1.1                          A bill for an act 
  1.2             relating to the operation of state government 
  1.3             services; appropriating money for the operation of the 
  1.4             departments of human services and health, the veterans 
  1.5             home board, the health related boards, the disability 
  1.6             council, the ombudsman for families, and the ombudsman 
  1.7             for mental health and mental retardation; including 
  1.8             provisions for agency management; children's programs; 
  1.9             basic health care programs; medical assistance and 
  1.10            general assistance medical care; long-term care; 
  1.11            state-operated services; mental health and 
  1.12            developmentally disabled; MinnesotaCare; child support 
  1.13            enforcement; assistance to families; health 
  1.14            department; amending Minnesota Statutes 1996, sections 
  1.15            13.99, by adding a subdivision; 16A.124, subdivision 
  1.16            4b; 62D.04, subdivision 5; 62E.14, by adding a 
  1.17            subdivision; 103I.101, subdivision 6; 103I.208; 
  1.18            103I.401, subdivision 1; 144.057, subdivision 1; 
  1.19            144.0721, subdivision 3; 144.121, subdivision 1, and 
  1.20            by adding subdivisions; 144.125; 144.2215; 144.226, 
  1.21            subdivision 1, and by adding a subdivision; 144.394; 
  1.22            144A.071, subdivisions 1, 2, and 4a; 144A.073, 
  1.23            subdivision 2; 144A.46, subdivision 5; 153A.17; 
  1.24            157.15, by adding subdivisions; 157.16, subdivision 3; 
  1.25            245.03, subdivision 2; 245.4882, subdivision 5; 
  1.26            245.493, subdivision 1, and by adding a subdivision; 
  1.27            245.652, subdivisions 1 and 2; 245.98, by adding a 
  1.28            subdivision; 245A.04, subdivisions 3 and 3a; 246.02, 
  1.29            subdivision 2; 252.025, subdivisions 1, 4, and by 
  1.30            adding a subdivision; 252.28, by adding a subdivision; 
  1.31            252.32, subdivisions 1a, 3, 3a, 3c, and 5; 254.04; 
  1.32            254B.02, subdivisions 1 and 3; 254B.04, subdivision 1; 
  1.33            254B.09, subdivisions 4, 5, and 7; 256.01, subdivision 
  1.34            2, and by adding a subdivision; 256.025, subdivisions 
  1.35            2 and 4; 256.045, subdivisions 3, 3b, 4, 5, 7, 8, and 
  1.36            10; 256.476, subdivisions 2, 3, 4, and 5; 256.82, 
  1.37            subdivision 1, and by adding a subdivision; 256.871, 
  1.38            subdivision 6; 256.935; 256.969, subdivision 1; 
  1.39            256.9695, subdivision 1; 256B.037, subdivision 1a; 
  1.40            256B.04, by adding a subdivision; 256B.056, 
  1.41            subdivisions 4 and 5; 256B.0625, subdivisions 13 and 
  1.42            15; 256B.0626; 256B.0627, subdivision 5, and by adding 
  1.43            a subdivision; 256B.064, subdivisions 1a, 1c, and 2; 
  1.44            256B.0911, subdivisions 2 and 7; 256B.0912, by adding 
  1.45            a subdivision; 256B.0913, subdivisions 10, 14, 15, and 
  1.46            by adding a subdivision; 256B.0915, subdivision 3, and 
  2.1             by adding a subdivision; 256B.19, subdivisions 1, 2a, 
  2.2             and 2b; 256B.421, subdivision 1; 256B.431, subdivision 
  2.3             25, and by adding subdivisions; 256B.433, by adding a 
  2.4             subdivision; 256B.434, subdivisions 2, 3, 4, 9, and 
  2.5             10; 256B.48, subdivision 6; 256B.49, subdivision 1, 
  2.6             and by adding a subdivision; 256B.69, subdivisions 2, 
  2.7             3a, 5, 5b, and by adding subdivisions; 256D.03, 
  2.8             subdivisions 2, 2a, 3b, and 6; 256D.36; 256F.11, 
  2.9             subdivision 2; 256G.02, subdivision 6; 256G.05, 
  2.10            subdivision 2; 256I.05, subdivision 1a, and by adding 
  2.11            a subdivision; 326.37, subdivision 1; 393.07, 
  2.12            subdivision 2; 466.01, subdivision 1; 469.155, 
  2.13            subdivision 4; 471.59, subdivision 11; 626.556, 
  2.14            subdivisions 10b, 10d, 10e, 10f, 11c, and by adding a 
  2.15            subdivision; 626.558, subdivisions 1 and 2; and 
  2.16            626.559, subdivision 5; Laws 1995, chapter 207, 
  2.17            articles 6, section 115; and 8, section 41, 
  2.18            subdivision 2; proposing coding for new law in 
  2.19            Minnesota Statutes, chapters 144; 145A; 157; 252; 
  2.20            256B; and 257; repealing Minnesota Statutes 1996, 
  2.21            sections 144.0721, subdivision 3; 144.1222, 
  2.22            subdivision 3; 145.9256; 256.026; 256.82, subdivision 
  2.23            1; 256B.041, subdivision 5; 256B.0625, subdivision 
  2.24            13b; 256B.0911, subdivision 4; 256B.19, subdivision 
  2.25            1a; and 469.154, subdivision 6; Minnesota Rules, part 
  2.26            9505.1000. 
  2.27  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  2.28                             ARTICLE 1
  2.29                           APPROPRIATIONS 
  2.30  Section 1.  [HEALTH AND HUMAN SERVICES APPROPRIATIONS.] 
  2.31     The sums shown in the columns marked "APPROPRIATIONS" are 
  2.32  appropriated from the general fund, or any other fund named, to 
  2.33  the agencies and for the purposes specified in the following 
  2.34  sections of this article, to be available for the fiscal years 
  2.35  indicated for each purpose.  The figures "1998" and "1999" where 
  2.36  used in this article, mean that the appropriation or 
  2.37  appropriations listed under them are available for the fiscal 
  2.38  year ending June 30, 1998, or June 30, 1999, respectively.  
  2.39  Where a dollar amount appears in parentheses, it means a 
  2.40  reduction of an appropriation.  
  2.41                          SUMMARY BY FUND
  2.42  APPROPRIATIONS                                      BIENNIAL
  2.43                            1998          1999           TOTAL
  2.44  General          $2,613,932,000 $2,728,335,000 $5,342,267,000
  2.45  State Government
  2.46  Special Revenue      31,629,000     31,882,000     63,511,000
  2.47  Metropolitan Landfill 
  2.48  Contingency Action Fund 193,000        193,000        386,000
  2.49  Trunk Highway         1,652,000      1,678,000      3,330,000
  2.50  TOTAL             2,647,406,000  2,762,088,000  5,409,494,000
  3.1                                              APPROPRIATIONS 
  3.2                                          Available for the Year 
  3.3                                              Ending June 30 
  3.4                                             1998         1999 
  3.5   Sec. 2.  COMMISSIONER OF 
  3.6   HUMAN SERVICES 
  3.7   Subdivision 1.  Total 
  3.8   Appropriation                      2,536,934,000  2,652,318,000
  3.9                 Summary by Fund
  3.10  General           2,536,481,000 2,651,856,000
  3.11  State Government
  3.12  Special Revenue         453,000       462,000
  3.13  Subd. 2.  Agency Management 
  3.14  General              26,116,000    25,186,000
  3.15  State Government
  3.16  Special Revenue         342,000       350,000
  3.17  The amounts that may be spent from the 
  3.18  appropriation for each purpose are as 
  3.19  follows: 
  3.20  (a) Financial Operations 
  3.21  General               8,433,000     7,415,000
  3.22  [RECEIPTS FOR SYSTEMS PROJECTS.] 
  3.23  Appropriations and federal receipts for 
  3.24  information system projects for MAXIS, 
  3.25  electronic benefit system, social 
  3.26  services information system, child 
  3.27  support enforcement, and Minnesota 
  3.28  medicaid information system (MMIS II) 
  3.29  must be deposited in the state system 
  3.30  account authorized in Minnesota 
  3.31  Statutes, section 256.014.  Money 
  3.32  appropriated for computer projects 
  3.33  approved by the information policy 
  3.34  office, funded by the legislature, and 
  3.35  approved by the commissioner of finance 
  3.36  may be transferred from one project to 
  3.37  another and from development to 
  3.38  operations as the commissioner of human 
  3.39  services considers necessary.  Any 
  3.40  unexpended balance in the appropriation 
  3.41  for these projects does not cancel but 
  3.42  is available for ongoing development 
  3.43  and operations. 
  3.44  [STATE-OPERATED SERVICES BILLING 
  3.45  SYSTEMS.] Of this appropriation, 
  3.46  $500,000 in fiscal year 1998 is to 
  3.47  modify the current state-operated 
  3.48  services billing and receipting system 
  3.49  to accommodate cost-per-service 
  3.50  charging.  As part of this project, the 
  3.51  commissioner shall develop cost 
  3.52  accounting methods to ensure that 
  3.53  regional treatment center chemical 
  3.54  dependency program charges are based on 
  3.55  actual costs. 
  3.56  (b) Legal & Regulation Operations 
  4.1   General               6,203,000     6,041,000
  4.2   State Government
  4.3   Special Revenue         342,000       350,000
  4.4   (c) Management Operations 
  4.5   General              11,480,000    11,730,000
  4.6   [COMMUNICATION COSTS.] The commissioner 
  4.7   shall continue to operate the 
  4.8   department of human services 
  4.9   communication systems account 
  4.10  established in Laws 1993, First Special 
  4.11  Session chapter 1, article 1, section 
  4.12  2, subdivision 2, to manage shared 
  4.13  communication costs necessary for the 
  4.14  operation of the programs the 
  4.15  commissioner supervises.  A 
  4.16  communications account may also be 
  4.17  established for each regional treatment 
  4.18  center which operates communication 
  4.19  systems.  Each account shall be used to 
  4.20  manage shared communication costs 
  4.21  necessary for the operation of programs 
  4.22  the commissioner supervises.  The 
  4.23  commissioner may distribute the costs 
  4.24  of operating and maintaining 
  4.25  communication systems to participants 
  4.26  in a manner that reflects actual 
  4.27  usage.  Costs may include acquisition, 
  4.28  licensing, insurance, maintenance, 
  4.29  repair, staff time, and other costs as 
  4.30  determined by the commissioner.  State, 
  4.31  county, and local government agencies 
  4.32  and nonprofit organizations involved in 
  4.33  the operation of programs the 
  4.34  commissioner supervises may participate 
  4.35  in the use of the department's 
  4.36  communication technology and share in 
  4.37  the cost of operation.  The 
  4.38  commissioner may accept on behalf of 
  4.39  the state any gift, bequest, devise, or 
  4.40  personal property of any kind or money 
  4.41  tendered to the state for any lawful 
  4.42  purpose pertaining to the communication 
  4.43  activities of the department.  Any 
  4.44  money received for this purpose must be 
  4.45  deposited in the department of human 
  4.46  services communication systems 
  4.47  accounts.  Money collected by the 
  4.48  commissioner for the use of 
  4.49  communication systems must be deposited 
  4.50  in the state communication systems 
  4.51  account and is appropriated to the 
  4.52  commissioner for purposes of this 
  4.53  section. 
  4.54  [ISSUANCE OPERATIONS CENTER.] Payments 
  4.55  to the commissioner from other 
  4.56  governmental units and private 
  4.57  enterprises for (1) services performed 
  4.58  by the issuance operations center, or 
  4.59  (2) reports generated by the payment 
  4.60  and eligibility systems must be 
  4.61  deposited in the state systems account 
  4.62  authorized in Minnesota Statutes, 
  4.63  section 256.014.  These payments are 
  4.64  appropriated to the commissioner for 
  4.65  the operation of the issuance center or 
  4.66  system, in accordance with Minnesota 
  5.1   Statutes, section 256.014. 
  5.2   Subd. 3.  Children's Grants
  5.3   General              37,627,000    40,327,000
  5.4   [FAMILY VISITATION CENTER TRANSFER.] 
  5.5   Effective July 1, 1997, all duties and 
  5.6   funding related to family visitation 
  5.7   centers under Minnesota Statutes, 
  5.8   section 256F.09, are transferred to the 
  5.9   commissioner of children, families, and 
  5.10  learning. 
  5.11  [INDIAN CHILD WELFARE ACT.] Of this 
  5.12  appropriation, $90,000 each year is to 
  5.13  provide grants according to Minnesota 
  5.14  Statutes, section 257.3571, subdivision 
  5.15  2a, to the Indian child welfare defense 
  5.16  corporation to promote statewide 
  5.17  compliance with the Indian Child 
  5.18  Welfare Act. 
  5.19  Subd. 4.  Children's Services Management
  5.20  General               3,371,000     1,902,000
  5.21  [SOCIAL SERVICES INFORMATION SYSTEM.] 
  5.22  Of this appropriation, $1,500,000 in 
  5.23  fiscal year 1998 is for training and 
  5.24  implementation costs related to the 
  5.25  social services information system.  
  5.26  Any unexpended funds shall not cancel 
  5.27  but shall be available for fiscal year 
  5.28  1999.  This appropriation shall not 
  5.29  become part of the base for the 
  5.30  biennium beginning July 1, 1999. 
  5.31  Subd. 5.  Basic Health Care Grants
  5.32                Summary by Fund
  5.33  General             844,280,000   932,852,000
  5.34  The amounts that may be spent from this 
  5.35  appropriation for each purpose are as 
  5.36  follows: 
  5.37  (a) MA Basic Health Care Grants-
  5.38  Families and Children
  5.39  General             325,922,000   368,325,000
  5.40  (b) MA Basic Health Care Grants- 
  5.41  Elderly & Disabled
  5.42  General             346,436,000   397,987,000
  5.43  [PUBLIC HEALTH NURSE ASSESSMENT.] The 
  5.44  reimbursement for public health nurse 
  5.45  visits relating to the provision of 
  5.46  personal care services under Minnesota 
  5.47  Statutes, sections 256B.0625, 
  5.48  subdivision 19a, and 256B.0627, is 
  5.49  $204.36 for the initial assessment 
  5.50  visit and $102.18 for each reassessment 
  5.51  visit. 
  5.52  [AUGMENTATIVE COMMUNICATION DEVICES.] 
  5.53  Augmentative communication devices that 
  5.54  are prior authorized by pass through 
  6.1   vendors during the period from January 
  6.2   1, 1997, until the augmentative 
  6.3   communication system distribution 
  6.4   service is operational, and which have 
  6.5   not been delivered, shall be paid under 
  6.6   the medical assistance program at the 
  6.7   actual price charged the pass through 
  6.8   vendor for the device, except that 
  6.9   payment shall not exceed the suggested 
  6.10  retail price on March 1, 1997, plus 20 
  6.11  percent to cover administrative costs 
  6.12  of prior authorization and billing and 
  6.13  shipping charges. 
  6.14  [SURCHARGE COMPLIANCE.] In the event 
  6.15  that federal financial participation in 
  6.16  the Minnesota medical assistance 
  6.17  program is reduced as a result of a 
  6.18  determination that Minnesota is out of 
  6.19  compliance with Public Law Number 
  6.20  102-234 or its implementing regulations 
  6.21  or with any other federal law designed 
  6.22  to restrict provider tax programs or 
  6.23  intergovernmental transfers, the 
  6.24  commissioner shall appeal the 
  6.25  determination to the fullest extent 
  6.26  permitted by law and may ratably reduce 
  6.27  all medical assistance and general 
  6.28  assistance medical care payments to 
  6.29  providers other than the state of 
  6.30  Minnesota in order to eliminate any 
  6.31  shortfall resulting from the reduced 
  6.32  federal funding.  Any amount later 
  6.33  recovered through the appeals process 
  6.34  shall be used to reimburse providers 
  6.35  for any ratable reductions taken. 
  6.36  (c) General Assistance Medical Care
  6.37  General             171,922,000   166,540,000
  6.38  [HEALTH CARE ACCESS TRANSFERS TO 
  6.39  GENERAL FUND.] Funds shall be 
  6.40  transferred from the health care access 
  6.41  fund to the general fund in an amount 
  6.42  equal to the projected savings to 
  6.43  general assistance medical care (GAMC) 
  6.44  that would result from the transition 
  6.45  of GAMC parents and adults without 
  6.46  children to MinnesotaCare.  Based on 
  6.47  this projection, for state fiscal year 
  6.48  1998, the amount transferred from the 
  6.49  health care access fund to the general 
  6.50  fund shall be $13,700,000.  The amount 
  6.51  of transfer, if any, necessary for 
  6.52  state fiscal year 1999 shall be 
  6.53  determined on a pro rata basis. 
  6.54  Subd. 6.  Basic Health Care Management
  6.55  General              23,427,000    24,458,000
  6.56  (a) Health Care Policy Administration
  6.57  General               4,256,000     4,316,000
  6.58  [CONSUMER SATISFACTION SURVEY.] Any 
  6.59  federal matching money received through 
  6.60  the medical assistance program for the 
  6.61  consumer satisfaction survey is 
  6.62  appropriated to the commissioner for 
  7.1   this purpose.  The commissioner may 
  7.2   expend the federal money received for 
  7.3   the consumer satisfaction survey in 
  7.4   either year of the biennium. 
  7.5   (b) Health Care Operations
  7.6   General              19,171,000    20,142,000
  7.7   [SYSTEMS CONTINUITY.] In the event of 
  7.8   disruption of technical systems or 
  7.9   computer operations, the commissioner 
  7.10  may use available grant appropriations 
  7.11  to ensure continuity of payments for 
  7.12  maintaining the health, safety, and 
  7.13  well-being of clients served by 
  7.14  programs administered by the department 
  7.15  of human services.  Grant funds must be 
  7.16  used in a manner consistent with the 
  7.17  original intent of the appropriation. 
  7.18  [PREPAID MEDICAL PROGRAMS.] The 
  7.19  nonfederal share of the prepaid medical 
  7.20  assistance program fund, which has been 
  7.21  appropriated to fund county managed 
  7.22  care advocacy and enrollment operating 
  7.23  costs, shall be disbursed as grants 
  7.24  using either a reimbursement or block 
  7.25  grant mechanism and may also be 
  7.26  transferred between grants and nongrant 
  7.27  administration costs with approval of 
  7.28  the commissioner of finance. 
  7.29  Subd. 7.  State-Operated Services
  7.30  General             207,074,000   203,429,000
  7.31  The amounts that may be spent from this 
  7.32  appropriation for each purpose are as 
  7.33  follows: 
  7.34  (a) RTC Facilities
  7.35  General             193,547,000   188,883,000
  7.36  [MITIGATION RELATED TO DD DOWNSIZING 
  7.37  AND MH PILOTS.] Money appropriated to 
  7.38  finance mitigation expenses related to 
  7.39  the downsizing of regional treatment 
  7.40  center developmental disabilities 
  7.41  programs and the establishment of 
  7.42  mental health pilot projects may be 
  7.43  transferred between fiscal years within 
  7.44  the biennium. 
  7.45  [NAMES REQUIRED ON GRAVES.] Of this 
  7.46  appropriation, $100,000 in fiscal year 
  7.47  1998 shall be disbursed to replace 
  7.48  numbers with the names of the deceased 
  7.49  person on a marker at all individual 
  7.50  graves located at regional treatment 
  7.51  centers operated by the commissioner or 
  7.52  formerly operated by the commissioner.  
  7.53  Where the installation of individual 
  7.54  markers with names is not feasible, the 
  7.55  commissioner shall install appropriate 
  7.56  memorial markers.  This project shall 
  7.57  be carried out in cooperation with the 
  7.58  state council on disability.  Of the 
  7.59  $100,000, $5,000 shall be transferred 
  7.60  to Advocating Change Together for a 
  8.1   public awareness campaign to increase 
  8.2   public knowledge of the issues 
  8.3   surrounding developmental disabilities 
  8.4   and to encourage private contributions 
  8.5   to assist in the completion of this 
  8.6   project. 
  8.7   [RTC CHEMICAL DEPENDENCY PROGRAMS.] 
  8.8   When the operations of the regional 
  8.9   treatment center chemical dependency 
  8.10  fund created in Minnesota Statutes, 
  8.11  section 246.18, subdivision 2, are 
  8.12  impeded by projected cash deficiencies 
  8.13  resulting from delays in the receipt of 
  8.14  grants, dedicated income, or other 
  8.15  similar receivables, and when the 
  8.16  deficiencies would be corrected within 
  8.17  the budget period involved, the 
  8.18  commissioner of finance may transfer 
  8.19  general fund cash reserves into this 
  8.20  account as necessary to meet cash 
  8.21  demands.  The cash flow transfers must 
  8.22  be returned to the general fund in the 
  8.23  fiscal year that the transfer was 
  8.24  made.  Any interest earned on general 
  8.25  fund cash flow transfers accrues to the 
  8.26  general fund and not the regional 
  8.27  treatment center chemical dependency 
  8.28  fund. 
  8.29  [SHORT-TERM TREATMENT PROGRAM.] The 
  8.30  commissioner shall report to the 
  8.31  legislature by January 15, 1998, with 
  8.32  recommendations on the establishment of 
  8.33  a short-term treatment program of less 
  8.34  than 45 days to be administered by the 
  8.35  Anoka regional center to serve persons 
  8.36  with mental illness.  The report must 
  8.37  include a plan to qualify the program 
  8.38  for medical assistance reimbursement 
  8.39  and estimates of the capital bonding 
  8.40  and ongoing funding necessary to 
  8.41  operate the program. 
  8.42  [RTC PILOT PROJECTS.] The commissioner 
  8.43  may authorize regional treatment 
  8.44  centers to enter into contracts with 
  8.45  health plans that provide services to 
  8.46  publicly funded clients to provide 
  8.47  services within the diagnostic 
  8.48  categories related to mental illness 
  8.49  and chemical dependency, provided that 
  8.50  the revenue is sufficient to cover 
  8.51  actual costs.  Regional treatment 
  8.52  centers may establish revenue-based 
  8.53  acute care services to be provided 
  8.54  under these contracts, separate from 
  8.55  the appropriation-based services 
  8.56  otherwise provided at the regional 
  8.57  treatment center.  The appropriation to 
  8.58  regional treatment centers may be used 
  8.59  to cover start-up costs related to 
  8.60  these services, offset by revenue.  The 
  8.61  commissioner, in conjunction with the 
  8.62  commissioner of administration, is 
  8.63  authorized to modify state contract 
  8.64  procedures that would otherwise impede 
  8.65  pilot projects in order for the 
  8.66  facility to participate in managed care 
  8.67  activities.  The commissioner may 
  8.68  delegate the execution of these 
  9.1   contracts to the chief executive 
  9.2   officer of the regional center.  The 
  9.3   commissioner shall report to the 
  9.4   legislature by January 15, 1998, on 
  9.5   pilot project development and 
  9.6   implementation. 
  9.7   [RTC RESTRUCTURING.] For purposes of 
  9.8   restructuring the regional treatment 
  9.9   centers and state nursing homes, any 
  9.10  regional treatment center or state 
  9.11  nursing home employee whose position is 
  9.12  to be eliminated shall be afforded the 
  9.13  options provided in applicable 
  9.14  collective bargaining agreements.  All 
  9.15  salary and mitigation allocations from 
  9.16  fiscal year 1998 shall be carried 
  9.17  forward into fiscal year 1999.  
  9.18  Provided there is no conflict with any 
  9.19  collective bargaining agreement, any 
  9.20  regional treatment center or state 
  9.21  nursing home position reduction must 
  9.22  only be accomplished through 
  9.23  mitigation, attrition, transfer, and 
  9.24  other measures as provided in state or 
  9.25  applicable collective bargaining 
  9.26  agreements and in Minnesota Statutes, 
  9.27  section 252.50, subdivision 11, and not 
  9.28  through layoff. 
  9.29  [DEVELOPMENT OF ADULT MENTAL HEALTH 
  9.30  PILOT PROJECTS.] The commissioner shall 
  9.31  ensure that exclusive bargaining 
  9.32  representatives are informed about and 
  9.33  allowed to participate in all aspects 
  9.34  of the development of adult mental 
  9.35  health pilot projects.  Prior to 
  9.36  authorizing additional funding for any 
  9.37  county adult mental health pilot 
  9.38  project, the commissioner shall give 
  9.39  written assurance to the affected 
  9.40  exclusive bargaining representatives 
  9.41  that the mental health pilot project: 
  9.42  (1) does not infringe on existing 
  9.43  collective bargaining agreements or the 
  9.44  relationships between public employees 
  9.45  and their employers; 
  9.46  (2) will effectively use bargaining 
  9.47  unit employees; and 
  9.48  (3) will foster cooperative and 
  9.49  constructive labor and management 
  9.50  practices under Minnesota Statutes, 
  9.51  chapters 43A and 179A. 
