1.1                          A bill for an act 
  1.2             relating to human services; changing provisions in 
  1.3             medical assistance, Medicare, and Minnesotacare; 
  1.4             modifying the medical assistance elderly waiver; 
  1.5             modifying a waiver request; changing implementation 
  1.6             date for treatment of income and resources for the 
  1.7             elderly waiver program; changing procedures for 
  1.8             nursing facilities cost reports; delaying study of the 
  1.9             elderly waiver expansion; providing an offset of HMO 
  1.10            surcharge; amending Minnesota Statutes 1996, sections 
  1.11            245.462, subdivisions 4 and 8; 245.4871, subdivision 
  1.12            4; 256.969, subdivisions 16 and 17; 256B.03, 
  1.13            subdivision 3; 256B.055, by adding a subdivision; 
  1.14            256B.057, subdivision 3a, and by adding a subdivision; 
  1.15            256B.0625, subdivisions 20 and 34; 256B.0911, 
  1.16            subdivision 4; 256B.19, subdivision 1; 256B.41, 
  1.17            subdivision 1; 256B.431, subdivision 2b, and by adding 
  1.18            a subdivision; 256B.501, subdivision 2; 256B.69, by 
  1.19            adding a subdivision; and 256D.03, subdivision 4; 
  1.20            Minnesota Statutes 1997 Supplement, sections 256.9657, 
  1.21            subdivision 3; 256.9685, subdivision 1; 256B.06, 
  1.22            subdivision 4; 256B.0627, subdivision 5; 256B.0645; 
  1.23            256B.0911, subdivisions 2 and 7; 256B.0915, 
  1.24            subdivision 1d; and 256B.77, subdivisions 7a and 12; 
  1.25            Laws 1997, chapter 203, article 4, section 64; 
  1.26            repealing Minnesota Statutes 1996, section 144.0721, 
  1.27            subdivision 3a; Minnesota Statutes 1997 Supplement, 
  1.28            sections 144.0721, subdivision 3; and 256B.0913, 
  1.29            subdivision 15. 
  1.30  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.31     Section 1.  Minnesota Statutes 1996, section 245.462, 
  1.32  subdivision 4, is amended to read: 
  1.33     Subd. 4.  [CASE MANAGER.] "Case manager" means an 
  1.34  individual employed by the county or other entity authorized by 
  1.35  the county board to provide case management services specified 
  1.36  in section 245.4711.  A case manager must ~~have a bachelor's~~ 
  1.37  ~~degree in one of the behavioral sciences or related fields from~~ 
  2.1   ~~an accredited college or university and have at least 2,000~~ 
  2.2   ~~hours of supervised experience in the delivery of services to~~ 
  2.3   ~~adults with mental illness, must be skilled in the process of~~ 
  2.4   ~~identifying and assessing a wide range of client needs, and must~~ 
  2.5   ~~be knowledgeable about local community resources and how to use~~ 
  2.6   ~~those resources for the benefit of the client~~ meet the 
  2.7   qualifications for mental health practitioners in subdivision 
  2.8   17.  The case manager shall meet in person with a mental health 
  2.9   professional at least once each month to obtain clinical 
  2.10  supervision of the case manager's activities.  Case managers 
  2.11  with a bachelor's degree but without 2,000 hours of supervised 
  2.12  experience in the delivery of services to adults with mental 
  2.13  illness must complete 40 hours of training approved by the 
  2.14  commissioner of human services in case management skills and in 
  2.15  the characteristics and needs of adults with serious and 
  2.16  persistent mental illness and must receive clinical supervision 
  2.17  regarding individual service delivery from a mental health 
  2.18  professional at least once each week until the requirement of 
  2.19  2,000 hours of supervised experience is met.  Case managers 
  2.20  without a bachelor's degree but with 6,000 hours of supervised 
  2.21  experience in the delivery of services to adults with mental 
  2.22  illness must complete 40 hours of training approved by the 
  2.23  commissioner of human services in case management skills and in 
  2.24  the characteristics and needs of adults with serious and 
  2.25  persistent mental illness.  Clinical supervision must be 
  2.26  documented in the client record. 
  2.27     Until June 30, 1999, ~~a refugee~~ an immigrant who does not 
  2.28  have the qualifications specified in this subdivision may 
  2.29  provide case management services to adult ~~refugees~~ immigrants 
  2.30  with serious and persistent mental illness who are members of 
  2.31  the same ethnic group as the case manager if the person:  (1) is 
  2.32  actively pursuing credits toward the completion of a bachelor's 
  2.33  degree in one of the behavioral sciences or a related field from 
  2.34  an accredited college or university; (2) completes 40 hours of 
  2.35  training as specified in this subdivision; and (3) receives 
  2.36  clinical supervision at least once a week until the requirements 
  3.1   of ~~obtaining a bachelor's degree and 2,000 hours of supervised~~ 
  3.2   ~~experience~~ this subdivision are met. 
  3.3      Sec. 2.  Minnesota Statutes 1996, section 245.462, 
  3.4   subdivision 8, is amended to read: 
  3.5      Subd. 8.  [DAY TREATMENT SERVICES.] "Day treatment," "day 
  3.6   treatment services," or "day treatment program" means a 
  3.7   structured program of treatment and care provided to an adult in 
  3.8   or by:  (1) a hospital accredited by the joint commission on 
  3.9   accreditation of health organizations and licensed under 
  3.10  sections 144.50 to 144.55; (2) a community mental health center 
  3.11  under section 245.62; or (3) an entity that is under contract 
  3.12  with the county board to operate a program that meets the 
  3.13  requirements of section 245.4712, subdivision 2, and Minnesota 
  3.14  Rules, parts 9505.0170 to 9505.0475.  Day treatment consists of 
  3.15  group psychotherapy and other intensive therapeutic services 
  3.16  that are provided at least one day a week ~~for a minimum~~ 
  3.17  ~~three-hour time block~~ by a multidisciplinary staff under the 
  3.18  clinical supervision of a mental health professional.  The 
  3.19  services are aimed at stabilizing the adult's mental health 
  3.20  status, providing mental health services, and developing and 
  3.21  improving the adult's independent living and socialization 
  3.22  skills.  The goal of day treatment is to reduce or relieve 
  3.23  mental illness and to enable the adult to live in the 
  3.24  community.  Day treatment services are not a part of inpatient 
  3.25  or residential treatment services.  Day treatment services are 
  3.26  distinguished from day care by their structured therapeutic 
  3.27  program of psychotherapy services.  The commissioner may limit 
  3.28  medical assistance reimbursement for day treatment to 15 hours 
  3.29  per week per person instead of the three hours per day per 
  3.30  person specified in Minnesota Rules, part 9505.0323, subpart 15. 
  3.31     Sec. 3.  Minnesota Statutes 1996, section 245.4871, 
  3.32  subdivision 4, is amended to read: 
  3.33     Subd. 4.  [CASE MANAGER.] (a) "Case manager" means an 
  3.34  individual employed by the county or other entity authorized by 
  3.35  the county board to provide case management services specified 
  3.36  in subdivision 3 for the child with severe emotional disturbance 
  4.1   and the child's family.  A case manager must have experience and 
  4.2   training in working with children. 
  4.3      (b) A case manager must meet the qualifications for a 
  4.4   mental health practitioner in subdivision 26: 
  4.5      (1) ~~have at least a bachelor's degree in one of the~~ 
  4.6   ~~behavioral sciences or a related field from an accredited~~ 
  4.7   ~~college or university;~~ 
  4.8      ~~(2) have at least 2,000 hours of supervised experience in~~ 
  4.9   ~~the delivery of mental health services to children;~~ 
  4.10     ~~(3)~~ have experience and training in identifying and 
  4.11  assessing a wide range of children's needs; and 
  4.12     ~~(4)~~ (2) be knowledgeable about local community resources 
  4.13  and how to use those resources for the benefit of children and 
  4.14  their families.  
  4.15     (c) The case manager may be a member of any professional 
  4.16  discipline that is part of the local system of care for children 
  4.17  established by the county board. 
  4.18     (d) The case manager must meet in person with a mental 
  4.19  health professional at least once each month to obtain clinical 
  4.20  supervision. 
  4.21     (e) Case managers with a bachelor's degree but without 
  4.22  2,000 hours of supervised experience in the delivery of mental 
  4.23  health services to children with emotional disturbance must: 
  4.24     (1) begin 40 hours of training approved by the commissioner 
  4.25  of human services in case management skills and in the 
  4.26  characteristics and needs of children with severe emotional 
  4.27  disturbance before beginning to provide case management 
  4.28  services; and 
  4.29     (2) receive clinical supervision regarding individual 
  4.30  service delivery from a mental health professional at least once 
  4.31  each week until the requirement of 2,000 hours of experience is 
  4.32  met. 
  4.33     (f) Clinical supervision must be documented in the child's 
  4.34  record.  When the case manager is not a mental health 
  4.35  professional, the county board must provide or contract for 
  4.36  needed clinical supervision. 
  5.1      (g) The county board must ensure that the case manager has 
  5.2   the freedom to access and coordinate the services within the 
  5.3   local system of care that are needed by the child. 
  5.4      (h) Until June 30, 1999, ~~a refugee~~ an immigrant who does 
  5.5   not have the qualifications specified in this subdivision may 
  5.6   provide case management services to child ~~refugees~~ immigrants 
  5.7   with severe emotional disturbance of the same ethnic group as 
  5.8   the ~~refugee~~ immigrant if the person:  
  5.9      (1) is actively pursuing credits toward the completion of a 
  5.10  bachelor's degree in one of the behavioral sciences or related 
  5.11  fields at an accredited college or university; 
  5.12     (2) completes 40 hours of training as specified in this 
  5.13  subdivision; and 
  5.14     (3) receives clinical supervision at least once a week 
  5.15  until the requirements of ~~obtaining a bachelor's degree and~~ 
  5.16  ~~2,000 hours of supervised experience~~ this subdivision are met. 
  5.17     (i) Case managers without a bachelor's degree but with 
  5.18  6,000 hours of supervised experience in the delivery of mental 
  5.19  health services to children with emotional disturbance must 
  5.20  begin 40 hours of training approved by the commissioner of human 
  5.21  services in case management skills and in the characteristics 
  5.22  and needs of children with severe emotional disturbance before 
  5.23  beginning to provide case management services. 
  5.24     Sec. 4.  Minnesota Statutes 1997 Supplement, section 
  5.25  256.9657, subdivision 3, is amended to read: 
  5.26     Subd. 3.  [HEALTH MAINTENANCE ORGANIZATION; COMMUNITY 
  5.27  INTEGRATED SERVICE NETWORK SURCHARGE.] (a) Effective October 1, 
  5.28  1992, each health maintenance organization with a certificate of 
  5.29  authority issued by the commissioner of health under chapter 62D 
  5.30  and each community integrated service network licensed by the 
  5.31  commissioner under chapter 62N shall pay to the commissioner of 
  5.32  human services a surcharge equal to six-tenths of one percent of 
  5.33  the total premium revenues of the health maintenance 
  5.34  organization or community integrated service network as reported 
  5.35  to the commissioner of health according to the schedule in 
  5.36  subdivision 4.  
  6.1      (b) For purposes of this subdivision, total premium revenue 
  6.2   means: 
  6.3      (1) premium revenue recognized on a prepaid basis from 
  6.4   individuals and groups for provision of a specified range of 
  6.5   health services over a defined period of time which is normally 
  6.6   one month, excluding premiums paid to a health maintenance 
  6.7   organization or community integrated service network from the 
  6.8   Federal Employees Health Benefit Program; 
  6.9      (2) premiums from Medicare wrap-around subscribers for 
  6.10  health benefits which supplement Medicare coverage; 
  6.11     (3) Medicare revenue, as a result of an arrangement between 
  6.12  a health maintenance organization or a community integrated 
  6.13  service network and the health care financing administration of 
  6.14  the federal Department of Health and Human Services, for 
  6.15  services to a Medicare beneficiary, excluding Medicare revenue 
  6.16  that states are prohibited from taxing under sections 4001 and 
  6.17  4002 of Public Law Number 105-33 received by a health 
  6.18  maintenance organization or community integrated service network 
  6.19  through risk sharing or Medicare + Choice contracts; and 
  6.20     (4) medical assistance revenue, as a result of an 
  6.21  arrangement between a health maintenance organization or 
  6.22  community integrated service network and a Medicaid state 
  6.23  agency, for services to a medical assistance beneficiary. 
  6.24     If advance payments are made under clause (1) or (2) to the 
  6.25  health maintenance organization or community integrated service 
  6.26  network for more than one reporting period, the portion of the 
  6.27  payment that has not yet been earned must be treated as a 
  6.28  liability. 
  6.29     (c) When a health maintenance organization or community 
  6.30  integrated service network merges or consolidates with or is 
  6.31  acquired by another health maintenance organization or community 
  6.32  integrated service network, the surviving corporation or the new 
  6.33  corporation shall be responsible for the annual surcharge 
  6.34  originally imposed on each of the entities or corporations 
  6.35  subject to the merger, consolidation, or acquisition, regardless 
  6.36  of whether one of the entities or corporations does not retain a 
  7.1   certificate of authority under chapter 62D or a license under 
  7.2   chapter 62N. 
