members;
(7) pay the personal care assistant and qualified professional based on actual hours
of services provided;
(8) withhold and pay all applicable federal and state taxes;
(9) effective January 1, 2010, document that the agency uses a minimum of 72.5
percent of the revenue generated by the medical assistance rate for personal care assistance
services for employee personal care assistant wages and benefits;
(10) make the arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;
(11) enter into a written agreement under subdivision 20 before services are provided;
(12) report suspected neglect and abuse to the common entry point according to
section 256B.0651;
(13) provide the recipient with a copy of the home care bill of rights at start of
service; and
    (14) request reassessments at least 60 days prior to the end of the current
authorization for personal care assistance services, on forms provided by the commissioner.
    Subd. 25. Personal care assistance provider agency; background studies.
Personal care assistance provider agencies enrolled to provide personal care assistance
services under the medical assistance program shall comply with the following:
(1) owners who have a five percent interest or more and all managing employees
are subject to a background study as provided in chapter 245C. This applies to currently
enrolled personal care assistance provider agencies and those agencies seeking enrollment
as a personal care assistance provider agency. Managing employee has the same meaning
as Code of Federal Regulations, title 42, section 455. An organization is barred from
enrollment if:
(i) the organization has not initiated background studies on owners and managing
employees; or
(ii) the organization has initiated background studies on owners and managing
employees, but the commissioner has sent the organization a notice that an owner or
managing employee of the organization has been disqualified under section 245C.14,
and the owner or managing employee has not received a set aside of the disqualification
under section 245C.22;
(2) a background study must be initiated and completed for all qualified
professionals; and
(3) a background study must be initiated and completed for all personal care
assistants.
    Subd. 26. Personal care assistance provider agency; communicable disease
prevention. A personal care assistance provider agency shall establish and implement
policies and procedures for prevention, control, and investigation of infections and
communicable diseases according to current nationally recognized infection control
practices or guidelines established by the United States Centers for Disease Control and
Prevention, as well as applicable regulations of other federal or state agencies.
    Subd. 27. Personal care assistance provider agency; ventilator training. The
personal care assistance provider agency is required to provide training for the personal
care assistant responsible for working with a recipient who is ventilator dependent. All
training must be administered by a respiratory therapist, nurse, or physician. Qualified
professional supervision by a nurse must be completed and documented on file in the
personal care assistant's employment record and the recipient's health record. If offering
personal care services to a ventilator-dependent recipient, the personal care assistance
provider agency shall demonstrate the ability to:
(1) train the personal care assistant;
(2) supervise the personal care assistant in ventilator operation and maintenance; and
(3) supervise the recipient and responsible party in ventilator operation and
maintenance.
    Subd. 28. Personal care assistance provider agency; required documentation.
Required documentation must be completed and kept in the personal care assistance
provider agency file or the recipient's home residence. The required documentation
consists of:
(1) employee files, including:
(i) applications for employment;
(ii) background study requests and results;
(iii) orientation records about the agency policies;
(iv) trainings completed with demonstration of competence;
(v) supervisory visits;
(vi) evaluations of employment; and
(vii) signature on fraud statement;
(2) recipient files, including:
(i) demographics;
(ii) emergency contact information and emergency backup plan;
(iii) personal care assistance service plan;
(iv) personal care assistance care plan;
(v) month-to-month service use plan;
(vi) all communication records;
(vii) start of service information, including the written agreement with recipient; and
(viii) date the home care bill of rights was given to the recipient;
(3) agency policy manual, including:
(i) policies for employment and termination;
(ii) grievance policies with resolution of consumer grievances;
(iii) staff and consumer safety;
(iv) staff misconduct; and
(v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and
resolution of consumer grievances;
(4) time sheets for each personal care assistant along with completed activity sheets
for each recipient served; and
(5) agency marketing and advertising materials and documentation of marketing
activities and costs.
    Subd. 29. Transitional assistance. The commissioner, counties, health plans,
tribes, and personal care assistance providers shall work together to provide transitional
assistance for recipients and families to come into compliance with the new requirements
of this section and ensure the personal care assistance services are not provided by the
housing provider.
    Subd. 30. Notice of service changes to recipients. The commissioner must provide:
(1) by October 31, 2009, information to recipients likely to be affected that (i)
describes the changes to the personal care assistance program that may result in the
loss of access to personal care assistance services, and (ii) includes resources to obtain
further information; and
(2) notice of changes in medical assistance home care services to each affected
recipient at least 30 days before the effective date of the change.
The notice shall include how to get further information on the changes, how to get help to
obtain other services, a list of community resources, and appeal rights. Notwithstanding
section 256.045, a recipient may request continued services pending appeal within the
time period allowed to request an appeal.
EFFECTIVE DATE.Subdivisions 4, 22, and 27 are effective January 1, 2010.

    Sec. 32. Minnesota Statutes 2008, section 256B.0911, subdivision 1, is amended to
read:
    Subdivision 1. Purpose and goal. (a) The purpose of long-term care consultation
services is to assist persons with long-term or chronic care needs in making long-term
care decisions and selecting options that meet their needs and reflect their preferences.
The availability of, and access to, information and other types of assistance, including
assessment and support planning, is also intended to prevent or delay certified nursing
facility placements and to provide transition assistance after admission. Further, the goal
of these services is to contain costs associated with unnecessary certified nursing facility
admissions. Long-term consultation services must be available to any person regardless
of public program eligibility. The commissioners commissioner of human services and
health shall seek to maximize use of available federal and state funds and establish the
broadest program possible within the funding available.
(b) These services must be coordinated with services long-term care options
counseling provided under section 256.975, subdivision 7, and with services provided by
other public and private agencies in the community section 256.01, subdivision 24, for
telephone assistance and follow up and to offer a variety of cost-effective alternatives to
persons with disabilities and elderly persons. The county or tribal agency or managed
care plan providing long-term care consultation services shall encourage the use of
volunteers from families, religious organizations, social clubs, and similar civic and
service organizations to provide community-based services.