  9.52  [CAMBRIDGE REGIONAL HUMAN SERVICES 
  9.53  CENTER.] (a) The commissioner shall 
  9.54  maintain capacity at Cambridge regional 
  9.55  human services center and shall 
  9.56  continue to provide residential and 
  9.57  crisis services at Cambridge for 
  9.58  persons with complex behavioral and 
  9.59  social problems committed by the courts 
  9.60  from the Faribault regional center and 
  9.61  Cambridge regional human services 
  9.62  center catchment areas.  Campus 
  9.63  programs shall operate with the aim of 
  9.64  facilitating the return of individuals 
  9.65  with clinically complex behavior and 
 10.1   social problems to community settings 
 10.2   and shall maintain sufficient support 
 10.3   services on campus as needed by the 
 10.4   programs. 
 10.5   (b) The commissioner shall develop and 
 10.6   present a plan and recommendations to 
 10.7   the legislature by January 15, 1998, 
 10.8   for the second phase of the Minnesota 
 10.9   extended treatment options (METO) 
 10.10  program at Cambridge regional human 
 10.11  services center to serve persons with 
 10.12  developmental disabilities who pose a 
 10.13  public risk.  Phase two shall increase 
 10.14  the on-campus program capacity of METO 
 10.15  by at least 36 additional beds. 
 10.16  [RTC STAFFING LEVELS.] In order to 
 10.17  maintain adequate staffing levels 
 10.18  during reallocations, downsizing, or 
 10.19  transfer of regional center nonfiscal 
 10.20  resources, the commissioner must ensure 
 10.21  that any reallocation of positions 
 10.22  between regional centers does not 
 10.23  reduce required staffing at regional 
 10.24  center programs for adults and 
 10.25  adolescents with mental illness. 
 10.26  Each regional treatment center serving 
 10.27  persons with mental illness must have a 
 10.28  written staffing plan based on program 
 10.29  services and treatment plans that are 
 10.30  required for individuals with mental 
 10.31  illness at the regional center using 
 10.32  standards established by the 
 10.33  commissioner.  The written plan must 
 10.34  include a detailed account of the 
 10.35  staffing needed at the regional center 
 10.36  for the following inpatient and other 
 10.37  psychiatric programs: 
 10.38  (1) acute inpatient; 
 10.39  (2) long-term inpatient; 
 10.40  (3) adolescent programs; and 
 10.41  (4) mobile and other crisis services 
 10.42  and transitional services. 
 10.43  If requested, the regional treatment 
 10.44  center chief executive officer must 
 10.45  provide the exclusive bargaining 
 10.46  representative or any other interested 
 10.47  party with a copy of the staffing plan. 
 10.48  If the exclusive bargaining 
 10.49  representative or another interested 
 10.50  party believes that actual staffing or 
 10.51  planned staffing for a regional 
 10.52  treatment center is not adequate to 
 10.53  provide necessary treatment, they may 
 10.54  request the ombudsman for mental health 
 10.55  and mental retardation to investigate, 
 10.56  report findings, and make 
 10.57  recommendations under Minnesota 
 10.58  Statutes, chapter 245.  If an 
 10.59  investigation is requested in light of 
 10.60  such circumstances, the report and 
 10.61  recommendations must be completed no 
 10.62  less than 30 days before an actual 
 11.1   reallocation, downsizing of staff, or 
 11.2   transfer of nonfiscal resources from a 
 11.3   regional treatment center. 
 11.4   By November 1, 1997, the commissioner 
 11.5   shall begin to develop regional 
 11.6   treatment center staffing plans for 
 11.7   inpatient and other psychiatric 
 11.8   programs.  The commissioner will 
 11.9   consult with representatives of 
 11.10  exclusive bargaining representatives 
 11.11  during the development of these plans.  
 11.12  By February 1, 1998, the commissioner 
 11.13  shall prepare and transmit to the 
 11.14  legislature a report of the staffing 
 11.15  level standards for regional treatment 
 11.16  centers.  The commissioner may also 
 11.17  recommend any changes in statute, 
 11.18  rules, and appropriations needed to 
 11.19  implement the recommendations. 
 11.20  [RTC POPULATION.] If the resident 
 11.21  population at the regional treatment 
 11.22  centers is projected to be higher than 
 11.23  the estimates upon which the medical 
 11.24  assistance forecast and budget 
 11.25  recommendations for the 1998-99 
 11.26  biennium is based, the amount of the 
 11.27  medical assistance appropriation that 
 11.28  is attributable to the cost of services 
 11.29  that would have been provided as an 
 11.30  alternative to regional treatment 
 11.31  center services, including resources 
 11.32  for community placements and waivered 
 11.33  services for persons with mental 
 11.34  retardation and related conditions, is 
 11.35  transferred to the residential 
 11.36  facilities appropriation. 
 11.37  [REPAIRS AND BETTERMENTS.] The 
 11.38  commissioner may transfer unencumbered 
 11.39  appropriation balances between fiscal 
 11.40  years for the state residential 
 11.41  facilities repairs and betterments 
 11.42  account and special equipment. 
 11.43  [PROJECT LABOR.] Wages for project 
 11.44  labor may be paid by the commissioner 
 11.45  of human services out of repairs and 
 11.46  betterments money if the individual is 
 11.47  to be engaged in a construction project 
 11.48  or a repair project of short-term and 
 11.49  nonrecurring nature.  Compensation for 
 11.50  project labor shall be based on the 
 11.51  prevailing wage rates, as defined in 
 11.52  Minnesota Statutes, section 177.42, 
 11.53  subdivision 6.  Project laborers are 
 11.54  excluded from the provisions of 
 11.55  Minnesota Statutes, sections 43A.22 to 
 11.56  43A.30, and shall not be eligible for 
 11.57  state-paid insurance and benefits. 
 11.58  (b) State-Operated Community
 11.59  Services - MI Adults 
 11.60  General               3,907,000     3,976,000
 11.61  (c) State-Operated Community 
 11.62  Services - DD
 11.63  General               9,620,000    10,570,000
 12.1   Subd. 8.  Continuing Care and 
 12.2   Community Support Grants
 12.3   General           1,114,122,000 1,156,630,000
 12.4   The amounts that may be spent from this 
 12.5   appropriation for each purpose are as 
 12.6   follows: 
 12.7   (a) Community Services Block Grants
 12.8       55,618,000     55,618,000 
 12.9   [CSSA TRADITIONAL APPROPRIATION.] 
 12.10  Notwithstanding Minnesota Statutes, 
 12.11  section 256E.06, the appropriations 
 12.12  available under that section in fiscal 
 12.13  years 1998 and 1999 must be distributed 
 12.14  to each county proportionately to the 
 12.15  aid received in calendar year 1996.  
 12.16  The commissioner, in consultation with 
 12.17  counties, shall study Minnesota 
 12.18  Statutes, section 256E.06, subdivision 
 12.19  2, and report findings and 
 12.20  recommendations to the legislature by 
 12.21  January 15, 1998. 
 12.22  (b) Consumer Support Grants
 12.23       1,757,000      1,757,000 
 12.24  (c) Aging Adult Service Grants
 12.25       7,605,000      7,608,000 
 12.26  [HOME CARE OMBUDSMAN PROGRAM.] Of this 
 12.27  appropriation, $100,000 each year of 
 12.28  the biennium shall be transferred to 
 12.29  the ombudsman for older Minnesotans to 
 12.30  assure statewide availability of home 
 12.31  care ombudsman services. 
 12.32  [HEALTH INSURANCE COUNSELING.] Of this 
 12.33  appropriation, $300,000 each year is 
 12.34  for the board on aging for the purpose 
 12.35  of health insurance counseling and 
 12.36  assistance grants to be awarded to the 
 12.37  area agencies on aging. 
 12.38  The board on aging shall award a grant 
 12.39  to each of the 14 area agencies on 
 12.40  aging to develop projects to provide 
 12.41  information about health coverage and 
 12.42  to provide assistance to individuals in 
 12.43  obtaining public and private health 
 12.44  care benefits.  Projects must: 
 12.45  (1) train and support staff and 
 12.46  volunteers to work in partnership to 
 12.47  provide one-on-one information and 
 12.48  assistance services; 
 12.49  (2) provide individual consumers with 
 12.50  assistance in understanding the terms 
 12.51  of a certificate, contract, or policy 
 12.52  of health coverage, including, but not 
 12.53  limited to, terms relating to covered 
 12.54  services, limitations on services, 
 12.55  limitations on access to providers, and 
 12.56  enrollee complaint and appeal 
 12.57  procedures; 
 13.1   (3) assist individuals to understand 
 13.2   medical bills and to process health 
 13.3   care claims and appeals to obtain 
 13.4   health care benefits; 
 13.5   (4) coordinate with existing health 
 13.6   insurance counseling programs serving 
 13.7   Medicare eligible individuals or 
 13.8   establish programs to serve all 
 13.9   consumers; and 
 13.10  (5) operate according to United States 
 13.11  Code, title 42, section 1395b-4, if 
 13.12  serving Medicare beneficiaries. 
 13.13  The board on aging shall allocate the 
 13.14  $300,000 each year to the 14 area 
 13.15  agencies on aging.  The Indian area 
 13.16  agency on aging shall receive a flat 
 13.17  grant of three percent of the annual 
 13.18  allocation.  All other area agencies 
 13.19  will receive a grant based on an age 
 13.20  60-plus population formula, except that 
 13.21  none of these area agencies on aging 
 13.22  shall receive less than a $15,000 base 
 13.23  allocation. 
 13.24  [CONGREGATE AND HOME-DELIVERED MEALS.] 
 13.25  The supplemental funding for nutrition 
 13.26  programs serving counties where 
 13.27  congregate and home-delivered meals 
 13.28  were locally financed prior to 
 13.29  participation in the nutrition program 
 13.30  of the Older Americans Act shall be 
 13.31  awarded at no less than the same levels 
 13.32  as in fiscal year 1997. 
 13.33  [INTRACTABLE EPILEPSY PROGRAM COLA.] Of 
 13.34  this appropriation, $10,000 each year 
 13.35  shall be disbursed for the purpose of 
 13.36  providing a cost of living adjustment 
 13.37  to the current base amount used as a 
 13.38  grant to provide a living skills 
 13.39  training program for persons with 
 13.40  intractable epilepsy who need 
 13.41  assistance in the transition to 
 13.42  independent living. 
 13.43  (d) Deaf and Hard-of-Hearing 
 13.44  Services Grants
 13.45       1,374,000      1,324,000 
 13.46  [SERVICES FOR DEAF AND HARD-OF-HEARING 
 13.47  ADULTS.] Of this appropriation, $50,000 
 13.48  each year shall be disbursed for a 
 13.49  grant to a nonprofit agency that serves 
 13.50  deaf and hard-of-hearing adults with 
 13.51  mental illness through residential 
 13.52  programs and supported housing outreach 
 13.53  activities.  The grant must be used to 
 13.54  expand community support services for 
 13.55  deaf and hard-of-hearing adults with 
 13.56  mental illness who use or wish to use 
 13.57  sign language as their primary means of 
 13.58  communication. 
 13.59  [SERVICE DOGS.] Of this appropriation, 
 13.60  $50,000 in fiscal year 1998 shall be 
 13.61  disbursed for grants to not-for-profit 
 13.62  organizations that train or provide 
 14.1   service dogs for persons with 
 14.2   disabilities.  The commissioner shall 
 14.3   report to the legislature by January 
 14.4   15, 1998, on the use of these grants. 
 14.5   [SERVICES TO DEAF-BLIND CHILDREN.] Of 
 14.6   this appropriation, $200,000 each year 
 14.7   shall be disbursed for deaf, 
 14.8   hard-of-hearing, and deaf blind 
 14.9   services described in clauses (1) and 
 14.10  (2): 
 14.11  (1) a grant to an organization that 
 14.12  provides services to deaf-blind persons 
 14.13  for purposes of providing additional 
 14.14  services to deaf-blind children and 
 14.15  their families, including the provision 
 14.16  of intervenors to assist deaf-blind 
 14.17  children in participating in their 
 14.18  community and family education 
 14.19  specialists to teach siblings and 
 14.20  parents skills to support the 
 14.21  deaf-blind child in the family, and a 
 14.22  grant to organizations that provide 
 14.23  services to deaf-blind persons for 
 14.24  purposes of providing assistance to 
 14.25  deaf-blind persons who are working 
 14.26  toward establishing and maintaining 
 14.27  independence.  The commissioner shall 
 14.28  use the request for proposal process to 
 14.29  award grants under this paragraph; and 
 14.30  (2) a grant for the deaf and 
 14.31  hard-of-hearing and deaf-blind 
 14.32  children.  The grant shall be used to 
 14.33  provide specialized statewide 
 14.34  psychological and social assessments, 
 14.35  family assessments, and school and 
 14.36  family consultation and training.  
 14.37  Services shall be provided in 
 14.38  cooperation with the Minnesota resource 
 14.39  center; the department of children, 
 14.40  families, and learning; the St. Paul 
 14.41  Ramsey health and wellness program 
 14.42  serving deaf and hard-of-hearing 
 14.43  people; and the Greater Minnesota 
 14.44  community mental health centers. 
 14.45  (e) Mental Health Grants
 14.46      48,128,000     49,428,000 
 14.47  [CHILDREN'S MENTAL HEALTH.] Of this 
 14.48  appropriation, $650,000 each year shall 
 14.49  be disbursed for the purpose of 
 14.50  awarding grants to counties for 
 14.51  children's mental health services.  In 
 14.52  awarding grants to counties, the 
 14.53  commissioner shall follow the process 
 14.54  in Minnesota Statutes, section 
 14.55  245.4886, subdivision 2.  The 
 14.56  commissioner shall ensure that grant 
 14.57  funds are not used to replace existing 
 14.58  funds. 
 14.59  [ADOLESCENT COMPULSIVE GAMBLING GRANT.] 
 14.60  $125,000 for fiscal year 1998 and 
 14.61  $125,000 for fiscal year 1999 shall be 
 14.62  transferred by the director of the 
 14.63  lottery from the lottery prize fund 
 14.64  created under Minnesota Statutes, 
 15.1   section 349A.10, subdivision 2, to the 
 15.2   general fund.  $125,000 for fiscal year 
 15.3   1998 and $125,000 for fiscal year 1999 
 15.4   is appropriated from the general fund 
 15.5   to the commissioner for the purposes of 
 15.6   a grant to a compulsive gambling 
 15.7   council located in St. Louis county for 
 15.8   a compulsive gambling prevention and 
 15.9   education project for adolescents. 
 15.10  (f) Developmental Disabilities
 15.11  Support Grants
 15.12       6,448,000      6,398,000 
 15.13  (g) Medical Assistance Long-Term 
 15.14  Care Waivers and Home Care
 15.15     255,540,000    297,609,000 
 15.16  [REIMBURSEMENT INCREASES.] Effective 
 15.17  for services rendered on or after July 
 15.18  1, 1997, the commissioner shall 
 15.19  increase reimbursement rates by five 
 15.20  percent for home- and community-based 
 15.21  waiver services for persons with mental 
 15.22  retardation or related conditions under 
 15.23  Minnesota Statutes, section 256B.501; 
 15.24  home- and community-based waiver 
 15.25  services for the elderly under 
 15.26  Minnesota Statutes, section 256B.0915; 
 15.27  community alternatives for disabled 
 15.28  individuals waiver services under 
 15.29  Minnesota Statutes, section 256B.49; 
 15.30  community alternative care waiver 
 15.31  services under Minnesota Statutes, 
 15.32  section 256B.49; traumatic brain injury 
 15.33  waiver services under Minnesota 
 15.34  Statutes, section 256B.49; nursing 
 15.35  services and home health services under 
 15.36  Minnesota Statutes, section 256B.0625, 
 15.37  subdivision 6a; personal care services 
 15.38  and nursing supervision of personal 
 15.39  care services under Minnesota Statutes, 
 15.40  section 256B.0625, subdivision 19a; 
 15.41  private duty nursing services under 
 15.42  Minnesota Statutes, section 256B.0625, 
 15.43  subdivision 7; day training and 
 15.44  habilitation services for adults with 
 15.45  mental retardation or related 
 15.46  conditions under Minnesota Statutes, 
 15.47  sections 252.40 to 252.47; physical 
 15.48  therapy services under Minnesota 
 15.49  Statutes, sections 256B.0625, 
 15.50  subdivision 8, and 256D.03, subdivision 
 15.51  4; occupational therapy services under 
 15.52  Minnesota Statutes, sections 256B.0625, 
 15.53  subdivision 8a, and 256D.03, 
 15.54  subdivision 4; speech-language therapy 
 15.55  services under Minnesota Statutes, 
 15.56  section 256D.03, subdivision 4, and 
 15.57  Minnesota Rules, part 9505.0390; 
 15.58  respiratory therapy services under 
 15.59  Minnesota Statutes, section 256D.03, 
 15.60  subdivision 4, and Minnesota Rules, 
 15.61  part 9505.0295; dental services under 
 15.62  Minnesota Statutes, sections 256B.0625, 
 15.63  subdivision 9, and 256D.03, subdivision 
 15.64  4; alternative care services under 
 15.65  Minnesota Statutes, section 256B.0913; 
 15.66  and semi-independent living services 
 16.1   under Minnesota Statutes, section 
 16.2   252.275.  The commissioner shall also 
 16.3   increase prepaid medical assistance 
 16.4   program capitation rates as appropriate 
 16.5   to reflect the rate increases in this 
 16.6   paragraph. 
 16.7   (h) Medical Assistance Long-Term
 16.8   Care Facilities
 16.9      582,688,000    591,859,000 
 16.10  [ICF/MR AND NURSING FACILITY 
 16.11  INFLATION.] The commissioner shall 
 16.12  grant inflation adjustments for nursing 
 16.13  facilities with rate years beginning 
 16.14  during the biennium according to 
 16.15  Minnesota Statutes, section 256B.431, 
 16.16  and shall grant inflation adjustments 
 16.17  for intermediate care facilities for 
 16.18  persons with mental retardation or 
 16.19  related conditions with rate years 
 16.20  beginning during the biennium according 
 16.21  to Minnesota Statutes, section 256B.501.
 16.22  [MORATORIUM EXCEPTIONS.] Of this 
 16.23  appropriation, $500,000 each year shall 
 16.24  be disbursed for the medical assistance 
 16.25  costs of moratorium exceptions approved 
 16.26  by the commissioner of health under 
 16.27  Minnesota Statutes, section 144A.073.  
 16.28  Unexpended money appropriated for 
 16.29  fiscal year 1998 does not cancel but is 
 16.30  available for fiscal year 1999.  This 
 16.31  appropriation shall not become part of 
 16.32  base-level funding for the biennium 
 16.33  beginning July 1, 1999. 
 16.34  [COUNTY WAIVERED SERVICES RESERVE.] 
 16.35  Notwithstanding the provisions of 
 16.36  Minnesota Statutes, section 256B.092, 
 16.37  subdivision 4, and Minnesota Rules, 
 16.38  part 9525.1830, subpart 2, the 
 16.39  commissioner may approve written 
 16.40  procedures and criteria for the 
 16.41  allocation of home- and community-based 
 16.42  waivered services funding for persons 
 16.43  with mental retardation or related 
 16.44  conditions which enables a county to 
 16.45  maintain a reserve resource account.  
 16.46  The reserve resource account may not 
 16.47  exceed five percent of the county 
 16.48  agency's total annual allocation of 
 16.49  home- and community-based waivered 
 16.50  services funds.  The reserve may be 
 16.51  utilized to ensure the county's ability 
 16.52  to meet the changing needs of current 
 16.53  recipients, to ensure the health and 
 16.54  safety needs of current recipients, or 
 16.55  to provide short-term emergency 
 16.56  intervention care to eligible waiver 
 16.57  recipients. 
 16.58  (i) Alternative Care Grants  
 16.59  General              48,257,000    32,147,000
 16.60  [PREADMISSION SCREENING TRANSFER.] 
 16.61  Effective the day following final 
 16.62  enactment, up to $40,000 of the 
 16.63  appropriation for preadmission 
 17.1   screening and alternative care for 
 17.2   fiscal year 1997 may be transferred to 
 17.3   the health care administration account 
 17.4   to pay the state's share of county 
 17.5   claims for conducting nursing home 
 17.6   assessments for persons with mental 
 17.7   illness or mental retardation as 
 17.8   required by Public Law Number 100-203. 
 17.9   [ALTERNATIVE CARE TRANSFER.] Any money 
 17.10  allocated to the alternative care 
 17.11  program that is not spent for the 
 17.12  purposes indicated does not cancel but 
 17.13  shall be transferred to the medical 
 17.14  assistance account. 
 17.15  [PREADMISSION SCREENING AMOUNT.] The 
 17.16  preadmission screening payment to all 
 17.17  counties shall continue at the payment 
 17.18  amount in effect for fiscal year 1997. 
 17.19  [PAS/AC APPROPRIATION.] The 
 17.20  commissioner may expend the money 
 17.21  appropriated for preadmission screening 
 17.22  and the alternative care program for 
 17.23  these purposes in either year of the 
 17.24  biennium. 
 17.25  (j) Group Residential Housing
 17.26  General              65,613,000    69,201,000
 17.27  [COUNTY SOCIAL SERVICE GRANTS FOR 
 17.28  FORMER GRH RECIPIENTS.] Notwithstanding 
 17.29  Laws 1995, chapter 207, article 1, 
 17.30  section 2, subdivision 3, section 13 of 
 17.31  this article, and Minnesota Statutes, 
 17.32  section 256E.06, effective July 1, 
 17.33  1995, the funds transferred under the 
 17.34  authority provided by Laws 1993, First 
 17.35  Special Session chapter 1, article 1, 
 17.36  section 2, subdivision 5, and Laws 
 17.37  1995, chapter 207, article 1, section 
 17.38  2, subdivision 3, to provide continuous 
 17.39  funding for persons no longer eligible 
 17.40  for group residential housing (GRH) 
 17.41  payments are added to the community 
 17.42  social services act funding for the 
 17.43  county in which the GRH setting was 
 17.44  located and must not be apportioned to 
 17.45  any other county or counties.  This 
 17.46  paragraph is effective the day 
 17.47  following final enactment. 
 17.48  (k) Chemical Dependency
 17.49  Entitlement Grants
 17.50  General              36,094,000    38,681,000
 17.51  [CHEMICAL DEPENDENCY FUNDS TRANSFER.] 
 17.52  $11,340,000 from the consolidated 
 17.53  chemical dependency general reserve 
 17.54  fund available in fiscal year 1998 is 
 17.55  transferred to the general fund. 
 17.56  (l) Chemical Dependency 
 17.57  Nonentitlement Grants
 17.58  General               5,000,000     5,000,000
 17.59  Subd. 9.  Continuing Care and
 18.1   Community Support Management
 18.2   General              19,129,000    18,754,000
 18.3   State Government
 18.4   Special Revenue         111,000       112,000
 18.5   [CONSUMER-OWNED HOUSING REVOLVING 
 18.6   ACCOUNT.] Effective the day following 
 18.7   final enactment, for the fiscal year 
 18.8   ending June 30, 1997, the commissioner 
 18.9   may transfer $25,000 of the 
 18.10  appropriation for health care to the 
 18.11  commissioner of the Minnesota housing 
 18.12  finance agency to establish an account 
 18.13  to finance the underwriting 
 18.14  requirements of the federal national 
 18.15  mortgage association pilot program for 
 18.16  persons with disabilities.  Any 
 18.17  unexpended balance in this account does 
 18.18  not cancel, but is available to the 
 18.19  commissioner of the Minnesota housing 
 18.20  finance agency for the ongoing purpose 
 18.21  of the account. 
 18.22  [REGION 10 QUALITY ASSURANCE 
 18.23  COMMISSION.] Of this appropriation, 
 18.24  $150,000 each year shall be transferred 
 18.25  to the region 10 quality assurance 
 18.26  commission for the costs associated 
 18.27  with the establishment and operation of 
 18.28  the quality assurance pilot project.  
 18.29  This appropriation shall not become 
 18.30  part of base-level funding for the 
 18.31  biennium beginning July 1, 1999. 
 18.32  [JOINT PURCHASER DEMONSTRATION 
 18.33  PROJECT.] Of this appropriation, 
 18.34  $50,000 in fiscal year 1998 is for a 
 18.35  grant to the Goodhue and Wabasha public 
 18.36  health service board to be used for the 
 18.37  development and start-up operational 
 18.38  costs for a joint purchaser 
 18.39  demonstration project described in Laws 
 18.40  1995, chapter 207, article 6, section 
 18.41  119, in Goodhue and Wabasha counties. 
 18.42  [PILOT PROJECT ON WOMEN'S MENTAL HEALTH 
 18.43  CRISIS SERVICES.] (a) Of this 
 18.44  appropriation, $100,000 in fiscal year 
 18.45  1998 is to develop a one-year pilot 
 18.46  project community-based crisis center 
 18.47  for women who are experiencing a mental 
 18.48  health crisis as a result of childhood 
 18.49  physical or sexual abuse.  The 
 18.50  commissioner shall provide pilot 
 18.51  project funding to Hennepin county to 
 18.52  contract with a four-bed adult foster 
 18.53  care facility to provide these services.