  7.3      (d) Effective July 1 of each year, the surviving 
  7.4   corporation's or the new corporation's surcharge shall be based 
  7.5   on the revenues earned in the second previous calendar year by 
  7.6   all of the entities or corporations subject to the merger, 
  7.7   consolidation, or acquisition regardless of whether one of the 
  7.8   entities or corporations does not retain a certificate of 
  7.9   authority under chapter 62D or a license under chapter 62N until 
  7.10  the total premium revenues of the surviving corporation include 
  7.11  the total premium revenues of all the merged entities as 
  7.12  reported to the commissioner of health. 
  7.13     (e) When a health maintenance organization or community 
  7.14  integrated service network, which is subject to liability for 
  7.15  the surcharge under this chapter, transfers, assigns, sells, 
  7.16  leases, or disposes of all or substantially all of its property 
  7.17  or assets, liability for the surcharge imposed by this chapter 
  7.18  is imposed on the transferee, assignee, or buyer of the health 
  7.19  maintenance organization or community integrated service network.
  7.20     (f) In the event a health maintenance organization or 
  7.21  community integrated service network converts its licensure to a 
  7.22  different type of entity subject to liability for the surcharge 
  7.23  under this chapter, but survives in the same or substantially 
  7.24  similar form, the surviving entity remains liable for the 
  7.25  surcharge regardless of whether one of the entities or 
  7.26  corporations does not retain a certificate of authority under 
  7.27  chapter 62D or a license under chapter 62N. 
  7.28     (g) The surcharge assessed to a health maintenance 
  7.29  organization or community integrated service network ends when 
  7.30  the entity ceases providing services for premiums and the 
  7.31  cessation is not connected with a merger, consolidation, 
  7.32  acquisition, or conversion. 
  7.33     Sec. 5.  Minnesota Statutes 1997 Supplement, section 
  7.34  256.9685, subdivision 1, is amended to read: 
  7.35     Subdivision 1.  [AUTHORITY.] The commissioner shall 
  7.36  establish procedures for determining medical assistance and 
  8.1   general assistance medical care payment rates under a 
  8.2   prospective payment system for inpatient hospital services in 
  8.3   hospitals that qualify as vendors of medical assistance.  The 
  8.4   commissioner shall establish, by rule, procedures for 
  8.5   implementing this section and sections 256.9686, 256.969, and 
  8.6   256.9695.  ~~The medical assistance payment rates must be based on~~ 
  8.7   ~~methods and standards that the commissioner finds are adequate~~ 
  8.8   ~~to provide for the costs that must be incurred for the care of~~ 
  8.9   ~~recipients in efficiently and economically operated hospitals.~~  
  8.10  Services must meet the requirements of section 256B.04, 
  8.11  subdivision 15, or 256D.03, subdivision 7, paragraph (b), to be 
  8.12  eligible for payment. 
  8.13     Sec. 6.  Minnesota Statutes 1996, section 256.969, 
  8.14  subdivision 16, is amended to read: 
  8.15     Subd. 16.  [INDIAN HEALTH SERVICE FACILITIES.] ~~Indian~~ 
  8.16  ~~health service~~ Facilities of the Indian Health Service and 
  8.17  facilities operated by a tribe or tribal organization under 
  8.18  funding authorized by title III of the Indian Self-Determination 
  8.19  and Education Assistance Act, Public Law Number 93-638, or by 
  8.20  United States Code, title 25, chapter 14, subchapter II, 
  8.21  sections 450f to 450n, are exempt from the rate establishment 
  8.22  methods required by this section and shall be ~~reimbursed at~~ 
  8.23  ~~charges as limited to the amount allowed under federal law~~ paid 
  8.24  according to the rate published by the United States assistant 
  8.25  secretary for health under authority of United States Code, 
  8.26  title 42, sections 248A and 248B.  
  8.27     Sec. 7.  Minnesota Statutes 1996, section 256.969, 
  8.28  subdivision 17, is amended to read: 
  8.29     Subd. 17.  [OUT-OF-STATE HOSPITALS IN LOCAL TRADE AREAS.] 
  8.30  Out-of-state hospitals that are located within a Minnesota local 
  8.31  trade area and that have more than 20 admissions in the base 
  8.32  year shall have rates established using the same procedures and 
  8.33  methods that apply to Minnesota hospitals.  For this subdivision 
  8.34  and subdivision 18, local trade area means a county contiguous 
  8.35  to Minnesota and located in a metropolitan statistical area as 
  8.36  determined by Medicare for October 1 prior to the most current 
  9.1   rebased rate year.  Hospitals that are not required by law to 
  9.2   file information in a format necessary to establish rates shall 
  9.3   have rates established based on the commissioner's estimates of 
  9.4   the information.  Relative values of the diagnostic categories 
  9.5   shall not be redetermined under this subdivision until required 
  9.6   by rule.  Hospitals affected by this subdivision shall then be 
  9.7   included in determining relative values.  However, hospitals 
  9.8   that have rates established based upon the commissioner's 
  9.9   estimates of information shall not be included in determining 
  9.10  relative values.  This subdivision is effective for hospital 
  9.11  fiscal years beginning on or after July 1, 1988.  A hospital 
  9.12  shall provide the information necessary to establish rates under 
  9.13  this subdivision at least 90 days before the start of the 
  9.14  hospital's fiscal year. 
  9.15     Sec. 8.  Minnesota Statutes 1996, section 256B.03, 
  9.16  subdivision 3, is amended to read: 
  9.17     Subd. 3.  [AMERICAN INDIAN HEALTH FUNDING.] Notwithstanding 
  9.18  subdivision 1 and sections 256B.0625 and 256D.03, subdivision 4, 
  9.19  paragraph ~~(f)~~ (i), the commissioner may make payments to 
  9.20  federally recognized Indian tribes with a reservation in the 
  9.21  state to provide medical assistance and general assistance 
  9.22  medical care to Indians, as defined under federal law, who 
  9.23  reside on or near the reservation.  The payments may be made in 
  9.24  the form of a block grant or other payment mechanism determined 
  9.25  in consultation with the tribe.  Any alternative payment 
  9.26  mechanism agreed upon by the tribes and the commissioner under 
  9.27  this subdivision is not dependent upon county agreement but is 
  9.28  intended to create a direct payment mechanism between the state 
  9.29  and the tribe for the administration of the medical assistance 
  9.30  ~~program~~ and general assistance medical care programs, and for 
  9.31  covered services.  
  9.32     For purposes of this subdivision, "Indian tribe" means a 
  9.33  tribe, band, or nation, or other organized group or community of 
  9.34  Indians that is recognized as eligible for the special programs 
  9.35  and services provided by the United States to Indians because of 
  9.36  their status as Indians and for which a reservation exists as is 
 10.1   consistent with Public Law Number 100-485, as amended. 
 10.2      Payments under this subdivision may not result in an 
 10.3   increase in expenditures that would not otherwise occur in the 
 10.4   medical assistance program under this chapter or the general 
 10.5   assistance medical care program under chapter 256D. 
 10.6      Sec. 9.  Minnesota Statutes 1996, section 256B.055, is 
 10.7   amended by adding a subdivision to read: 
 10.8      Subd. 7a.  [SPECIAL CATEGORY FOR DISABLED 
 10.9   CHILDREN.] Medical assistance may be paid for a person who is 
 10.10  under age 18 and who meets income and asset eligibility 
 10.11  requirements of the Supplemental Security Income program if the 
 10.12  person was receiving Supplemental Security Income payments on 
 10.13  the date of enactment of section 211(a) of Public Law Number 
 10.14  104-193, the Personal Responsibility and Work Opportunity Act of 
 10.15  1996, and the person would have continued to receive such 
 10.16  payments except for the change in the childhood disability 
 10.17  criteria in section 211(a) of Public Law Number 104-193. 
 10.18     Sec. 10.  Minnesota Statutes 1996, section 256B.057, 
 10.19  subdivision 3a, is amended to read: 
 10.20     Subd. 3a.  [ELIGIBILITY FOR PAYMENT OF MEDICARE PART B 
 10.21  PREMIUMS.] A person who would otherwise be eligible as a 
 10.22  qualified Medicare beneficiary under subdivision 3, except the 
 10.23  person's income is in excess of the limit, is eligible for 
 10.24  medical assistance reimbursement of Medicare Part B premiums if 
 10.25  the person's income is less than ~~110~~ 120 percent of the official 
 10.26  federal poverty guidelines for the applicable family size.  ~~The~~ 
 10.27  ~~income limit shall increase to 120 percent of the official~~ 
 10.28  ~~federal poverty guidelines for the applicable family size on~~ 
 10.29  ~~January 1, 1995.~~ 
 10.30     Sec. 11.  Minnesota Statutes 1996, section 256B.057, is 
 10.31  amended by adding a subdivision to read: 
 10.32     Subd. 3b.  [QUALIFIED INDIVIDUALS.] Beginning July 1, 1998, 
 10.33  to the extent of the federal allocation to Minnesota, a person, 
 10.34  who would otherwise be eligible as a qualified Medicare 
 10.35  beneficiary under subdivision 3, except that the person's income 
 10.36  is in excess of the limit, is eligible as a qualified individual 
 11.1   according to the following criteria: 
 11.2      (1) if the person's income is greater than 120 percent, but 
 11.3   less than 135 percent of the official federal poverty guidelines 
 11.4   for the applicable family size, the person is eligible for 
 11.5   medical assistance reimbursement of Medicare Part B premiums; or 
 11.6      (2) if the person's income is greater than 135 percent but 
 11.7   less than 175 percent of the official federal poverty guidelines 
 11.8   for the applicable family size, the person is eligible for 
 11.9   medical assistance reimbursement of that portion of the Medicare 
 11.10  Part B premium attributable to an increase in Part B 
 11.11  expenditures which resulted from the shift of home care services 
 11.12  from Medicare Part A to Medicare Part B under section 4732 of 
 11.13  Public Law Number 105-33, the Balanced Budget Act of 1997. 
 11.14     The commissioner shall limit enrollment of qualifying 
 11.15  individuals under this subdivision according to the requirements 
 11.16  of section 4732 of Public Law Number 105-33. 
 11.17     Sec. 12.  Minnesota Statutes 1997 Supplement, section 
 11.18  256B.06, subdivision 4, is amended to read: 
 11.19     Subd. 4.  [CITIZENSHIP REQUIREMENTS.] (a) Eligibility for 
 11.20  medical assistance is limited to citizens of the United States, 
 11.21  qualified noncitizens as defined in this subdivision, and other 
 11.22  persons residing lawfully in the United States. 
 11.23     (b) "Qualified noncitizen" means a person who meets one of 
 11.24  the following immigration criteria: 
 11.25     (1) admitted for lawful permanent residence according to 
 11.26  United States Code, title 8; 
 11.27     (2) admitted to the United States as a refugee according to 
 11.28  United States Code, title 8, section 1157; 
 11.29     (3) granted asylum according to United States Code, title 
 11.30  8, section 1158; 
 11.31     (4) granted withholding of deportation according to United 
 11.32  States Code, title 8, section 1253(h); 
 11.33     (5) paroled for a period of at least one year according to 
 11.34  United States Code, title 8, section 1182(d)(5); 
 11.35     (6) granted conditional entrant status according to United 
 11.36  States Code, title 8, section 1153(a)(7); ~~or~~ 
 12.1      (7) determined to be a battered noncitizen by the United 
 12.2   States Attorney General according to the Illegal Immigration 
 12.3   Reform and Immigrant Responsibility Act of 1996, title V of the 
 12.4   Omnibus Consolidated Appropriations Bill, Public Law Number 
 12.5   104-200; 
 12.6      (8) is a child of a noncitizen determined to be a battered 
 12.7   noncitizen by the United States Attorney General according to 
 12.8   the Illegal Immigration Reform and Immigrant Responsibility Act 
 12.9   of 1996, title V of the Omnibus Consolidated Appropriations 
 12.10  Bill, Public Law Number 104-200; or 
 12.11     (9) determined to be a Cuban or Haitian entrant as defined 
 12.12  in section 501(e) of Public Law Number 96-422, the Refugee 
 12.13  Education Assistance Act of 1980. 
 12.14     (c) All qualified noncitizens who were residing in the 
 12.15  United States before August 22, 1996, who otherwise meet the 
 12.16  eligibility requirements of chapter 256B, are eligible for 
 12.17  medical assistance with federal financial participation. 