    Sec. 33. Minnesota Statutes 2008, section 256B.0911, subdivision 1a, is amended to
read:
    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
(a) "Long-term care consultation services" means:
(1) providing information and education to the general public regarding availability
of the services authorized under this section;
(2) an intake process that provides access to the services described in this section;
(3) assessment of the health, psychological, and social needs of referred individuals;
(4) assistance in identifying services needed to maintain an individual in the least
restrictive most inclusive environment;
(5) (2) providing recommendations on cost-effective community services that are
available to the individual;
(6) (3) development of an individual's person-centered community support plan;
(7) (4) providing information regarding eligibility for Minnesota health care
programs;
(5) face-to-face long-term care consultation assessments, which may be completed
in a hospital, nursing facility, intermediate care facility for persons with developmental
disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
residence;
(8) preadmission (6) federally mandated screening to determine the need for
a nursing facility institutional level of care under section 256B.0911, subdivision 4,
paragraph (a);
(9) preliminary (7) determination of Minnesota health care programs home and
community-based waiver service eligibility including level of care determination for
individuals who need a nursing facility an institutional level of care as defined under
section 144.0724, subdivision 11, or 256B.092, service eligibility including state plan
home care services identified in section 256B.0625, subdivisions 6, 7, and 19, paragraphs
(a) and (c), based on assessment and support plan development with appropriate referrals
for final determination;
(10) (8) providing recommendations for nursing facility placement when there are
no cost-effective community services available; and
(11) (9) assistance to transition people back to community settings after facility
admission.
(b) "Long-term options counseling" means the services provided by the linkage
lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes
telephone assistance and follow up once a long-term care consultation assessment has
been completed.
(b) (c) "Minnesota health care programs" means the medical assistance program
under chapter 256B and the alternative care program under section 256B.0913.
(d) "Lead agencies" means counties or a collaboration of counties, tribes, and health
plans administering long-term care consultation assessment and support planning services.
EFFECTIVE DATE.This section is effective January 1, 2011.

    Sec. 34. Minnesota Statutes 2008, section 256B.0911, is amended by adding a
subdivision to read:
    Subd. 2b. Certified assessors. (a) Beginning January 1, 2011, each lead agency
shall use certified assessors who have completed training and certification process
determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate
best practices in assessment and support planning including person-centered planning
principals and have a common set of skills that must ensure consistency and equitable
access to services statewide. Assessors must be part of a multidisciplinary team of
professionals that includes public health nurses, social workers, and other professionals
as defined in paragraph (b). For persons with complex health care needs, a public health
nurse or registered nurse from a multidisciplinary team must be consulted.
(b) Certified assessors are persons with a minimum of a bachelor's degree in social
work, nursing with a public health nursing certificate, or other closely related field with at
least one year of home and community-based experience or a two-year registered nursing
degree with at least three years of home and community-based experience that have
received training and certification specific to assessment and consultation for long-term
care services in the state.

    Sec. 35. Minnesota Statutes 2008, section 256B.0911, is amended by adding a
subdivision to read:
    Subd. 2c. Assessor training and certification. The commissioner shall develop a
curriculum and an assessor certification process to begin no later than January 1, 2010.
All existing lead agency staff designated to provide the services defined in subdivision
1a must be certified by December 30, 2010. Each lead agency is required to ensure that
they have sufficient numbers of certified assessors to provide long-term consultation
assessment and support planning within the timelines and parameters of the service by
January 1, 2011. Certified assessors are required to be recertified every three years.

    Sec. 36. Minnesota Statutes 2008, section 256B.0911, subdivision 3, is amended to
read:
    Subd. 3. Long-term care consultation team. (a) Until January 1, 2011, a long-term
care consultation team shall be established by the county board of commissioners. Each
local consultation team shall consist of at least one social worker and at least one public
health nurse from their respective county agencies. The board may designate public
health or social services as the lead agency for long-term care consultation services. If a
county does not have a public health nurse available, it may request approval from the
commissioner to assign a county registered nurse with at least one year experience in
home care to participate on the team. Two or more counties may collaborate to establish
a joint local consultation team or teams.
(b) The team is responsible for providing long-term care consultation services to
all persons located in the county who request the services, regardless of eligibility for
Minnesota health care programs.
(c) The commissioner shall allow arrangements and make recommendations that
encourage counties to collaborate to establish joint local long-term care consultation teams
to ensure that long-term care consultations are done within the timelines and parameters
of the service. This includes integrated service models as required in subdivision 1,
paragraph (b).

    Sec. 37. Minnesota Statutes 2008, section 256B.0911, subdivision 3a, is amended to
read:
    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
services planning, or other assistance intended to support community-based living,
including persons who need assessment in order to determine waiver or alternative
care program eligibility, must be visited by a long-term care consultation team within
ten working 15 calendar days after the date on which an assessment was requested or
recommended. After January 1, 2011, these requirements also apply to personal care
assistance services, private duty nursing, and home health agency services, on timelines
established in subdivision 5. Face-to-face assessments must be conducted according
to paragraphs (b) to (i).
    (b) The county may utilize a team of either the social worker or public health nurse,
or both,. After January 1, 2011, lead agencies shall use certified assessors to conduct the
assessment in a face-to-face interview. The consultation team members must confer
regarding the most appropriate care for each individual screened or assessed.
    (c) The long-term care consultation team must assess the health and social needs of
the person assessment must be comprehensive and include a person-centered assessment
of the health, psychological, functional, environmental, and social needs of referred
individuals and provide information necessary to develop a support plan that meets the
consumers needs, using an assessment form provided by the commissioner.
    (d) The team must conduct the assessment must be conducted in a face-to-face
interview with the person being assessed and the person's legal representative, if applicable
as required by legally executed documents, and other individuals as requested by the
person, who can provide information on the needs, strengths, and preferences of the
person necessary to develop a support plan that ensures the person's health and safety, but
who is not a provider of service or has any financial interest in the provision of services.
    (e) The team must provide the person, or the person's legal representative, must
be provided with written recommendations for facility- or community-based services.
The team must document or institutional care that include documentation that the most
cost-effective alternatives available were offered to the individual. For purposes of
this requirement, "cost-effective alternatives" means community services and living
arrangements that cost the same as or less than nursing facility institutional care.
    (f) If the person chooses to use community-based services, the team must provide
the person or the person's legal representative must be provided with a written community
support plan, regardless of whether the individual is eligible for Minnesota health care
programs. The A person may request assistance in developing a community support plan
identifying community supports without participating in a complete assessment. Upon
a request for assistance identifying community support, the person must be transferred
or referred to the services available under sections 256.975, subdivision 7, and 256.01,
subdivision 24, for telephone assistance and follow up.
    (g) The person has the right to make the final decision between nursing
facility institutional placement and community placement after the screening team's
recommendation recommendations have been provided, except as provided in subdivision
4a, paragraph (c).
    (h) The team must give the person receiving assessment or support planning, or
the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:
    (1) the need for and purpose of preadmission screening if the person selects nursing
facility placement;
    (2) the role of the long-term care consultation assessment and support planning in
waiver and alternative care program eligibility determination;
    (3) information about Minnesota health care programs;
    (4) the person's freedom to accept or reject the recommendations of the team;
    (5) the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13;
    (6) the long-term care consultant's decision regarding the person's need for nursing
facility institutional level of care as determined under criteria established in section
144.0724, subdivision 11, or 256B.092; and
    (7) the person's right to appeal the decision regarding the need for nursing facility
level of care or the county's final decisions regarding public programs eligibility according
to section 256.045, subdivision 3.
    (i) Face-to-face assessment completed as part of eligibility determination for
the alternative care, elderly waiver, community alternatives for disabled individuals,
community alternative care, and traumatic brain injury waiver programs under sections
256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility for no more
than 60 calendar days after the date of assessment. The effective eligibility start date
for these programs can never be prior to the date of assessment. If an assessment was
completed more than 60 days before the effective waiver or alternative care program
eligibility start date, assessment and support plan information must be updated in a
face-to-face visit and documented in the department's Medicaid Management Information
System (MMIS). The effective date of program eligibility in this case cannot be prior to
the date the updated assessment is completed.