 18.54  (b) The commissioner shall apply to the 
 18.55  federal government for all necessary 
 18.56  waivers of medical assistance 
 18.57  requirements for funding of mental 
 18.58  health clinics so that the services in 
 18.59  paragraph (a) may be reimbursed by 
 18.60  medical assistance, upon legislative 
 18.61  approval, effective July 1, 1998. 
 18.62  [PILOT PROJECT FOR ASSISTED LIVING 
 18.63  SERVICES FOR SENIOR CITIZENS IN PUBLIC 
 19.1   HOUSING.] Of this appropriation, 
 19.2   $75,000 in fiscal year 1998 is for a 
 19.3   pilot project to provide assisted 
 19.4   living services for unserved and 
 19.5   underserved frail elderly and disabled 
 19.6   persons with a focus on those who 
 19.7   experience language and cultural 
 19.8   barriers.  The project shall offer 
 19.9   frail elderly persons an opportunity to 
 19.10  receive community-based support 
 19.11  services in a public housing setting to 
 19.12  enable them to remain in their homes.  
 19.13  The project shall also serve younger 
 19.14  disabled persons on waiver programs who 
 19.15  live in public housing and would 
 19.16  otherwise be in nursing homes.  The 
 19.17  commissioner shall provide pilot 
 19.18  project funding to Hennepin county to 
 19.19  contract with the Korean service center 
 19.20  at the Cedars high-rises.  The center 
 19.21  shall agree to do the following: 
 19.22  (1) facilitate or provide needed 
 19.23  community support services while taking 
 19.24  advantage of current local, state, and 
 19.25  federal programs that provide services 
 19.26  to senior citizens and handicapped 
 19.27  individuals; 
 19.28  (2) negotiate appropriate agreements 
 19.29  with the Minneapolis public housing 
 19.30  authority and Hennepin county; 
 19.31  (3) ensure that all participants are 
 19.32  screened for eligibility for services 
 19.33  by Hennepin county; 
 19.34  (4) become a licensed home care service 
 19.35  provider or subcontract with a licensed 
 19.36  provider to deliver needed services; 
 19.37  (5) contract for meals to be provided 
 19.38  through its congregate dining program; 
 19.39  and 
 19.40  (6) form other partnerships as needed 
 19.41  to ensure the development of a 
 19.42  successful, culturally sensitive 
 19.43  program for meeting the needs of 
 19.44  Korean, Southeast Asian, and other 
 19.45  frail elderly and disabled persons 
 19.46  living in public housing in southeast 
 19.47  Minneapolis. 
 19.48  [SNOW DAYS.] Of this appropriation, 
 19.49  $45,000 in fiscal year 1998 shall be 
 19.50  disbursed to reimburse day training and 
 19.51  habilitation providers for days during 
 19.52  which the provider was closed as a 
 19.53  result of severe weather conditions in 
 19.54  December 1996 to March 1997.  A day 
 19.55  training provider must request the aid 
 19.56  and provide relevant information to the 
 19.57  commissioner.  If the appropriation is 
 19.58  insufficient to reimburse for all 
 19.59  closed days reported by providers, the 
 19.60  commissioner shall make pro rata 
 19.61  reductions in the reimbursement 
 19.62  amount.  This money shall be 
 19.63  distributed no later than September 15, 
 19.64  1997. 
 20.1   Subd. 10.  Economic Support Grants
 20.2   General             222,159,000   210,836,000
 20.3   The amounts that may be spent from this 
 20.4   appropriation for each purpose are: 
 20.5   (a) Assistance to Families Grants
 20.6   General              92,253,000   110,688,000
 20.7   [GIFTS.] Notwithstanding Minnesota 
 20.8   Statutes, chapter 7, the commissioner 
 20.9   may accept on behalf of the state 
 20.10  additional funding from sources other 
 20.11  than state funds for the purpose of 
 20.12  financing the cost of assistance 
 20.13  program grants or administration of 
 20.14  them.  All additional funding is 
 20.15  appropriated to the commissioner for 
 20.16  use as designated by the grantee of 
 20.17  funding. 
 20.18  (b) Work Grants              
 20.19  General              13,786,000    13,792,000
 20.20  (c) Minnesota Family 
 20.21  Investment Program
 20.22  General              20,520,000       -0-    
 20.23  [WELFARE REFORM CARRYOVER.] Unexpended 
 20.24  grant funds for statewide 
 20.25  implementation of the Minnesota family 
 20.26  investment program-statewide, work 
 20.27  first, and employment and training 
 20.28  programs appropriated in fiscal year 
 20.29  1998 for the implementation of welfare 
 20.30  reform initiatives shall not cancel but 
 20.31  shall be available to the commissioner 
 20.32  for these purposes in fiscal year 1999. 
 20.33  (d) Aid to Families With     
 20.34  Dependent Children
 20.35  General               7,695,000       -0-
 20.36  [AFDC SUPPLEMENTARY GRANTS.] Of the 
 20.37  appropriation for AFDC, the 
 20.38  commissioner shall provide 
 20.39  supplementary grants not to exceed 
 20.40  $200,000 a year for AFDC until the AFDC 
 20.41  program no longer exists.  The 
 20.42  commissioner shall include the 
 20.43  following costs in determining the 
 20.44  amount of the supplementary grants:  
 20.45  major home repairs, repair of major 
 20.46  home appliances, utility recaps, 
 20.47  supplementary dietary needs not covered 
 20.48  by medical assistance, and replacements 
 20.49  of furnishings and essential major 
 20.50  appliances. 
 20.51  [CASH BENEFITS IN ADVANCE.] The 
 20.52  commissioner, with the advance approval 
 20.53  of the commissioner of finance, is 
 20.54  authorized to issue cash assistance 
 20.55  benefits up to three days before the 
 20.56  first day of each month, including 
 20.57  three days before the start of each 
 21.1   state fiscal year.  Three percent of 
 21.2   the money appropriated for assistance 
 21.3   to families grants for each fiscal year 
 21.4   is available to the commissioner in the 
 21.5   previous fiscal year.  If that amount 
 21.6   is insufficient for the costs incurred, 
 21.7   an additional amount of the 
 21.8   appropriation as needed may be 
 21.9   transferred with the advance approval 
 21.10  of the commissioner of finance.  This 
 21.11  paragraph is effective the day 
 21.12  following final enactment. 
 21.13  (f) Child Support Enforcement
 21.14  General               5,209,000     5,009,000
 21.15  [CHILD SUPPORT PAYMENT CENTER.] 
 21.16  Payments to the commissioner from other 
 21.17  governmental units, private 
 21.18  enterprises, and individuals for 
 21.19  services performed by the child support 
 21.20  payment center must be deposited in the 
 21.21  state systems account authorized under 
 21.22  Minnesota Statutes, section 256.014.  
 21.23  These payments are appropriated to the 
 21.24  commissioner for the operation of the 
 21.25  child support payment center or system, 
 21.26  according to Minnesota Statutes, 
 21.27  section 256.014. 
 21.28  [CHILD SUPPORT ENFORCEMENT PAYMENT 
 21.29  CENTER RECOUPMENT ACCOUNT.] The child 
 21.30  support enforcement payment center is 
 21.31  authorized to establish an account to 
 21.32  cover checks issued in error or in 
 21.33  cases where insufficient funds are 
 21.34  available to pay the checks.  All 
 21.35  recoupments against payments from the 
 21.36  account must be deposited in the child 
 21.37  support enforcement payment center 
 21.38  recoupment account and are appropriated 
 21.39  to the commissioner for the purposes of 
 21.40  the account.  Any unexpended balance in 
 21.41  the account does not cancel, but is 
 21.42  available until expended.  For the 
 21.43  period June 1, 1997, through June 30, 
 21.44  1997, the commissioner may transfer 
 21.45  fiscal year 1997 general fund 
 21.46  administrative money to the child 
 21.47  support enforcement payment center 
 21.48  recoupment account to cover 
 21.49  underfinanced and unfunded checks 
 21.50  during this period only.  This 
 21.51  paragraph is effective the day 
 21.52  following final enactment. 
 21.53  [CHILD SUPPORT ENFORCEMENT CARRYOVER.] 
 21.54  Unexpended funds for child support 
 21.55  enforcement grants and county 
 21.56  performance incentives for fiscal year 
 21.57  1998 do not cancel but are available to 
 21.58  the commissioner for these purposes for 
 21.59  fiscal year 1999. 
 21.60  (g) General Assistance
 21.61  General              55,019,000    51,583,000
 21.62  [GA STANDARD.] The commissioner shall 
 21.63  set the monthly standard of assistance 
 22.1   for general assistance units consisting 
 22.2   of an adult recipient who is childless 
 22.3   and unmarried or living apart from his 
 22.4   or her parents or a legal guardian at 
 22.5   $203, provided that if the policy 
 22.6   designed to make welfare benefits a 
 22.7   neutral factor in the decision to move 
 22.8   to Minnesota and to best manage the 
 22.9   benefit appropriation for needy 
 22.10  Minnesotans, while providing a safety 
 22.11  net for recent interstate migrants, is 
 22.12  enjoined or otherwise prevented from 
 22.13  being implemented, the standard is $94. 
 22.14  (h) Minnesota Supplemental Aid
 22.15  General              25,572,000    27,659,000
 22.16  (i) Refugee Services         
 22.17  General               2,105,000     2,105,000
 22.18  [CITIZENSHIP TRAINING.] The funds 
 22.19  appropriated for citizenship training 
 22.20  shall be awarded to nonprofit 
 22.21  organizations through a competitive 
 22.22  bidding process based on criteria 
 22.23  established by the commissioner.  
 22.24  Notice of the availability of funds 
 22.25  shall be published in the State 
 22.26  Register.  This appropriation shall not 
 22.27  become part of base-level funding for 
 22.28  the biennium beginning July 1, 1999. 
 22.29  Subd. 11.  Economic Support  
 22.30  Management
 22.31  General              39,176,000    37,482,000
 22.32  The amounts that may be spent from this 
 22.33  appropriation for each purpose are: 
 22.34  (a) Economic Support Policy  
 22.35  Administration
 22.36  General              10,234,000     8,626,000
 22.37  [PLAN FOR TRIBAL OPERATION OF FAMILY 
 22.38  ASSISTANCE PROGRAM.] Of this 
 22.39  appropriation, $75,000 each year is 
 22.40  appropriated to the commissioner to 
 22.41  assist tribes in the development and 
 22.42  implementation of a plan for providing 
 22.43  state funds in support of a family 
 22.44  assistance program and employment and 
 22.45  training programs administered by 
 22.46  Indian tribes that have a reservation 
 22.47  in Minnesota and that have federal 
 22.48  approval to operate a tribal program.  
 22.49  The commissioner and the tribes shall 
 22.50  collaborate in the development of the 
 22.51  plan.  The plan shall be reported to 
 22.52  the legislature no later than February 
 22.53  15, 1998.  This appropriation shall not 
 22.54  become part of base-level funding for 
 22.55  the biennium beginning July 1, 1999. 
 22.56  [NEW CHANCE PROGRAM.] Of this 
 22.57  appropriation, $140,000 each year is 
 22.58  for a grant to the "new chance" 
 22.59  program.  The new chance program shall 
 23.1   provide comprehensive services through 
 23.2   a private, nonprofit agency to young 
 23.3   parents in Hennepin county who have 
 23.4   dropped out of school and are receiving 
 23.5   public assistance.  The program 
 23.6   administrator shall report annually to 
 23.7   the commissioner on skills development, 
 23.8   education, job training, and job 
 23.9   placement outcomes for program 
 23.10  participants. 
 23.11  [TEMPORARY HUNGER PREVENTION AND 
 23.12  COMMUNITY DEVELOPMENT INITIATIVE.] (a) 
 23.13  The commissioner of human services, in 
 23.14  conjunction with the commissioner of 
 23.15  agriculture, shall create and 
 23.16  administer the "Minnesota grown" 
 23.17  component of the program called the 
 23.18  temporary hunger prevention and 
 23.19  community development initiative.  The 
 23.20  program shall consist of "Minnesota 
 23.21  grown" coupons.  The total benefit for 
 23.22  an individual or family shall be 35 
 23.23  percent of the actual amount of the 
 23.24  food stamp benefit for which the 
 23.25  individual or family would otherwise be 
 23.26  eligible, but for the individual or 
 23.27  family's noncitizen status.  The 
 23.28  program is intended to serve legal 
 23.29  noncitizens who are ineligible for the 
 23.30  federal food stamp program because of 
 23.31  changes in the citizenship requirements 
 23.32  made by Public Law Number 104-193.  The 
 23.33  commissioners of human services and 
 23.34  agriculture shall determine the most 
 23.35  effective way to administer the program 
 23.36  within the limit of the appropriation 
 23.37  for the program.  For purposes of 
 23.38  paragraphs (a) to (c), "legal 
 23.39  noncitizen" has the meaning given in 
 23.40  Minnesota Statutes, section 256J.11, if 
 23.41  enacted. 
 23.42  (b) The benefit for which the 
 23.43  individual or family is eligible shall 
 23.44  be issued by the commissioner of 
 23.45  agriculture through the "Minnesota 
 23.46  grown" coupon program, except that the 
 23.47  percentage issued as coupons must be 
 23.48  rounded to the nearest five dollars and 
 23.49  not exceed $100 nor be less than $20.  
 23.50  Each month the commissioner of human 
 23.51  services shall provide to the 
 23.52  commissioner of agriculture the names 
 23.53  of the heads of households who are 
 23.54  eligible for the "Minnesota grown" 
 23.55  coupon program, the addresses, and the 
 23.56  amount of coupons the household should 
 23.57  be issued.  The amount of the 
 23.58  "Minnesota grown" coupons must be 
 23.59  excluded as income under the AFDC, 
 23.60  refugee cash assistance, general 
 23.61  assistance, MFIP, MFIP-R, MFIP-S, and 
 23.62  food stamp programs.  
 23.63  (c) The temporary hunger prevention and 
 23.64  community development initiative 
 23.65  program shall serve otherwise eligible 
 23.66  legal noncitizens who reside in this 
 23.67  state as of March 1, 1997.  An 
 23.68  otherwise eligible legal noncitizen who 
 24.1   seeks assistance under the temporary 
 24.2   hunger prevention and community 
 24.3   development initiative program shall 
 24.4   receive assistance provided the legal 
 24.5   noncitizen: 
 24.6   (1) is enrolled in a literacy class, 
 24.7   English as a second language class, or 
 24.8   a citizenship class; 
 24.9   (2) is applying for admission to a 
 24.10  literacy class, English as a second 
 24.11  language class, or a citizenship class, 
 24.12  and is on a waiting list; 
 24.13  (3) is in the process of applying for a 
 24.14  waiver from the Immigration and 
 24.15  Naturalization Service of the English 
 24.16  language or civics requirement of the 
 24.17  citizenship test; 
 24.18  (4) has submitted an application for 
 24.19  citizenship to the Immigration and 
 24.20  Naturalization Service and is waiting 
 24.21  for a testing date or a subsequent 
 24.22  swearing in ceremony; or 
 24.23  (5) has been denied citizenship due to 
 24.24  a failure to pass the test after two 
 24.25  attempts or because of an inability to 
 24.26  understand the rights and 
 24.27  responsibilities of becoming a United 
 24.28  States citizen, as documented by the 
 24.29  Immigration and Naturalization Service 
 24.30  or the county. 
 24.31  [COMBINED MANUAL PRODUCTION COSTS.] The 
 24.32  commissioner may increase the fee 
 24.33  charged to, and may retain money 
 24.34  received from, individuals and private 
 24.35  entities in order to recover the 
 24.36  difference between the costs of 
 24.37  producing the department of human 
 24.38  services combined manual and the 
 24.39  subsidized price charged to individuals 
 24.40  and private entities on January 1, 
 24.41  1996.  The provision does not apply to 
 24.42  government agencies and nonprofit 
 24.43  agencies serving the legal or social 
 24.44  service needs of clients. 
 24.45  (b) Economic Support Policy  
 24.46  Operations
 24.47  General              28,942,000    28,856,000
 24.48  [ELECTRONIC BENEFIT TRANSFER (EBT) 
 24.49  COUNTY ALLOCATION.] Of the amount 
 24.50  appropriated for electronic benefit 
 24.51  transfer, an allocation shall be made 
 24.52  each year to counties for EBT-related 
 24.53  expenses.  One hundred percent of the 
 24.54  money shall be allocated to counties 
 24.55  based on each county's average monthly 
 24.56  number of food stamp households as a 
 24.57  proportion of statewide average monthly 
 24.58  food stamp households for the fiscal 
 24.59  year ending June 30, 1996. 
 24.60  Subd. 12.  Federal TANF Funds       
 25.1   [FEDERAL TANF FUNDS.] Federal Temporary 
 25.2   Assistance For Needy Families block 
 25.3   grant funds authorized under title I of 
 25.4   Public Law Number 104-193, the Personal 
 25.5   Responsibility and Work Opportunity Act 
 25.6   of 1996, are appropriated to the 
 25.7   department of human services in amounts 
 25.8   up to $278,400,000 in fiscal year 1998 
 25.9   and $277,244,000 in fiscal year 1999.  
 25.10  The Minnesota family investment 
 25.11  program-statewide/TANF reserve account 
 25.12  is created in the state treasury.  
 25.13  Funds designated by the legislature and 
 25.14  earnings available from the federal 
 25.15  TANF block grant appropriated to the 
 25.16  commissioner but not expended in the 
 25.17  biennium beginning July 1, 1997, shall 
 25.18  be retained in the reserve account to 
 25.19  be expended for the Minnesota family 
 25.20  investment program-statewide in fiscal 
 25.21  year 2000 and subsequent fiscal years. 
 25.22  [UNEXPENDED CHILD CARE FUNDS.] All 
 25.23  unexpended child care assistance grant 
 25.24  funds for the biennium ending June 30, 
 25.25  1999, must not cancel to the general 
 25.26  fund but shall be transferred to the 
 25.27  TANF reserve account. 
 25.28  Sec. 3.  COMMISSIONER OF HEALTH 
 25.29  Subdivision 1.  Total 
 25.30  Appropriation                         72,570,000    73,628,000
 25.31                Summary by Fund
 25.32  General              50,799,000    51,633,000
 25.33  Metropolitan Landfill
 25.34  Contingency Action Fund 193,000       193,000
 25.35  State Government
 25.36  Special Revenue      21,578,000    21,802,000
 25.37  [LANDFILL CONTINGENCY.] The 
 25.38  appropriation from the metropolitan 
 25.39  landfill contingency action fund shall 
 25.40  be disbursed for monitoring well water 
 25.41  supplies and conducting health 
 25.42  assessments in the metropolitan area. 
 25.43  Subd. 2.  Health Systems
 25.44  and Special Populations               48,668,000     49,791,000
 25.45                Summary by Fund
 25.46  General              39,805,000    40,898,000
 25.47  State Government
 25.48  Special Revenue       8,863,000     8,893,000
 25.49  [FEES FOR DRUG AND ALCOHOL COUNSELOR 
 25.50  LICENSE.] When setting fees for the 
 25.51  drug and alcohol counselor license, the 
 25.52  commissioner is exempt from Minnesota 
 25.53  Statutes, section 16A.1285, subdivision 
 25.54  2. 
 25.55  [FEES FOR HEARING INSTRUMENT DISPENSERS 
 25.56  LICENSE.] When setting fees for the 
 25.57  hearing instrument dispensers license, 
 26.1   the commissioner is exempt from 
 26.2   Minnesota Statutes, section 16A.1285, 
 26.3   subdivision 2. 
 26.4   [STATE VITAL STATISTICS REDESIGN 
 26.5   PROJECT ACCOUNT.] The amount 
 26.6   appropriated from the state government 
 26.7   special revenue fund for the vital 
 26.8   records redesign project shall be 
 26.9   available until expended for 
 26.10  development and implementation. 
 26.11  [COMPUTER PROJECTS] Money appropriated 
 26.12  for computer projects approved by the 
 26.13  information policy office, funded by 
 26.14  the legislature, and approved by the 
 26.15  commissioner of finance does not cancel 
 26.16  but is available for development and 
 26.17  implementation. 
 26.18  [COMPLEMENTARY MEDICINE STUDY.] (a) Of 
 26.19  the general fund appropriation, $20,000 
 26.20  in fiscal year 1998 shall be disbursed 
 26.21  for the commissioner of health, in 
 26.22  consultation with the commissioner of 
 26.23  commerce, to conduct a study based on 
 26.24  existing literature, information, and 
 26.25  data on the scope of complementary 
 26.26  medicine offered in this state.  The 
 26.27  commissioner shall: 
 26.28  (1) include the types of complementary 
 26.29  medicine therapies available in this 
 26.30  state; 
 26.31  (2) contact national and state 
 26.32  complementary medicine associations for 
 26.33  literature, information, and data; 
 26.34  (3) conduct a general literary review 
 26.35  for information and data on 
 26.36  complementary medicine; 
 26.37  (4) contact the departments of commerce 
 26.38  and human services for information on 
 26.39  existing registrations, licenses, 
 26.40  certificates, credentials, policies, 
 26.41  and regulations; and 
 26.42  (5) determine by sample, if 
 26.43  complementary medicine is currently 
 26.44  covered by health plan companies and 
 26.45  the extent of the coverage. 
 26.46  In conducting this review, the 
 26.47  commissioner shall consult with the 
 26.48  office of alternative medicine through 
 26.49  the National Institute of Health. 
 26.50  (b) The commissioner shall, in 
 26.51  consultation with the advisory 
 26.52  committee, report the study findings to 
 26.53  the legislature by January 15, 1998.  
 26.54  As part of the report, the commissioner 
 26.55  shall make recommendations on whether 
 26.56  the state should credential or regulate 
 26.57  any of the complementary medicine 
 26.58  providers. 
 26.59  (c) The commissioner shall appoint an 
 26.60  advisory committee to provide expertise 
 27.1   and advice on the study.  The committee 
 27.2   must include representation from the 
 27.3   following groups:  health care 
 27.4   providers, including providers of 
 27.5   complementary medicine; health plan 
 27.6   companies; and consumers.  The advisory 
 27.7   committee is governed by Minnesota 
 27.8   Statutes, section 15.059, for 
 27.9   membership terms and removal of members.
 27.10  (d) For purposes of this study, the 
 27.11  term "complementary medicine" includes, 
 27.12  but is not limited to, acupuncture, 
 27.13  homeopathy, manual healing, 
 27.14  macrobiotics, naturopathy, biofeedback, 
 27.15  mind/body control therapies, 
 27.16  traditional and ethnomedicine 
 27.17  therapies, structural manipulations and 
 27.18  energetic therapies, bioelectromagnetic 
 27.19  therapies, and herbal medicine. 
 27.20  [DOWN SYNDROME.] Of the general fund 
 27.21  appropriation, $15,000 in fiscal year 
 27.22  1998 shall be disbursed for a grant to 
 27.23  a nonprofit organization that provides 
 27.24  support to individuals with Down 
 27.25  Syndrome and their families, for the 
 27.26  purpose of providing all obstetricians, 
 27.27  certified nurse-midwives, and family 
 27.28  physicians licensed to practice in this 
 27.29  state with informational packets on 
 27.30  Down Syndrome.  The packets must 
 27.31  include, at a minimum, a fact sheet on 
 27.32  Down Syndrome, a list of counseling and 
 27.33  support groups for families with 
 27.34  children with Down Syndrome, and a list 
 27.35  of special needs adoption resources.  
 27.36  The informational packets must be made 
 27.37  available to any pregnant patient who 
 27.38  has tested positive for Down Syndrome, 
 27.39  either through a screening test or 
 27.40  amniocentesis. 
 27.41  [NEWBORN SCREENING FOR HEARING LOSS 
 27.42  PROGRAM IMPLEMENTATION PLAN.] (a) Of 
 27.43  the general fund appropriation, $18,000 
 27.44  in fiscal year 1998 shall be disbursed 
 27.45  to pay the costs of coordinating with 
 27.46  hospitals, the medical community, 
 27.47  audiologists, insurance companies, 
 27.48  parents, and deaf and hard-of-hearing 
 27.49  citizens to establish and implement a 
 27.50  voluntary plan for hospitals and other 
 27.51  health care facilities to screen all 
 27.52  infants for hearing loss. 
 27.53  (b) The plan to achieve universal 
 27.54  screening of infants for hearing loss 
 27.55  on a voluntary basis shall be 
 27.56  formulated by a department work group, 
 27.57  including the following representatives:
 27.58  (1) a representative of the health 
 27.59  insurance industry designated by the 
 27.60  health insurance industry; 
 27.61  (2) a representative of the Minnesota 
 27.62  Hospital and Healthcare Partnership; 
 27.63  (3) a total of two representatives from 
 27.64  the following physician groups 
 28.1   designated by the Minnesota Medical 
 28.2   Association:  pediatrics, family 
 28.3   practice, and ENT; 
 28.4   (4) two audiologists designated by the 
 28.5   Minnesota Speech-Language-Hearing 
 28.6   Association and the Minnesota Academy 
 28.7   of Audiology; 
 28.8   (5) a representative of hospital 
 28.9   neonatal nurseries; 
 28.10  (6) a representative of part H (IDEA) 
 28.11  early childhood special education; 
 28.12  (7) the commissioner of health or a 
 28.13  designee; 
 28.14  (8) a representative of the department 
 28.15  of human services; 
 28.16  (9) a public health nurse; 
 28.17  (10) a parent of a deaf or 
 28.18  hard-of-hearing child; 
 28.19  (11) a deaf or hard-of-hearing person; 
 28.20  and 
 28.21  (12) a representative of the Minnesota 
 28.22  commission serving deaf and 
 28.23  hard-of-hearing people. 