 12.18     (d) All qualified noncitizens who entered the United States 
 12.19  on or after August 22, 1996, and who otherwise meet the 
 12.20  eligibility requirements of chapter 256B, are eligible for 
 12.21  medical assistance with federal financial participation through 
 12.22  November 30, 1996. 
 12.23     Beginning December 1, 1996, qualified noncitizens who 
 12.24  entered the United States on or after August 22, 1996, and who 
 12.25  otherwise meet the eligibility requirements of chapter 256B are 
 12.26  eligible for medical assistance with federal participation for 
 12.27  five years if they meet one of the following criteria: 
 12.28     (i) refugees admitted to the United States according to 
 12.29  United States Code, title 8, section 1157; 
 12.30     (ii) persons granted asylum according to United States 
 12.31  Code, title 8, section 1158; 
 12.32     (iii) persons granted withholding of deportation according 
 12.33  to United States Code, title 8, section 1253(h); 
 12.34     (iv) veterans of the United States Armed Forces with an 
 12.35  honorable discharge for a reason other than noncitizen status, 
 12.36  their spouses and unmarried minor dependent children; or 
 13.1      (v) persons on active duty in the United States Armed 
 13.2   Forces, other than for training, their spouses and unmarried 
 13.3   minor dependent children. 
 13.4      Beginning December 1, 1996, qualified noncitizens who do 
 13.5   not meet one of the criteria in items (i) to (v) are eligible 
 13.6   for medical assistance without federal financial participation 
 13.7   as described in paragraph (j). 
 13.8      (e) Noncitizens who are not qualified noncitizens as 
 13.9   defined in paragraph (b), who are lawfully residing in the 
 13.10  United States and who otherwise meet the eligibility 
 13.11  requirements of chapter 256B, are eligible for medical 
 13.12  assistance under clauses (1) to (3).  These individuals must 
 13.13  cooperate with the Immigration and Naturalization Service to 
 13.14  pursue any applicable immigration status, including citizenship, 
 13.15  that would qualify them for medical assistance with federal 
 13.16  financial participation. 
 13.17     (1) Persons who were medical assistance recipients on 
 13.18  August 22, 1996, are eligible for medical assistance with 
 13.19  federal financial participation through December 31, 1996. 
 13.20     (2) Beginning January 1, 1997, persons described in clause 
 13.21  (1) are eligible for medical assistance without federal 
 13.22  financial participation as described in paragraph (j). 
 13.23     (3) Beginning December 1, 1996, persons residing in the 
 13.24  United States prior to August 22, 1996, who were not receiving 
 13.25  medical assistance and persons who arrived on or after August 
 13.26  22, 1996, are eligible for medical assistance without federal 
 13.27  financial participation as described in paragraph (j). 
 13.28     (f) Nonimmigrants who otherwise meet the eligibility 
 13.29  requirements of chapter 256B are eligible for the benefits as 
 13.30  provided in paragraphs (g) to (i).  For purposes of this 
 13.31  subdivision, a "nonimmigrant" is a person in one of the classes 
 13.32  listed in United States Code, title 8, section 1101(a)(15). 
 13.33     (g) Payment shall also be made for care and services that 
 13.34  are furnished to noncitizens, regardless of immigration status, 
 13.35  who otherwise meet the eligibility requirements of chapter 256B, 
 13.36  if such care and services are necessary for the treatment of an 
 14.1   emergency medical condition, except for organ transplants and 
 14.2   related care and services and routine prenatal care.  
 14.3      (h) For purposes of this subdivision, the term "emergency 
 14.4   medical condition" means a medical condition that meets the 
 14.5   requirements of United States Code, title 42, section 1396b(v). 
 14.6      (i) Pregnant noncitizens who are undocumented or 
 14.7   nonimmigrants, who otherwise meet the eligibility requirements 
 14.8   of chapter 256B, are eligible for medical assistance payment 
 14.9   without federal financial participation for care and services 
 14.10  through the period of pregnancy, and 60 days postpartum, except 
 14.11  for labor and delivery.  
 14.12     (j) Qualified noncitizens as described in paragraph (d), 
 14.13  and all other noncitizens lawfully residing in the United States 
 14.14  as described in paragraph (e), who are ineligible for medical 
 14.15  assistance with federal financial participation and who 
 14.16  otherwise meet the eligibility requirements of chapter 256B and 
 14.17  of this paragraph, are eligible for medical assistance without 
 14.18  federal financial participation.  Qualified noncitizens as 
 14.19  described in paragraph (d) are only eligible for medical 
 14.20  assistance without federal financial participation for five 
 14.21  years from their date of entry into the United States.  
 14.22     (k) The commissioner shall submit to the legislature by 
 14.23  December 31, 1998, a report on the number of recipients and cost 
 14.24  of coverage of care and services made according to paragraphs 
 14.25  (i) and (j). 
 14.26     Sec. 13.  Minnesota Statutes 1996, section 256B.0625, 
 14.27  subdivision 20, is amended to read: 
 14.28     Subd. 20.  [MENTAL ~~ILLNESS~~ HEALTH CASE MANAGEMENT.] (a) To 
 14.29  the extent authorized by rule of the state agency, medical 
 14.30  assistance covers case management services to persons with 
 14.31  serious and persistent mental illness ~~or subject to federal~~ 
 14.32  ~~approval,~~ and children with severe emotional disturbance.  
 14.33  Services provided under this section must meet the relevant 
 14.34  standards in sections 245.461 to 245.4888, the Comprehensive 
 14.35  Adult and Children's Mental Health Acts, Minnesota Rules, parts 
 14.36  9520.0900 to 9520.0926, and 9505.0322, subparts 1 to 8, 13, and 
 15.1   14. 
 15.2      (b) Entities meeting program standards set out in rules 
 15.3   governing family community support services as defined in 
 15.4   section 245.4871, subdivision 17, are eligible for medical 
 15.5   assistance reimbursement for case management services for 
 15.6   children with severe emotional disturbance when these services 
 15.7   meet the program standards in Minnesota Rules, parts 9520.0900 
 15.8   to 9520.0926 and 9505.0322, excluding subpart 6. 
 15.9      ~~(b) In counties where fewer than 50 percent of children~~ 
 15.10  ~~estimated to be eligible under medical assistance to receive~~ 
 15.11  ~~case management services for children with severe emotional~~ 
 15.12  ~~disturbance actually receive these services in state fiscal year~~ 
 15.13  ~~1995, community mental health centers serving those counties,~~ 
 15.14  ~~entities meeting program standards in Minnesota Rules, parts~~ 
 15.15  ~~9520.0570 to 9520.0870, and other entities authorized by the~~ 
 15.16  ~~commissioner are eligible for medical assistance reimbursement~~ 
 15.17  ~~for case management services for children with severe emotional~~ 
 15.18  ~~disturbance when these services meet the program standards in~~ 
 15.19  ~~Minnesota Rules, parts 9520.0900 to 9520.0926 and 9505.0322,~~ 
 15.20  ~~excluding subpart 6.~~ 
 15.21     (c) Medical assistance and MinnesotaCare payment for mental 
 15.22  health case management shall be made on a monthly basis.  
 15.23  Payment is based on face-to-face or telephone contacts between 
 15.24  the case manager and the client, client's family, primary 
 15.25  caregiver, legal representative, or other relevant person 
 15.26  identified as necessary to the development or implementation of 
 15.27  the goals of the individual service plan regarding the status of 
 15.28  the client, the individual service plan, or the goals for the 
 15.29  client. 
 15.30     (d) Payment for mental health case management provided by 
 15.31  county or state staff shall be based on the monthly rate 
 15.32  methodology under section 256B.094, subdivision 6, paragraph 
 15.33  (b), with separate rates calculated for children and adults. 
 15.34     (e) Payment for mental health case management provided by 
 15.35  county-contracted vendors shall be based on a monthly rate 
 15.36  negotiated by the host county.  If the service is provided by a 
 16.1   team of contracted vendors, the county may negotiate a team rate 
 16.2   with a vendor who is a member of the team.  The team shall 
 16.3   determine how to distribute the rate among its members.  No 
 16.4   reimbursement received by contracted vendors shall be returned 
 16.5   to the county, except to reimburse the county for advance 
 16.6   funding provided by the county to the vendor. 
 16.7      (f) If the service is provided by a team which includes 
 16.8   contracted vendors and county or state staff, the costs for 
 16.9   county or state staff participation in the team shall be 
 16.10  included in the rate for county-provided services.  In this 
 16.11  case, the contracted vendor and the county may each receive 
 16.12  separate payment for services provided by each entity in the 
 16.13  same month.  
 16.14     (g) The commissioner shall calculate the state share of 
 16.15  actual medical assistance and general assistance medical care 
 16.16  payments for each county, based on the higher of calendar year 
 16.17  1995 or 1996, trend that amount forward to 1999, and transfer 
 16.18  the result from medical assistance and general assistance 
 16.19  medical care to each county's mental health grants under 
 16.20  sections 245.4886 and 256E.12 for calendar year 1999.  The 
 16.21  minimum amount added to each county's mental health grant shall 
 16.22  be $3,000 per year for children and $5,000 per year for adults.  
 16.23  The total amount transferred shall become part of the base for 
 16.24  future mental health grants for each county. 
 16.25     (h) Any net increase in revenue to the county as a result 
 16.26  of the change in this section must be used to provide expanded 
 16.27  mental health services as defined in sections 245.461 to 
 16.28  245.4888, the Comprehensive Adult and Children's Mental Health 
 16.29  Acts.  "Increased revenue" has the meaning given in Minnesota 
 16.30  Rules, part 9520.0903, subpart 3.  
 16.31     (i) Notwithstanding section 256B.19, subdivision 1, the 
 16.32  nonfederal share of costs for mental health case management 
 16.33  shall be provided by the recipient's county of responsibility, 
 16.34  as defined in sections 256G.01 to 256G.12, from sources other 
 16.35  than federal funds or funds used to match other federal funds.  
 16.36     (j) The commissioner may suspend, reduce, or terminate the 
 17.1   reimbursement to a provider that does not meet the reporting or 
 17.2   other requirements of this section.  The county of 
 17.3   responsibility, as defined in sections 256G.01 to 256G.12, is 
 17.4   responsible for any federal disallowances.  The county may share 
 17.5   this responsibility with its contracted vendors.  
 17.6      (k) The commissioner shall set aside a portion of the 
 17.7   federal funds earned under this section to repay the special 
 17.8   revenue maximization account under section 256.01, subdivision 
 17.9   2, clause (15).  The repayment is limited to: 
 17.10     (1) the costs of developing and implementing this section; 
 17.11  and 
 17.12     (2) programming the information systems. 
 17.13     (l) Notwithstanding section 256.025, subdivision 2, 
 17.14  payments to counties for case management expenditures under this 
 17.15  section shall only be made from federal earnings from services 
 17.16  provided under this section.  Payments to contracted vendors 
 17.17  shall include both the federal earnings and the county share. 
 17.18     (m) Notwithstanding section 256B.041, county payments for 
 17.19  the cost of mental health case management services provided by 
 17.20  county or state staff shall not be made to the state treasurer.  
 17.21  For the purposes of mental health case management services 
 17.22  provided by county or state staff under this section, the 
 17.23  centralized disbursement of payments to counties under section 
 17.24  256B.041 consists only of federal earnings from services 
 17.25  provided under this section. 
 17.26     Sec. 14.  Minnesota Statutes 1996, section 256B.0625, 
 17.27  subdivision 34, is amended to read: 
 17.28     Subd. 34.  [AMERICAN INDIAN HEALTH SERVICES FACILITIES.] 
 17.29  Medical assistance payments to ~~American Indian health services~~ 
 17.30  ~~facilities for outpatient medical services billed after June 30,~~ 
 17.31  ~~1990, must be~~ facilities of the Indian Health Service and 
 17.32  facilities operated by a tribe or tribal organization under 
 17.33  funding authorized by United States Code, title 25, sections 
 17.34  450f to 450n, or title III of the Indian Self-Determination and 
 17.35  Education Assistance Act, Public Law Number 93-638, shall be at 
 17.36  the option of the facility in accordance with the rate published 
 18.1   by the United States Assistant Secretary for Health under the 
 18.2   authority of United States Code, title 42, sections 248(a) and 
 18.3   249(b).  General assistance medical care payments to facilities 
 18.4   of the American Indian health services and facilities operated 
 18.5   by a tribe or tribal organization for the provision of 
 18.6   outpatient medical care services billed after June 30, 1990, 
 18.7   must be in accordance with the general assistance medical care 
 18.8   rates paid for the same services when provided in a facility 
 18.9   other than ~~an American~~ a facility of the Indian Health 
 18.10  Service or a facility operated by a tribe or tribal organization.
 18.11     Sec. 15.  Minnesota Statutes 1997 Supplement, section 
 18.12  256B.0627, subdivision 5, is amended to read: 
 18.13     Subd. 5.  [LIMITATION ON PAYMENTS.] Medical assistance 
 18.14  payments for home care services shall be limited according to 
 18.15  this subdivision.  
 18.16     (a)  [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 
 18.17  recipient may receive the following home care services during a 
 18.18  calendar year: 
 18.19     (1) any initial assessment; 
 18.20     (2) up to two reassessments per year done to determine a 
 18.21  recipient's need for personal care services; and 
 18.22     (3) up to five skilled nurse visits.  