    Sec. 38. Minnesota Statutes 2008, section 256B.0911, subdivision 3b, is amended to
read:
    Subd. 3b. Transition assistance. (a) A long-term care consultation team shall
provide assistance to persons residing in a nursing facility, hospital, regional treatment
center, or intermediate care facility for persons with developmental disabilities who
request or are referred for assistance. Transition assistance must include assessment,
community support plan development, referrals to long-term care options counseling
under section 256B.975, subdivision 10, for community support plan implementation and
to Minnesota health care programs, and referrals to programs that provide assistance
with housing. Transition assistance must also include information about the Centers for
Independent Living and the Senior LinkAge Line, and about other organizations that
can provide assistance with relocation efforts, and information about contacting these
organizations to obtain their assistance and support.
    (b) The county shall develop transition processes with institutional social workers
and discharge planners to ensure that:
    (1) persons admitted to facilities receive information about transition assistance
that is available;
    (2) the assessment is completed for persons within ten working days of the date of
request or recommendation for assessment; and
    (3) there is a plan for transition and follow-up for the individual's return to the
community. The plan must require notification of other local agencies when a person
who may require assistance is screened by one county for admission to a facility located
in another county.
    (c) If a person who is eligible for a Minnesota health care program is admitted to a
nursing facility, the nursing facility must include a consultation team member or the case
manager in the discharge planning process.

    Sec. 39. Minnesota Statutes 2008, section 256B.0911, subdivision 3c, is amended to
read:
    Subd. 3c. Transition to housing with services. (a) Housing with services
establishments offering or providing assisted living under chapter 144G shall inform
all prospective residents of the availability of and contact information for transitional
consultation services under this subdivision prior to executing a lease or contract with the
prospective resident. The purpose of transitional long-term care consultation is to support
persons with current or anticipated long-term care needs in making informed choices
among options that include the most cost-effective and least restrictive settings, and to
delay spenddown to eligibility for publicly funded programs by connecting people to
alternative services in their homes before transition to housing with services. Regardless
of the consultation, prospective residents maintain the right to choose housing with
services or assisted living if that option is their preference.
    (b) Transitional consultation services are provided as determined by the
commissioner of human services in partnership with county long-term care consultation
units, and the Area Agencies on Aging, and are a combination of telephone-based
and in-person assistance provided under models developed by the commissioner. The
consultation shall be performed in a manner that provides objective and complete
information. Transitional consultation must be provided within five working days of the
request of the prospective resident as follows:
    (1) the consultation must be provided by a qualified professional as determined by
the commissioner;
    (2) the consultation must include a review of the prospective resident's reasons for
considering assisted living, the prospective resident's personal goals, a discussion of the
prospective resident's immediate and projected long-term care needs, and alternative
community services or assisted living settings that may meet the prospective resident's
needs; and
    (3) the prospective resident shall be informed of the availability of long-term care
consultation services described in subdivision 3a that are available at no charge to the
prospective resident to assist the prospective resident in assessment and planning to meet
the prospective resident's long-term care needs. The Senior LinkAge Line and long-term
care consultation team shall give the highest priority to referrals who are at highest risk of
nursing facility placement or as needed for determining eligibility.

    Sec. 40. Minnesota Statutes 2008, section 256B.0911, subdivision 4a, is amended to
read:
    Subd. 4a. Preadmission screening activities related to nursing facility
admissions. (a) All applicants to Medicaid certified nursing facilities, including certified
boarding care facilities, must be screened prior to admission regardless of income, assets,
or funding sources for nursing facility care, except as described in subdivision 4b. The
purpose of the screening is to determine the need for nursing facility level of care as
described in paragraph (d) and to complete activities required under federal law related to
mental illness and developmental disability as outlined in paragraph (b).
(b) A person who has a diagnosis or possible diagnosis of mental illness or
developmental disability must receive a preadmission screening before admission
regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need
for further evaluation and specialized services, unless the admission prior to screening is
authorized by the local mental health authority or the local developmental disabilities case
manager, or unless authorized by the county agency according to Public Law 101-508.
The following criteria apply to the preadmission screening:
(1) the county must use forms and criteria developed by the commissioner to identify
persons who require referral for further evaluation and determination of the need for
specialized services; and
(2) the evaluation and determination of the need for specialized services must be
done by:
(i) a qualified independent mental health professional, for persons with a primary or
secondary diagnosis of a serious mental illness; or
(ii) a qualified developmental disability professional, for persons with a primary or
secondary diagnosis of developmental disability. For purposes of this requirement, a
qualified developmental disability professional must meet the standards for a qualified
developmental disability professional under Code of Federal Regulations, title 42, section
483.430.
(c) The local county mental health authority or the state developmental disability
authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
nursing facility if the individual does not meet the nursing facility level of care criteria or
needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
purposes of this section, "specialized services" for a person with developmental disability
means active treatment as that term is defined under Code of Federal Regulations, title
42, section 483.440 (a)(1).
(d) The determination of the need for nursing facility level of care must be made
according to criteria established in section 144.0724, subdivision 11, and 256B.092,
using forms developed by the commissioner. In assessing a person's needs, consultation
team members shall have a physician available for consultation and shall consider the
assessment of the individual's attending physician, if any. The individual's physician must
be included if the physician chooses to participate. Other personnel may be included on
the team as deemed appropriate by the county.
EFFECTIVE DATE.The section is effective January 1, 2011.

    Sec. 41. Minnesota Statutes 2008, section 256B.0911, subdivision 5, is amended to
read:
    Subd. 5. Administrative activity. The commissioner shall minimize the number
of forms required in the provision of long-term care consultation services and shall
limit the screening document to items necessary for community support plan approval,
reimbursement, program planning, evaluation, and policy development streamline the
processes, including timelines for when assessments need to be completed, required to
provide the services in this section and shall implement integrated solutions to automate
the business processes to the extent necessary for community support plan approval,
reimbursement, program planning, evaluation, and policy development.