 28.24  Members of the work group shall not 
 28.25  collect a per diem or compensation as 
 28.26  provided in Minnesota Statutes, section 
 28.27  15.0575. 
 28.28  (c) The plan shall include measurable 
 28.29  goals and timetables for the 
 28.30  achievement of universal screening of 
 28.31  infants for hearing loss throughout the 
 28.32  state and shall include the design and 
 28.33  implementation of needed training to 
 28.34  assist hospitals and other health care 
 28.35  facilities screen infants for hearing 
 28.36  loss according to recognized standards 
 28.37  of care. 
 28.38  (d) The work group shall report to the 
 28.39  legislature by January 15, 1998, 
 28.40  concerning progress toward the 
 28.41  achievement of universal screening of 
 28.42  infants in Minnesota for the purpose of 
 28.43  assisting the legislature to determine 
 28.44  whether this goal can be accomplished 
 28.45  on a voluntary basis. 
 28.46  [AMERICAN INDIAN DIABETES.] Of this 
 28.47  appropriation, $90,000 each year shall 
 28.48  be disbursed for a comprehensive 
 28.49  school-based intervention program 
 28.50  designed to reduce the risk factors 
 28.51  associated with diabetes among American 
 28.52  Indian school children in grades 1 
 28.53  through 4. The appropriation for fiscal 
 28.54  year 1999 is available only if matched 
 28.55  by $1 of nonstate money for each $1 of 
 28.56  the appropriation.  The commissioner 
 28.57  shall convene an American Indian 
 28.58  diabetes prevention advisory task 
 29.1   force.  The task force must include 
 29.2   representatives from the American 
 29.3   Indian tribes located in the state and 
 29.4   urban American Indian representatives.  
 29.5   The task force shall advise the 
 29.6   commissioner on the adaptation of 
 29.7   curricula and the dissemination of 
 29.8   information designed to reduce the risk 
 29.9   factors associated with diabetes among 
 29.10  American Indian school children in 
 29.11  grades 1 through 4.  The curricula and 
 29.12  information must be sensitive to 
 29.13  traditional American Indian values and 
 29.14  culture and must encourage full 
 29.15  participation by the American Indian 
 29.16  community. 
 29.17  [FETAL ALCOHOL SYNDROME.] Of the 
 29.18  general fund appropriation, $500,000 in 
 29.19  fiscal year 1998 shall be disbursed to 
 29.20  prevent and reduce harm from fetal 
 29.21  alcohol syndrome and fetal alcohol 
 29.22  effect.  Unexpended funds do not cancel 
 29.23  but are available for fiscal year 1999. 
 29.24  [MN ENABL.] Of the general fund 
 29.25  appropriation, $500,000 each year shall 
 29.26  be disbursed for the continuation and 
 29.27  expansion of the Minnesota education 
 29.28  now and babies later (MN ENABL) 
 29.29  program.  The appropriation shall 
 29.30  include the continuation of the 
 29.31  contract with the attorney general's 
 29.32  office for the development and 
 29.33  implementation of the media and public 
 29.34  relations campaign.  
 29.35  [BIRTH DEFECTS INFORMATION SYSTEM.] Of 
 29.36  the general fund appropriation, 
 29.37  $600,000 in fiscal year 1998 and 
 29.38  $1,000,000 in fiscal year 1999 shall be 
 29.39  disbursed to administer the birth 
 29.40  defects information system. 
 29.41  [IMMUNIZATION REGISTRIES.] Of this 
 29.42  appropriation, $525,000 each year shall 
 29.43  be disbursed for grants to local 
 29.44  communities for the central collection 
 29.45  of immunization registry data for all 
 29.46  persons of an age specified by the 
 29.47  registry within a geographic area, 
 29.48  beginning with the filing of their 
 29.49  birth registrations. 
 29.50  [INFANT HEARING SCREENING PROGRAM.] Of 
 29.51  the general fund appropriation, $25,000 
 29.52  in fiscal year 1998 shall be disbursed 
 29.53  for a grant to a hospital in Staples, 
 29.54  Minnesota, for the infant hearing 
 29.55  screening program. 
 29.56  [WIC TRANSFERS.] General fund 
 29.57  appropriations for the women, infants, 
 29.58  and children food supplement program 
 29.59  (WIC) are available for either year of 
 29.60  the biennium.  Transfers of 
 29.61  appropriations between fiscal years 
 29.62  must be for the purpose of maximizing 
 29.63  federal funds or minimizing 
 29.64  fluctuations in the number of 
 29.65  participants.  
 30.1   [WIC APPROPRIATION.] Of the general 
 30.2   fund appropriation, $1,150,000 in 
 30.3   fiscal year 1998 and $1,000,000 in 
 30.4   fiscal year 1999 shall be disbursed for 
 30.5   the women, infants, and children food 
 30.6   supplement program (WIC).  This 
 30.7   appropriation shall not become part of 
 30.8   base-level funding for the biennium 
 30.9   beginning July 1, 1999. 
 30.10  [LOCAL PUBLIC HEALTH FINANCING.] Of the 
 30.11  general fund appropriation, $6,000,000 
 30.12  each year shall be disbursed for local 
 30.13  public health financing and shall be 
 30.14  distributed according to the community 
 30.15  health service subsidy formula in 
 30.16  Minnesota Statutes, section 145A.13.  
 30.17  [SERVICES FOR CHILDREN CARRYOVER.] 
 30.18  General fund appropriations for 
 30.19  treatment services in the services for 
 30.20  children with special health care needs 
 30.21  program are available for either year 
 30.22  of the biennium. 
 30.23  Subd. 3.  Health Protection          20,852,000     20,662,000
 30.24                Summary by Fund
 30.25  General               8,102,000     7,718,000
 30.26  Metro Landfill
 30.27  Contingency             193,000       193,000
 30.28  State Government 
 30.29  Special Revenue      12,557,000    12,751,000
 30.30  [HIV/AIDS PREVENTION.] (a) Of the 
 30.31  general fund appropriation, $500,000 in 
 30.32  fiscal year 1998 shall be disbursed to 
 30.33  provide funding for HIV/AIDS prevention 
 30.34  grants under Minnesota Statutes, 
 30.35  section 145.924.  
 30.36  (b) Of the general fund appropriation, 
 30.37  $100,000 each year shall be disbursed 
 30.38  for activities related to prevention of 
 30.39  perinatal transmission of HIV, a 
 30.40  statewide education campaign for 
 30.41  pregnant women and their health care 
 30.42  providers, and demonstration grants to 
 30.43  providers to develop procedures for 
 30.44  incorporating HIV awareness and 
 30.45  education into perinatal care. 
 30.46  (c) The appropriations in paragraphs 
 30.47  (a) and (b) shall not become part of 
 30.48  base-level funding for the biennium 
 30.49  beginning July 1, 1999. 
 30.50  Subd. 4.  Management and
 30.51  Support Services                       3,050,000      3,175,000
 30.52                Summary by Fund
 30.53  General               2,892,000     3,017,000
 30.54  State Government
 30.55  Special Revenue         158,000       158,000
 30.56  Sec. 4.  VETERANS NURSING   
 31.1   HOMES BOARD                           23,721,000     22,172,000 
 31.2   [SPECIAL REVENUE ACCOUNT.] The general 
 31.3   fund appropriations made to the 
 31.4   veterans homes board shall be 
 31.5   transferred to a veterans homes special 
 31.6   revenue account in the special revenue 
 31.7   fund in the same manner as other 
 31.8   receipts are deposited according to 
 31.9   Minnesota Statutes, section 198.34, and 
 31.10  are appropriated to the veterans homes 
 31.11  board of directors for the operation of 
 31.12  board facilities and programs. 
 31.13  [SETTING THE COST OF CARE.] The 
 31.14  veterans homes board may set the cost 
 31.15  of care at the Fergus Falls facility 
 31.16  based on the cost of average skilled 
 31.17  nursing care provided to residents of 
 31.18  the Minneapolis veterans home for 
 31.19  fiscal years 1998 and 1999. 
 31.20  [LICENSED CAPACITY.] The department of 
 31.21  health shall not reduce the licensed 
 31.22  bed capacity for the Minneapolis 
 31.23  veterans home pending completion of the 
 31.24  project authorized by Laws 1990, 
 31.25  chapter 610, article 1, section 9, 
 31.26  subdivision 3.  
 31.27  [ALLOWANCE FOR FOOD.] The allowance for 
 31.28  food may be adjusted annually to 
 31.29  reflect changes in the producer price 
 31.30  index, as prepared by the United States 
 31.31  Bureau of Labor Statistics, with the 
 31.32  approval of the commissioner of 
 31.33  finance.  Adjustments for fiscal year 
 31.34  1998 and fiscal year 1999 must be based 
 31.35  on the June 1996 and June 1997 producer 
 31.36  price index respectively, but the 
 31.37  adjustment must be prorated if it would 
 31.38  require money in excess of the 
 31.39  appropriation. 
 31.40  Sec. 5.  HEALTH-RELATED BOARDS 
 31.41  Subdivision 1.  Total       
 31.42  Appropriation                          9,598,000      9,618,000 
 31.43  [STATE GOVERNMENT SPECIAL REVENUE 
 31.44  FUND.] The appropriations in this 
 31.45  section are from the state government 
 31.46  special revenue fund. 
 31.47  [NO SPENDING IN EXCESS OF REVENUES.] 
 31.48  The commissioner of finance shall not 
 31.49  permit the allotment, encumbrance, or 
 31.50  expenditure of money appropriated in 
 31.51  this section in excess of the 
 31.52  anticipated biennial revenues or 
 31.53  accumulated surplus revenues from fees 
 31.54  collected by the boards.  Neither this 
 31.55  provision nor Minnesota Statutes, 
 31.56  section 214.06, applies to transfers 
 31.57  from the general contingent account. 
 31.58  Subd. 2.  Board of Chiropractic 
 31.59  Examiners                                332,000        340,000
 31.60  Subd. 3.  Board of Dentistry             742,000        760,000
 32.1   Subd. 4.  Board of Dietetic
 32.2   and Nutrition Practice                    90,000         90,000
 32.3   Subd. 5.  Board of Marriage and 
 32.4   Family Therapy                           103,000        104,000
 32.5   Subd. 6.  Board of Medical  
 32.6   Practice                               3,672,000      3,711,000
 32.7   Of these appropriations, $109,000 the 
 32.8   first year and $110,000 the second year 
 32.9   are for the Health Professional 
 32.10  Services Activity. 
 32.11  Subd. 7.  Board of Nursing             2,067,000      2,106,000
 32.12  [DISCIPLINE AND LICENSING SYSTEMS 
 32.13  PROJECT.] Of this appropriation, 
 32.14  $235,000 the first year and $235,000 
 32.15  the second year shall be disbursed to 
 32.16  complete the implementation of the 
 32.17  discipline and licensing systems 
 32.18  project.  
 32.19  Subd. 8.  Board of Nursing 
 32.20  Home Administrators                      177,000        181,000
 32.21  Subd. 9.  Board of Optometry              82,000         85,000
 32.22  Subd. 10.  Board of Pharmacy           1,020,000      1,040,000
 32.23  Of this appropriation, $216,000 the 
 32.24  first year and $222,000 the second year 
 32.25  shall be disbursed for the health 
 32.26  boards administrative services unit.  
 32.27  The administrative services unit may 
 32.28  receive and expend reimbursements for 
 32.29  services performed for other agencies. 
 32.30  Subd. 11.  Board of Podiatry              33,000         33,000
 32.31  Subd. 12.  Board of Psychology           424,000        436,000
 32.32  Subd. 13.  Board of Social Work          715,000        588,000
 32.33  Subd. 14.  Board of Veterinary 
 32.34  Medicine                                 141,000        144,000
 32.35  Sec. 6.  EMERGENCY MEDICAL
 32.36  SERVICES BOARD                         2,436,000      2,262,000 
 32.37                Summary by Fund
 32.38  General                 784,000       584,000
 32.39  Trunk Highway         1,652,000     1,678,000
 32.40  [COMPREHENSIVE ADVANCED LIFE SUPPORT 
 32.41  (CALS).] Of this appropriation, 
 32.42  $194,000 in fiscal year 1998 shall be 
 32.43  disbursed to implement the 
 32.44  comprehensive advanced life support 
 32.45  (CALS) program or similar program and 
 32.46  $6,000 is for administrative costs of 
 32.47  implementing the CALS program. 
 32.48  Sec. 7.  COUNCIL ON DISABILITY           616,000        631,000
 32.49  Sec. 8.  OMBUDSMAN FOR MENTAL 
 32.50  HEALTH AND MENTAL RETARDATION          1,374,000      1,298,000
 33.1   [CARRYOVER.] $25,000 of the 
 33.2   appropriation from Laws 1995, chapter 
 33.3   207, article 1, section 7, does not 
 33.4   cancel but is available until June 30, 
 33.5   1999. 
 33.6   Sec. 9.  OMBUDSMAN
 33.7   FOR FAMILIES                             157,000        161,000
 33.8   Sec. 10.  TRANSFERS 
 33.9   Subdivision 1.  Entitlement programs
 33.10  Transfers of unencumbered 
 33.11  entitled grant and aid appropriations 
 33.12  for the biennium ending June 30, 1999.
 33.13  The commissioner of human services, 
 33.14  with the approval of the commissioner 
 33.15  of finance, and after notification of 
 33.16  the chair of the senate health and 
 33.17  family security budget division and the 
 33.18  chair of the house of representatives 
 33.19  health and human services finance 
 33.20  division, may transfer unencumbered 
 33.21  appropriation balances for the biennium 
 33.22  ending June 30, 1999, within fiscal 
 33.23  years among the aid to families with 
 33.24  dependent children, Minnesota family 
 33.25  investment plan, general assistance, 
 33.26  general assistance medical care, 
 33.27  medical assistance, Minnesota 
 33.28  supplemental aid, and group residential 
 33.29  housing programs, assistance to 
 33.30  families grants, and the entitlement 
 33.31  portion of the chemical dependency 
 33.32  consolidated treatment fund, and 
 33.33  between fiscal years of the biennium. 
 33.34  Subd. 2.  Approval required 
 33.35  Positions, salary money, and nonsalary 
 33.36  administrative money may be transferred 
 33.37  within the departments of human 
 33.38  services and health and within the 
 33.39  programs operated by the veterans 
 33.40  nursing homes board as the 
 33.41  commissioners and the board consider 
 33.42  necessary, with the advance approval of 
 33.43  the commissioner of finance.  The 
 33.44  commissioner of finance shall inform 
 33.45  the chairs of the health and human 
 33.46  services finance division of the house 
 33.47  of representatives and the health and 
 33.48  family security budget division of the 
 33.49  senate quarterly about transfers made 
 33.50  under this provision. 
 33.51  Subd. 3.  Transfer 
 33.52  Funding appropriated by the legislature 
 33.53  may not be transferred to a different 
 33.54  department than specified by the 
 33.55  legislature without legislative 
 33.56  authority. 
 33.57  Sec. 11.  PROVISIONS  
 33.58  (a) Money appropriated to the 
 33.59  commissioner of human services for the 
 33.60  purchase of provisions within the item 
 34.1   "current expense" must be used solely 
 34.2   for that purpose.  Money provided and 
 34.3   not used for the purchase of provisions 
 34.4   must be canceled into the fund from 
 34.5   which appropriated, except that money 
 34.6   provided and not used for the purchase 
 34.7   of provisions because of population 
 34.8   decreases may be transferred and used 
 34.9   for the purchase of drugs and medical 
 34.10  and hospital supplies and equipment 
 34.11  with written approval of the governor 
 34.12  after consultation with the legislative 
 34.13  advisory commission. 
 34.14  (b) For fiscal year 1998, the allowance 
 34.15  for food may be adjusted to the 
 34.16  equivalent of the 75th percentile of 
 34.17  the comparable raw food costs for 
 34.18  community nursing homes as reported to 
 34.19  the commissioner of human services.  
 34.20  For fiscal year 1999 an adjustment may 
 34.21  be made to reflect the annual change in 
 34.22  the United States Bureau of Labor 
 34.23  Statistics producer price index as of 
 34.24  June 1998 with the approval of the 
 34.25  commissioner of finance.  The 
 34.26  adjustments for either year must be 
 34.27  prorated if they would require money in 
 34.28  excess of this appropriation. 
 34.29  Sec. 12.  CARRYOVER LIMITATION
 34.30  None of the appropriations in this act 
 34.31  which are allowed to be carried forward 
 34.32  from fiscal year 1998 to fiscal year 
 34.33  1999 shall become part of the 
 34.34  base-level funding for the 2000-2001 
 34.35  biennial budget, unless specifically 
 34.36  directed by the legislature. 
 34.37  Sec. 13.  SUNSET OF UNCODIFIED LANGUAGE
 34.38  All uncodified language contained in 
 34.39  this article expires on June 30, 1999, 
 34.40  unless a different expiration date is 
 34.41  explicit. 
 34.42                             ARTICLE 2
 34.43           HEALTH DEPARTMENT AND HEALTH PLAN REGULATIONS
 34.44     Section 1.  Minnesota Statutes 1996, section 13.99, is 
 34.45  amended by adding a subdivision to read: 
 34.46     Subd. 32a.  [BIRTH DEFECTS INFORMATION SYSTEM.] Data on 
 34.47  individuals in the birth defects information system maintained 
 34.48  by the commissioner of health are classified in section 144.2217.
 34.49     Sec. 2.  Minnesota Statutes 1996, section 103I.101, 
 34.50  subdivision 6, is amended to read: 
 34.51     Subd. 6.  [FEES FOR VARIANCES.] The commissioner shall 
 34.52  charge a nonrefundable application fee of ~~$100~~ $120 to cover the 
 34.53  administrative cost of processing a request for a variance or 
 35.1   modification of rules adopted by the commissioner under this 
 35.2   chapter. 
 35.3      Sec. 3.  Minnesota Statutes 1996, section 103I.208, is 
 35.4   amended to read: 
 35.5      103I.208 [~~WELL~~ NOTIFICATION FILING FEES AND PERMIT FEES.] 
 35.6      Subdivision 1.  [WELL NOTIFICATION FEE.] The well 
 35.7   notification fee to be paid by a property owner is:  
 35.8      (1) for a new well, ~~$100~~ $120, which includes the state 
 35.9   core function fee; ~~and~~ 
 35.10     (2) for a well sealing, $20, which includes the state core 
 35.11  function fee; and 
 35.12     (3) for construction of a dewatering well, ~~$100~~ $120, which 
 35.13  includes the state core function fee, for each well except a 
 35.14  dewatering project comprising five or more wells shall be 
 35.15  assessed a single fee of ~~$500~~ $600 for the wells recorded on the 
 35.16  notification. 
 35.17     Subd. 1a.  [STATE CORE FUNCTION FEE.] The state core 
 35.18  function fee to be collected by the state and delegated boards 
 35.19  of health and used to support state core functions is: 
 35.20     (1) for a new well, $20; and 
 35.21     (2) for a well sealing, $5.  
 35.22     Subd. 2.  [PERMIT FEE.] The permit fee to be paid by a 
 35.23  property owner is:  
 35.24     (1) for a well that is not in use under a maintenance 
 35.25  permit, $100 annually; 
 35.26     (2) for construction of a monitoring well, ~~$100~~ $120, which 
 35.27  includes the state core function fee; 
 35.28     (3) for a monitoring well that is unsealed under a 
 35.29  maintenance permit, $100 annually; 
 35.30     (4) for monitoring wells used as a leak detection device at 
 35.31  a single motor fuel retail outlet or petroleum bulk storage site 
 35.32  excluding tank farms, the construction permit fee is ~~$100~~ $120, 
 35.33  which includes the state core function fee, per site regardless 
 35.34  of the number of wells constructed on the site, and the annual 
 35.35  fee for a maintenance permit for unsealed monitoring wells is 
 35.36  $100 per site regardless of the number of monitoring wells 
 36.1   located on site; 
 36.2      (5) for a groundwater thermal exchange device, in addition 
 36.3   to the notification fee for wells, ~~$100~~ $120, which includes the 
 36.4   state core function fee; 
 36.5      (6) for a vertical heat exchanger, ~~$100~~ $120; ~~and~~ 
 36.6      (7) for a dewatering well that is unsealed under a 
 36.7   maintenance permit, $100 annually for each well, except a 
 36.8   dewatering project comprising more than five wells shall be 
 36.9   issued a single permit for $500 annually for wells recorded on 
 36.10  the permit; and 
 36.11     (8) for excavating holes for the purpose of installing 
 36.12  elevator shafts, $120 for each hole. 
 36.13     Sec. 4.  Minnesota Statutes 1996, section 103I.401, 
 36.14  subdivision 1, is amended to read: 
 36.15     Subdivision 1.  [PERMIT REQUIRED.] (a) A person may not 
 36.16  construct an elevator shaft until a permit for the hole or 
 36.17  excavation is issued by the commissioner.  
 36.18     (b) ~~The fee for excavating holes for the purpose of~~ 
 36.19  ~~installing elevator shafts is $100 for each hole.~~ 
 36.20     ~~(c)~~ The elevator shaft permit preempts local permits except 
 36.21  local building permits, and counties and home rule charter or 
 36.22  statutory cities may not require a permit for elevator shaft 
 36.23  holes or excavations. 
 36.24     Sec. 5.  Minnesota Statutes 1996, section 144.121, 
 36.25  subdivision 1, is amended to read: 
 36.26     Subdivision 1.  [REGISTRATION; FEES.] The fee for the 
 36.27  registration for X-ray machines and ~~radium~~ other sources of 
 36.28  ionizing radiation required to be registered under rules adopted 
 36.29  by the state commissioner of health pursuant to section 144.12, 
 36.30  shall be in an amount ~~prescribed by the commissioner~~ as 
 36.31  described in subdivision 1a pursuant to section 144.122.  ~~The~~ 
 36.32  ~~first fee for registration shall be due on January 1, 1975.~~  The 
 36.33  registration shall expire and be renewed as prescribed by the 
 36.34  commissioner pursuant to section 144.122. 
 36.35     Sec. 6.  Minnesota Statutes 1996, section 144.121, is 
 36.36  amended by adding a subdivision to read: 
 37.1      Subd. 1a.  [FEES FOR X-RAY MACHINES AND OTHER SOURCES OF 
 37.2   IONIZING RADIATION.] After July 1, 1997, a facility with x-ray 
 37.3   machines or other sources of ionizing radiation must biennially 
 37.4   pay an initial or biennial renewal registration fee consisting 
 37.5   of a base facility fee of $132 and an additional fee for each 
 37.6   x-ray machine or other source of ionizing radiation as follows:  
 37.7     (1) medical or veterinary equipment                   $106
 37.8     (2) dental x-ray equipment                            $ 66
 37.9     (3) accelerator                                       $132
 37.10    (4) radiation therapy equipment                       $132
 37.11    (5) x-ray equipment not used on humans or animals     $106
 37.12    (6) devices with sources of ionizing radiation
 37.13        not used on humans or animals                     $106
 37.14    (7) sources of radium                                 $198
 37.15     Sec. 7.  Minnesota Statutes 1996, section 144.121, is 
 37.16  amended by adding a subdivision to read: 
 37.17     Subd. 1b.  [PENALTY FEE FOR LATE REGISTRATION.] 
 37.18  Applications for initial or renewal registrations submitted to 
 37.19  the commissioner after the time specified by the commissioner 
 37.20  shall be accompanied by a penalty fee of $20 in addition to the 
 37.21  fees prescribed in subdivision 1a. 
 37.22     Sec. 8.  Minnesota Statutes 1996, section 144.121, is 
 37.23  amended by adding a subdivision to read: 
 37.24     Subd. 1c.  [FEE FOR X-RAY MACHINES AND OTHER SOURCES OF 
 37.25  IONIZING RADIATION REGISTERED DURING LAST 12 MONTHS OF A 
 37.26  BIENNIAL REGISTRATION PERIOD.] The initial registration fee of 
 37.27  x-ray machines or other sources of radiation required to be 
 37.28  registered during the last 12 months of a biennial registration 
 37.29  period will be 50 percent of the applicable registration fee 
 37.30  prescribed in subdivision 1a. 
 37.31     Sec. 9.  [144.1223] [ENCLOSED ARENAS.] 
 37.32     Subdivision 1.  [DEFINITIONS.] For purposes of this 
 37.33  section, the following terms have the meanings given them. 
 37.34     (a) "Enclosed arena" means any building with a roof and a 
 37.35  majority of the sides closed that is used for sports events, 
 37.36  entertainment, and demonstrations.  