 18.23     (b)  [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 
 18.24  services above the limits in paragraph (a) must receive the 
 18.25  commissioner's prior authorization, except when: 
 18.26     (1) the home care services were required to treat an 
 18.27  emergency medical condition that if not immediately treated 
 18.28  could cause a recipient serious physical or mental disability, 
 18.29  continuation of severe pain, or death.  The provider must 
 18.30  request retroactive authorization no later than five working 
 18.31  days after giving the initial service.  The provider must be 
 18.32  able to substantiate the emergency by documentation such as 
 18.33  reports, notes, and admission or discharge histories; 
 18.34     (2) the home care services were provided on or after the 
 18.35  date on which the recipient's eligibility began, but before the 
 18.36  date on which the recipient was notified that the case was 
 19.1   opened.  Authorization will be considered if the request is 
 19.2   submitted by the provider within 20 working days of the date the 
 19.3   recipient was notified that the case was opened; 
 19.4      (3) a third-party payor for home care services has denied 
 19.5   or adjusted a payment.  Authorization requests must be submitted 
 19.6   by the provider within 20 working days of the notice of denial 
 19.7   or adjustment.  A copy of the notice must be included with the 
 19.8   request; 
 19.9      (4) the commissioner has determined that a county or state 
 19.10  human services agency has made an error; or 
 19.11     (5) the professional nurse determines an immediate need for 
 19.12  up to 40 skilled nursing or home health aide visits per calendar 
 19.13  year and submits a request for authorization within 20 working 
 19.14  days of the initial service date, and medical assistance is 
 19.15  determined to be the appropriate payer. 
 19.16     (c)  [RETROACTIVE AUTHORIZATION.] A request for retroactive 
 19.17  authorization will be evaluated according to the same criteria 
 19.18  applied to prior authorization requests.  
 19.19     (d)  [ASSESSMENT AND SERVICE PLAN.] Assessments under 
 19.20  section 256B.0627, subdivision 1, paragraph (a), shall be 
 19.21  conducted initially, and at least annually thereafter, in person 
 19.22  with the recipient and result in a completed service plan using 
 19.23  forms specified by the commissioner.  Within 30 days of 
 19.24  recipient or responsible party request for home care services, 
 19.25  the assessment, the service plan, and other information 
 19.26  necessary to determine medical necessity such as diagnostic or 
 19.27  testing information, social or medical histories, and hospital 
 19.28  or facility discharge summaries shall be submitted to the 
 19.29  commissioner.  For personal care services: 
 19.30     (1) The amount and type of service authorized based upon 
 19.31  the assessment and service plan will follow the recipient if the 
 19.32  recipient chooses to change providers.  
 19.33     (2) If the recipient's medical need changes, the 
 19.34  recipient's provider may assess the need for a change in service 
 19.35  authorization and request the change from the county public 
 19.36  health nurse.  Within 30 days of the request, the public health 
 20.1   nurse will determine whether to request the change in services 
 20.2   based upon the provider assessment, or conduct a home visit to 
 20.3   assess the need and determine whether the change is appropriate. 
 20.4      (3) To continue to receive personal care services ~~when the~~ 
 20.5   ~~recipient displays no significant change, the county public~~ 
 20.6   ~~health nurse has the option to review with the commissioner, or~~ 
 20.7   ~~the commissioner's designee, the service plan on record and~~ 
 20.8   ~~receive authorization for up to an additional 12 months at a~~ 
 20.9   ~~time for up to three years.~~ after the first year, the recipient 
 20.10  or the responsible party, in conjunction with the public health 
 20.11  nurse, may complete a service update on forms developed by the 
 20.12  commissioner.  The service update may substitute for the annual 
 20.13  reassessment described in subdivision 1. 
 20.14     (e)  [PRIOR AUTHORIZATION.] The commissioner, or the 
 20.15  commissioner's designee, shall review the assessment, the 
 20.16  service plan, and any additional information that is submitted.  
 20.17  The commissioner shall, within 30 days after receiving a 
 20.18  complete request, assessment, and service plan, authorize home 
 20.19  care services as follows:  
 20.20     (1)  [HOME HEALTH SERVICES.] All home health services 
 20.21  provided by a licensed nurse or a home health aide must be prior 
 20.22  authorized by the commissioner or the commissioner's designee.  
 20.23  Prior authorization must be based on medical necessity and 
 20.24  cost-effectiveness when compared with other care options.  When 
 20.25  home health services are used in combination with personal care 
 20.26  and private duty nursing, the cost of all home care services 
 20.27  shall be considered for cost-effectiveness.  The commissioner 
 20.28  shall limit nurse and home health aide visits to no more than 
 20.29  one visit each per day. 
 20.30     (2)  [PERSONAL CARE SERVICES.] (i) All personal care 
 20.31  services and registered nurse supervision must be prior 
 20.32  authorized by the commissioner or the commissioner's designee 
 20.33  except for the assessments established in paragraph (a).  The 
 20.34  amount of personal care services authorized must be based on the 
 20.35  recipient's home care rating.  A child may not be found to be 
 20.36  dependent in an activity of daily living if because of the 
 21.1   child's age an adult would either perform the activity for the 
 21.2   child or assist the child with the activity and the amount of 
 21.3   assistance needed is similar to the assistance appropriate for a 
 21.4   typical child of the same age.  Based on medical necessity, the 
 21.5   commissioner may authorize: 
 21.6      (A) up to two times the average number of direct care hours 
 21.7   provided in nursing facilities for the recipient's comparable 
 21.8   case mix level; or 
 21.9      (B) up to three times the average number of direct care 
 21.10  hours provided in nursing facilities for recipients who have 
 21.11  complex medical needs or are dependent in at least seven 
 21.12  activities of daily living and need physical assistance with 
 21.13  eating or have a neurological diagnosis; or 
 21.14     (C) up to 60 percent of the average reimbursement rate, as 
 21.15  of July 1, 1991, for care provided in a regional treatment 
 21.16  center for recipients who have Level I behavior, plus any 
 21.17  inflation adjustment as provided by the legislature for personal 
 21.18  care service; or 
 21.19     (D) up to the amount the commissioner would pay, as of July 
 21.20  1, 1991, plus any inflation adjustment provided for home care 
 21.21  services, for care provided in a regional treatment center for 
 21.22  recipients referred to the commissioner by a regional treatment 
 21.23  center preadmission evaluation team.  For purposes of this 
 21.24  clause, home care services means all services provided in the 
 21.25  home or community that would be included in the payment to a 
 21.26  regional treatment center; or 
 21.27     (E) up to the amount medical assistance would reimburse for 
 21.28  facility care for recipients referred to the commissioner by a 
 21.29  preadmission screening team established under section 256B.0911 
 21.30  or 256B.092; and 
 21.31     (F) a reasonable amount of time for the provision of 
 21.32  nursing supervision of personal care services.  
 21.33     (ii) The number of direct care hours shall be determined 
 21.34  according to the annual cost report submitted to the department 
 21.35  by nursing facilities.  The average number of direct care hours, 
 21.36  as established by May 1, 1992, shall be calculated and 
 22.1   incorporated into the home care limits on July 1, 1992.  These 
 22.2   limits shall be calculated to the nearest quarter hour. 
 22.3      (iii) The home care rating shall be determined by the 
 22.4   commissioner or the commissioner's designee based on information 
 22.5   submitted to the commissioner by the county public health nurse 
 22.6   on forms specified by the commissioner.  The home care rating 
 22.7   shall be a combination of current assessment tools developed 
 22.8   under sections 256B.0911 and 256B.501 with an addition for 
 22.9   seizure activity that will assess the frequency and severity of 
 22.10  seizure activity and with adjustments, additions, and 
 22.11  clarifications that are necessary to reflect the needs and 
 22.12  conditions of recipients who need home care including children 
 22.13  and adults under 65 years of age.  The commissioner shall 
 22.14  establish these forms and protocols under this section and shall 
 22.15  use an advisory group, including representatives of recipients, 
 22.16  providers, and counties, for consultation in establishing and 
 22.17  revising the forms and protocols. 
 22.18     (iv) A recipient shall qualify as having complex medical 
 22.19  needs if the care required is difficult to perform and because 
 22.20  of recipient's medical condition requires more time than 
 22.21  community-based standards allow or requires more skill than 
 22.22  would ordinarily be required and the recipient needs or has one 
 22.23  or more of the following: 
 22.24     (A) daily tube feedings; 
 22.25     (B) daily parenteral therapy; 
 22.26     (C) wound or decubiti care; 
 22.27     (D) postural drainage, percussion, nebulizer treatments, 
 22.28  suctioning, tracheotomy care, oxygen, mechanical ventilation; 
 22.29     (E) catheterization; 
 22.30     (F) ostomy care; 
 22.31     (G) quadriplegia; or 
 22.32     (H) other comparable medical conditions or treatments the 
 22.33  commissioner determines would otherwise require institutional 
 22.34  care.  
 22.35     (v) A recipient shall qualify as having Level I behavior if 
 22.36  there is reasonable supporting evidence that the recipient 
 23.1   exhibits, or that without supervision, observation, or 
 23.2   redirection would exhibit, one or more of the following 
 23.3   behaviors that cause, or have the potential to cause: 
 23.4      (A) injury to the recipient's own body; 
 23.5      (B) physical injury to other people; or 
 23.6      (C) destruction of property. 
 23.7      (vi) Time authorized for personal care relating to Level I 
 23.8   behavior in subclause (v), items (A) to (C), shall be based on 
 23.9   the predictability, frequency, and amount of intervention 
 23.10  required. 
 23.11     (vii) A recipient shall qualify as having Level II behavior 
 23.12  if the recipient exhibits on a daily basis one or more of the 
 23.13  following behaviors that interfere with the completion of 
 23.14  personal care services under subdivision 4, paragraph (a): 
 23.15     (A) unusual or repetitive habits; 
 23.16     (B) withdrawn behavior; or 
 23.17     (C) offensive behavior. 
 23.18     (viii) A recipient with a home care rating of Level II 
 23.19  behavior in subclause (vii), items (A) to (C), shall be rated as 
 23.20  comparable to a recipient with complex medical needs under 
 23.21  subclause (iv).  If a recipient has both complex medical needs 
 23.22  and Level II behavior, the home care rating shall be the next 
 23.23  complex category up to the maximum rating under subclause (i), 
 23.24  item (B). 
 23.25     (3)  [PRIVATE DUTY NURSING SERVICES.] All private duty 
 23.26  nursing services shall be prior authorized by the commissioner 
 23.27  or the commissioner's designee.  Prior authorization for private 
 23.28  duty nursing services shall be based on medical necessity and 
 23.29  cost-effectiveness when compared with alternative care options.  
 23.30  The commissioner may authorize medically necessary private duty 
 23.31  nursing services in quarter-hour units when: 
 23.32     (i) the recipient requires more individual and continuous 
 23.33  care than can be provided during a nurse visit; or 
 23.34     (ii) the cares are outside of the scope of services that 
 23.35  can be provided by a home health aide or personal care assistant.
 23.36     The commissioner may authorize: 
 24.1      (A) up to two times the average amount of direct care hours 
 24.2   provided in nursing facilities statewide for case mix 
 24.3   classification "K" as established by the annual cost report 
 24.4   submitted to the department by nursing facilities in May 1992; 
 24.5      (B) private duty nursing in combination with other home 
 24.6   care services up to the total cost allowed under clause (2); 
 24.7      (C) up to 16 hours per day if the recipient requires more 
 24.8   nursing than the maximum number of direct care hours as 
 24.9   established in item (A) and the recipient meets the hospital 
 24.10  admission criteria established under Minnesota Rules, parts 
 24.11  9505.0500 to 9505.0540.  
 24.12     The commissioner may authorize up to 16 hours per day of 
 24.13  medically necessary private duty nursing services or up to 24 
 24.14  hours per day of medically necessary private duty nursing 
 24.15  services until such time as the commissioner is able to make a 
 24.16  determination of eligibility for recipients who are 
 24.17  cooperatively applying for home care services under the 
 24.18  community alternative care program developed under section 
 24.19  256B.49, or until it is determined by the appropriate regulatory 
 24.20  agency that a health benefit plan is or is not required to pay 
 24.21  for appropriate medically necessary health care services.  
 24.22  Recipients or their representatives must cooperatively assist 
 24.23  the commissioner in obtaining this determination.  Recipients 
 24.24  who are eligible for the community alternative care program may 
 24.25  not receive more hours of nursing under this section than would 
 24.26  otherwise be authorized under section 256B.49. 
 24.27     (4)  [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 
 24.28  ventilator-dependent, the monthly medical assistance 
 24.29  authorization for home care services shall not exceed what the 
 24.30  commissioner would pay for care at the highest cost hospital 
 24.31  designated as a long-term hospital under the Medicare program.  
 24.32  For purposes of this clause, home care services means all 
 24.33  services provided in the home that would be included in the 
 24.34  payment for care at the long-term hospital.  
 24.35  "Ventilator-dependent" means an individual who receives 
 24.36  mechanical ventilation for life support at least six hours per 
 25.1   day and is expected to be or has been dependent for at least 30 
 25.2   consecutive days.  