    Sec. 42. Minnesota Statutes 2008, section 256B.0911, subdivision 6, is amended to
read:
    Subd. 6. Payment for long-term care consultation services. (a) The total payment
for each county must be paid monthly by certified nursing facilities in the county. The
monthly amount to be paid by each nursing facility for each fiscal year must be determined
by dividing the county's annual allocation for long-term care consultation services by 12
to determine the monthly payment and allocating the monthly payment to each nursing
facility based on the number of licensed beds in the nursing facility. Payments to counties
in which there is no certified nursing facility must be made by increasing the payment
rate of the two facilities located nearest to the county seat.
    (b) The commissioner shall include the total annual payment determined under
paragraph (a) for each nursing facility reimbursed under section 256B.431 or 256B.434
according to section 256B.431, subdivision 2b, paragraph (g).
    (c) In the event of the layaway, delicensure and decertification, or removal from
layaway of 25 percent or more of the beds in a facility, the commissioner may adjust
the per diem payment amount in paragraph (b) and may adjust the monthly payment
amount in paragraph (a). The effective date of an adjustment made under this paragraph
shall be on or after the first day of the month following the effective date of the layaway,
delicensure and decertification, or removal from layaway.
    (d) Payments for long-term care consultation services are available to the county
or counties to cover staff salaries and expenses to provide the services described in
subdivision 1a. The county shall employ, or contract with other agencies to employ, within
the limits of available funding, sufficient personnel to provide long-term care consultation
services while meeting the state's long-term care outcomes and objectives as defined in
section 256B.0917, subdivision 1. The county shall be accountable for meeting local
objectives as approved by the commissioner in the biennial home and community-based
services quality assurance plan on a form provided by the commissioner.
    (e) Notwithstanding section 256B.0641, overpayments attributable to payment of the
screening costs under the medical assistance program may not be recovered from a facility.
    (f) The commissioner of human services shall amend the Minnesota medical
assistance plan to include reimbursement for the local consultation teams.
    (g) The county may bill, as case management services, assessments, support
planning, and follow-along provided to persons determined to be eligible for case
management under Minnesota health care programs. No individual or family member
shall be charged for an initial assessment or initial support plan development provided
under subdivision 3a or 3b.
(h) The commissioner shall develop an alternative payment methodology for
long-term care consultation services that includes the funding available under this
subdivision, and sections 256B.092 and 256B.0659. In developing the new payment
methodology, the commissioner shall consider the maximization of federal funding for
this activity.

    Sec. 43. Minnesota Statutes 2008, section 256B.0911, subdivision 7, is amended to
read:
    Subd. 7. Reimbursement for certified nursing facilities. (a) Medical assistance
reimbursement for nursing facilities shall be authorized for a medical assistance recipient
only if a preadmission screening has been conducted prior to admission or the county has
authorized an exemption. Medical assistance reimbursement for nursing facilities shall
not be provided for any recipient who the local screener has determined does not meet the
level of care criteria for nursing facility placement in section 144.0724, subdivision 11, or,
if indicated, has not had a level II OBRA evaluation as required under the federal Omnibus
Budget Reconciliation Act of 1987 completed unless an admission for a recipient with
mental illness is approved by the local mental health authority or an admission for a
recipient with developmental disability is approved by the state developmental disability
authority.
    (b) The nursing facility must not bill a person who is not a medical assistance
recipient for resident days that preceded the date of completion of screening activities as
required under subdivisions 4a, 4b, and 4c. The nursing facility must include unreimbursed
resident days in the nursing facility resident day totals reported to the commissioner.
EFFECTIVE DATE.The section is effective January 1, 2011.

    Sec. 44. Minnesota Statutes 2008, section 256B.0913, subdivision 4, is amended to
read:
    Subd. 4. Eligibility for funding for services for nonmedical assistance recipients.
    (a) Funding for services under the alternative care program is available to persons who
meet the following criteria:
    (1) the person has been determined by a community assessment under section
256B.0911 to be a person who would require the level of care provided in a nursing
facility, but for the provision of services under the alternative care program. Effective
January 1, 2011, this determination must be made according to the criteria established in
section 144.0724, subdivision 11;
    (2) the person is age 65 or older;
    (3) the person would be eligible for medical assistance within 135 days of admission
to a nursing facility;
    (4) the person is not ineligible for the payment of long-term care services by the
medical assistance program due to an asset transfer penalty under section 256B.0595 or
equity interest in the home exceeding $500,000 as stated in section 256B.056;
    (5) the person needs long-term care services that are not funded through other state
or federal funding;
    (6) except for individuals described in clause (7), the monthly cost of the alternative
care services funded by the program for this person does not exceed 75 percent of the
monthly limit described under section 256B.0915, subdivision 3a. This monthly limit
does not prohibit the alternative care client from payment for additional services, but in no
case may the cost of additional services purchased under this section exceed the difference
between the client's monthly service limit defined under section 256B.0915, subdivision
3
, and the alternative care program monthly service limit defined in this paragraph. If
care-related supplies and equipment or environmental modifications and adaptations are or
will be purchased for an alternative care services recipient, the costs may be prorated on a
monthly basis for up to 12 consecutive months beginning with the month of purchase.
If the monthly cost of a recipient's other alternative care services exceeds the monthly
limit established in this paragraph, the annual cost of the alternative care services shall be
determined. In this event, the annual cost of alternative care services shall not exceed 12
times the monthly limit described in this paragraph; and
    (7) for individuals assigned a case mix classification A as described under section
256B.0915, subdivision 3a, paragraph (a), with (i) no dependencies in activities of daily
living, (ii) only one dependency in bathing, dressing, grooming, or walking, or (iii) a
dependency score of less than three if eating is the only dependency as determined by an
assessment performed under section 256B.0911, the monthly cost of alternative care
services funded by the program cannot exceed $600 per month for all new participants
enrolled in the program on or after July 1, 2009. This monthly limit shall be applied to
all other participants who meet this criteria at reassessment. This monthly limit shall be
increased annually as described in section 256B.0915, subdivision 3a, paragraph (a). This
monthly limit does not prohibit the alternative care client from payment for additional
services, but in no case may the cost of additional services purchased exceed the difference
between the client's monthly service limit defined in this clause and the limit described in
clause (6) for case mix classification A; and
(8) the person is making timely payments of the assessed monthly fee.
A person is ineligible if payment of the fee is over 60 days past due, unless the person
agrees to:
    (i) the appointment of a representative payee;
    (ii) automatic payment from a financial account;
    (iii) the establishment of greater family involvement in the financial management of
payments; or
    (iv) another method acceptable to the lead agency to ensure prompt fee payments.
    The lead agency may extend the client's eligibility as necessary while making
arrangements to facilitate payment of past-due amounts and future premium payments.
Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
reinstated for a period of 30 days.
    (b) Alternative care funding under this subdivision is not available for a person
who is a medical assistance recipient or who would be eligible for medical assistance
without a spenddown or waiver obligation. A person whose initial application for medical
assistance and the elderly waiver program is being processed may be served under the
alternative care program for a period up to 60 days. If the individual is found to be eligible
for medical assistance, medical assistance must be billed for services payable under the
federally approved elderly waiver plan and delivered from the date the individual was
found eligible for the federally approved elderly waiver plan. Notwithstanding this
provision, alternative care funds may not be used to pay for any service the cost of which:
(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation;
or (iii) is used to pay a medical assistance income spenddown for a person who is eligible
to participate in the federally approved elderly waiver program under the special income
standard provision.
    (c) Alternative care funding is not available for a person who resides in a licensed
nursing home, certified boarding care home, hospital, or intermediate care facility, except
for case management services which are provided in support of the discharge planning
process for a nursing home resident or certified boarding care home resident to assist with
a relocation process to a community-based setting.
    (d) Alternative care funding is not available for a person whose income is greater
than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal
to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal
year for which alternative care eligibility is determined, who would be eligible for the
elderly waiver with a waiver obligation.