 38.1      (b) "Ice arena" means any building with a roof and a 
 38.2   majority of the sides closed that contains an ice rink.  
 38.3      (c) "Motorized event" means sporting events or 
 38.4   entertainment at which internal combustion engine vehicles or 
 38.5   equipment are used for racing, competition, or demonstration 
 38.6   including, but not limited to, trucks, midget cars, motorcycles, 
 38.7   and snowmobiles.  
 38.8      (d) "Resurfacing machine" means an ice resurfacing machine. 
 38.9      Subd. 2.  [CERTIFICATION; INSPECTION AND MONITORING.] The 
 38.10  commissioner of health shall adopt rules and enforce applicable 
 38.11  laws and rules relating to the operation and maintenance of 
 38.12  enclosed arenas in which internal combustion engines are 
 38.13  operated.  Periodic inspection and monitoring of the enclosed 
 38.14  arenas shall be made by the commissioner of health.  The 
 38.15  frequency of the inspection shall be prescribed by the 
 38.16  commissioner on the basis of the frequency of use of internal 
 38.17  combustion engines and as required in subdivision 3.  
 38.18     Subd. 3.  [FEES.] After October 1, 1997, enclosed arenas 
 38.19  must annually pay an initial or annual renewal certification fee 
 38.20  as follows:  
 38.21     (a) $450 per sheet of ice for ice arenas that use internal 
 38.22  combustion engine ice resurfacing machines provided that each 
 38.23  ice arena is inspected no less than once every year.  
 38.24     (b) $200 per sheet of ice for ice arenas that use electric 
 38.25  ice resurfacing machines while other ice cleaning and 
 38.26  preparation equipment use internal combustion engines provided 
 38.27  that each ice arena is inspected no less than once every two 
 38.28  years.  
 38.29     (c) $50 per sheet of ice for ice arenas that use both 
 38.30  electric ice resurfacing machines and electric equipment to 
 38.31  clean and prepare ice provided that each ice arena is inspected 
 38.32  no less than once every four years.  
 38.33     (d) $250 per motorized event held in an enclosed arena.  
 38.34  The fee is payable 30 days prior to the date of the event 
 38.35  provided that the enclosed arena is inspected no less than once 
 38.36  per event.  
 39.1      Subd. 4.  [FEES FOR VARIANCES.] The commissioner shall 
 39.2   charge a nonrefundable application fee of $100 to cover the 
 39.3   administrative cost of processing a request for a variance from 
 39.4   rules adopted by the commissioner under this chapter.  
 39.5      Subd. 5.  [PRORATING AND LATE FEE.] The fee for the initial 
 39.6   certification fee for an enclosed arena shall be prorated for 
 39.7   less than 50 percent of the certification period to the amount 
 39.8   of 50 percent of the fee as described in subdivision 3.  A late 
 39.9   fee of $15 shall be assessed to renewal certifications submitted 
 39.10  to the commissioner after the time specified by the commissioner 
 39.11  in addition to the fees prescribed in subdivision 3. 
 39.12     Sec. 10.  Minnesota Statutes 1996, section 144.125, is 
 39.13  amended to read: 
 39.14     144.125 [TESTS OF INFANTS FOR INBORN METABOLIC ERRORS.] 
 39.15     It is the duty of (1) the administrative officer or other 
 39.16  person in charge of each institution caring for infants 28 days 
 39.17  or less of age and (2) the person required in pursuance of the 
 39.18  provisions of section 144.215, to register the birth of a child, 
 39.19  to cause to have administered to every infant or child in its 
 39.20  care tests for hemoglobinopathy, phenylketonuria, and other 
 39.21  inborn errors of metabolism in accordance with rules prescribed 
 39.22  by the state commissioner of health.  In determining which tests 
 39.23  must be administered, the commissioner shall take into 
 39.24  consideration the adequacy of laboratory methods to detect the 
 39.25  inborn metabolic error, the ability to treat or prevent medical 
 39.26  conditions caused by the inborn metabolic error, and the 
 39.27  severity of the medical conditions caused by the inborn 
 39.28  metabolic error.  Testing and the recording and reporting of the 
 39.29  results of the tests shall be performed at the times and in the 
 39.30  manner prescribed by the commissioner of health.  The 
 39.31  commissioner shall charge laboratory service fees for conducting 
 39.32  the tests of infants for inborn metabolic errors so that the 
 39.33  total of fees collected will approximate the costs of conducting 
 39.34  the tests and implementing and maintaining a system to follow-up 
 39.35  infants with inborn metabolic errors.  Costs associated with 
 39.36  capital expenditures and the development of new procedures may 
 40.1   be prorated over a three-year period when calculating the amount 
 40.2   of the fees. 
 40.3      Sec. 11.  Minnesota Statutes 1996, section 144.2215, is 
 40.4   amended to read: 
 40.5      144.2215 [BIRTH DEFECTS ~~REGISTRY~~ INFORMATION SYSTEM.] 
 40.6      Subdivision 1.  [ESTABLISHMENT.] The commissioner of health 
 40.7   shall ~~develop a statewide birth defects registry system to~~ 
 40.8   ~~provide for the collection, analysis, and dissemination of birth~~ 
 40.9   ~~defects information.  The commissioner shall consult with~~ 
 40.10  ~~representatives and experts in epidemiology, medicine,~~ 
 40.11  ~~insurance, health maintenance organizations, genetics,~~ 
 40.12  ~~consumers, and voluntary organizations in developing the system~~ 
 40.13  ~~and may phase in the implementation of the system~~ establish a 
 40.14  statewide population-based birth defects information system to 
 40.15  collect, analyze, and disseminate information regarding the risk 
 40.16  for and incidence of birth defects. 
 40.17     Subd. 2.  [DUTIES OF COMMISSIONER.] The commissioner of 
 40.18  health shall design the birth defects information system to 
 40.19  allow the commissioner to: 
 40.20     (1) monitor incidence trends of birth defects to detect 
 40.21  potential public health problems, predict risks, and assist in 
 40.22  responding to birth defects clusters; 
 40.23     (2) more accurately target intervention resources for 
 40.24  communities and individuals and their families; 
 40.25     (3) inform health professionals and the public of the 
 40.26  prevalence of and risks for birth defects; and 
 40.27     (4) promote high quality research to provide better 
 40.28  information for the prevention of birth defects. 
 40.29     Subd. 3.  [RULEMAKING.] The commissioner of health shall 
 40.30  adopt rules necessary to implement and administer the birth 
 40.31  defects information system.  The rules must address, but are not 
 40.32  limited to, the following: 
 40.33     (1) defining "case" for purposes of birth defects data 
 40.34  collection; 
 40.35     (2) establishing the type and scope of data to be collected 
 40.36  for each case; 
 41.1      (3) establishing a mechanism and assigning responsibility 
 41.2   for case ascertainment; and 
 41.3      (4) establishing criteria for contracts made with outside 
 41.4   entities to conduct studies using data collected by the birth 
 41.5   defects information system.  The criteria may include 
 41.6   requirements for a written protocol outlining the purpose and 
 41.7   public benefit of the study, peer review by other scientists, 
 41.8   methods and facilities to protect the privacy of the data, and 
 41.9   qualifications of the researcher proposing to undertake the 
 41.10  study.  
 41.11     Subd. 4.  [NOTICE.] (a) Within 30 days after making a 
 41.12  determination to enter a case into the birth defects information 
 41.13  system, the commissioner of health shall make a good faith 
 41.14  reasonable effort to notify the individual, or the parent or 
 41.15  guardian if the individual is a minor, of what data on the 
 41.16  individual has been entered into the system.  
 41.17     (b) Notice under this subdivision is not required if a 
 41.18  birth defect case was identified solely by prenatal diagnosis or 
 41.19  through fetal death or death certificate data. 
 41.20     Subd. 5.  [DEMONSTRATION PROJECTS.] The commissioner of 
 41.21  health shall evaluate and modify, as necessary, the birth 
 41.22  defects information system using demonstration projects.  The 
 41.23  commissioner shall use the results of the demonstration projects 
 41.24  to implement a refined birth defects information system 
 41.25  statewide. 
 41.26     Subd. 6.  [ADVISORY COMMITTEE.] The commissioner of health 
 41.27  shall appoint an advisory committee of 16 members to advise the 
 41.28  commissioner on the planning, implementation, evaluation, and 
 41.29  review of the birth defects information system.  The terms, 
 41.30  compensation, and removal of members are governed by section 
 41.31  15.059, except that the members do not receive per diem 
 41.32  compensation.  Members of the advisory committee shall represent 
 41.33  various geographical regions of the state.  Each of the 
 41.34  following professions must be represented in the advisory 
 41.35  committee:  epidemiologist, public health specialist, physician, 
 41.36  geneticist, health care provider, health information management 
 42.1   specialist, and health insurance provider.  The advisory 
 42.2   committee shall expire on June 30, 2001. 
 42.3      Subd. 7.  [REPORT.] The commissioner of health shall 
 42.4   prepare and transmit to the governor and the legislature a 
 42.5   report on the status and activities of the birth defects 
 42.6   information system no later than January 15 of every 
 42.7   odd-numbered year beginning in 1999. 
 42.8      Sec. 12.  [144.2216] [BIRTH DEFECTS RECORDS AND REPORTS 
 42.9   REQUIRED.] 
 42.10     Subdivision 1.  [PERSON PRACTICING HEALING 
 42.11  ARTS.] Notwithstanding section 144.335, a person licensed to 
 42.12  practice the healing arts in any form, upon request of the 
 42.13  commissioner of health, shall provide the commissioner with 
 42.14  access to information on each birth defect case in the manner 
 42.15  and at the times that the commissioner designates. 
 42.16     Subd. 2.  [HOSPITALS AND SIMILAR 
 42.17  INSTITUTIONS.] Notwithstanding section 144.335, a hospital, 
 42.18  medical clinic, medical laboratory, or other institution for the 
 42.19  hospitalization, clinical or laboratory diagnosis, or care of 
 42.20  human beings shall provide the commissioner of health with 
 42.21  access to information on each birth defect case in the manner 
 42.22  and at the times that the commissioner designates.  This 
 42.23  subdivision does not apply to institutions described in section 
 42.24  144A.09, subdivision 1. 
 42.25     Subd. 3.  [OTHER DATA REPOSITORIES.] Notwithstanding 
 42.26  section 144.335, other repositories of data on the diagnosis or 
 42.27  care of human beings may provide the commissioner of health with 
 42.28  access to information on each case of birth defects in the 
 42.29  manner and at the times that the commissioner designates. 
 42.30     Subd. 4.  [REPORTING WITHOUT LIABILITY.] Furnishing 
 42.31  information under this section in good faith shall not subject a 
 42.32  person, hospital, medical clinic, medical laboratory, data 
 42.33  repository, or other institution to an action for damages or 
 42.34  other relief. 
 42.35     Sec. 13.  [144.2217] [CLASSIFICATION OF BIRTH DEFECTS 
 42.36  INFORMATION SYSTEM DATA.] 
 43.1      Data collected, received, or maintained on individuals and 
 43.2   nonindividuals with regard to the birth defects information 
 43.3   system are private data on individuals and nonpublic data on 
 43.4   nonindividuals, respectively, and may be used only for the 
 43.5   purposes specified in sections 144.2215 to 144.2218.  
 43.6   Notwithstanding section 13.03, subdivisions 6 to 8; 13.10, 
 43.7   subdivisions 1 to 4; 138.17, or any other law to the contrary, 
 43.8   all data collected, received, or maintained by the commissioner 
 43.9   of health with regard to the birth defects information system 
 43.10  retains the classification designated under this section and 
 43.11  section 13.384 and may not be disclosed other than according to 
 43.12  this section and section 144.2218. 
 43.13     Sec. 14.  [144.2218] [TRANSFERS OF BIRTH DEFECTS 
 43.14  INFORMATION SYSTEM DATA TO OTHER GOVERNMENT AGENCIES.] 
 43.15     Subdivision 1.  [INTERSTATE TRANSFERS OF DATA.] Data 
 43.16  collected by the birth defects information system may be 
 43.17  disseminated to a state government agency in another state 
 43.18  solely for purposes consistent with sections 144.2215 to 
 43.19  144.2218, provided that the state government agency agrees to 
 43.20  maintain the data as provided by section 144.2217. 
 43.21     Subd. 2.  [INTRASTATE TRANSFERS OF DATA.] Data collected by 
 43.22  the birth defects information system may be disseminated to 
 43.23  another state government agency in this state upon determination 
 43.24  by the commissioner of health that another state government 
 43.25  agency could help an individual registered in the system gain 
 43.26  access to social, educational, or medical services for which the 
 43.27  individual is eligible, if the commissioner of health obtains 
 43.28  the prior consent of the individual. 
 43.29     Sec. 15.  Minnesota Statutes 1996, section 144.226, 
 43.30  subdivision 1, is amended to read: 
 43.31     Subdivision 1.  [WHICH SERVICES ARE FOR FEE.] The fees 
 43.32  for ~~any of~~ the following services shall be ~~in~~ the following or 
 43.33  an amount prescribed by rule of the commissioner: 
 43.34     (a) The fee for the issuance of a certified copy or 
 43.35  certification of a vital record, or a certification that the 
 43.36  record cannot be found~~;~~ is $8.  No fee shall be charged for a 
 44.1   certified birth or death record that is reissued within one year 
 44.2   of the original issue, if the previously issued record is 
 44.3   surrendered. 
 44.4      (b) The fee for the replacement of a birth ~~certificate;~~ 
 44.5   record for all events except adoption is $20. 
 44.6      (c) The fee for the filing of a delayed registration of 
 44.7   birth or death~~;~~ is $20. 
 44.8      (d) The ~~alteration, correction, or completion~~ fee for the 
 44.9   amendment of any vital record~~, provided that~~ when requested more 
 44.10  than one year after the filing of the record is $20.  No fee 
 44.11  shall be charged for an ~~alteration, correction, or~~ 
 44.12  ~~completion~~ amendment requested within one year after the filing 
 44.13  of the certificate~~; and~~. 
 44.14     (e) The fee for the verification of information from ~~or~~ 
 44.15  ~~noncertified copies of~~ vital records is $8 when the applicant 
 44.16  furnishes the specific information to locate the record.  When 
 44.17  the applicant does not furnish specific information, the fee is 
 44.18  $20 per hour for staff time expended.  Specific information 
 44.19  shall include the correct date of the event and the correct name 
 44.20  of the registrant.  Fees charged shall approximate the costs 
 44.21  incurred in searching and copying the records.  The fee shall be 
 44.22  payable at time of application. 
 44.23     (f) The fee for issuance of a certified or noncertified 
 44.24  copy of any document on file pertaining to a vital record or a 
 44.25  certification that the record cannot be found is $8. 
 44.26     Sec. 16.  Minnesota Statutes 1996, section 144.226, is 
 44.27  amended by adding a subdivision to read: 
 44.28     Subd. 4.  [VITAL RECORDS SURCHARGE.] In addition to any fee 
 44.29  prescribed under subdivision 1, there is a nonrefundable 
 44.30  surcharge of $3 for each certified and noncertified birth or 
 44.31  death record.  The local or state registrar shall forward this 
 44.32  amount to the state treasurer to be deposited into the state 
 44.33  government special revenue fund.  This surcharge shall not be 
 44.34  charged under those circumstances in which no fee for a birth or 
 44.35  death record is permitted under subdivision 1, paragraph (a).  
 44.36  This surcharge requirement expires June 30, 2002. 
 45.1      Sec. 17.  Minnesota Statutes 1996, section 144.394, is 
 45.2   amended to read: 
 45.3      144.394 [~~SMOKING PREVENTION~~ HEALTH PROMOTION AND 
 45.4   EDUCATION.] 
 45.5      The commissioner may sell at market value~~,~~ all ~~nonsmoking~~ 
 45.6   ~~or tobacco use prevention advertising~~ health promotion and 
 45.7   health education materials.  Proceeds from the sale of the 
 45.8   ~~advertising~~ materials are appropriated to the department of 
 45.9   health for ~~its nonsmoking~~ the program that developed the 
 45.10  material. 
 45.11     Sec. 18.  [145A.16] [HOME VISITING PROGRAMS FOR INFANT 
 45.12  CARE.] 
 45.13     Subdivision 1.  [ESTABLISHMENT.] The commissioner shall 
 45.14  establish a grant program to fund universal home visiting 
 45.15  programs designed to serve all live births in designated 
 45.16  geographic areas.  The commissioner shall designate the 
 45.17  geographic area to be served by each program.  At least one 
 45.18  program must provide home visiting services to families within 
 45.19  the seven-county metropolitan area, and at least one program 
 45.20  must provide home visiting services to families outside the 
 45.21  metropolitan area.  The purpose of the program is to strengthen 
 45.22  families and to promote positive parenting and healthy child 
 45.23  development.  
 45.24     Subd. 2.  [STEERING COMMITTEE.] The commissioner shall 
 45.25  establish an ad hoc steering committee to develop and implement 
 45.26  a comprehensive plan for the universal home visiting programs.  
 45.27  The members of the ad hoc steering committee shall include, at a 
 45.28  minimum, representatives of local public health departments, 
 45.29  public health nurses, other health care providers, 
 45.30  paraprofessionals, community-based family workers, 
 45.31  representatives of the state councils of color, representatives 
 45.32  of health insurance plans, and other individuals with expertise 
 45.33  in the field of home visiting, early childhood health and 
 45.34  development, and child abuse prevention.  
 45.35     Subd. 3.  [PROGRAM REQUIREMENTS.] The commissioner shall 
 45.36  award grants using a request for proposal system.  Existing home 
 46.1   visiting programs or a family services collaborative established 
 46.2   under section 256F.13 may apply for the grants.  Health 
 46.3   information and assessment, counseling, social support, 
 46.4   educational services, and referral to community resources must 
 46.5   be offered to all families, regardless of need or risk, 
 46.6   beginning prenatally or as soon after birth as possible, and 
 46.7   continuing as needed.  Each program applying for a grant must 
 46.8   have access to adequate community resources to complement the 
 46.9   home visiting services and must be designed to: 
 46.10     (1) identify all newborn infants within the geographic area 
 46.11  served by the program.  Identification may be made prenatally or 
 46.12  at the time of birth; 
 46.13     (2) offer a home visit by a trained home visitor.  If home 
 46.14  visiting is accepted, the first visit must occur prenatally or 
 46.15  as soon after birth as possible and must include an assessment 
 46.16  by a public health nurse; 
 46.17     (3) offer, at a minimum, information on infant care, child 
 46.18  growth and development, positive parenting, the prevention of 
 46.19  disease and exposure to environmental hazards, and support 
 46.20  services available in the community; 
 46.21     (4) provide information on and referral to health care 
 46.22  services, if needed, including information on health care 
 46.23  coverage for which the individual or family may be eligible and 
 46.24  information on family planning, pediatric preventive services, 
 46.25  immunizations, and developmental assessments, and provide 
 46.26  information on the availability of public assistance programs as 
 46.27  appropriate; 
 46.28     (5) recruit home visit workers who will represent all the 
 46.29  races, cultures, and languages spoken by eligible families in 
 46.30  the designated geographic areas; and 
 46.31     (6) train and supervise home visitors in accordance with 
 46.32  the requirements established under subdivision 5.  
 46.33     Subd. 4.  [COORDINATION.] To minimize duplication, a 
 46.34  program receiving a grant must establish a coalition that 
 46.35  includes parents, health care providers that provide services to 
 46.36  families with young children in the service area, and 
 47.1   representatives of local schools, governmental and nonprofit 
 47.2   agencies, community-based organizations, health insurance plans, 
 47.3   and local hospitals.  A program may use the family services 
 47.4   collaborative as the coalition if a collaborative is established 
 47.5   in the area served by the program.  The coalition must designate 
 47.6   the roles of all provider agencies, family identification 
 47.7   methods, referral mechanisms, and payment responsibilities 
 47.8   appropriate for the existing systems in the program's service 
 47.9   area.  The coalition must also coordinate with other programs 
 47.10  offered by school boards under section 121.882, subdivision 2b, 
 47.11  and programs offered under section 145A.15.  
 47.12     Subd. 5.  [TRAINING.] The commissioner shall establish 
 47.13  training requirements for home visitors and minimum requirements 
 47.14  for supervision by a public health nurse.  The requirements for 
 47.15  nurses must be consistent with chapter 148.  Training must 
 47.16  include child development, positive parenting techniques, and 
 47.17  diverse cultural practices in child rearing and family systems.  
 47.18  A program may use grant money to train home visitors. 
 47.19     Subd. 6.  [EVALUATION.] (a) The commissioner shall evaluate 
 47.20  the effectiveness of the home visiting programs, taking into 
 47.21  consideration the following goals:  
 47.22     (1) appropriate child growth, development, and access to 
 47.23  health care; 
 47.24     (2) appropriate utilization of preventive health care and 
 47.25  medical care for acute illnesses; 
 47.26     (3) lower rates of substantiated child abuse and neglect; 
 47.27     (4) up-to-date immunizations; 
 47.28     (5) a reduction in unintended pregnancies; 
 47.29     (6) increasing families' understanding of lead poisoning 
 47.30  prevention; 
 47.31     (7) lower rates of unintentional injuries; and 
 47.32     (8) fewer hospitalizations and emergency room visits.  
 47.33     (b) The commissioner shall compare overall outcomes of 
 47.34  universal home visiting programs with targeted home visiting 
 47.35  programs and report the findings to the legislature.  The report 
 47.36  must also include information on how home visiting programs will 
 48.1   coordinate activities and preventive services provided by health 
 48.2   plans and other organizations. 
 48.3      (c) The commissioner shall report to the legislature by 
 48.4   February 15, 1998, on the comprehensive plan for the universal 
 48.5   home visiting programs and recommend any draft legislation 
 48.6   needed to implement the plan.  The commissioner shall report to 
 48.7   the legislature biennially beginning December 15, 2001, on the 
 48.8   effectiveness of the universal home visiting programs.  In the 
 48.9   report due December 15, 2001, the commissioner shall include 
 48.10  recommendations on the feasibility and cost of expanding the 
 48.11  program statewide.  
 48.12     Subd. 7.  [TECHNICAL ASSISTANCE.] The commissioner shall 
 48.13  provide administrative and technical assistance to each program, 
 48.14  including assistance conducting short- and long-term evaluations 
 48.15  of the home visiting program required under subdivision 6.  The 
 48.16  commissioner may request research and evaluation support from 
 48.17  the University of Minnesota.  
 48.18     Subd. 8.  [MATCHING FUNDS.] The commissioner and the grant 
 48.19  programs shall seek to supplement any state funding with private 
 48.20  and other nonstate funding sources, including other grants and 
 48.21  insurance coverage for services provided.  Program funding may 
 48.22  be used only to supplement, not to replace, existing funds being 
 48.23  used for home visiting.  
 48.24     Subd. 9.  [PAYMENT FOR HOME VISITING SERVICES.] Any health 
 48.25  plan that provides services to families or individuals enrolled 
 48.26  in medical assistance, general assistance medical care, or the 
 48.27  MinnesotaCare program must contract with the programs receiving 
 48.28  grants under this section and the programs established under 
 48.29  section 145A.15 that are providing home visiting services in the 
 48.30  area served by the health plan to provide home visiting services 
 48.31  covered under medical assistance, general assistance medical 
 48.32  care, or the MinnesotaCare program to their enrollees.  A health 
 48.33  plan may require a home visiting program to comply with the 
 48.34  health plan's requirements on the same basis as the health 
 48.35  plan's other participating providers. 
 48.36     Sec. 19.  Minnesota Statutes 1996, section 153A.17, is 
 49.1   amended to read: 
 49.2      153A.17 [EXPENSES; FEES.] 
 49.3      The expenses for administering the certification 
 49.4   requirements including the complaint handling system for hearing 
 49.5   aid dispensers in sections 153A.14 and 153A.15 and the consumer 
 49.6   information center under section 153A.18 must be paid from 
 49.7   initial application and examination fees, renewal fees, 
 49.8   penalties, and fines.  All fees are nonrefundable.  The 
 49.9   certificate application fee is ~~$280~~ $425, the examination fee is 
 49.10  $200 for the written portion and $200 for the practical portion 
 49.11  each time one or the other is taken, and the trainee application 
 49.12  fee is $100~~, except that the certification application fee for a~~ 
 49.13  ~~registered audiologist is $280 minus the audiologist~~ 
 49.14  ~~registration fee of $101~~.  ~~In addition, both certification and~~ 
 49.15  ~~examination fees are subject to~~ Notwithstanding the policy set 
 49.16  forth in section 16A.1285, subdivision 2, a surcharge of 
 49.17  ~~$60~~ $250 shall be paid at the time of application or renewal in 
 49.18  each of the next five years to recover~~, over a five-year period,~~ 
 49.19  the commissioner's accumulated direct expenditures for 
 49.20  administering the requirements of this chapter~~, but not~~ 
 49.21  ~~registration of hearing instrument dispensers under section~~ 
 49.22  ~~214.13, before November 1, 1994~~.  The penalty fee for late 
 49.23  submission of a renewal application is ~~$70~~ $108.  All fees, 
 49.24  penalties, and fines received must be deposited in the state 
 49.25  government special revenue fund.  The commissioner may prorate 
 49.26  the certification fee for new applicants based on the number of 
 49.27  quarters remaining in the annual certification period. 