 25.3      (f)  [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 
 25.4   or the commissioner's designee shall determine the time period 
 25.5   for which a prior authorization shall be effective.  If the 
 25.6   recipient continues to require home care services beyond the 
 25.7   duration of the prior authorization, the home care provider must 
 25.8   request a new prior authorization.  Under no circumstances, 
 25.9   other than the exceptions in paragraph (b), shall a prior 
 25.10  authorization be valid prior to the date the commissioner 
 25.11  receives the request or for more than 12 months.  A recipient 
 25.12  who appeals a reduction in previously authorized home care 
 25.13  services may continue previously authorized services, other than 
 25.14  temporary services under paragraph (h), pending an appeal under 
 25.15  section 256.045.  The commissioner must provide a detailed 
 25.16  explanation of why the authorized services are reduced in amount 
 25.17  from those requested by the home care provider.  
 25.18     (g)  [APPROVAL OF HOME CARE SERVICES.] The commissioner or 
 25.19  the commissioner's designee shall determine the medical 
 25.20  necessity of home care services, the level of caregiver 
 25.21  according to subdivision 2, and the institutional comparison 
 25.22  according to this subdivision, the cost-effectiveness of 
 25.23  services, and the amount, scope, and duration of home care 
 25.24  services reimbursable by medical assistance, based on the 
 25.25  assessment, primary payer coverage determination information as 
 25.26  required, the service plan, the recipient's age, the cost of 
 25.27  services, the recipient's medical condition, and diagnosis or 
 25.28  disability.  The commissioner may publish additional criteria 
 25.29  for determining medical necessity according to section 256B.04. 
 25.30     (h)  [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 
 25.31  The agency nurse, the independently enrolled private duty nurse, 
 25.32  or county public health nurse may request a temporary 
 25.33  authorization for home care services by telephone.  The 
 25.34  commissioner may approve a temporary level of home care services 
 25.35  based on the assessment, and service or care plan information, 
 25.36  and primary payer coverage determination information as required.
 26.1   Authorization for a temporary level of home care services 
 26.2   including nurse supervision is limited to the time specified by 
 26.3   the commissioner, but shall not exceed 45 days, unless extended 
 26.4   because the county public health nurse has not completed the 
 26.5   required assessment and service plan, or the commissioner's 
 26.6   determination has not been made.  The level of services 
 26.7   authorized under this provision shall have no bearing on a 
 26.8   future prior authorization. 
 26.9      (i)  [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 
 26.10  Home care services provided in an adult or child foster care 
 26.11  setting must receive prior authorization by the department 
 26.12  according to the limits established in paragraph (a). 
 26.13     The commissioner may not authorize: 
 26.14     (1) home care services that are the responsibility of the 
 26.15  foster care provider under the terms of the foster care 
 26.16  placement agreement and administrative rules.  Requests for home 
 26.17  care services for recipients residing in a foster care setting 
 26.18  must include the foster care placement agreement and 
 26.19  determination of difficulty of care; 
 26.20     (2) personal care services when the foster care license 
 26.21  holder is also the personal care provider or personal care 
 26.22  assistant unless the recipient can direct the recipient's own 
 26.23  care, or case management is provided as required in section 
 26.24  256B.0625, subdivision 19a; 
 26.25     (3) personal care services when the responsible party is an 
 26.26  employee of, or under contract with, or has any direct or 
 26.27  indirect financial relationship with the personal care provider 
 26.28  or personal care assistant, unless case management is provided 
 26.29  as required in section 256B.0625, subdivision 19a; 
 26.30     (4) home care services when the number of foster care 
 26.31  residents is greater than four unless the county responsible for 
 26.32  the recipient's foster placement made the placement prior to 
 26.33  April 1, 1992, requests that home care services be provided, and 
 26.34  case management is provided as required in section 256B.0625, 
 26.35  subdivision 19a; or 
 26.36     (5) home care services when combined with foster care 
 27.1   payments, other than room and board payments that exceed the 
 27.2   total amount that public funds would pay for the recipient's 
 27.3   care in a medical institution. 
 27.4      Sec. 16.  Minnesota Statutes 1997 Supplement, section 
 27.5   256B.0645, is amended to read: 
 27.6      256B.0645 [PROVIDER PAYMENTS; RETROACTIVE CHANGES IN 
 27.7   ELIGIBILITY.] 
 27.8      Payment to a provider for a health care service provided to 
 27.9   a general assistance medical care recipient who is later 
 27.10  determined eligible for medical assistance or MinnesotaCare 
 27.11  according to section 256L.14 for the period in which the health 
 27.12  care service was provided, ~~shall be considered payment in full,~~ 
 27.13  ~~and shall not~~ may be adjusted due to the change in eligibility.  
 27.14  This section ~~applies~~ does not apply to ~~both fee-for-service~~ 
 27.15  ~~payments and~~ payments made to health plans on a prepaid 
 27.16  capitated basis. 
 27.17     Sec. 17.  Minnesota Statutes 1997 Supplement, section 
 27.18  256B.0911, subdivision 2, is amended to read: 
 27.19     Subd. 2.  [PERSONS REQUIRED TO BE SCREENED; EXEMPTIONS.] 
 27.20  All applicants to Medicaid certified nursing facilities must be 
 27.21  screened prior to admission, regardless of income, assets, or 
 27.22  funding sources, except the following: 
 27.23     (1) patients who, having entered acute care facilities from 
 27.24  certified nursing facilities, are returning to a certified 
 27.25  nursing facility; 
 27.26     (2) residents transferred from other certified nursing 
 27.27  facilities located within the state of Minnesota; 
 27.28     (3) individuals who have a contractual right to have their 
 27.29  nursing facility care paid for indefinitely by the veteran's 
 27.30  administration; 
 27.31     (4) individuals who are enrolled in the Ebenezer/Group 
 27.32  Health social health maintenance organization project, or 
 27.33  enrolled in a demonstration project under section 256B.69, 
 27.34  subdivision ~~18~~ 8, at the time of application to a nursing home; 
 27.35     (5) individuals previously screened and currently being 
 27.36  served under the alternative care program or under a home and 
 28.1   community-based services waiver authorized under section 1915(c) 
 28.2   of the Social Security Act; or 
 28.3      (6) individuals who are admitted to a certified nursing 
 28.4   facility for a short-term stay, which, based upon a physician's 
 28.5   certification, is expected to be 14 days or less in duration, 
 28.6   and who have been screened and approved for nursing facility 
 28.7   admission within the previous six months.  This exemption 
 28.8   applies only if the screener determines at the time of the 
 28.9   initial screening of the six-month period that it is appropriate 
 28.10  to use the nursing facility for short-term stays and that there 
 28.11  is an adequate plan of care for return to the home or 
 28.12  community-based setting.  If a stay exceeds 14 days, the 
 28.13  individual must be referred no later than the first county 
 28.14  working day following the 14th resident day for a screening, 
 28.15  which must be completed within five working days of the 
 28.16  referral.  Payment limitations in subdivision 7 will apply to an 
 28.17  individual found at screening to not meet the level of care 
 28.18  criteria for admission to a certified nursing facility. 
 28.19     Regardless of the exemptions in clauses (2) to (6), persons 
 28.20  who have a diagnosis or possible diagnosis of mental illness, 
 28.21  mental retardation, or a related condition must receive a 
 28.22  preadmission screening before admission unless the admission 
 28.23  prior to screening is authorized by the local mental health 
 28.24  authority or the local developmental disabilities case manager, 
 28.25  or unless authorized by the county agency according to Public 
 28.26  Law Number 101-508. 
 28.27     Before admission to a Medicaid certified nursing home or 
 28.28  boarding care home, all persons must be screened and approved 
 28.29  for admission through an assessment process.  The nursing 
 28.30  facility is authorized to conduct case mix assessments which are 
 28.31  not conducted by the county public health nurse under Minnesota 
 28.32  Rules, part 9549.0059.  The designated county agency is 
 28.33  responsible for distributing the quality assurance and review 
 28.34  form for all new applicants to nursing homes. 
 28.35     Other persons who are not applicants to nursing facilities 
 28.36  must be screened if a request is made for a screening. 
 29.1      Sec. 18.  Minnesota Statutes 1996, section 256B.0911, 
 29.2   subdivision 4, is amended to read: 
 29.3      Subd. 4.  [RESPONSIBILITIES OF THE COUNTY AND THE SCREENING 
 29.4   TEAM.] (a) The county shall: 
 29.5      (1) provide information and education to the general public 
 29.6   regarding availability of the preadmission screening program; 
 29.7      (2) accept referrals from individuals, families, human 
 29.8   service and health professionals, and hospital and nursing 
 29.9   facility personnel; 
 29.10     (3) assess the health, psychological, and social needs of 
 29.11  referred individuals and identify services needed to maintain 
 29.12  these persons in the least restrictive environments; 
 29.13     (4) determine if the individual screened needs nursing 
 29.14  facility level of care; 
 29.15     (5) assess specialized service needs based upon an 
 29.16  evaluation by: 
 29.17     (i) a qualified independent mental health professional for 
 29.18  persons with a primary or secondary diagnosis of a serious 
 29.19  mental illness; and 
 29.20     (ii) a qualified mental retardation professional for 
 29.21  persons with a primary or secondary diagnosis of mental 
 29.22  retardation or related conditions.  For purposes of this clause, 
 29.23  a qualified mental retardation professional must meet the 
 29.24  standards for a qualified mental retardation professional in 
 29.25  Code of Federal Regulations, title 42, section 483.430; 
 29.26     (6) make recommendations for individuals screened regarding 
 29.27  cost-effective community services which are available to the 
 29.28  individual; 
 29.29     (7) make recommendations for individuals screened regarding 
 29.30  nursing home placement when there are no cost-effective 
 29.31  community services available; 
 29.32     (8) develop an individual's community care plan and provide 
 29.33  follow-up services as needed; and 
 29.34     (9) prepare and submit reports that may be required by the 
 29.35  commissioner of human services. 
 29.36     (b) The screener shall document that the most 
 30.1   cost-effective alternatives available were offered to the 
 30.2   individual or the individual's legal representative.  For 
 30.3   purposes of this section, "cost-effective alternatives" means 
 30.4   community services and living arrangements that cost the same or 
 30.5   less than nursing facility care. 
 30.6      (c) ~~Screeners shall adhere to the level of care criteria~~ 
 30.7   ~~for admission to a certified nursing facility established under~~ 
 30.8   ~~section 144.0721.~~  
 30.9      ~~(d)~~ For persons who are eligible for medical assistance or 
 30.10  who would be eligible within 180 days of admission to a nursing 
 30.11  facility and who are admitted to a nursing facility, the nursing 
 30.12  facility must include a screener or the case manager in the 
 30.13  discharge planning process for those individuals who the team 
 30.14  has determined have discharge potential.  The screener or the 
 30.15  case manager must ensure a smooth transition and follow-up for 
 30.16  the individual's return to the community. 
 30.17     Screeners shall cooperate with other public and private 
 30.18  agencies in the community, in order to offer a variety of 
 30.19  cost-effective services to the disabled and elderly.  The 
 30.20  screeners shall encourage the use of volunteers from families, 
 30.21  religious organizations, social clubs, and similar civic and 
 30.22  service organizations to provide services. 
 30.23     Sec. 19.  Minnesota Statutes 1997 Supplement, section 
 30.24  256B.0911, subdivision 7, is amended to read: 
 30.25     Subd. 7.  [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.] 
 30.26  (a) Medical assistance reimbursement for nursing facilities 
 30.27  shall be authorized for a medical assistance recipient only if a 
 30.28  preadmission screening has been conducted prior to admission or 
 30.29  the local county agency has authorized an exemption.  Medical 
 30.30  assistance reimbursement for nursing facilities shall not be 
 30.31  provided for any recipient who the local screener has determined 
 30.32  does not meet the level of care criteria for nursing facility 
 30.33  placement or, if indicated, has not had a level II PASARR 
 30.34  evaluation completed unless an admission for a recipient with 
 30.35  mental illness is approved by the local mental health authority 
 30.36  or an admission for a recipient with mental retardation or 
 31.1   related condition is approved by the state mental retardation 
 31.2   authority.  ~~The county preadmission screening team may deny~~ 
 31.3   ~~certified nursing facility admission using the level of care~~ 
 31.4   ~~criteria established under section 144.0721 and deny medical~~ 
 31.5   ~~assistance reimbursement for certified nursing facility care.~~  
 31.6   ~~Persons receiving care in a certified nursing facility or~~ 
 31.7   ~~certified boarding care home who are reassessed by the~~ 
 31.8   ~~commissioner of health according to section 144.0722 and~~ 
 31.9   ~~determined to no longer meet the level of care criteria for a~~ 
 31.10  ~~certified nursing facility or certified boarding care home may~~ 
 31.11  ~~no longer remain a resident in the certified nursing facility or~~ 
 31.12  ~~certified boarding care home and must be relocated to the~~ 
 31.13  ~~community if the persons were admitted on or after July 1, 1998.~~ 
 31.14     (b) ~~Persons receiving services under section 256B.0913,~~ 
 31.15  ~~subdivisions 1 to 14, or 256B.0915 who are reassessed and found~~ 
 31.16  ~~to not meet the level of care criteria for admission to a~~ 
 31.17  ~~certified nursing facility or certified boarding care home may~~ 
 31.18  ~~no longer receive these services if persons were admitted to the~~ 
 31.19  ~~program on or after July 1, 1998.~~  The commissioner shall make a 
 31.20  request to the health care financing administration for a waiver 
 31.21  allowing screening team approval of Medicaid payments for 
 31.22  certified nursing facility care.  An individual has a choice and 
 31.23  makes the final decision between nursing facility placement and 
 31.24  community placement after the screening team's recommendation, 
 31.25  except as provided in paragraphs (b) and (c).  