    Sec. 45. Minnesota Statutes 2008, section 256B.0915, subdivision 3a, is amended to
read:
    Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of
waivered services to an individual elderly waiver client except for individuals described
in paragraph (b) shall be the weighted average monthly nursing facility rate of the case
mix resident class to which the elderly waiver client would be assigned under Minnesota
Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance needs allowance
as described in subdivision 1d, paragraph (a), until the first day of the state fiscal year in
which the resident assessment system as described in section 256B.438 for nursing home
rate determination is implemented. Effective on the first day of the state fiscal year in
which the resident assessment system as described in section 256B.438 for nursing home
rate determination is implemented and the first day of each subsequent state fiscal year, the
monthly limit for the cost of waivered services to an individual elderly waiver client shall
be the rate of the case mix resident class to which the waiver client would be assigned
under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on the last day of the
previous state fiscal year, adjusted by the greater of any legislatively adopted home and
community-based services percentage rate increase or the average statewide percentage
increase in nursing facility payment rates.
    (b) The monthly limit for the cost of waivered services to an individual elderly
waiver client assigned to a case mix classification A under paragraph (a) with (1) no
dependencies in activities of daily living, (2) only one dependency in bathing, dressing,
grooming, or walking, or (3) a dependency score of less than three if eating is the only
dependency, shall be the lower of the case mix classification amount for case mix A as
determined under paragraph (a) or the case mix classification amount for case mix A
effective on October 1, 2008, per month for all new participants enrolled in the program
on or after July 1, 2009. This monthly limit shall be applied to all other participants who
meet this criteria at reassessment.
(c) If extended medical supplies and equipment or environmental modifications are
or will be purchased for an elderly waiver client, the costs may be prorated for up to
12 consecutive months beginning with the month of purchase. If the monthly cost of a
recipient's waivered services exceeds the monthly limit established in paragraph (a) or (b),
the annual cost of all waivered services shall be determined. In this event, the annual cost
of all waivered services shall not exceed 12 times the monthly limit of waivered services
as described in paragraph (a) or (b).

    Sec. 46. Minnesota Statutes 2008, section 256B.0915, subdivision 3e, is amended to
read:
    Subd. 3e. Customized living service rate. (a) Payment for customized living
services shall be a monthly rate negotiated and authorized by the lead agency within the
parameters established by the commissioner. The payment agreement must delineate the
services that have been customized for each recipient and specify the amount of each
component service included in the recipient's customized living service to be provided
plan. The lead agency shall ensure that there is a documented need for all within the
parameters established by the commissioner for all component customized living services
authorized. Customized living services must not include rent or raw food costs.
(b) The negotiated payment rate must be based on the amount of component services
to be provided utilizing component rates established by the commissioner. Counties and
tribes shall use tools issued by the commissioner to develop and document customized
living service plans and rates.
Negotiated (c) Component service rates must not exceed payment rates for
comparable elderly waiver or medical assistance services and must reflect economies of
scale. Customized living services must not include rent or raw food costs.
    (b) (d) The individualized monthly negotiated authorized payment for the
customized living services service plan shall not exceed the nonfederal share, in effect
on July 1 of the state fiscal year for which the rate limit is being calculated, 50 percent
of the greater of either the statewide or any of the geographic groups' weighted average
monthly nursing facility rate of the case mix resident class to which the elderly waiver
eligible client would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,
less the maintenance needs allowance as described in subdivision 1d, paragraph (a), until
the July 1 of the state fiscal year in which the resident assessment system as described
in section 256B.438 for nursing home rate determination is implemented. Effective on
July 1 of the state fiscal year in which the resident assessment system as described in
section 256B.438 for nursing home rate determination is implemented and July 1 of each
subsequent state fiscal year, the individualized monthly negotiated authorized payment
for the services described in this clause shall not exceed the limit described in this clause
which was in effect on June 30 of the previous state fiscal year and which has been
adjusted by the greater of any legislatively adopted home and community-based services
cost-of-living percentage increase or any legislatively adopted statewide percent rate
increase for nursing facilities updated annually based on legislatively adopted changes to
all service rate maximums for home and community-based service providers.
    (c) (e) Customized living services are delivered by a provider licensed by the
Department of Health as a class A or class F home care provider and provided in a
building that is registered as a housing with services establishment under chapter 144D.

    Sec. 47. Minnesota Statutes 2008, section 256B.0915, subdivision 3h, is amended to
read:
    Subd. 3h. Service rate limits; 24-hour customized living services. (a) The
payment rates rate for 24-hour customized living services is a monthly rate negotiated
and authorized by the lead agency within the parameters established by the commissioner
of human services. The payment agreement must delineate the services that have been
customized for each recipient and specify the amount of each component service included
in each recipient's customized living service to be provided plan. The lead agency
shall ensure that there is a documented need within the parameters established by the
commissioner for all component customized living services authorized. The lead agency
shall not authorize 24-hour customized living services unless there is a documented need
for 24-hour supervision.
(b) For purposes of this section, "24-hour supervision" means that the recipient
requires assistance due to needs related to one or more of the following:
    (1) intermittent assistance with toileting, positioning, or transferring;
    (2) cognitive or behavioral issues;
    (3) a medical condition that requires clinical monitoring; or
    (4) other conditions or needs as defined by the commissioner of human services for
all new participants enrolled in the program on or after January 1, 2011, and all other
participants at their first reassessment after January 1, 2011, dependency in at least two
of the following activities of daily living as determined by assessment under section
256B.0911: bathing; dressing; grooming; walking; or eating; and needs medication
management and at least 50 hours of service per month. The lead agency shall ensure that
the frequency and mode of supervision of the recipient and the qualifications of staff
providing supervision are described and meet the needs of the recipient. Customized
living services must not include rent or raw food costs.
(c) The negotiated payment rate for 24-hour customized living services must be
based on the amount of component services to be provided utilizing component rates
established by the commissioner. Counties and tribes will use tools issued by the
commissioner to develop and document customized living plans and authorize rates.
Negotiated (d) Component service rates must not exceed payment rates for
comparable elderly waiver or medical assistance services and must reflect economies
of scale.
(e) The individually negotiated authorized 24-hour customized living payments,
in combination with the payment for other elderly waiver services, including case
management, must not exceed the recipient's community budget cap specified in
subdivision 3a. Customized living services must not include rent or raw food costs.
(f) The individually authorized 24-hour customized living payment rates shall not
exceed the 95 percentile of statewide monthly authorizations for 24-hour customized
living services in effect and in the Medicaid management information systems on March
31, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050
to 9549.0059, to which elderly waiver service clients are assigned. When there are
fewer than 50 authorizations in effect in the case mix resident class, the commissioner
shall multiply the calculated service payment rate maximum for the A classification by
the standard weight for that classification under Minnesota Rules, parts 9549.0050 to
9549.0059, to determine the applicable payment rate maximum. Service payment rate
maximums shall be updated annually based on legislatively adopted changes to all service
rates for home and community-based service providers.
    (g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner
may establish alternative payment rate systems for 24-hour customized living services in
housing with services establishments which are freestanding buildings with a capacity of
16 or fewer, by applying a single hourly rate for covered component services provided
in either:
    (1) licensed corporate adult foster homes; or
    (2) specialized dementia care units which meet the requirements of section 144D.065
and in which:
    (i) each resident is offered the option of having their own apartment; or
    (ii) the units are licensed as board and lodge establishments with maximum capacity
of eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205,
subparts 1, 2, 3, and 4, item A.