 49.28     Sec. 20.  Minnesota Statutes 1996, section 157.15, is 
 49.29  amended by adding a subdivision to read: 
 49.30     Subd. 16.  [CRITICAL CONTROL POINT.] "Critical control 
 49.31  point" means a point or procedure in a specific food system 
 49.32  where loss of control may result in an unacceptable health risk. 
 49.33     Sec. 21.  Minnesota Statutes 1996, section 157.15, is 
 49.34  amended by adding a subdivision to read: 
 49.35     Subd. 17.  [HACCP PLAN.] "Hazard analysis critical control 
 49.36  point (HACCP) plan" means a written document that delineates the 
 50.1   formal procedures for following the HACCP principles developed 
 50.2   by the National Advisory Committee on Microbiological Criteria 
 50.3   for Foods. 
 50.4      Sec. 22.  Minnesota Statutes 1996, section 157.15, is 
 50.5   amended by adding a subdivision to read: 
 50.6      Subd. 18.  [HAZARD.] "Hazard" means any biological, 
 50.7   chemical, or physical property that may cause an unacceptable 
 50.8   consumer health risk.  
 50.9      Sec. 23.  Minnesota Statutes 1996, section 157.16, 
 50.10  subdivision 3, is amended to read: 
 50.11     Subd. 3.  [ESTABLISHMENT FEES; DEFINITIONS.] (a) The 
 50.12  following fees are required for food and beverage service 
 50.13  establishments, hotels, motels, lodging establishments, and 
 50.14  resorts licensed under this chapter.  Food and beverage service 
 50.15  establishments must pay the highest applicable fee under 
 50.16  paragraph (e), clause (1), (2), (3), or (4), and establishments 
 50.17  serving alcohol must pay the highest applicable fee under 
 50.18  paragraph (e), clause (6) or (7). 
 50.19     (b) All food and beverage service establishments, except 
 50.20  special event food stands, and all hotels, motels, lodging 
 50.21  establishments, and resorts shall pay an annual base fee of $100.
 50.22     (c) A special event food stand shall pay a flat fee of $60 
 50.23  annually.  "Special event food stand" means a fee category where 
 50.24  food is prepared or served in conjunction with celebrations, 
 50.25  county fairs, or special events from a special event food stand 
 50.26  as defined in section 157.15. 
 50.27     (d) A special event food stand-limited shall pay a flat fee 
 50.28  of $30. 
 50.29     (e) In addition to the base fee in paragraph (b), each food 
 50.30  and beverage service establishment, other than a special event 
 50.31  food stand, and each hotel, motel, lodging establishment, and 
 50.32  resort shall pay an additional annual fee for each fee category 
 50.33  as specified in this paragraph: 
 50.34     (1) Limited food menu selection, $30.  "Limited food menu 
 50.35  selection" means a fee category that provides one or more of the 
 50.36  following: 
 51.1      (i) prepackaged food that receives heat treatment and is 
 51.2   served in the package; 
 51.3      (ii) frozen pizza that is heated and served; 
 51.4      (iii) a continental breakfast such as rolls, coffee, juice, 
 51.5   milk, and cold cereal; 
 51.6      (iv) soft drinks, coffee, or nonalcoholic beverages; or 
 51.7      (v) cleaning for eating, drinking, or cooking utensils, 
 51.8   when the only food served is prepared off site. 
 51.9      (2) Small ~~menu selection with limited equipment~~ 
 51.10  establishment, including boarding establishments, $55.  
 51.11  "Small ~~menu selection with limited equipment~~ establishment" 
 51.12  means a fee category that has no salad bar and meets one or more 
 51.13  of the following: 
 51.14     (i) possesses food service equipment that consists of no 
 51.15  more than a deep fat fryer, a grill, two hot holding containers, 
 51.16  and one or more microwave ovens; 
 51.17     (ii) serves dipped ice cream or soft serve frozen desserts; 
 51.18     (iii) serves breakfast in an owner-occupied bed and 
 51.19  breakfast establishment; ~~or~~ 
 51.20     (iv) is a boarding establishment; or 
 51.21     (v) meets the equipment criteria in clause (3), item (i) or 
 51.22  (ii), and has a maximum patron seating capacity of not more than 
 51.23  50.  
 51.24     (3) ~~Small~~ Medium establishment ~~with full menu selection~~, 
 51.25  $150.  "~~Small~~ Medium establishment ~~with full menu selection~~" 
 51.26  means a fee category that meets one or more of the following: 
 51.27     (i) possesses food service equipment that includes a range, 
 51.28  oven, steam table, salad bar, or salad preparation area; 
 51.29     (ii) possesses food service equipment that includes more 
 51.30  than one deep fat fryer, one grill, or two hot holding 
 51.31  containers; or 
 51.32     (iii) is an establishment where food is prepared at one 
 51.33  location and served at one or more separate locations. 
 51.34     Establishments meeting criteria in clause (2), item (v), 
 51.35  are not included in this fee category.  
 51.36     (4) Large establishment ~~with full menu selection~~, $250.  
 52.1   "Large establishment ~~with full menu selection~~" means either: 
 52.2      (i) a fee category that (A) meets the criteria in clause 
 52.3   (3), items (i) or (ii), for a ~~small~~ medium establishment ~~with~~ 
 52.4   ~~full menu selection~~, (B) seats more than 175 people, and (C) 
 52.5   offers the full menu selection an average of five or more days a 
 52.6   week during the weeks of operation; or 
 52.7      (ii) a fee category that (A) meets the criteria in clause 
 52.8   (3), item (iii), for a ~~small~~ medium establishment ~~with full menu~~ 
 52.9   ~~selection~~, and (B) prepares and serves 500 or more meals per day.
 52.10     (5) Other food and beverage service, including food carts, 
 52.11  mobile food units, seasonal temporary food stands, and seasonal 
 52.12  permanent food stands, $30. 
 52.13     (6) Beer or wine table service, $30.  "Beer or wine table 
 52.14  service" means a fee category where the only alcoholic beverage 
 52.15  service is beer or wine, served to customers seated at tables. 
 52.16     (7) Alcoholic beverage service, other than beer or wine 
 52.17  table service, $75. 
 52.18     "Alcohol beverage service, other than beer or wine table 
 52.19  service" means a fee category where alcoholic mixed drinks are 
 52.20  served or where beer or wine are served from a bar. 
 52.21     (8) Lodging per sleeping accommodation unit, $4, including 
 52.22  hotels, motels, lodging establishments, and resorts, up to a 
 52.23  maximum of $400.  "Lodging per sleeping accommodation unit" 
 52.24  means a fee category including the number of guest rooms, 
 52.25  cottages, or other rental units of a hotel, motel, lodging 
 52.26  establishment, or resort; or the number of beds in a dormitory. 
 52.27     (9) First public swimming pool, $100; each additional 
 52.28  public swimming pool, $50.  "Public swimming pool" means a fee 
 52.29  category that has the meaning given in Minnesota Rules, part 
 52.30  4717.0250, subpart 8. 
 52.31     (10) First spa, $50; each additional spa, $25.  "Spa pool" 
 52.32  means a fee category that has the meaning given in Minnesota 
 52.33  Rules, part 4717.0250, subpart 9. 
 52.34     (11) Private sewer or water, $30.  "Individual private 
 52.35  water" means a fee category with a water supply other than a 
 52.36  community public water supply as defined in Minnesota Rules, 
 53.1   chapter 4720.  "Individual private sewer" means a fee category 
 53.2   with an individual sewage treatment system which uses subsurface 
 53.3   treatment and disposal. 
 53.4      (f) A fee is not required for a food and beverage service 
 53.5   establishment operated by a school as defined in sections 120.05 
 53.6   and 120.101. 
 53.7      (g) A fee of $150 for review of the construction plans must 
 53.8   accompany the initial license application for food and beverage 
 53.9   service establishments, hotels, motels, lodging establishments, 
 53.10  or resorts. 
 53.11     (h) When existing food and beverage service establishments, 
 53.12  hotels, motels, lodging establishments, or resorts are 
 53.13  extensively remodeled, a fee of $150 must be submitted with the 
 53.14  remodeling plans. 
 53.15     (i) Seasonal temporary food stands, special event food 
 53.16  stands, and special event food stands-limited are not required 
 53.17  to submit construction or remodeling plans for review. 
 53.18     Sec. 24.  [157.215] [PILOT PROJECT.] 
 53.19     The commissioner of health is authorized to issue a request 
 53.20  for participation to the regulated food and beverage service 
 53.21  establishment industry and to select up to 25 pilot projects 
 53.22  utilizing HACCP quality assurance principles for monitoring risk.
 53.23     Sec. 25.  Minnesota Statutes 1996, section 326.37, 
 53.24  subdivision 1, is amended to read: 
 53.25     Subdivision 1.  [RULES.] The state commissioner of health 
 53.26  may, by rule, prescribe minimum standards which shall be 
 53.27  uniform, and which standards shall thereafter be effective for 
 53.28  all new plumbing installations, including additions, extensions, 
 53.29  alterations, and replacements connected with any water or sewage 
 53.30  disposal system owned or operated by or for any municipality, 
 53.31  institution, factory, office building, hotel, apartment 
 53.32  building, or any other place of business regardless of location 
 53.33  or the population of the city or town in which located.  
 53.34  Notwithstanding the provisions of Minnesota Rules, part 
 53.35  4715.3130, as they apply to plan review, the commissioner may 
 53.36  allow plumbing construction, alteration, or extension to proceed.
 54.1      The commissioner shall administer the provisions of 
 54.2   sections 326.37 to 326.45 and for such purposes may employ 
 54.3   plumbing inspectors and other assistants. 
 54.4      Sec. 26.  [REPEALER.] 
 54.5      Minnesota Statutes 1996, sections 144.1222, subdivision 3; 
 54.6   and 145.9256, are repealed. 
 54.7      Sec. 27.  [EFFECTIVE DATE.] 
 54.8      Sections 2, 3, and 4 amending the well management program 
 54.9   are effective July 1, 1998. 
 54.10                             ARTICLE 3
 54.11                           LONG-TERM CARE
 54.12     Section 1.  Minnesota Statutes 1996, section 144A.071, 
 54.13  subdivision 1, is amended to read: 
 54.14     Subdivision 1.  [FINDINGS.] The legislature declares that a 
 54.15  moratorium on the licensure and medical assistance certification 
 54.16  of new nursing home beds and construction projects that exceed 
 54.17  ~~the lesser of $500,000 or 25 percent of a facility's appraised~~ 
 54.18  ~~value~~ $750,000 is necessary to control nursing home expenditure 
 54.19  growth and enable the state to meet the needs of its elderly by 
 54.20  providing high quality services in the most appropriate manner 
 54.21  along a continuum of care.  
 54.22     Sec. 2.  Minnesota Statutes 1996, section 144A.071, 
 54.23  subdivision 2, is amended to read: 
 54.24     Subd. 2.  [MORATORIUM.] The commissioner of health, in 
 54.25  coordination with the commissioner of human services, shall deny 
 54.26  each request for new licensed or certified nursing home or 
 54.27  certified boarding care beds except as provided in subdivision 3 
 54.28  or 4a, or section 144A.073.  "Certified bed" means a nursing 
 54.29  home bed or a boarding care bed certified by the commissioner of 
 54.30  health for the purposes of the medical assistance program, under 
 54.31  United States Code, title 42, sections 1396 et seq.  
 54.32     The commissioner of human services, in coordination with 
 54.33  the commissioner of health, shall deny any request to issue a 
 54.34  license under section 252.28 and chapter 245A to a nursing home 
 54.35  or boarding care home, if that license would result in an 
 54.36  increase in the medical assistance reimbursement amount.  
 55.1      In addition, the commissioner of health must not approve 
 55.2   any construction project whose cost exceeds ~~$500,000, or 25~~ 
 55.3   ~~percent of the facility's appraised value, whichever is less,~~ 
 55.4   $750,000 unless: 
 55.5      (a) any construction costs exceeding ~~the lesser of $500,000~~ 
 55.6   ~~or 25 percent of the facility's appraised value~~ $750,000 are not 
 55.7   added to the facility's appraised value and are not included in 
 55.8   the facility's payment rate for reimbursement under the medical 
 55.9   assistance program; or 
 55.10     (b) the project: 
 55.11     (1) has been approved through the process described in 
 55.12  section 144A.073; 
 55.13     (2) meets an exception in subdivision 3 or 4a; 
 55.14     (3) is necessary to correct violations of state or federal 
 55.15  law issued by the commissioner of health; 
 55.16     (4) is necessary to repair or replace a portion of the 
 55.17  facility that was damaged by fire, lightning, groundshifts, or 
 55.18  other such hazards, including environmental hazards, provided 
 55.19  that the provisions of subdivision 4a, clause (a), are met; 
 55.20     (5) as of May 1, 1992, the facility has submitted to the 
 55.21  commissioner of health written documentation evidencing that the 
 55.22  facility meets the "commenced construction" definition as 
 55.23  specified in subdivision 1a, clause (d), or that substantial 
 55.24  steps have been taken prior to April 1, 1992, relating to the 
 55.25  construction project.  "Substantial steps" require that the 
 55.26  facility has made arrangements with outside parties relating to 
 55.27  the construction project and include the hiring of an architect 
 55.28  or construction firm, submission of preliminary plans to the 
 55.29  department of health or documentation from a financial 
 55.30  institution that financing arrangements for the construction 
 55.31  project have been made; or 
 55.32     (6) is being proposed by a licensed nursing facility that 
 55.33  is not certified to participate in the medical assistance 
 55.34  program and will not result in new licensed or certified beds. 
 55.35     Prior to the final plan approval of any construction 
 55.36  project, the commissioner of health shall be provided with an 
 56.1   itemized cost estimate for the project construction costs.  If a 
 56.2   construction project is anticipated to be completed in phases, 
 56.3   the total estimated cost of all phases of the project shall be 
 56.4   submitted to the commissioner and shall be considered as one 
 56.5   construction project.  Once the construction project is 
 56.6   completed and prior to the final clearance by the commissioner, 
 56.7   the total project construction costs for the construction 
 56.8   project shall be submitted to the commissioner.  If the final 
 56.9   project construction cost exceeds the dollar threshold in this 
 56.10  subdivision, the commissioner of human services shall not 
 56.11  recognize any of the project construction costs or the related 
 56.12  financing costs in excess of this threshold in establishing the 
 56.13  facility's property-related payment rate. 
 56.14     The dollar thresholds for construction projects are as 
 56.15  follows:  for construction projects other than those authorized 
 56.16  in clauses (1) to (6), the dollar threshold is ~~$500,000 or 25~~ 
 56.17  ~~percent of appraised value, whichever is less~~ $750,000.  For 
 56.18  projects authorized after July 1, 1993, under clause (1), the 
 56.19  dollar threshold is the cost estimate submitted with a proposal 
 56.20  for an exception under section 144A.073, plus inflation as 
 56.21  calculated according to section 256B.431, subdivision 3f, 
 56.22  paragraph (a).  For projects authorized under clauses (2) to 
 56.23  (4), the dollar threshold is the itemized estimate project 
 56.24  construction costs submitted to the commissioner of health at 
 56.25  the time of final plan approval, plus inflation as calculated 
 56.26  according to section 256B.431, subdivision 3f, paragraph (a). 
 56.27     The commissioner of health shall adopt rules to implement 
 56.28  this section or to amend the emergency rules for granting 
 56.29  exceptions to the moratorium on nursing homes under section 
 56.30  144A.073.  
 56.31     Sec. 3.  Minnesota Statutes 1996, section 144A.071, 
 56.32  subdivision 4a, is amended to read: 
 56.33     Subd. 4a.  [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 
 56.34  best interest of the state to ensure that nursing homes and 
 56.35  boarding care homes continue to meet the physical plant 
 56.36  licensing and certification requirements by permitting certain 
 57.1   construction projects.  Facilities should be maintained in 
 57.2   condition to satisfy the physical and emotional needs of 
 57.3   residents while allowing the state to maintain control over 
 57.4   nursing home expenditure growth. 
 57.5      The commissioner of health in coordination with the 
 57.6   commissioner of human services, may approve the renovation, 
 57.7   replacement, upgrading, or relocation of a nursing home or 
 57.8   boarding care home, under the following conditions: 
 57.9      (a) to license or certify beds in a new facility 
 57.10  constructed to replace a facility or to make repairs in an 
 57.11  existing facility that was destroyed or damaged after June 30, 
 57.12  1987, by fire, lightning, or other hazard provided:  
 57.13     (i) destruction was not caused by the intentional act of or 
 57.14  at the direction of a controlling person of the facility; 
 57.15     (ii) at the time the facility was destroyed or damaged the 
 57.16  controlling persons of the facility maintained insurance 
 57.17  coverage for the type of hazard that occurred in an amount that 
 57.18  a reasonable person would conclude was adequate; 
 57.19     (iii) the net proceeds from an insurance settlement for the 
 57.20  damages caused by the hazard are applied to the cost of the new 
 57.21  facility or repairs; 
 57.22     (iv) the new facility is constructed on the same site as 
 57.23  the destroyed facility or on another site subject to the 
 57.24  restrictions in section 144A.073, subdivision 5; 
 57.25     (v) the number of licensed and certified beds in the new 
 57.26  facility does not exceed the number of licensed and certified 
 57.27  beds in the destroyed facility; and 
 57.28     (vi) the commissioner determines that the replacement beds 
 57.29  are needed to prevent an inadequate supply of beds. 
 57.30  Project construction costs incurred for repairs authorized under 
 57.31  this clause shall not be considered in the dollar threshold 
 57.32  amount defined in subdivision 2; 
 57.33     (b) to license or certify beds that are moved from one 
 57.34  location to another within a nursing home facility, provided the 
 57.35  total costs of remodeling performed in conjunction with the 
 57.36  relocation of beds does not exceed ~~25 percent of the appraised~~ 
 58.1   ~~value of the facility or $500,000, whichever is less~~ $750,000; 
 58.2      (c) to license or certify beds in a project recommended for 
 58.3   approval under section 144A.073; 
 58.4      (d) to license or certify beds that are moved from an 
 58.5   existing state nursing home to a different state facility, 
 58.6   provided there is no net increase in the number of state nursing 
 58.7   home beds; 
 58.8      (e) to certify and license as nursing home beds boarding 
 58.9   care beds in a certified boarding care facility if the beds meet 
 58.10  the standards for nursing home licensure, or in a facility that 
 58.11  was granted an exception to the moratorium under section 
 58.12  144A.073, and if the cost of any remodeling of the facility does 
 58.13  not exceed ~~25 percent of the appraised value of the facility or~~ 
 58.14  ~~$500,000, whichever is less~~ $750,000.  If boarding care beds are 
 58.15  licensed as nursing home beds, the number of boarding care beds 
 58.16  in the facility must not increase beyond the number remaining at 
 58.17  the time of the upgrade in licensure.  The provisions contained 
 58.18  in section 144A.073 regarding the upgrading of the facilities do 
 58.19  not apply to facilities that satisfy these requirements; 
 58.20     (f) to license and certify up to 40 beds transferred from 
 58.21  an existing facility owned and operated by the Amherst H. Wilder 
 58.22  Foundation in the city of St. Paul to a new unit at the same 
 58.23  location as the existing facility that will serve persons with 
 58.24  Alzheimer's disease and other related disorders.  The transfer 
 58.25  of beds may occur gradually or in stages, provided the total 
 58.26  number of beds transferred does not exceed 40.  At the time of 
 58.27  licensure and certification of a bed or beds in the new unit, 
 58.28  the commissioner of health shall delicense and decertify the 
 58.29  same number of beds in the existing facility.  As a condition of 
 58.30  receiving a license or certification under this clause, the 
 58.31  facility must make a written commitment to the commissioner of 
 58.32  human services that it will not seek to receive an increase in 
 58.33  its property-related payment rate as a result of the transfers 
 58.34  allowed under this paragraph; 
 58.35     (g) to license and certify nursing home beds to replace 
 58.36  currently licensed and certified boarding care beds which may be 
 59.1   located either in a remodeled or renovated boarding care or 
 59.2   nursing home facility or in a remodeled, renovated, newly 
 59.3   constructed, or replacement nursing home facility within the 
 59.4   identifiable complex of health care facilities in which the 
 59.5   currently licensed boarding care beds are presently located, 
 59.6   provided that the number of boarding care beds in the facility 
 59.7   or complex are decreased by the number to be licensed as nursing 
 59.8   home beds and further provided that, if the total costs of new 
 59.9   construction, replacement, remodeling, or renovation exceed ten 
 59.10  percent of the appraised value of the facility or $200,000, 
 59.11  whichever is less, the facility makes a written commitment to 
 59.12  the commissioner of human services that it will not seek to 
 59.13  receive an increase in its property-related payment rate by 
 59.14  reason of the new construction, replacement, remodeling, or 
 59.15  renovation.  The provisions contained in section 144A.073 
 59.16  regarding the upgrading of facilities do not apply to facilities 
 59.17  that satisfy these requirements; 
 59.18     (h) to license as a nursing home and certify as a nursing 
 59.19  facility a facility that is licensed as a boarding care facility 
 59.20  but not certified under the medical assistance program, but only 
 59.21  if the commissioner of human services certifies to the 
 59.22  commissioner of health that licensing the facility as a nursing 
 59.23  home and certifying the facility as a nursing facility will 
 59.24  result in a net annual savings to the state general fund of 
 59.25  $200,000 or more; 
 59.26     (i) to certify, after September 30, 1992, and prior to July 
 59.27  1, 1993, existing nursing home beds in a facility that was 
 59.28  licensed and in operation prior to January 1, 1992; 
 59.29     (j) to license and certify new nursing home beds to replace 
 59.30  beds in a facility condemned as part of an economic 
 59.31  redevelopment plan in a city of the first class, provided the 
 59.32  new facility is located within one mile of the site of the old 
 59.33  facility.  Operating and property costs for the new facility 
 59.34  must be determined and allowed under existing reimbursement 
 59.35  rules; 
 59.36     (k) to license and certify up to 20 new nursing home beds 
 60.1   in a community-operated hospital and attached convalescent and 
 60.2   nursing care facility with 40 beds on April 21, 1991, that 
 60.3   suspended operation of the hospital in April 1986.  The 
 60.4   commissioner of human services shall provide the facility with 
 60.5   the same per diem property-related payment rate for each 
 60.6   additional licensed and certified bed as it will receive for its 
 60.7   existing 40 beds; 
 60.8      (l) to license or certify beds in renovation, replacement, 
 60.9   or upgrading projects as defined in section 144A.073, 
 60.10  subdivision 1, so long as the cumulative total costs of the 
 60.11  facility's remodeling projects do not exceed ~~25 percent of the~~ 
 60.12  ~~appraised value of the facility or $500,000, whichever is less~~ 
 60.13  $750,000; 
 60.14     (m) to license and certify beds that are moved from one 
 60.15  location to another for the purposes of converting up to five 
 60.16  four-bed wards to single or double occupancy rooms in a nursing 
 60.17  home that, as of January 1, 1993, was county-owned and had a 
 60.18  licensed capacity of 115 beds; 
 60.19     (n) to allow a facility that on April 16, 1993, was a 
 60.20  106-bed licensed and certified nursing facility located in 
 60.21  Minneapolis to layaway all of its licensed and certified nursing 
 60.22  home beds.  These beds may be relicensed and recertified in a 
 60.23  newly-constructed teaching nursing home facility affiliated with 
 60.24  a teaching hospital upon approval by the legislature.  The 
 60.25  proposal must be developed in consultation with the interagency 
 60.26  committee on long-term care planning.  The beds on layaway 
 60.27  status shall have the same status as voluntarily delicensed and 
 60.28  decertified beds, except that beds on layaway status remain 
 60.29  subject to the surcharge in section 256.9657.  This layaway 
 60.30  provision expires ~~July 1, 1997~~ January 15, 1998; 
 60.31     (o) to allow a project which will be completed in 
 60.32  conjunction with an approved moratorium exception project for a 
 60.33  nursing home in southern Cass county and which is directly 
 60.34  related to that portion of the facility that must be repaired, 
 60.35  renovated, or replaced, to correct an emergency plumbing problem 
 60.36  for which a state correction order has been issued and which 
 61.1   must be corrected by August 31, 1993; 
 61.2      (p) to allow a facility that on April 16, 1993, was a 
 61.3   368-bed licensed and certified nursing facility located in 
 61.4   Minneapolis to layaway, upon 30 days prior written notice to the 
 61.5   commissioner, up to 30 of the facility's licensed and certified 
 61.6   beds by converting three-bed wards to single or double 
 61.7   occupancy.  Beds on layaway status shall have the same status as 
 61.8   voluntarily delicensed and decertified beds except that beds on 
 61.9   layaway status remain subject to the surcharge in section 
 61.10  256.9657, remain subject to the license application and renewal 
 61.11  fees under section 144A.07 and shall be subject to a $100 per 
 61.12  bed reactivation fee.  In addition, at any time within three 
 61.13  years of the effective date of the layaway, the beds on layaway 
 61.14  status may be: 
 61.15     (1) relicensed and recertified upon relocation and 
 61.16  reactivation of some or all of the beds to an existing licensed 
 61.17  and certified facility or facilities located in Pine River, 
 61.18  Brainerd, or International Falls; provided that the total 
 61.19  project construction costs related to the relocation of beds 
 61.20  from layaway status for any facility receiving relocated beds 
 61.21  may not exceed the dollar threshold provided in subdivision 2 
 61.22  unless the construction project has been approved through the 
 61.23  moratorium exception process under section 144A.073; 
 61.24     (2) relicensed and recertified, upon reactivation of some 
 61.25  or all of the beds within the facility which placed the beds in 
 61.26  layaway status, if the commissioner has determined a need for 
 61.27  the reactivation of the beds on layaway status. 