 31.26     (c) The local county mental health authority or the state 
 31.27  mental retardation authority under Public Law Numbers 100-203 
 31.28  and 101-508 may prohibit admission to a nursing facility, if the 
 31.29  individual does not meet the nursing facility level of care 
 31.30  criteria or needs specialized services as defined in Public Law 
 31.31  Numbers 100-203 and 101-508.  For purposes of this section, 
 31.32  "specialized services" for a person with mental retardation or a 
 31.33  related condition means "active treatment" as that term is 
 31.34  defined in Code of Federal Regulations, title 42, section 
 31.35  483.440(a)(1). 
 31.36     (d) Upon the receipt by the commissioner of approval by the 
 32.1   Secretary of Health and Human Services of the waiver requested 
 32.2   under paragraph (a), the local screener shall deny medical 
 32.3   assistance reimbursement for nursing facility care for an 
 32.4   individual whose long-term care needs can be met in a 
 32.5   community-based setting and whose cost of community-based home 
 32.6   care services is less than 75 percent of the average payment for 
 32.7   nursing facility care for that individual's case mix 
 32.8   classification, and who is either: 
 32.9      (i) a current medical assistance recipient being screened 
 32.10  for admission to a nursing facility; or 
 32.11     (ii) an individual who would be eligible for medical 
 32.12  assistance within 180 days of entering a nursing facility and 
 32.13  who meets a nursing facility level of care. 
 32.14     (e) Appeals from the screening team's recommendation or the 
 32.15  county agency's final decision shall be made according to 
 32.16  section 256.045, subdivision 3. 
 32.17     Sec. 20.  Minnesota Statutes 1997 Supplement, section 
 32.18  256B.0915, subdivision 1d, is amended to read: 
 32.19     Subd. 1d.  [POSTELIGIBILITY TREATMENT OF INCOME AND 
 32.20  RESOURCES FOR ELDERLY WAIVER.] (a) Notwithstanding the 
 32.21  provisions of section 256B.056, the commissioner shall make the 
 32.22  following amendment to the medical assistance elderly waiver 
 32.23  program effective July 1, ~~1997~~ 1999, or upon federal approval, 
 32.24  whichever is later. 
 32.25     A recipient's maintenance needs will be an amount equal to 
 32.26  the Minnesota supplemental aid equivalent rate as defined in 
 32.27  section 256I.03, subdivision 5, plus the medical assistance 
 32.28  personal needs allowance as defined in section 256B.35, 
 32.29  subdivision 1, paragraph (a), when applying posteligibility 
 32.30  treatment of income rules to the gross income of elderly waiver 
 32.31  recipients, except for individuals whose income is in excess of 
 32.32  the special income standard according to Code of Federal 
 32.33  Regulations, title 42, section 435.236. 
 32.34     (b) The commissioner of human services shall secure 
 32.35  approval of additional elderly waiver slots sufficient to serve 
 32.36  persons who will qualify under the revised income standard 
 33.1   described in paragraph (a) before implementing section 
 33.2   256B.0913, subdivision 16. 
 33.3      Sec. 21.  Minnesota Statutes 1996, section 256B.19, 
 33.4   subdivision 1, is amended to read: 
 33.5      Subdivision 1.  [DIVISION OF COST.] The state and county 
 33.6   share of medical assistance costs not paid by federal funds 
 33.7   shall be as follows:  
 33.8      (1) ninety percent state funds and ten percent county 
 33.9   funds, unless otherwise provided below; 
 33.10     (2) beginning January 1, 1992, 50 percent state funds and 
 33.11  50 percent county funds for the cost of placement of severely 
 33.12  emotionally disturbed children in regional treatment centers; 
 33.13  and 
 33.14     (3) beginning with services provided after January 1, 1999, 
 33.15  100 percent county funds for mental health case management.  
 33.16     For counties that participate in a Medicaid demonstration 
 33.17  project under sections 256B.69 and 256B.71, the division of the 
 33.18  nonfederal share of medical assistance expenses for payments 
 33.19  made to prepaid health plans or for payments made to health 
 33.20  maintenance organizations in the form of prepaid capitation 
 33.21  payments, this division of medical assistance expenses shall be 
 33.22  95 percent by the state and five percent by the county of 
 33.23  financial responsibility.  
 33.24     In counties where prepaid health plans are under contract 
 33.25  to the commissioner to provide services to medical assistance 
 33.26  recipients, the cost of court ordered treatment ordered without 
 33.27  consulting the prepaid health plan that does not include 
 33.28  diagnostic evaluation, recommendation, and referral for 
 33.29  treatment by the prepaid health plan is the responsibility of 
 33.30  the county of financial responsibility.  
 33.31     Sec. 22.  Minnesota Statutes 1996, section 256B.41, 
 33.32  subdivision 1, is amended to read: 
 33.33     Subdivision 1.  [AUTHORITY.] The commissioner shall 
 33.34  establish, by rule, procedures for determining rates for care of 
 33.35  residents of nursing facilities which qualify as vendors of 
 33.36  medical assistance, and for implementing the provisions of this 
 34.1   section and sections 256B.421, 256B.431, 256B.432, 256B.433, 
 34.2   256B.47, 256B.48, 256B.50, and 256B.502.  The procedures shall 
 34.3   ~~be based on methods and standards that the commissioner finds~~ 
 34.4   ~~are adequate to provide for the costs that must be incurred for~~ 
 34.5   ~~the care of residents in efficiently and economically operated~~ 
 34.6   ~~nursing facilities and shall~~ specify the costs that are 
 34.7   allowable for establishing payment rates through medical 
 34.8   assistance. 
 34.9      Sec. 23.  Minnesota Statutes 1996, section 256B.431, 
 34.10  subdivision 2b, is amended to read: 
 34.11     Subd. 2b.  [OPERATING COSTS, AFTER JULY 1, 1985.] (a) For 
 34.12  rate years beginning on or after July 1, 1985, the commissioner 
 34.13  shall establish procedures for determining per diem 
 34.14  reimbursement for operating costs.  
 34.15     (b) The commissioner shall contract with an econometric 
 34.16  firm with recognized expertise in and access to national 
 34.17  economic change indices that can be applied to the appropriate 
 34.18  cost categories when determining the operating cost payment rate.
 34.19     (c) The commissioner shall analyze and evaluate each 
 34.20  nursing facility's cost report of allowable operating costs 
 34.21  incurred by the nursing facility during the reporting year 
 34.22  immediately preceding the rate year for which the payment rate 
 34.23  becomes effective.  
 34.24     (d) The commissioner shall establish limits on actual 
 34.25  allowable historical operating cost per diems based on cost 
 34.26  reports of allowable operating costs for the reporting year that 
 34.27  begins October 1, 1983, taking into consideration relevant 
 34.28  factors including resident needs, geographic location, and size 
 34.29  of the nursing facility~~, and the costs that must be incurred for~~ 
 34.30  ~~the care of residents in an efficiently and economically~~ 
 34.31  ~~operated nursing facility~~.  In developing the geographic groups 
 34.32  for purposes of reimbursement under this section, the 
 34.33  commissioner shall ensure that nursing facilities in any county 
 34.34  contiguous to the Minneapolis-St. Paul seven-county metropolitan 
 34.35  area are included in the same geographic group.  The limits 
 34.36  established by the commissioner shall not be less, in the 
 35.1   aggregate, than the 60th percentile of total actual allowable 
 35.2   historical operating cost per diems for each group of nursing 
 35.3   facilities established under subdivision 1 based on cost reports 
 35.4   of allowable operating costs in the previous reporting year.  
 35.5   For rate years beginning on or after July 1, 1989, facilities 
 35.6   located in geographic group I as described in Minnesota Rules, 
 35.7   part 9549.0052, on January 1, 1989, may choose to have the 
 35.8   commissioner apply either the care related limits or the other 
 35.9   operating cost limits calculated for facilities located in 
 35.10  geographic group II, or both, if either of the limits calculated 
 35.11  for the group II facilities is higher.  The efficiency incentive 
 35.12  for geographic group I nursing facilities must be calculated 
 35.13  based on geographic group I limits.  The phase-in must be 
 35.14  established utilizing the chosen limits.  For purposes of these 
 35.15  exceptions to the geographic grouping requirements, the 
 35.16  definitions in Minnesota Rules, parts 9549.0050 to 9549.0059 
 35.17  (Emergency), and 9549.0010 to 9549.0080, apply.  The limits 
 35.18  established under this paragraph remain in effect until the 
 35.19  commissioner establishes a new base period.  Until the new base 
 35.20  period is established, the commissioner shall adjust the limits 
 35.21  annually using the appropriate economic change indices 
 35.22  established in paragraph (e).  In determining allowable 
 35.23  historical operating cost per diems for purposes of setting 
 35.24  limits and nursing facility payment rates, the commissioner 
 35.25  shall divide the allowable historical operating costs by the 
 35.26  actual number of resident days, except that where a nursing 
 35.27  facility is occupied at less than 90 percent of licensed 
 35.28  capacity days, the commissioner may establish procedures to 
 35.29  adjust the computation of the per diem to an imputed occupancy 
 35.30  level at or below 90 percent.  The commissioner shall establish 
 35.31  efficiency incentives as appropriate.  The commissioner may 
 35.32  establish efficiency incentives for different operating cost 
 35.33  categories.  The commissioner shall consider establishing 
 35.34  efficiency incentives in care related cost categories.  The 
 35.35  commissioner may combine one or more operating cost categories 
 35.36  and may use different methods for calculating payment rates for 
 36.1   each operating cost category or combination of operating cost 
 36.2   categories.  For the rate year beginning on July 1, 1985, the 
 36.3   commissioner shall: 
 36.4      (1) allow nursing facilities that have an average length of 
 36.5   stay of 180 days or less in their skilled nursing level of care, 
 36.6   125 percent of the care related limit and 105 percent of the 
 36.7   other operating cost limit established by rule; and 
 36.8      (2) exempt nursing facilities licensed on July 1, 1983, by 
 36.9   the commissioner to provide residential services for the 
 36.10  physically handicapped under Minnesota Rules, parts 9570.2000 to 
 36.11  9570.3600, from the care related limits and allow 105 percent of 
 36.12  the other operating cost limit established by rule. 
 36.13     For the purpose of calculating the other operating cost 
 36.14  efficiency incentive for nursing facilities referred to in 
 36.15  clause (1)  or (2), the commissioner shall use the other 
 36.16  operating cost limit established by rule before application of 
 36.17  the 105 percent. 
 36.18     (e) The commissioner shall establish a composite index or 
 36.19  indices by determining the appropriate economic change 
 36.20  indicators to be applied to specific operating cost categories 
 36.21  or combination of operating cost categories.  
 36.22     (f) Each nursing facility shall receive an operating cost 
 36.23  payment rate equal to the sum of the nursing facility's 
 36.24  operating cost payment rates for each operating cost category.  
 36.25  The operating cost payment rate for an operating cost category 
 36.26  shall be the lesser of the nursing facility's historical 
 36.27  operating cost in the category increased by the appropriate 
 36.28  index established in paragraph (e) for the operating cost 
 36.29  category plus an efficiency incentive established pursuant to 
 36.30  paragraph (d) or the limit for the operating cost category 
 36.31  increased by the same index.  If a nursing facility's actual 
 36.32  historic operating costs are greater than the prospective 
 36.33  payment rate for that rate year, there shall be no retroactive 
 36.34  cost settle-up.  In establishing payment rates for one or more 
 36.35  operating cost categories, the commissioner may establish 
 36.36  separate rates for different classes of residents based on their 
 37.1   relative care needs.  