    Sec. 48. Minnesota Statutes 2008, section 256B.0915, subdivision 5, is amended to
read:
    Subd. 5. Assessments and reassessments for waiver clients. (a) Each client
shall receive an initial assessment of strengths, informal supports, and need for services
in accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a
client served under the elderly waiver must be conducted at least every 12 months and at
other times when the case manager determines that there has been significant change in
the client's functioning. This may include instances where the client is discharged from
the hospital. There must be a determination that the client requires nursing facility level of
care as defined in section 144.0724, subdivision 11, at initial and subsequent assessments
to initiate and maintain participation in the waiver program.
(b) Regardless of other assessments identified in section 144.0724, subdivision
4, as appropriate to determine nursing facility level of care for purposes of medical
assistance payment for nursing facility services, only face-to-face assessments conducted
according to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility
level of care determination will be accepted for purposes of initial and ongoing access to
waiver service payment.
EFFECTIVE DATE.This section is effective January 1, 2011.

    Sec. 49. Minnesota Statutes 2008, section 256B.0915, is amended by adding a
subdivision to read:
    Subd. 10. Waiver payment rates; managed care organizations. The
commissioner shall adjust the elderly waiver capitation payment rates for managed care
organizations paid under section 256B.69, subdivisions 6a and 23, to reflect the maximum
service rate limits for customized living services and 24-hour customized living services
under subdivisions 3e and 3h for the contract period beginning October 1, 2009. Medical
assistance rates paid to customized living providers by managed care organizations
under this section shall not exceed the maximum service rate limits determined by the
commissioner under subdivisions 3e and 3h.

    Sec. 50. Minnesota Statutes 2008, section 256B.0916, subdivision 2, is amended to
read:
    Subd. 2. Distribution of funds; partnerships. (a) Beginning with fiscal year 2000,
the commissioner shall distribute all funding available for home and community-based
waiver services for persons with developmental disabilities to individual counties or to
groups of counties that form partnerships to jointly plan, administer, and authorize funding
for eligible individuals. The commissioner shall encourage counties to form partnerships
that have a sufficient number of recipients and funding to adequately manage the risk
and maximize use of available resources.
    (b) Counties must submit a request for funds and a plan for administering the
program as required by the commissioner. The plan must identify the number of clients to
be served, their ages, and their priority listing based on:
    (1) requirements in Minnesota Rules, part 9525.1880; and
    (2) unstable living situations due to the age or incapacity of the primary caregiver;
statewide priorities identified in section 256B.092, subdivision 12.
    (3) the need for services to avoid out-of-home placement of children;
    (4) the need to serve persons affected by private sector ICF/MR closures; and
    (5) the need to serve persons whose consumer support grant exception amount
was eliminated in 2004.
The plan must also identify changes made to improve services to eligible persons and to
improve program management.
    (c) In allocating resources to counties, priority must be given to groups of counties
that form partnerships to jointly plan, administer, and authorize funding for eligible
individuals and to counties determined by the commissioner to have sufficient waiver
capacity to maximize resource use.
    (d) Within 30 days after receiving the county request for funds and plans, the
commissioner shall provide a written response to the plan that includes the level of
resources available to serve additional persons.
    (e) Counties are eligible to receive medical assistance administrative reimbursement
for administrative costs under criteria established by the commissioner.

    Sec. 51. Minnesota Statutes 2008, section 256B.0917, is amended by adding a
subdivision to read:
    Subd. 14. Essential community supports grants. (a) The purpose of the essential
community supports grant program is to provide targeted services to persons 65 years and
older who need essential community support, but whose needs do not meet the level of
care required for nursing facility placement under section 144.0724, subdivision 11.
(b) Within the limits of the appropriation and not to exceed $400 per person per
month, funding must be available to a person who:
(1) is age 65 or older;
(2) is not eligible for medical assistance;
(3) would otherwise be financially eligible for the alternative care program under
section 256B.0913, subdivision 4;
(4) has received a community assessment under section 256B.0911, subdivision 3a
or 3b, and does not require the level of care provided in a nursing facility;
(5) has a community support plan; and
(6) has been determined by a community assessment under section 256B.0911,
subdivision 3a or 3b, to be a person who would require provision of at least one of the
following services, as defined in the approved elderly waiver plan, in order to maintain
their community residence:
(i) caregiver support;
(ii) homemaker;
(iii) chore; or
(iv) a personal emergency response device or system.
(c) The person receiving any of the essential community supports in this subdivision
must also receive service coordination as part of their community support plan.
(d) A person who has been determined to be eligible for an essential community
support grant must be reassessed at least annually and continue to meet the criteria in
paragraph (b) to remain eligible for an essential community support grant.
(e) The commissioner shall allocate grants to counties and tribes under contract with
the department based upon the historic use of the medical assistance elderly waiver and
alternative care grant programs and other criteria as determined by the commissioner.
EFFECTIVE DATE.This section is effective January 1, 2011.