 61.28     The property-related payment rate of a facility placing 
 61.29  beds on layaway status must be adjusted by the incremental 
 61.30  change in its rental per diem after recalculating the rental per 
 61.31  diem as provided in section 256B.431, subdivision 3a, paragraph 
 61.32  (d).  The property-related payment rate for a facility 
 61.33  relicensing and recertifying beds from layaway status must be 
 61.34  adjusted by the incremental change in its rental per diem after 
 61.35  recalculating its rental per diem using the number of beds after 
 61.36  the relicensing to establish the facility's capacity day 
 62.1   divisor, which shall be effective the first day of the month 
 62.2   following the month in which the relicensing and recertification 
 62.3   became effective.  Any beds remaining on layaway status more 
 62.4   than three years after the date the layaway status became 
 62.5   effective must be removed from layaway status and immediately 
 62.6   delicensed and decertified; 
 62.7      (q) ~~to license and certify beds in a renovation and~~ 
 62.8   ~~remodeling project to convert 13 three-bed wards into 13 two-bed~~ 
 62.9   ~~rooms and 13 single-bed rooms, expand space, and add~~ 
 62.10  ~~improvements in a nursing home that, as of January 1, 1994, met~~ 
 62.11  ~~the following conditions:  the nursing home was located in~~ 
 62.12  ~~Ramsey county; was not owned by a hospital corporation; had a~~ 
 62.13  ~~licensed capacity of 64 beds; and had been ranked among the top~~ 
 62.14  ~~15 applicants by the 1993 moratorium exceptions advisory review~~ 
 62.15  ~~panel.  The total project construction cost estimate for this~~ 
 62.16  ~~project must not exceed the cost estimate submitted in~~ 
 62.17  ~~connection with the 1993 moratorium exception process;~~ 
 62.18     ~~(r)~~ to license and certify beds in a renovation and 
 62.19  remodeling project to convert 12 four-bed wards into 24 two-bed 
 62.20  rooms, expand space, and add improvements in a nursing home 
 62.21  that, as of January 1, 1994, met the following conditions:  the 
 62.22  nursing home was located in Ramsey county; had a licensed 
 62.23  capacity of 154 beds; and had been ranked among the top 15 
 62.24  applicants by the 1993 moratorium exceptions advisory review 
 62.25  panel.  The total project construction cost estimate for this 
 62.26  project must not exceed the cost estimate submitted in 
 62.27  connection with the 1993 moratorium exception process; 
 62.28     ~~(s)~~ (r) to license and certify up to 117 beds that are 
 62.29  relocated from a licensed and certified 138-bed nursing facility 
 62.30  located in St. Paul to a hospital with 130 licensed hospital 
 62.31  beds located in South St. Paul, provided that the nursing 
 62.32  facility and hospital are owned by the same or a related 
 62.33  organization and that prior to the date the relocation is 
 62.34  completed the hospital ceases operation of its inpatient 
 62.35  hospital services at that hospital.  After relocation, the 
 62.36  nursing facility's status under section 256B.431, subdivision 
 63.1   2j, shall be the same as it was prior to relocation.  The 
 63.2   nursing facility's property-related payment rate resulting from 
 63.3   the project authorized in this paragraph shall become effective 
 63.4   no earlier than April 1, 1996.  For purposes of calculating the 
 63.5   incremental change in the facility's rental per diem resulting 
 63.6   from this project, the allowable appraised value of the nursing 
 63.7   facility portion of the existing health care facility physical 
 63.8   plant prior to the renovation and relocation may not exceed 
 63.9   $2,490,000; 
 63.10     ~~(t)~~ (s) to license and certify two beds in a facility to 
 63.11  replace beds that were voluntarily delicensed and decertified on 
 63.12  June 28, 1991; 
 63.13     ~~(u)~~ (t) to allow 16 licensed and certified beds located on 
 63.14  July 1, 1994, in a 142-bed nursing home and 21-bed boarding care 
 63.15  home facility in Minneapolis, notwithstanding the licensure and 
 63.16  certification after July 1, 1995, of the Minneapolis facility as 
 63.17  a 147-bed nursing home facility after completion of a 
 63.18  construction project approved in 1993 under section 144A.073, to 
 63.19  be laid away upon 30 days' prior written notice to the 
 63.20  commissioner.  Beds on layaway status shall have the same status 
 63.21  as voluntarily delicensed or decertified beds except that they 
 63.22  shall remain subject to the surcharge in section 256.9657.  The 
 63.23  16 beds on layaway status may be relicensed as nursing home beds 
 63.24  and recertified at any time within five years of the effective 
 63.25  date of the layaway upon relocation of some or all of the beds 
 63.26  to a licensed and certified facility located in Watertown, 
 63.27  provided that the total project construction costs related to 
 63.28  the relocation of beds from layaway status for the Watertown 
 63.29  facility may not exceed the dollar threshold provided in 
 63.30  subdivision 2 unless the construction project has been approved 
 63.31  through the moratorium exception process under section 144A.073. 
 63.32     The property-related payment rate of the facility placing 
 63.33  beds on layaway status must be adjusted by the incremental 
 63.34  change in its rental per diem after recalculating the rental per 
 63.35  diem as provided in section 256B.431, subdivision 3a, paragraph 
 63.36  (d).  The property-related payment rate for the facility 
 64.1   relicensing and recertifying beds from layaway status must be 
 64.2   adjusted by the incremental change in its rental per diem after 
 64.3   recalculating its rental per diem using the number of beds after 
 64.4   the relicensing to establish the facility's capacity day 
 64.5   divisor, which shall be effective the first day of the month 
 64.6   following the month in which the relicensing and recertification 
 64.7   became effective.  Any beds remaining on layaway status more 
 64.8   than five years after the date the layaway status became 
 64.9   effective must be removed from layaway status and immediately 
 64.10  delicensed and decertified; 
 64.11     ~~(v)~~ (u) to license and certify beds that are moved within 
 64.12  an existing area of a facility or to a newly-constructed 
 64.13  addition which is built for the purpose of eliminating three- 
 64.14  and four-bed rooms and adding space for dining, lounge areas, 
 64.15  bathing rooms, and ancillary service areas in a nursing home 
 64.16  that, as of January 1, 1995, was located in Fridley and had a 
 64.17  licensed capacity of 129 beds; ~~or~~ 
 64.18     ~~(w)~~ (v) to relocate 36 beds in Crow Wing county and four 
 64.19  beds from Hennepin county to a 160-bed facility in Crow Wing 
 64.20  county, provided all the affected beds are under common 
 64.21  ownership; or 
 64.22     (w) to license and certify beds in a renovation and 
 64.23  remodeling project to convert 13 three-bed wards into 13 two-bed 
 64.24  rooms and 13 single-bed rooms, expand space, and add 
 64.25  improvements in a nursing home that, as of January 1, 1994, met 
 64.26  the following conditions:  the nursing home was located in 
 64.27  Ramsey county, was not owned by a hospital corporation, had a 
 64.28  licensed capacity of 64 beds, and had been ranked among the top 
 64.29  15 applicants by the 1993 moratorium exceptions advisory review 
 64.30  panel.  The total project construction cost estimate for this 
 64.31  project must not exceed the cost estimate submitted in 
 64.32  connection with the 1993 moratorium exception process. 
 64.33     Sec. 4.  Minnesota Statutes 1996, section 144A.073, 
 64.34  subdivision 2, is amended to read: 
 64.35     Subd. 2.  [REQUEST FOR PROPOSALS.] At the authorization by 
 64.36  the legislature of additional medical assistance expenditures 
 65.1   for exceptions to the moratorium on nursing homes, the 
 65.2   interagency committee shall publish in the State Register a 
 65.3   request for proposals for nursing home projects to be licensed 
 65.4   or certified under section 144A.071, subdivision 4a, clause 
 65.5   (c).  The public notice of this funding and the request for 
 65.6   proposals must specify how the approval criteria will be 
 65.7   prioritized by the advisory review panel, the interagency 
 65.8   long-term care planning committee, and the commissioner.  The 
 65.9   notice must describe the information that must accompany a 
 65.10  request and state that proposals must be submitted to the 
 65.11  interagency committee within 90 days of the date of 
 65.12  publication.  The notice must include the amount of the 
 65.13  legislative appropriation available for the additional costs to 
 65.14  the medical assistance program of projects approved under this 
 65.15  section.  If no money is appropriated for a year, the 
 65.16  interagency committee shall publish a notice to that effect, and 
 65.17  no proposals shall be requested.  If money is appropriated, the 
 65.18  interagency committee shall initiate the application and review 
 65.19  process described in this section at least twice each biennium 
 65.20  and up to four times each biennium, according to dates 
 65.21  established by rule.  Authorized funds shall be allocated 
 65.22  proportionally to the number of processes.  Funds not encumbered 
 65.23  by an earlier process within a biennium shall carry forward to 
 65.24  subsequent iterations of the process.  Authorization for 
 65.25  expenditures does not carry forward into the following 
 65.26  biennium.  To be considered for approval, a proposal must 
 65.27  include the following information: 
 65.28     (1) whether the request is for renovation, replacement, 
 65.29  upgrading, conversion, or relocation; 
 65.30     (2) a description of the problem the project is designed to 
 65.31  address; 
 65.32     (3) a description of the proposed project; 
 65.33     (4) an analysis of projected costs of the nursing facility 
 65.34  proposal, which are not required to exceed the cost threshold 
 65.35  referred to in section 144A.071, subdivision 1, to be considered 
 65.36  under this section, including initial construction and 
 66.1   remodeling costs; site preparation costs; financing costs, 
 66.2   including the current estimated long-term financing costs of the 
 66.3   proposal, which consists of estimates of the amount and sources 
 66.4   of money, reserves if required under the proposed funding 
 66.5   mechanism, annual payments schedule, interest rates, length of 
 66.6   term, closing costs and fees, insurance costs, and any completed 
 66.7   marketing study or underwriting review; and estimated operating 
 66.8   costs during the first two years after completion of the 
 66.9   project; 
 66.10     (5) for proposals involving replacement of all or part of a 
 66.11  facility, the proposed location of the replacement facility and 
 66.12  an estimate of the cost of addressing the problem through 
 66.13  renovation; 
 66.14     (6) for proposals involving renovation, an estimate of the 
 66.15  cost of addressing the problem through replacement; 
 66.16     (7) the proposed timetable for commencing construction and 
 66.17  completing the project; 
 66.18     (8) a statement of any licensure or certification issues, 
 66.19  such as certification survey deficiencies; 
 66.20     (9) the proposed relocation plan for current residents if 
 66.21  beds are to be closed so that the department of human services 
 66.22  can estimate the total costs of a proposal; and 
 66.23     (10) other information required by permanent rule of the 
 66.24  commissioner of health in accordance with subdivisions 4 and 8. 
 66.25     Sec. 5.  Minnesota Statutes 1996, section 252.28, is 
 66.26  amended by adding a subdivision to read: 
 66.27     Subd. 3a.  [LICENSING EXCEPTION.] Notwithstanding the 
 66.28  provisions of subdivision 3, the commissioner may license 
 66.29  service sites, each accommodating up to six residents moving 
 66.30  from a 48-bed intermediate care facility for persons with mental 
 66.31  retardation or related conditions located in Dakota county that 
 66.32  is closing under section 252.292. 
 66.33     Sec. 6.  Minnesota Statutes 1996, section 256B.431, 
 66.34  subdivision 25, is amended to read: 
 66.35     Subd. 25.  [CHANGES TO NURSING FACILITY REIMBURSEMENT 
 66.36  BEGINNING JULY 1, 1995.] The nursing facility reimbursement 
 67.1   changes in paragraphs (a) to (h) shall apply in the sequence 
 67.2   specified to Minnesota Rules, parts 9549.0010 to 9549.0080, and 
 67.3   this section, beginning July 1, 1995. 
 67.4      (a) The eight-cent adjustment to care-related rates in 
 67.5   subdivision 22, paragraph (e), shall no longer apply. 
 67.6      (b) For rate years beginning on or after July 1, 1995, the 
 67.7   commissioner shall limit a nursing facility's allowable 
 67.8   operating per diem for each case mix category for each rate year 
 67.9   as in clauses (1) to (3). 
 67.10     (1) For the rate year beginning July 1, 1995, the 
 67.11  commissioner shall group nursing facilities into two groups, 
 67.12  freestanding and nonfreestanding, within each geographic group, 
 67.13  using their operating cost per diem for the case mix A 
 67.14  classification.  A nonfreestanding nursing facility is a nursing 
 67.15  facility whose other operating cost per diem is subject to the 
 67.16  hospital attached, short length of stay, or the rule 80 limits.  
 67.17  All other nursing facilities shall be considered freestanding 
 67.18  nursing facilities.  The commissioner shall then array all 
 67.19  nursing facilities in each grouping by their allowable case mix 
 67.20  A operating cost per diem.  In calculating a nursing facility's 
 67.21  operating cost per diem for this purpose, the commissioner shall 
 67.22  exclude the raw food cost per diem related to providing special 
 67.23  diets that are based on religious beliefs, as determined in 
 67.24  subdivision 2b, paragraph (h).  For those nursing facilities in 
 67.25  each grouping whose case mix A operating cost per diem: 
 67.26     (i) is at or below the median minus 1.0 standard deviation 
 67.27  of the array, the commissioner shall limit the nursing 
 67.28  facility's allowable operating cost per diem for each case mix 
 67.29  category to the lesser of the prior reporting year's allowable 
 67.30  operating cost per diems plus the inflation factor as 
 67.31  established in paragraph (f), clause (2), increased by six 
 67.32  percentage points, or the current reporting year's corresponding 
 67.33  allowable operating cost per diem; 
 67.34     (ii) is between minus .5 standard deviation and minus 1.0 
 67.35  standard deviation below the median of the array, the 
 67.36  commissioner shall limit the nursing facility's allowable 
 68.1   operating cost per diem for each case mix category to the lesser 
 68.2   of the prior reporting year's allowable operating cost per diems 
 68.3   plus the inflation factor as established in paragraph (f), 
 68.4   clause (2), increased by four percentage points, or the current 
 68.5   reporting year's corresponding allowable operating cost per 
 68.6   diem; or 
 68.7      (iii) is equal to or above minus .5 standard deviation 
 68.8   below the median of the array, the commissioner shall limit the 
 68.9   nursing facility's allowable operating cost per diem for each 
 68.10  case mix category to the lesser of the prior reporting year's 
 68.11  allowable operating cost per diems plus the inflation factor as 
 68.12  established in paragraph (f), clause (2), increased by three 
 68.13  percentage points, or the current reporting year's corresponding 
 68.14  allowable operating cost per diem. 
 68.15     (2) For the rate year beginning on July 1, 1996, the 
 68.16  commissioner shall limit the nursing facility's allowable 
 68.17  operating cost per diem for each case mix category to the lesser 
 68.18  of the prior reporting year's allowable operating cost per diems 
 68.19  plus the inflation factor as established in paragraph (f), 
 68.20  clause (2), increased by one percentage point or the current 
 68.21  reporting year's corresponding allowable operating cost per 
 68.22  diems; and 
 68.23     (3) For rate years beginning on or after July 1, 1997, the 
 68.24  commissioner shall limit the nursing facility's allowable 
 68.25  operating cost per diem for each case mix category to the lesser 
 68.26  of the reporting year prior to the current reporting year's 
 68.27  allowable operating cost per diems plus the inflation factor as 
 68.28  established in paragraph (f), clause (2), or the current 
 68.29  reporting year's corresponding allowable operating cost per 
 68.30  diems. 
 68.31     (c) For rate years beginning on July 1, 1995, the 
 68.32  commissioner shall limit the allowable operating cost per diems 
 68.33  for high cost nursing facilities.  After application of the 
 68.34  limits in paragraph (b) to each nursing facility's operating 
 68.35  cost per diems, the commissioner shall group nursing facilities 
 68.36  into two groups, freestanding or nonfreestanding, within each 
 69.1   geographic group.  A nonfreestanding nursing facility is a 
 69.2   nursing facility whose other operating cost per diems are 
 69.3   subject to hospital attached, short length of stay, or rule 80 
 69.4   limits.  All other nursing facilities shall be considered 
 69.5   freestanding nursing facilities.  The commissioner shall then 
 69.6   array all nursing facilities within each grouping by their 
 69.7   allowable case mix A operating cost per diems.  In calculating a 
 69.8   nursing facility's operating cost per diem for this purpose, the 
 69.9   commissioner shall exclude the raw food cost per diem related to 
 69.10  providing special diets that are based on religious beliefs, as 
 69.11  determined in subdivision 2b, paragraph (h).  For those nursing 
 69.12  facilities in each grouping whose case mix A operating cost per 
 69.13  diem exceeds 1.0 standard deviation above the median, the 
 69.14  commissioner shall reduce their allowable operating cost per 
 69.15  diems by two percent.  For those nursing facilities in each 
 69.16  grouping whose case mix A operating cost per diem exceeds 0.5 
 69.17  standard deviation above the median but is less than or equal to 
 69.18  1.0 standard deviation above the median, the commissioner shall 
 69.19  reduce their allowable operating cost per diems by one percent. 
 69.20     (d) For rate years beginning on or after July 1, 1996, the 
 69.21  commissioner shall limit the allowable operating cost per diems 
 69.22  for high cost nursing facilities.  After application of the 
 69.23  limits in paragraph (b) to each nursing facility's operating 
 69.24  cost per diems, the commissioner shall group nursing facilities 
 69.25  into two groups, freestanding or nonfreestanding, within each 
 69.26  geographic group.  A nonfreestanding nursing facility is a 
 69.27  nursing facility whose other operating cost per diems are 
 69.28  subject to hospital attached, short length of stay, or rule 80 
 69.29  limits.  All other nursing facilities shall be considered 
 69.30  freestanding nursing facilities.  The commissioner shall then 
 69.31  array all nursing facilities within each grouping by their 
 69.32  allowable case mix A operating cost per diems.  In calculating a 
 69.33  nursing facility's operating cost per diem for this purpose, the 
 69.34  commissioner shall exclude the raw food cost per diem related to 
 69.35  providing special diets that are based on religious beliefs, as 
 69.36  determined in subdivision 2b, paragraph (h).  In those nursing 
 70.1   facilities in each grouping whose case mix A operating cost per 
 70.2   diem exceeds 1.0 standard deviation above the median, the 
 70.3   commissioner shall reduce their allowable operating cost per 
 70.4   diems by three percent.  For those nursing facilities in each 
 70.5   grouping whose case mix A operating cost per diem exceeds 0.5 
 70.6   standard deviation above the median but is less than or equal to 
 70.7   1.0 standard deviation above the median, the commissioner shall 
 70.8   reduce their allowable operating cost per diems by two percent. 
 70.9      (e) For rate years beginning on or after July 1, 1995, the 
 70.10  commissioner shall determine a nursing facility's efficiency 
 70.11  incentive by first computing the allowable difference, which is 
 70.12  the lesser of $4.50 or the amount by which the facility's other 
 70.13  operating cost limit exceeds its nonadjusted other operating 
 70.14  cost per diem for that rate year.  The commissioner shall 
 70.15  compute the efficiency incentive by: 
 70.16     (1) subtracting the allowable difference from $4.50 and 
 70.17  dividing the result by $4.50; 
 70.18     (2) multiplying 0.20 by the ratio resulting from clause 
 70.19  (1), and then; 
 70.20     (3) adding 0.50 to the result from clause (2); and 
 70.21     (4) multiplying the result from clause (3) times the 
 70.22  allowable difference. 
 70.23     The nursing facility's efficiency incentive payment shall 
 70.24  be the lesser of $2.25 or the product obtained in clause (4). 
 70.25     (f) For rate years beginning on or after July 1, 1995, the 
 70.26  forecasted price index for a nursing facility's allowable 
 70.27  operating cost per diems shall be determined under clauses (1) 
 70.28  to (3) using the change in the Consumer Price Index-All Items 
 70.29  (United States city average) (CPI-U) or the change in the 
 70.30  Nursing Home Market Basket, both as forecasted by Data Resources 
 70.31  Inc., whichever is applicable.  The commissioner shall use the 
 70.32  indices as forecasted in the fourth quarter of the calendar year 
 70.33  preceding the rate year, subject to subdivision 2l, paragraph 
 70.34  (c).  If, as a result of federal legislative or administrative 
 70.35  action, the methodology used to calculate the Consumer Price 
 70.36  Index-All Items (United States city average) (CPI-U) changes, 
 71.1   the commissioner shall develop a conversion factor or other 
 71.2   methodology to convert the CPI-U index factor that results from 
 71.3   the new methodology to an index factor that approximates, as 
 71.4   closely as possible, the index factor that would have resulted 
 71.5   from application of the original CPI-U methodology prior to any 
 71.6   changes in methodology.  The commissioner shall use the 
 71.7   conversion factor or other methodology to calculate an adjusted 
 71.8   inflation index.  The adjusted inflation index must be used to 
 71.9   calculate payment rates under this section instead of the CPI-U 
 71.10  index specified in paragraph (d).  If the commissioner is 
 71.11  required to develop an adjusted inflation index, the 
 71.12  commissioner shall report to the legislature as part of the next 
 71.13  budget submission the fiscal impact of applying this index. 
 71.14     (1) The CPI-U forecasted index for allowable operating cost 
 71.15  per diems shall be based on the 21-month period from the 
 71.16  midpoint of the nursing facility's reporting year to the 
 71.17  midpoint of the rate year following the reporting year. 
 71.18     (2) The Nursing Home Market Basket forecasted index for 
 71.19  allowable operating costs and per diem limits shall be based on 
 71.20  the 12-month period between the midpoints of the two reporting 
 71.21  years preceding the rate year. 
 71.22     (3) For rate years beginning on or after July 1, 1996, the 
 71.23  forecasted index for operating cost limits referred to in 
 71.24  subdivision 21, paragraph (b), shall be based on the CPI-U for 
 71.25  the 12-month period between the midpoints of the two reporting 
 71.26  years preceding the rate year. 
 71.27     (g) After applying these provisions for the respective rate 
 71.28  years, the commissioner shall index these allowable operating 
 71.29  costs per diems by the inflation factor provided for in 
 71.30  paragraph (f), clause (1), and add the nursing facility's 
 71.31  efficiency incentive as computed in paragraph (e). 
 71.32     (h) (1) A nursing facility licensed for 302 beds on 
 71.33  September 30, 1993, that was approved under the moratorium 
 71.34  exception process in section 144A.073 for a partial replacement, 
 71.35  and completed the replacement project in December 1994, is 
 71.36  exempt from paragraphs (b) to (d) for rate years beginning on or 
 72.1   after July 1, 1995. 
 72.2      (2) For the rate year beginning July 1, 1997, after 
 72.3   computing this nursing facility's payment rate according to 
 72.4   section 256B.434, the commissioner shall make a one-year rate 
 72.5   adjustment of $8.62 to the facility's contract payment rate for 
 72.6   the rate effect of operating cost changes associated with the 
 72.7   facility's 1994 downsizing project. 
 72.8      (3) For rate years beginning on or after July 1, 1997, the 
 72.9   commissioner shall add 35 cents to the facility's base property 
 72.10  related payment rate for the rate effect of reducing its 
 72.11  licensed capacity to 290 beds from 302 beds and shall add 83 
 72.12  cents to the facility's real estate tax and special assessment 
 72.13  payment rate for payments in lieu of real estate taxes.  The 
 72.14  adjustments in this clause shall remain in effect for the 
 72.15  duration of the facility's contract under section 256B.434. 
 72.16     (i) Notwithstanding Laws 1996, chapter 451, article 3, 
 72.17  section 11, paragraph (h), for the rate years beginning on July 
 72.18  1, 1996, July 1, 1997, and July 1, 1998, a nursing facility 
 72.19  licensed for 40 beds effective May 1, 1992, with a subsequent 
 72.20  increase of 20 Medicare/Medicaid certified beds, effective 
 72.21  January 26, 1993, in accordance with an increase in licensure is 
 72.22  exempt from paragraphs (b) to (d). 