 37.2      (g) The commissioner shall include the reported actual real 
 37.3   estate tax liability or payments in lieu of real estate tax of 
 37.4   each nursing facility as an operating cost of that nursing 
 37.5   facility.  Allowable costs under this subdivision for payments 
 37.6   made by a nonprofit nursing facility that are in lieu of real 
 37.7   estate taxes shall not exceed the amount which the nursing 
 37.8   facility would have paid to a city or township and county for 
 37.9   fire, police, sanitation services, and road maintenance costs 
 37.10  had real estate taxes been levied on that property for those 
 37.11  purposes.  For rate years beginning on or after July 1, 1987, 
 37.12  the reported actual real estate tax liability or payments in 
 37.13  lieu of real estate tax of nursing facilities shall be adjusted 
 37.14  to include an amount equal to one-half of the dollar change in 
 37.15  real estate taxes from the prior year.  The commissioner shall 
 37.16  include a reported actual special assessment, and reported 
 37.17  actual license fees required by the Minnesota department of 
 37.18  health, for each nursing facility as an operating cost of that 
 37.19  nursing facility.  For rate years beginning on or after July 1, 
 37.20  1989, the commissioner shall include a nursing facility's 
 37.21  reported public employee retirement act contribution for the 
 37.22  reporting year as apportioned to the care-related operating cost 
 37.23  categories and other operating cost categories multiplied by the 
 37.24  appropriate composite index or indices established pursuant to 
 37.25  paragraph (e) as costs under this paragraph.  Total adjusted 
 37.26  real estate tax liability, payments in lieu of real estate tax, 
 37.27  actual special assessments paid, the indexed public employee 
 37.28  retirement act contribution, and license fees paid as required 
 37.29  by the Minnesota department of health, for each nursing facility 
 37.30  (1) shall be divided by actual resident days in order to compute 
 37.31  the operating cost payment rate for this operating cost 
 37.32  category, (2) shall not be used to compute the care-related 
 37.33  operating cost limits or other operating cost limits established 
 37.34  by the commissioner, and (3) shall not be increased by the 
 37.35  composite index or indices established pursuant to paragraph 
 37.36  (e), unless otherwise indicated in this paragraph. 
 38.1      (h) For rate years beginning on or after July 1, 1987, the 
 38.2   commissioner shall adjust the rates of a nursing facility that 
 38.3   meets the criteria for the special dietary needs of its 
 38.4   residents and the requirements in section 31.651.  The 
 38.5   adjustment for raw food cost shall be the difference between the 
 38.6   nursing facility's allowable historical raw food cost per diem 
 38.7   and 115 percent of the median historical allowable raw food cost 
 38.8   per diem of the corresponding geographic group. 
 38.9      The rate adjustment shall be reduced by the applicable 
 38.10  phase-in percentage as provided under subdivision 2h. 
 38.11     ~~(i) For the cost report year ending September 30, 1996, and~~ 
 38.12  ~~for all subsequent reporting years, certified nursing facilities~~ 
 38.13  ~~must identify, differentiate, and record resident day statistics~~ 
 38.14  ~~for residents in case mix classification A who, on or after July~~ 
 38.15  ~~1, 1996, meet the modified level of care criteria in section~~ 
 38.16  ~~144.0721.  The resident day statistics shall be separated into~~ 
 38.17  ~~case mix classification A-1 for any resident day meeting the~~ 
 38.18  ~~high-function class A level of care criteria and case mix~~ 
 38.19  ~~classification A-2 for other case mix class A resident days.~~ 
 38.20     Sec. 24.  Minnesota Statutes 1996, section 256B.431, is 
 38.21  amended by adding a subdivision to read: 
 38.22     Subd. 27.  [SPEND-UP AND HIGH COST LIMITS INDEXED; NOT 
 38.23  REBASED.] (a) For rate years beginning on or after July 1, 1998, 
 38.24  the commissioner shall modify the determination of the spend-up 
 38.25  limits referred to in subdivision 26, paragraph (a), by indexing 
 38.26  each group's previous year's median value by the factor in 
 38.27  subdivision 26, paragraph (d), clause (2), plus one percentage 
 38.28  point.  
 38.29     (b) For rate years beginning on or after July 1, 1998, the 
 38.30  commissioner shall modify the determination of the high cost 
 38.31  limits referred to in subdivision 26, paragraph (b), by indexing 
 38.32  each group's previous year's high cost per diem limits at .5 and 
 38.33  one standard deviations above the median by the factor in 
 38.34  subdivision 26, paragraph (d), clause (2), plus one percentage 
 38.35  point. 
 38.36     Sec. 25.  Minnesota Statutes 1996, section 256B.501, 
 39.1   subdivision 2, is amended to read: 
 39.2      Subd. 2.  [AUTHORITY.] The commissioner shall establish 
 39.3   procedures and rules for determining rates for care of residents 
 39.4   of intermediate care facilities for persons with mental 
 39.5   retardation or related conditions which qualify as providers of 
 39.6   medical assistance and waivered services.  ~~Approved rates shall~~ 
 39.7   ~~be established on the basis of methods and standards that the~~ 
 39.8   ~~commissioner finds adequate to provide for the costs that must~~ 
 39.9   ~~be incurred for the quality care of residents in efficiently and~~ 
 39.10  ~~economically operated facilities and services.~~  The procedures 
 39.11  shall specify the costs that are allowable for payment through 
 39.12  medical assistance.  The commissioner may use experts from 
 39.13  outside the department in the establishment of the procedures. 
 39.14     Sec. 26.  Minnesota Statutes 1996, section 256B.69, is 
 39.15  amended by adding a subdivision to read: 
 39.16     Subd. 25.  [EXEMPTION FROM ENROLLMENT.] (a) American Indian 
 39.17  recipients of medical assistance who live on or near a 
 39.18  reservation, as defined in Code of Federal Regulations, title 
 39.19  42, section 36.22(a)(6), are exempt from enrollment with a 
 39.20  demonstration provider under this subdivision until the 
 39.21  commissioner of human services obtains federal approval for, and 
 39.22  implements, the purchasing model described in paragraph (b).  
 39.23  American Indian recipients may enroll voluntarily with a 
 39.24  demonstration provider despite this exemption. 
 39.25     (b) Beginning January 1, 1999, the commissioner of human 
 39.26  services shall have the authority to implement a purchasing 
 39.27  model that requires American Indian recipients of medical 
 39.28  assistance who live on or near a reservation, as defined in Code 
 39.29  of Federal Regulations, title 42, section 36.22(a)(6), to enroll 
 39.30  with a demonstration provider, and also allows recipients to 
 39.31  receive health care services payable on a fee-for-service basis 
 39.32  at American Indian Health Services facilities and facilities 
 39.33  operated by a tribe or tribal organization under funding 
 39.34  authorized by United States Code, title 25, sections 450f to 
 39.35  450n, or title III of the Indian Self-Determination and 
 39.36  Education Assistance Act, Public Law Number 93-638.  
 40.1   Implementation of this purchasing model is contingent on federal 
 40.2   approval. 
 40.3      (c) For purposes of this subdivision, "American Indian" has 
 40.4   the meaning given to persons to whom services will be provided 
 40.5   for in Code of Federal Regulations, title 42, section 36.12. 
 40.6      (d) This subdivision also applies to American Indian 
 40.7   recipients of general assistance medical care under section 
 40.8   256D.03, subdivision 4, paragraph (d), and American Indians 
 40.9   enrolled in county-based purchasing under section 256B.692. 
 40.10     Sec. 27.  Minnesota Statutes 1997 Supplement, section 
 40.11  256B.77, subdivision 7a, is amended to read: 
 40.12     Subd. 7a.  [ELIGIBLE INDIVIDUALS.] (a) Persons are eligible 
 40.13  for the demonstration project as provided in this subdivision. 
 40.14     (b) "Eligible individuals" means those persons living in 
 40.15  the demonstration site who are eligible for medical assistance 
 40.16  and are disabled based on a disability determination under 
 40.17  section 256B.055, subdivisions 7 and 12, or who are eligible for 
 40.18  medical assistance and have been diagnosed as having: 
 40.19     (1) serious and persistent mental illness as defined in 
 40.20  section 245.462, subdivision 20; 
 40.21     (2) severe emotional disturbance as defined in section 
 40.22  245.487, subdivision 6; or 
 40.23     (3) mental retardation, or being a mentally retarded person 
 40.24  as defined in section 252A.02, or a related condition as defined 
 40.25  in section 252.27, subdivision 1a. 
 40.26  Other individuals may be included at the option of the county 
 40.27  authority based on agreement with the commissioner. 
 40.28     (c) Eligible individuals residing on a federally recognized 
 40.29  Indian reservation may be excluded from participation in the 
 40.30  demonstration project at the discretion of the tribal government 
 40.31  based on agreement with the commissioner, in consultation with 
 40.32  the county authority. 
 40.33     (d) Eligible individuals include individuals in excluded 
 40.34  time status, as defined in chapter 256G.  Enrollees in excluded 
 40.35  time at the time of enrollment shall remain in excluded time 
 40.36  status as long as they live in the demonstration site and shall 
 41.1   be eligible for 90 days after placement outside the 
 41.2   demonstration site if they move to excluded time status in a 
 41.3   county within Minnesota other than their county of financial 
 41.4   responsibility. 
 41.5      (e) A person who is a sexual psychopathic personality as 
 41.6   defined in section 253B.02, subdivision 18a, or a sexually 
 41.7   dangerous person as defined in section 253B.02, subdivision 18b, 
 41.8   is excluded from enrollment in the demonstration project. 
 41.9      Sec. 28.  Minnesota Statutes 1997 Supplement, section 
 41.10  256B.77, subdivision 12, is amended to read: 
 41.11     Subd. 12.  [SERVICE COORDINATION.] (a) For purposes of this 
 41.12  section, "service coordinator" means an individual selected by 
 41.13  the enrollee or the enrollee's legal representative and 
 41.14  authorized by the county administrative entity or service 
 41.15  delivery organization to work in partnership with the enrollee 
 41.16  to develop, coordinate, and in some instances, provide supports 
 41.17  and services identified in the personal support plan.  Service 
 41.18  coordinators may only provide services and supports if the 
 41.19  enrollee is informed of potential conflicts of interest, is 
 41.20  given alternatives, and gives informed consent.  Eligible 
 41.21  service coordinators are individuals age 18 or older who meet 
 41.22  the qualifications as described in paragraph (b).  Enrollees, 
 41.23  their legal representatives, or their advocates are eligible to 
 41.24  be service coordinators if they have the capabilities to perform 
 41.25  the activities and functions outlined in paragraph (b).  
 41.26  Providers licensed under chapter 245A to provide residential 
 41.27  services, or providers who are providing residential services 
 41.28  covered under the group residential housing program may not act 
 41.29  as service coordinator for enrollees for whom they provide 
 41.30  residential services.  This does not apply to providers of 
 41.31  short-term detoxification services.  Each county administrative 
 41.32  entity or service delivery organization may develop further 
 41.33  criteria for eligible vendors of service coordination during the 
 41.34  demonstration period and shall determine whom it contracts with 
 41.35  or employs to provide service coordination.  County 
 41.36  administrative entities and service delivery organizations may 
 42.1   pay enrollees or their advocates or legal representatives for 
 42.2   service coordination activities. 
 42.3      (b) The service coordinator shall act as a facilitator, 
 42.4   working in partnership with the enrollee to ensure that their 
 42.5   needs are identified and addressed.  The level of involvement of 
 42.6   the service coordinator shall depend on the needs and desires of 
 42.7   the enrollee.  The service coordinator shall have the knowledge, 
 42.8   skills, and abilities to, and is responsible for: 
 42.9      (1) arranging for an initial assessment, and periodic 
 42.10  reassessment as necessary, of supports and services based on the 
 42.11  enrollee's strengths, needs, choices, and preferences in life 
 42.12  domain areas; 
 42.13     (2) developing and updating the personal support plan based 
 42.14  on relevant ongoing assessment; 
 42.15     (3) arranging for and coordinating the provisions of 
 42.16  supports and services, including knowledgeable and skilled 
 42.17  specialty services and prevention and early intervention 
 42.18  services, within the limitations negotiated with the county 
 42.19  administrative entity or service delivery organization; 
 42.20     (4) assisting the enrollee and the enrollee's legal 
 42.21  representative, if any, to maximize informed choice of and 
 42.22  control over services and supports and to exercise the 
 42.23  enrollee's rights and advocate on behalf of the enrollee; 
 42.24     (5) monitoring the progress toward achieving the enrollee's 
 42.25  outcomes in order to evaluate and adjust the timeliness and 
 42.26  adequacy of the implementation of the personal support plan; 
 42.27     (6) facilitating meetings and effectively collaborating 
 42.28  with a variety of agencies and persons, including attending 
 42.29  individual family service plan and individual education plan 
 42.30  meetings when requested by the enrollee or the enrollee's legal 
 42.31  representative; 
 42.32     (7) soliciting and analyzing relevant information; 
 42.33     (8) communicating effectively with the enrollee and with 
 42.34  other individuals participating in the enrollee's plan; 
 42.35     (9) educating and communicating effectively with the 
 42.36  enrollee about good health care practices and risk to the 
 43.1   enrollee's health with certain behaviors; 
 43.2      (10) having knowledge of basic enrollee protection 
 43.3   requirements, including data privacy; 
 43.4      (11) informing, educating, and assisting the enrollee in 
 43.5   identifying available service providers and accessing needed 
 43.6   resources and services beyond the limitations of the medical 
 43.7   assistance benefit set covered services; and 
 43.8      (12) providing other services as identified in the personal 
 43.9   support plan.  