    Sec. 52. Minnesota Statutes 2008, section 256B.092, subdivision 8a, is amended to
read:
    Subd. 8a. County concurrence. (a) If the county of financial responsibility wishes
to place a person in another county for services, the county of financial responsibility shall
seek concurrence from the proposed county of service and the placement shall be made
cooperatively between the two counties. Arrangements shall be made between the two
counties for ongoing social service, including annual reviews of the person's individual
service plan. The county where services are provided may not make changes in the
person's service plan without approval by the county of financial responsibility.
(b) When a person has been screened and authorized for services in an intermediate
care facility for persons with developmental disabilities or for home and community-based
services for persons with developmental disabilities, the case manager shall assist that
person in identifying a service provider who is able to meet the needs of the person
according to the person's individual service plan. If the identified service is to be provided
in a county other than the county of financial responsibility, the county of financial
responsibility shall request concurrence of the county where the person is requesting to
receive the identified services. The county of service may refuse to concur if:
(1) it can demonstrate that the provider is unable to provide the services identified in
the person's individual service plan as services that are needed and are to be provided; or
(2) in the case of an intermediate care facility for persons with developmental
disabilities, there has been no authorization for admission by the admission review team
as required in section 256B.0926; or.
(3) in the case of home and community-based services for persons with
developmental disabilities, the county of service can demonstrate that the prospective
provider has failed to substantially comply with the terms of a past contract or has had a
prior contract terminated within the last 12 months for failure to provide adequate services,
or has received a notice of intent to terminate the contract.
(c) The county of service shall notify the county of financial responsibility of
concurrence or refusal to concur no later than 20 working days following receipt of the
written request. Unless other mutually acceptable arrangements are made by the involved
county agencies, the county of financial responsibility is responsible for costs of social
services and the costs associated with the development and maintenance of the placement.
The county of service may request that the county of financial responsibility purchase
case management services from the county of service or from a contracted provider
of case management when the county of financial responsibility is not providing case
management as defined in this section and rules adopted under this section, unless other
mutually acceptable arrangements are made by the involved county agencies. Standards
for payment limits under this section may be established by the commissioner. Financial
disputes between counties shall be resolved as provided in section 256G.09.

    Sec. 53. Minnesota Statutes 2008, section 256B.092, is amended by adding a
subdivision to read:
    Subd. 11. Residential support services. (a) Upon federal approval, there is
established a new service called residential support that is available on the CAC, CADI,
DD, and TBI waivers. Existing waiver service descriptions must be modified to the extent
necessary to ensure there is no duplication between other services. Residential support
services must be provided by vendors licensed as a community residential setting as
defined in section 245A.11, subdivision 8.
(b) Residential support services must meet the following criteria:
(1) providers of residential support services must own or control the residential site;
(2) the residential site must not be the primary residence of the license holder;
(3) the residential site must have a designated program supervisor responsible for
program oversight, development, and implementation of policies and procedures;
(4) the provider of residential support services must provide supervision, training,
and assistance as described in the person's community support plan; and
(5) the provider of residential support services must meet the requirements of
licensure and additional requirements of the person's community support plan.
(c) Providers of residential support services that meet the definition in paragraph (a)
must be registered using a process determined by the commissioner beginning July 1, 2009.

    Sec. 54. Minnesota Statutes 2008, section 256B.092, is amended by adding a
subdivision to read:
    Subd. 12. Waivered services statewide priorities. (a) The commissioner shall
establish statewide priorities for individuals on the waiting list for developmental
disabilities (DD) waiver services, as of January 1, 2010. The statewide priorities must
include, but are not limited to, individuals who continue to have a need for waiver services
after they have maximized the use of state plan services and other funding resources,
including natural supports, prior to accessing waiver services, and who meet at least one
of the following criteria:
(1) have unstable living situations due to the age, incapacity, or sudden loss of
the primary caregivers;
(2) are moving from an institution due to bed closures;
(3) experience a sudden closure of their current living arrangement;
(4) require protection from confirmed abuse, neglect, or exploitation;
(5) experience a sudden change in need that can no longer be met through state plan
services or other funding resources alone; or
(6) meet other priorities established by the department.
(b) When allocating resources to lead agencies, the commissioner must take into
consideration the number of individuals waiting who meet statewide priorities and the
lead agencies' current use of waiver funds and existing service options.
(c) The commissioner shall evaluate the impact of the use of statewide priorities and
provide recommendations to the legislature on whether to continue the use of statewide
priorities in the November 1, 2011, annual report required by the commissioner in sections
256B.0916, subdivision 7, and 256B.49, subdivision 21.

    Sec. 55. [256B.0948] FOSTER CARE RATE LIMITS.
The commissioner shall decrease by five percent rates for adult foster care and
supportive living services that are reimbursed under section 256B.092 or 256B.49, and
are above the 95th percentile of the statewide rates for the service. The reduction in rates
shall take into account the acuity of individuals served based on the methodology used to
allocate dollars to local lead agency budgets, and assure that affected service rates are not
reduced below the rate level represented by the above percentile due to this rate change.
Lead agency contracts for services specified in this section shall be amended to implement
these rate changes for services rendered on or after July 1, 2009. The commissioner shall
make corresponding reductions to waiver allocations and capitated rates.

    Sec. 56. Minnesota Statutes 2008, section 256B.37, subdivision 1, is amended to read:
    Subdivision 1. Subrogation. Upon furnishing medical assistance or alternative
care services under section 256B.0913 to any person who has private accident or health
care coverage, or receives or has a right to receive health or medical care from any
type of organization or entity, or has a cause of action arising out of an occurrence that
necessitated the payment of medical assistance, the state agency or the state agency's agent
shall be subrogated, to the extent of the cost of medical care furnished, to any rights the
person may have under the terms of the coverage, or against the organization or entity
providing or liable to provide health or medical care, or under the cause of action.
    The right of subrogation created in this section includes all portions of the cause
of action, notwithstanding any settlement allocation or apportionment that purports to
dispose of portions of the cause of action not subject to subrogation.

    Sec. 57. Minnesota Statutes 2008, section 256B.37, subdivision 5, is amended to read:
    Subd. 5. Private benefits to be used first. Private accident and health care coverage
including Medicare for medical services is primary coverage and must be exhausted before
medical assistance is or alternative care services are paid for medical services including
home health care, personal care assistant services, hospice, supplies and equipment, or
services covered under a Centers for Medicare and Medicaid Services waiver. When a
person who is otherwise eligible for medical assistance has private accident or health care
coverage, including Medicare or a prepaid health plan, the private health care benefits
available to the person must be used first and to the fullest extent.

    Sec. 58. Minnesota Statutes 2008, section 256B.434, subdivision 4, is amended to read:
    Subd. 4. Alternate rates for nursing facilities. (a) For nursing facilities which
have their payment rates determined under this section rather than section 256B.431, the
commissioner shall establish a rate under this subdivision. The nursing facility must enter
into a written contract with the commissioner.
    (b) A nursing facility's case mix payment rate for the first rate year of a facility's
contract under this section is the payment rate the facility would have received under
section 256B.431.
    (c) A nursing facility's case mix payment rates for the second and subsequent years
of a facility's contract under this section are the previous rate year's contract payment
rates plus an inflation adjustment and, for facilities reimbursed under this section or
section 256B.431, an adjustment to include the cost of any increase in Health Department
licensing fees for the facility taking effect on or after July 1, 2001. The index for the
inflation adjustment must be based on the change in the Consumer Price Index-All Items
(United States City average) (CPI-U) forecasted by the commissioner of finance's national
economic consultant, as forecasted in the fourth quarter of the calendar year preceding
the rate year. The inflation adjustment must be based on the 12-month period from the
midpoint of the previous rate year to the midpoint of the rate year for which the rate is
being determined. For the rate years beginning on July 1, 1999, July 1, 2000, July 1, 2001,
July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006, July 1, 2007, July 1,
2008, October 1, 2009, and October 1, 2010, October 1, 2011, and October 1, 2012. This
paragraph shall apply only to the property-related payment rate, except that adjustments
to include the cost of any increase in Health Department licensing fees taking effect on
or after July 1, 2001, shall be provided. Beginning in 2005, adjustment to the property
payment rate under this section and section 256B.431 shall be effective on October 1.
In determining the amount of the property-related payment rate adjustment under this
paragraph, the commissioner shall determine the proportion of the facility's rates that are
property-related based on the facility's most recent cost report.
    (d) The commissioner shall develop additional incentive-based payments of up to
five percent above a facility's operating payment rate for achieving outcomes specified
in a contract. The commissioner may solicit contract amendments and implement those
which, on a competitive basis, best meet the state's policy objectives. The commissioner
shall limit the amount of any incentive payment and the number of contract amendments
under this paragraph to operate the incentive payments within funds appropriated for this
purpose. The contract amendments may specify various levels of payment for various
levels of performance. Incentive payments to facilities under this paragraph may be in the
form of time-limited rate adjustments or onetime supplemental payments. In establishing
the specified outcomes and related criteria, the commissioner shall consider the following
state policy objectives:
    (1) successful diversion or discharge of residents to the residents' prior home or other
community-based alternatives;
    (2) adoption of new technology to improve quality or efficiency;
    (3) improved quality as measured in the Nursing Home Report Card;
    (4) reduced acute care costs; and
    (5) any additional outcomes proposed by a nursing facility that the commissioner
finds desirable.
    (e) Notwithstanding the threshold in section 256B.431, subdivision 16, facilities that
take action to come into compliance with existing or pending requirements of the life
safety code provisions or federal regulations governing sprinkler systems must receive
reimbursement for the costs associated with compliance if all of the following conditions
are met:
    (1) the expenses associated with compliance occurred on or after January 1, 2005,
and before December 31, 2008;
    (2) the costs were not otherwise reimbursed under subdivision 4f or section
144A.071 or 144A.073; and
    (3) the total allowable costs reported under this paragraph are less than the minimum
threshold established under section 256B.431, subdivision 15, paragraph (e), and
subdivision 16.
The commissioner shall use money appropriated for this purpose to provide to qualifying
nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30,
2008. Nursing facilities that have spent money or anticipate the need to spend money
to satisfy the most recent life safety code requirements by (1) installing a sprinkler
system or (2) replacing all or portions of an existing sprinkler system may submit to the
commissioner by June 30, 2007, on a form provided by the commissioner the actual
costs of a completed project or the estimated costs, based on a project bid, of a planned
project. The commissioner shall calculate a rate adjustment equal to the allowable
costs of the project divided by the resident days reported for the report year ending
September 30, 2006. If the costs from all projects exceed the appropriation for this
purpose, the commissioner shall allocate the money appropriated on a pro rata basis
to the qualifying facilities by reducing the rate adjustment determined for each facility
by an equal percentage. Facilities that used estimated costs when requesting the rate
adjustment shall report to the commissioner by January 31, 2009, on the use of this
money on a form provided by the commissioner. If the nursing facility fails to provide
the report, the commissioner shall recoup the money paid to the facility for this purpose.
If the facility reports expenditures allowable under this subdivision that are less than
the amount received in the facility's annualized rate adjustment, the commissioner shall
recoup the difference.

    Sec. 59. Minnesota Statutes 2008, section 256B.434, is amended by adding a
subdivision to read:
    Subd. 21. Payment of post-PERA pension benefit costs. Nursing facilities that
convert or converted after September 30, 2006, from public to private ownership shall
have a portion of their post-PERA pension costs treated as a component of the historic
operating rate. Effective for the rate years beginning on or after October 1, 2009, and prior
to October 1, 2016, the commissioner shall determine the pension costs to be included
in the facility's base for determining rates under this section by using the following
formula: post-privatization pension benefit costs as a percent of salary shall be determined
from either the cost report for the first full reporting year after privatization or the most
recent report year available, whichever is later. This percentage shall be applied to the
salary costs of the alternative payment system base rate year to determine the allowable
amount of pension costs. The adjustments provided for in sections 256B.431, 256B.434,
256B.441, and any other law enacted after the base rate year and prior to the year for
which rates are being determined shall be applied to the allowable amount. The adjusted
allowable amount shall be added to the operating rate effective the first rate year PERA
ceases to remain as a pass-through component of the rate.

    Sec. 60. Minnesota Statutes 2008, section 256B.437, subdivision 6, is amended to read:
    Subd. 6. Planned closure rate adjustment. (a) The commissioner of human
services shall calculate the amount of the planned closure rate adjustment available under
subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):
(1) the amount available is the net reduction of nursing facility beds multiplied
by $2,080;
(2) the total number of beds in the nursing facility or facilities receiving the planned
closure rate adjustment must be identified;
(3) capacity days are determined by multiplying the number determined under
clause (2) by 365; and
(4) the planned closure rate adjustment is the amount available in clause (1), divided
by capacity days determined under clause (3).
(b) A planned closure rate adjustment under this section is effective on the first day
of the month following completion of closure of the facility designated for closure in the
application and becomes part of the nursing facility's total operating payment rate.
(c) Applicants may use the planned closure rate adjustment to allow for a property
payment for a new nursing facility or an addition to an existing nursing facility or as an
operating payment rate adjustment. Applications approved under this subdivision are
exempt from other requirements for moratorium exceptions under section 144A.073,
subdivisions 2 and 3
.
(d) Upon the request of a closing facility, the commissioner must allow the facility a
closure rate adjustment as provided under section 144A.161, subdivision 10.
(e) A facility that has received a planned closure rate adjustment may reassign it
to another facility that is under the same ownership at any time within three years of its
effective date. The amount of the adjustment shall be computed according to paragraph (a).
(f) If the per bed dollar amount specified in paragraph (a), clause (1), is increased,
the commissioner shall recalculate planned closure rate adjustments for facilities that
delicense beds under this section on or after July 1, 2001, to reflect the increase in the per
bed dollar amount. The recalculated planned closure rate adjustment shall be effective
from the date the per bed dollar amount is increased.
(g) For planned closures approved after June 30, 2009, the commissioner of human
services shall calculate the amount of the planned closure rate adjustment available under
subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).

    Sec. 61. Minnesota Statutes 2008, section 256B.441, subdivision 55, is amended to
read:
    Subd. 55. Phase-in of rebased operating payment rates. (a) For the rate years
beginning October 1, 2008, to October 1, 2015, the operating payment rate calculated
under this section shall be phased in by blending the