 43.10     (c) For the demonstration project, the qualifications and 
 43.11  standards for service coordination in this section shall replace 
 43.12  comparable existing provisions of existing statutes and rules 
 43.13  governing case management for eligible individuals. 
 43.14     ~~(d) The provisions of this subdivision apply only to the~~ 
 43.15  ~~demonstration sites that begin implementation on July 1, 1998.~~ 
 43.16     Sec. 29.  Minnesota Statutes 1996, section 256D.03, 
 43.17  subdivision 4, is amended to read: 
 43.18     Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] (a) 
 43.19  For a person who is eligible under subdivision 3, paragraph (a), 
 43.20  clause (3), general assistance medical care covers, except as 
 43.21  provided in paragraph (c): 
 43.22     (1) inpatient hospital services; 
 43.23     (2) outpatient hospital services; 
 43.24     (3) services provided by Medicare certified rehabilitation 
 43.25  agencies; 
 43.26     (4) prescription drugs and other products recommended 
 43.27  through the process established in section 256B.0625, 
 43.28  subdivision 13; 
 43.29     (5) equipment necessary to administer insulin and 
 43.30  diagnostic supplies and equipment for diabetics to monitor blood 
 43.31  sugar level; 
 43.32     (6) eyeglasses and eye examinations provided by a physician 
 43.33  or optometrist; 
 43.34     (7) hearing aids; 
 43.35     (8) prosthetic devices; 
 43.36     (9) laboratory and X-ray services; 
 44.1      (10) physician's services; 
 44.2      (11) medical transportation; 
 44.3      (12) chiropractic services as covered under the medical 
 44.4   assistance program; 
 44.5      (13) podiatric services; 
 44.6      (14) dental services; 
 44.7      (15) outpatient services provided by a mental health center 
 44.8   or clinic that is under contract with the county board and is 
 44.9   established under section 245.62; 
 44.10     (16) day treatment services for mental illness provided 
 44.11  under contract with the county board; 
 44.12     (17) prescribed medications for persons who have been 
 44.13  diagnosed as mentally ill as necessary to prevent more 
 44.14  restrictive institutionalization; 
 44.15     (18) ~~case management services for a person with serious and~~ 
 44.16  ~~persistent mental illness who would be eligible for medical~~ 
 44.17  ~~assistance except that the person resides in an institution for~~ 
 44.18  ~~mental diseases;~~ 
 44.19     ~~(19)~~ psychological services, medical supplies and 
 44.20  equipment, and Medicare premiums, coinsurance and deductible 
 44.21  payments; 
 44.22     ~~(20)~~ (19) medical equipment not specifically listed in this 
 44.23  paragraph when the use of the equipment will prevent the need 
 44.24  for costlier services that are reimbursable under this 
 44.25  subdivision; 
 44.26     ~~(21)~~ (20) services performed by a certified pediatric nurse 
 44.27  practitioner, a certified family nurse practitioner, a certified 
 44.28  adult nurse practitioner, a certified obstetric/gynecological 
 44.29  nurse practitioner, or a certified geriatric nurse practitioner 
 44.30  in independent practice, if the services are otherwise covered 
 44.31  under this chapter as a physician service, and if the service is 
 44.32  within the scope of practice of the nurse practitioner's license 
 44.33  as a registered nurse, as defined in section 148.171; and 
 44.34     ~~(22)~~ (21) services of a certified public health nurse or a 
 44.35  registered nurse practicing in a public health nursing clinic 
 44.36  that is a department of, or that operates under the direct 
 45.1   authority of, a unit of government, if the service is within the 
 45.2   scope of practice of the public health nurse's license as a 
 45.3   registered nurse, as defined in section 148.171.  
 45.4      (b) Except as provided in paragraph (c), for a recipient 
 45.5   who is eligible under subdivision 3, paragraph (a), clause (1) 
 45.6   or (2), general assistance medical care covers the services 
 45.7   listed in paragraph (a) with the exception of special 
 45.8   transportation services. 
 45.9      (c) Gender reassignment surgery and related services are 
 45.10  not covered services under this subdivision unless the 
 45.11  individual began receiving gender reassignment services prior to 
 45.12  July 1, 1995.  
 45.13     (d) In order to contain costs, the commissioner of human 
 45.14  services shall select vendors of medical care who can provide 
 45.15  the most economical care consistent with high medical standards 
 45.16  and shall where possible contract with organizations on a 
 45.17  prepaid capitation basis to provide these services.  The 
 45.18  commissioner shall consider proposals by counties and vendors 
 45.19  for prepaid health plans, competitive bidding programs, block 
 45.20  grants, or other vendor payment mechanisms designed to provide 
 45.21  services in an economical manner or to control utilization, with 
 45.22  safeguards to ensure that necessary services are provided.  
 45.23  Before implementing prepaid programs in counties with a county 
 45.24  operated or affiliated public teaching hospital or a hospital or 
 45.25  clinic operated by the University of Minnesota, the commissioner 
 45.26  shall consider the risks the prepaid program creates for the 
 45.27  hospital and allow the county or hospital the opportunity to 
 45.28  participate in the program in a manner that reflects the risk of 
 45.29  adverse selection and the nature of the patients served by the 
 45.30  hospital, provided the terms of participation in the program are 
 45.31  competitive with the terms of other participants considering the 
 45.32  nature of the population served.  Payment for services provided 
 45.33  pursuant to this subdivision shall be as provided to medical 
 45.34  assistance vendors of these services under sections 256B.02, 
 45.35  subdivision 8, and 256B.0625.  For payments made during fiscal 
 45.36  year 1990 and later years, the commissioner shall consult with 
 46.1   an independent actuary in establishing prepayment rates, but 
 46.2   shall retain final control over the rate methodology.  
 46.3   Notwithstanding the provisions of subdivision 3, an individual 
 46.4   who becomes ineligible for general assistance medical care 
 46.5   because of failure to submit income reports or recertification 
 46.6   forms in a timely manner, shall remain enrolled in the prepaid 
 46.7   health plan and shall remain eligible for general assistance 
 46.8   medical care coverage through the last day of the month in which 
 46.9   the enrollee became ineligible for general assistance medical 
 46.10  care. 
 46.11     (e) The commissioner of human services may reduce payments 
 46.12  provided under sections 256D.01 to 256D.21 and 261.23 in order 
 46.13  to remain within the amount appropriated for general assistance 
 46.14  medical care, within the following restrictions~~.~~: 
 46.15     (i) For the period July 1, 1985 to December 31, 1985, 
 46.16  reductions below the cost per service unit allowable under 
 46.17  section 256.966, are permitted only as follows:  payments for 
 46.18  inpatient and outpatient hospital care provided in response to a 
 46.19  primary diagnosis of chemical dependency or mental illness may 
 46.20  be reduced no more than 30 percent; payments for all other 
 46.21  inpatient hospital care may be reduced no more than 20 percent.  
 46.22  Reductions below the payments allowable under general assistance 
 46.23  medical care for the remaining general assistance medical care 
 46.24  services allowable under this subdivision may be reduced no more 
 46.25  than ten percent. 
 46.26     (ii) For the period January 1, 1986 to December 31, 1986, 
 46.27  reductions below the cost per service unit allowable under 
 46.28  section 256.966 are permitted only as follows:  payments for 
 46.29  inpatient and outpatient hospital care provided in response to a 
 46.30  primary diagnosis of chemical dependency or mental illness may 
 46.31  be reduced no more than 20 percent; payments for all other 
 46.32  inpatient hospital care may be reduced no more than 15 percent.  
 46.33  Reductions below the payments allowable under general assistance 
 46.34  medical care for the remaining general assistance medical care 
 46.35  services allowable under this subdivision may be reduced no more 
 46.36  than five percent. 
 47.1      (iii) For the period January 1, 1987 to June 30, 1987, 
 47.2   reductions below the cost per service unit allowable under 
 47.3   section 256.966 are permitted only as follows:  payments for 
 47.4   inpatient and outpatient hospital care provided in response to a 
 47.5   primary diagnosis of chemical dependency or mental illness may 
 47.6   be reduced no more than 15 percent; payments for all other 
 47.7   inpatient hospital care may be reduced no more than ten 
 47.8   percent.  Reductions below the payments allowable under medical 
 47.9   assistance for the remaining general assistance medical care 
 47.10  services allowable under this subdivision may be reduced no more 
 47.11  than five percent.  
 47.12     (iv) For the period July 1, 1987 to June 30, 1988, 
 47.13  reductions below the cost per service unit allowable under 
 47.14  section 256.966 are permitted only as follows:  payments for 
 47.15  inpatient and outpatient hospital care provided in response to a 
 47.16  primary diagnosis of chemical dependency or mental illness may 
 47.17  be reduced no more than 15 percent; payments for all other 
 47.18  inpatient hospital care may be reduced no more than five percent.
 47.19  Reductions below the payments allowable under medical assistance 
 47.20  for the remaining general assistance medical care services 
 47.21  allowable under this subdivision may be reduced no more than 
 47.22  five percent. 
 47.23     (v) For the period July 1, 1988 to June 30, 1989, 
 47.24  reductions below the cost per service unit allowable under 
 47.25  section 256.966 are permitted only as follows:  payments for 
 47.26  inpatient and outpatient hospital care provided in response to a 
 47.27  primary diagnosis of chemical dependency or mental illness may 
 47.28  be reduced no more than 15 percent; payments for all other 
 47.29  inpatient hospital care may not be reduced.  Reductions below 
 47.30  the payments allowable under medical assistance for the 
 47.31  remaining general assistance medical care services allowable 
 47.32  under this subdivision may be reduced no more than five percent. 
 47.33     (f) There shall be no copayment required of any recipient 
 47.34  of benefits for any services provided under this subdivision.  A 
 47.35  hospital receiving a reduced payment as a result of this section 
 47.36  may apply the unpaid balance toward satisfaction of the 
 48.1   hospital's bad debts. 
 48.2      ~~(f)~~ (g) Any county may, from its own resources, provide 
 48.3   medical payments for which state payments are not made. 
 48.4      ~~(g)~~ (h) Chemical dependency services that are reimbursed 
 48.5   under chapter 254B must not be reimbursed under general 
 48.6   assistance medical care. 
 48.7      ~~(h)~~ (i) The maximum payment for new vendors enrolled in the 
 48.8   general assistance medical care program after the base year 
 48.9   shall be determined from the average usual and customary charge 
 48.10  of the same vendor type enrolled in the base year. 
 48.11     ~~(i)~~ (j) The conditions of payment for services under this 
 48.12  subdivision are the same as the conditions specified in rules 
 48.13  adopted under chapter 256B governing the medical assistance 
 48.14  program, unless otherwise provided by statute or rule. 
 48.15     Sec. 30.  Laws 1997, chapter 203, article 4, section 64, is 
 48.16  amended to read:  
 48.17     Sec. 64.  [STUDY OF ELDERLY WAIVER EXPANSION.] 
 48.18     The commissioner of human services shall appoint a task 
 48.19  force that includes representatives of counties, health plans, 
 48.20  consumers, and legislators to study the impact of the expansion 
 48.21  of the elderly waiver program under section 4 and to make 
 48.22  recommendations for any changes in law necessary to facilitate 
 48.23  an efficient and equitable relationship between the elderly 
 48.24  waiver program and the Minnesota senior health options project.  
 48.25  Based on the results of the task force study, the commissioner 
 48.26  may seek any federal waivers needed to improve the relationship 
 48.27  between the elderly waiver and the Minnesota senior health 
 48.28  options project.  The commissioner shall report the results of 
 48.29  the task force study to the legislature by ~~January 15, 1998~~ July 
 48.30  1, 2000. 
 48.31     Sec. 31.  [OFFSET OF HMO SURCHARGE.] 
 48.32     Beginning October 1, 1998, and ending December 31, 1998, 
 48.33  the commissioner of human services shall offset monthly charges 
 48.34  for the health maintenance organization surcharge by the monthly 
 48.35  amount the health maintenance organization overpaid from August 
 48.36  1, 1997, to September 30, 1998, due to taxation of Medicare 
 49.1   revenues prohibited by section 256.9657, subdivision 3. 
 49.2      Sec. 32.  [REPEALER.] 
 49.3      Minnesota Statutes 1996, section 144.0721, subdivision 3a; 
 49.4   and Minnesota Statutes 1997 Supplement, sections 144.0721, 
 49.5   subdivision 3; and 256B.0913, subdivision 15, are repealed. 
 49.6      Sec. 33.  [EFFECTIVE DATES.] 
 49.7      Section 4 is effective retroactive to August 1, 1997.  
 49.8      Sections 9 and 12 are effective retroactive to July 1, 1997.
 49.9      Sections 13, 21, and 29 are effective January 1, 1999. 
 49.10     Section 16 is effective for changes in eligibility that 
 49.11  occur on or after July 1, 1998. 
 49.12     Section 26 is effective 30 days after final enactment.