 72.23     (j) For the rate year beginning July 1, 1997, the 
 72.24  commissioner shall compute the payment rate for a nursing 
 72.25  facility licensed for 94 beds on September 30, 1996, that 
 72.26  applied in October 1993 for approval of a total replacement 
 72.27  under the moratorium exception process in section 144A.073, and 
 72.28  completed the approved replacement in June 1995, with an 
 72.29  aggregate spend-up limit under paragraph (b) or Laws 1996, 
 72.30  chapter 451, article 3, section 11, increased by $3.98, and 
 72.31  after computing the facility's payment rate according to this 
 72.32  section, the commissioner shall make a one year positive rate 
 72.33  adjustment of $3.19 for operating costs related to the newly 
 72.34  constructed total replacement, without application of paragraphs 
 72.35  (b) to (d) or Laws 1996, chapter 451, article 3, section 11.  
 72.36  The facility's per diems, before the $3.19 adjustment, shall be 
 73.1   used as the prior reporting year's allowable operating cost per 
 73.2   diems for payment rate calculation for the rate year beginning 
 73.3   July 1, 1998. 
 73.4      (k) For the purpose of applying the limit under paragraph 
 73.5   (b), clause (3), a nursing facility in Hibbing licensed for 192 
 73.6   beds shall have the prior year's allowable other operating cost 
 73.7   per diems increased by $2.67 before adding the inflation in 
 73.8   paragraph (f), clause (2), for the rate year beginning July 1, 
 73.9   1997. 
 73.10     (l) For the purpose of applying the limit under paragraph 
 73.11  (b), clause (3), a nursing facility in Kandiyohi county licensed 
 73.12  for 86 beds that was granted hospital-attached status on 
 73.13  December 1, 1994, shall have the prior year's allowable 
 73.14  operating cost per diems increased by $7.984 before adding the 
 73.15  inflation in paragraph (f), clause (2), for the rate year 
 73.16  beginning on July 1, 1997. 
 73.17     Sec. 7.  Minnesota Statutes 1996, section 256B.431, is 
 73.18  amended by adding a subdivision to read: 
 73.19     Subd. 26.  [NURSING FACILITY REIMBURSEMENT BEGINNING JULY 
 73.20  1, 1997.] For rate years beginning on or after July 1, 1997, the 
 73.21  total operating cost payment rates for a nursing facility shall 
 73.22  be the greater of the total operating cost payment rates 
 73.23  determined under this section or the total operating cost 
 73.24  payment rates in effect on June 30, 1997, subject to rate 
 73.25  adjustments due to field audit or rate appeal resolution.  This 
 73.26  provision shall not apply to subsequent field audit adjustments 
 73.27  of the nursing facility's operating cost rates for rate years 
 73.28  beginning on or after July 1, 1997. 
 73.29     Sec. 8.  Minnesota Statutes 1996, section 256B.433, is 
 73.30  amended by adding a subdivision to read: 
 73.31     Subd. 3a.  [EXEMPTION FROM REQUIREMENT FOR SEPARATE THERAPY 
 73.32  BILLING.] The provisions of subdivision 3 do not apply to 
 73.33  nursing facilities that are reimbursed according to the 
 73.34  provisions of section 256B.431 and are located in a county 
 73.35  participating in the prepaid medical assistance program. 
 73.36     Sec. 9.  Minnesota Statutes 1996, section 256B.434, 
 74.1   subdivision 9, is amended to read: 
 74.2      Subd. 9.  [MANAGED CARE CONTRACTS FOR OTHER SERVICES.] 
 74.3   Beginning July 1, 1995, the commissioner may contract with 
 74.4   nursing facilities that have entered into alternative payment 
 74.5   demonstration project contracts under this section to provide 
 74.6   medical assistance services other than nursing facility care to 
 74.7   residents of the facility under a prepaid, managed care payment 
 74.8   system.  ~~For purposes of contracts entered into under this~~ 
 74.9   ~~subdivision, the commissioner may waive one or more of the~~ 
 74.10  ~~requirements for payment for ancillary services in section~~ 
 74.11  ~~256B.433.~~  Managed care contracts for other services may be 
 74.12  entered into at any time during the duration of a nursing 
 74.13  facility's alternative payment demonstration project contract, 
 74.14  and the terms of the managed care contracts need not coincide 
 74.15  with the terms of the alternative payment demonstration project 
 74.16  contract. 
 74.17     Sec. 10.  Minnesota Statutes 1996, section 256B.434, 
 74.18  subdivision 10, is amended to read: 
 74.19     Subd. 10.  [EXEMPTIONS.] (a) To the extent permitted by 
 74.20  federal law, (1) a facility that has entered into a contract 
 74.21  under this section is not required to file a cost report, as 
 74.22  defined in Minnesota Rules, part 9549.0020, subpart 13, for any 
 74.23  year after the base year that is the basis for the calculation 
 74.24  of the contract payment rate for the first rate year of the 
 74.25  alternative payment demonstration project contract; and (2) a 
 74.26  facility under contract is not subject to audits of historical 
 74.27  costs or revenues, or paybacks or retroactive adjustments based 
 74.28  on these costs or revenues, except audits, paybacks, or 
 74.29  adjustments relating to the cost report that is the basis for 
 74.30  calculation of the first rate year under the contract. 
 74.31     (b) A facility that is under contract with the commissioner 
 74.32  under this section is not subject to the moratorium on licensure 
 74.33  or certification of new nursing home beds in section 144A.071, 
 74.34  unless the project results in a net increase in bed capacity or 
 74.35  involves relocation of beds from one site to another.  Contract 
 74.36  payment rates must not be adjusted to reflect any additional 
 75.1   costs that a nursing facility incurs as a result of a 
 75.2   construction project undertaken under this paragraph.  In 
 75.3   addition, as a condition of entering into a contract under this 
 75.4   section, a nursing facility must agree that any future medical 
 75.5   assistance payments for nursing facility services will not 
 75.6   reflect any additional costs attributable to the sale of a 
 75.7   nursing facility under this section and to construction 
 75.8   undertaken under this paragraph that otherwise would not be 
 75.9   authorized under the moratorium in section 144A.073.  Nothing in 
 75.10  this section prevents a nursing facility participating in the 
 75.11  alternative payment demonstration project under this section 
 75.12  from seeking approval of an exception to the moratorium through 
 75.13  the process established in section 144A.073, and if approved the 
 75.14  facility's rates shall be adjusted to reflect the cost of the 
 75.15  project. 
 75.16     (c) Notwithstanding section 256B.48, subdivision 6, 
 75.17  paragraphs (c), (d), and (e), and pursuant to any terms and 
 75.18  conditions contained in the facility's contract, a nursing 
 75.19  facility that is under contract with the commissioner under this 
 75.20  section is in compliance with section 256B.48, subdivision 6, 
 75.21  paragraph (b), if the facility is Medicare certified. 
 75.22     (d) Notwithstanding paragraph (a), if by April 1, 1996, the 
 75.23  health care financing administration has not approved a required 
 75.24  waiver, or the health care financing administration otherwise 
 75.25  requires cost reports to be filed prior to the waiver's 
 75.26  approval, the commissioner shall require a cost report for the 
 75.27  rate year. 
 75.28     (e) A facility that is under contract with the commissioner 
 75.29  under this section shall be allowed to change therapy 
 75.30  arrangements from an unrelated vendor to a related vendor during 
 75.31  the term of the contract.  The commissioner may develop 
 75.32  reasonable requirements designed to prevent an increase in 
 75.33  therapy utilization for residents enrolled in the medical 
 75.34  assistance program. 
 75.35     Sec. 11.  Minnesota Statutes 1996, section 256I.05, 
 75.36  subdivision 1a, is amended to read: 
 76.1      Subd. 1a.  [SUPPLEMENTARY RATES.] In addition to the room 
 76.2   and board rate specified in subdivision 1, the county agency may 
 76.3   negotiate a payment not to exceed $426.37 for other services 
 76.4   necessary to provide room and board provided by the group 
 76.5   residence if the residence is licensed by or registered by the 
 76.6   department of health, or licensed by the department of human 
 76.7   services to provide services in addition to room and board, and 
 76.8   if the provider of services is not also concurrently receiving 
 76.9   funding for services for a recipient under a home and 
 76.10  community-based waiver under title XIX of the Social Security 
 76.11  Act; or funding from the medical assistance program under 
 76.12  section 256B.0627, subdivision 4, for personal care services for 
 76.13  residents in the setting; or residing in a setting which 
 76.14  receives funding under Minnesota Rules, parts 9535.2000 to 
 76.15  9535.3000.  If funding is available for other necessary services 
 76.16  through a home and community-based waiver, or personal care 
 76.17  services under section 256B.0627, subdivision 4, then the GRH 
 76.18  rate is limited to the rate set in subdivision 1.  The 
 76.19  registration and licensure requirement does not apply to 
 76.20  establishments which are exempt from state licensure because 
 76.21  they are located on Indian reservations and for which the tribe 
 76.22  has prescribed health and safety requirements.  Service payments 
 76.23  under this section may be prohibited under rules to prevent the 
 76.24  supplanting of federal funds with state funds.  The commissioner 
 76.25  shall pursue the feasibility of obtaining the approval of the 
 76.26  Secretary of Health and Human Services to provide home and 
 76.27  community-based waiver services under title XIX of the Social 
 76.28  Security Act for residents who are not eligible for an existing 
 76.29  home and community-based waiver due to a primary diagnosis of 
 76.30  mental illness or chemical dependency and shall apply for a 
 76.31  waiver if it is determined to be cost-effective.  The 
 76.32  commissioner is authorized to make cost-neutral transfers from 
 76.33  the GRH fund for beds under this section to other funding 
 76.34  programs administered by the department after consultation with 
 76.35  the county or counties in which the affected beds are located.  
 76.36  The commissioner may also make cost-neutral transfers from the 
 77.1   GRH fund to county human service agencies for beds permanently 
 77.2   removed from the GRH census under a plan submitted by the county 
 77.3   agency and approved by the commissioner.  The commissioner shall 
 77.4   report the amount of any transfers under this provision annually 
 77.5   to the legislature. 
 77.6      Sec. 12.  Minnesota Statutes 1996, section 256I.05, is 
 77.7   amended by adding a subdivision to read: 
 77.8      Subd. 1d.  [SUPPLEMENTARY SERVICE RATES FOR CERTAIN 
 77.9   FACILITIES SERVING PERSONS WITH MENTAL ILLNESS OR CHEMICAL 
 77.10  DEPENDENCY.] Notwithstanding the provisions of subdivisions 1a 
 77.11  and 1c for the fiscal year ending June 30, 1998, a county agency 
 77.12  may negotiate a supplementary service rate in addition to the 
 77.13  board and lodging rate for facilities licensed and registered by 
 77.14  the Minnesota department of health under section 157.17 prior to 
 77.15  December 31, 1994, if the facility meets the following criteria: 
 77.16     (1) at least 75 percent of the residents have a primary 
 77.17  diagnosis of mental illness, chemical dependency, or both, and 
 77.18  have related special needs; 
 77.19     (2) the facility provides 24-hour, on-site, year-round 
 77.20  supportive services by qualified staff capable of intervention 
 77.21  in a crisis of persons with late-state inebriety or mental 
 77.22  illness who are vulnerable to abuse or neglect; 
 77.23     (3) the services at the facility include, but are not 
 77.24  limited to: 
 77.25     (i) secure central storage of medication; 
 77.26     (ii) reminders and monitoring of medication for 
 77.27  self-administration; 
 77.28     (iii) support for developing an individual medical and 
 77.29  social service plan, updating the plan, and monitoring 
 77.30  compliance with the plan; and 
 77.31     (iv) assistance with setting up meetings, appointments, and 
 77.32  transportation to access medical, chemical health, and mental 
 77.33  health service providers; 
 77.34     (4) each resident has a documented need for at least one of 
 77.35  the services provided; 
 77.36     (5) each resident has been offered an opportunity to apply 
 78.1   for admission to a licensed residential treatment program for 
 78.2   mental illness, chemical dependency, or both, have refused that 
 78.3   offer, and the offer and their refusal has been documented to 
 78.4   writing; and 
 78.5      (6) the residents are not eligible for home- and 
 78.6   community-based services waivers because of their unique need 
 78.7   for community support. 
 78.8      The total supplementary service rate must not exceed $500. 
 78.9      Sec. 13.  [RATE CLARIFICATION.] 
 78.10     For the rate years beginning October 1, 1997, and October 
 78.11  1, 1998, the commissioner of human services shall exempt 
 78.12  intermediate care facilities for persons with mental retardation 
 78.13  (ICF/MR) from reductions to the payment rates under Minnesota 
 78.14  Statutes, section 256B.501, subdivision 5b, paragraph (d), 
 78.15  clause (6), if the facility: 
 78.16     (1) has had a settle-up payment rate established in the 
 78.17  reporting year preceding the rate year for the one-time rate 
 78.18  adjustment; 
 78.19     (2) is a newly established facility; 
 78.20     (3) is an A to B conversion that has been converted under 
 78.21  Minnesota Statutes, section 252.292, since rate year 1990; 
 78.22     (4) has a payment rate subject to a community conversion 
 78.23  project under Minnesota Statutes, section 252.292; 
 78.24     (5) has a payment rate established under Minnesota 
 78.25  Statutes, section 245A.12 or 245A.13; 
 78.26     (6) is a facility created by the relocation of more than 25 
 78.27  percent of the capacity of a related facility during the 
 78.28  reporting year; or 
 78.29     (7) is a downsizing project that was authorized by 
 78.30  Minnesota Statutes, section 252.291, subdivision 3, in the 
 78.31  reporting year preceding the rate year. 
 78.32     Sec. 14.  [ICF/MR REIMBURSEMENT OCTOBER 1, 1997, TO OCTOBER 
 78.33  1, 1999.] 
 78.34     (a) Notwithstanding any contrary provision in Minnesota 
 78.35  Statutes, section 256B.501, for the rate years beginning October 
 78.36  1, 1997, and October 1, 1998, the commissioner of human services 
 79.1   shall, for purposes of the spend-up limit, array facilities 
 79.2   within each grouping established under Minnesota Statutes, 
 79.3   section 256B.501, subdivision 5b, paragraph (d), clause (4), by 
 79.4   each facility's cost per resident day.  A facility's cost per 
 79.5   resident day shall be determined by dividing its allowable 
 79.6   historical general operating cost for the reporting year by the 
 79.7   facility's resident days for the reporting year.  Facilities 
 79.8   with a cost per resident day at or above the median shall be 
 79.9   limited to the lesser of: 
 79.10     (1) the current reporting year's cost per resident day; or 
 79.11     (2) the prior report year's cost per resident day plus the 
 79.12  inflation factor established under Minnesota Statutes, section 
 79.13  256B.501, subdivision 3c, clause (2), increased by three 
 79.14  percentage points. 
 79.15  In no case shall the amount of this reduction exceed:  three 
 79.16  percent for a facility with a licensed capacity greater than 16 
 79.17  beds; two percent for a facility with a licensed capacity of 
 79.18  nine to 16 beds; and one percent for a facility with a licensed 
 79.19  capacity of eight or fewer beds. 
 79.20     (b) The commissioner shall not apply the limits established 
 79.21  under Minnesota Statutes, section 256B.501, subdivision 5b, 
 79.22  paragraph (d), clause (8), for the rate years beginning October 
 79.23  1, 1997, and October 1, 1998. 
 79.24                             ARTICLE 4
 79.25        MEDICAL ASSISTANCE, GENERAL ASSISTANCE MEDICAL CARE,
 79.26                  AND CHEMICAL DEPENDENCY SERVICES
 79.27     Section 1.  Minnesota Statutes 1996, section 62E.14, is 
 79.28  amended by adding a subdivision to read: 
 79.29     Subd. 4e.  [WAIVER OF PREEXISTING CONDITIONS; PERSONS 
 79.30  COVERED BY PUBLICLY FUNDED HEALTH PROGRAMS.] A person may enroll 
 79.31  in the comprehensive plan with a waiver of the preexisting 
 79.32  condition limitation in subdivision 3, provided that:  
 79.33     (1) the person was formerly enrolled in the medical 
 79.34  assistance, general assistance medical care, or MinnesotaCare 
 79.35  program; 
 79.36     (2) the person is a Minnesota resident; and 
 80.1      (3) the person applies within 90 days of termination from 
 80.2   medical assistance, general assistance medical care, or 
 80.3   MinnesotaCare program. 
 80.4      Sec. 2.  Minnesota Statutes 1996, section 254B.02, 
 80.5   subdivision 3, is amended to read: 
 80.6      Subd. 3.  [RESERVE ACCOUNT.] The commissioner shall 
 80.7   allocate money from the reserve account to counties that, during 
 80.8   the current fiscal year, have met or exceeded the base level of 
 80.9   expenditures for eligible chemical dependency services from 
 80.10  local money.  The commissioner shall establish the base level 
 80.11  for fiscal year 1988 as the amount of local money used for 
 80.12  eligible services in calendar year 1986.  In later years, the 
 80.13  base level must be increased in the same proportion as state 
 80.14  appropriations to implement Laws 1986, chapter 394, sections 8 
 80.15  to 20, are increased.  The base level must be decreased if the 
 80.16  fund balance from which allocations are made under section 
 80.17  254B.02, subdivision 1, is decreased in later years.  The local 
 80.18  match rate for the reserve account is the same rate as applied 
 80.19  to the initial allocation.  Reserve account payments must not be 
 80.20  included when calculating the county adjustments made according 
 80.21  to subdivision 2.  For counties providing medical assistance or 
 80.22  general assistance medical care through managed care plans on 
 80.23  January 1, 1996, the base year is fiscal year 1995.  For 
 80.24  counties beginning provision of managed care after January 1, 
 80.25  1996, the base year is the most recent fiscal year before 
 80.26  enrollment in managed care begins.  For counties providing 
 80.27  managed care, the base level will be increased or decreased in 
 80.28  proportion to changes in the fund balance from which allocations 
 80.29  are made under subdivision 2, but will be additionally increased 
 80.30  or decreased in proportion to the change in county adjusted 
 80.31  population made in subdivision 1, paragraphs (b) and (c). 
 80.32     Sec. 3. Minnesota Statutes 1996, section 254B.04, 
 80.33  subdivision 1, is amended to read: 
 80.34     Subdivision 1.  [ELIGIBILITY.] (a) Persons eligible for 
 80.35  benefits under Code of Federal Regulations, title 25, part 20, 
 80.36  persons eligible for medical assistance benefits under sections 
 81.1   256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6, 
 81.2   or who meet the income standards of section 256B.056, 
 81.3   subdivision 4, and persons eligible for general assistance 
 81.4   medical care under section 256D.03, subdivision 3, are entitled 
 81.5   to chemical dependency fund services.  State money appropriated 
 81.6   for this paragraph must be placed in a separate account 
 81.7   established for this purpose. 
 81.8      (b) A person not entitled to services under paragraph (a), 
 81.9   but with family income that is less than 60 percent of the state 
 81.10  median income for a family of like size and composition, shall 
 81.11  be eligible to receive chemical dependency fund services within 
 81.12  the limit of funds available after persons entitled to services 
 81.13  under paragraph (a) have been served.  A county may spend money 
 81.14  from its own sources to serve persons under this paragraph.  
 81.15  State money appropriated for this paragraph must be placed in a 
 81.16  separate account established for this purpose. 
 81.17     (c) Persons whose income is between 60 percent and 115 
 81.18  percent of the state median income shall be eligible for 
 81.19  chemical dependency services on a sliding fee basis, within the 
 81.20  limit of funds available, after persons entitled to services 
 81.21  under paragraph (a) and persons eligible for services under 
 81.22  paragraph (b) have been served.  Persons eligible under this 
 81.23  paragraph must contribute to the cost of services according to 
 81.24  the sliding fee scale established under subdivision 3.  A county 
 81.25  may spend money from its own sources to provide services to 
 81.26  persons under this paragraph.  State money appropriated for this 
 81.27  paragraph must be placed in a separate account established for 
 81.28  this purpose. 
 81.29     ~~(d) Notwithstanding the provisions of paragraphs (b) and~~ 
 81.30  ~~(c), state funds appropriated to serve persons who are not~~ 
 81.31  ~~entitled under the provisions of paragraph (a), shall be~~ 
 81.32  ~~expended for chemical dependency treatment services for~~ 
 81.33  ~~nonentitled but eligible persons who have children in their~~ 
 81.34  ~~household, are pregnant, or are younger than 18 years old.~~  
 81.35  ~~These persons may have household incomes up to 60 percent of the~~ 
 81.36  ~~state median income.  Any funds in addition to the amounts~~ 
 82.1   ~~necessary to serve the persons identified in this paragraph~~ 
 82.2   ~~shall be expended according to the provisions of paragraphs (b)~~ 
 82.3   ~~and (c).~~  
 82.4      Sec. 4.  Minnesota Statutes 1996, section 256.969, 
 82.5   subdivision 1, is amended to read: 
 82.6      Subdivision 1.  [HOSPITAL COST INDEX.] (a) The hospital 
 82.7   cost index shall be the change in the Consumer Price Index-All 
 82.8   Items (United States city average) (CPI-U) forecasted by Data 
 82.9   Resources, Inc.  The commissioner shall use the indices as 
 82.10  forecasted in the third quarter of the calendar year prior to 
 82.11  the rate year.  The hospital cost index may be used to adjust 
 82.12  the base year operating payment rate through the rate year on an 
 82.13  annually compounded basis.  
 82.14     (b) For fiscal years beginning on or after July 1, 1993, 
 82.15  the commissioner of human services shall not provide automatic 
 82.16  annual inflation adjustments for hospital payment rates under 
 82.17  medical assistance, nor under general assistance medical care, 
 82.18  except that the inflation adjustments under paragraph (a) for 
 82.19  medical assistance, excluding general assistance medical care, 
 82.20  shall apply through calendar year ~~1997~~ 1999.  The commissioner 
 82.21  of finance shall include as a budget change request in each 
 82.22  biennial detailed expenditure budget submitted to the 
 82.23  legislature under section 16A.11 annual adjustments in hospital 
 82.24  payment rates under medical assistance and general assistance 
 82.25  medical care, based upon the hospital cost index. 
 82.26     Sec. 5.  Minnesota Statutes 1996, section 256.9695, 
 82.27  subdivision 1, is amended to read: 
 82.28     Subdivision 1.  [APPEALS.] A hospital may appeal a decision 
 82.29  arising from the application of standards or methods under 
 82.30  section 256.9685, 256.9686, or 256.969, if an appeal would 
 82.31  result in a change to the hospital's payment rate or payments.  
 82.32  Both overpayments and underpayments that result from the 
 82.33  submission of appeals shall be implemented.  Regardless of any 
 82.34  appeal outcome, relative values shall not be recalculated.  The 
 82.35  appeal shall be heard by an administrative law judge according 
 82.36  to sections 14.57 to 14.62, or upon agreement by both parties, 
 83.1   according to a modified appeals procedure established by the 
 83.2   commissioner and the office of administrative hearings.  In any 
 83.3   proceeding under this section, the appealing party must 
 83.4   demonstrate by a preponderance of the evidence that the 
 83.5   commissioner's determination is incorrect or not according to 
 83.6   law. 
 83.7      (a) To appeal a payment rate or payment determination or a 
 83.8   determination made from base year information, the hospital 
 83.9   shall file a written appeal request to the commissioner within 
 83.10  60 days of the date the payment rate determination was mailed.  
 83.11  The appeal request shall specify:  (i) the disputed items; (ii) 
 83.12  the authority in federal or state statute or rule upon which the 
 83.13  hospital relies for each disputed item; and (iii) the name and 
 83.14  address of the person to contact regarding the appeal.  Facts to 
 83.15  be considered in any appeal of base year information are limited 
 83.16  to those in existence at the time the payment rates of the first 
 83.17  rate year were established from the base year information.  In 
 83.18  the case of Medicare settled appeals, the 60-day appeal period 
 83.19  shall begin on the mailing date of the notice by the Medicare 
 83.20  program or the date the medical assistance payment rate 
 83.21  determination notice is mailed, whichever is later. 
 83.22     (b) To appeal a payment rate or payment change that results 
 83.23  from a difference in case mix between the base year and a rate 
 83.24  year, the procedures and requirements of paragraph (a) apply.  
 83.25  However, the appeal must be filed with the commissioner within 
 83.26  120 days after the end of a rate year.  A case mix appeal must 
 83.27  apply to the cost of services to all medical assistance patients 
 83.28  that received inpatient services from the hospital during the 
 83.29  rate year appealed.  For case mix appeals filed after January 1, 
 83.30  1997, the difference in case mix and the corresponding payment 
 83.31  adjustment must exceed a threshold of ten percent. 
 83.32     Sec. 6.  Minnesota Statutes 1996, section 256B.04, is 
 83.33  amended by adding a subdivision to read: 
 83.34     Subd. 1a.  [COMPREHENSIVE HEALTH SERVICES SYSTEM.] The 
 83.35  commissioner shall carry out the duties in this section with the 
 83.36  participation of the boards of county commissioners, and with 
 84.1   full consideration for the interests of counties, to plan and 
 84.2   implement a unified, accountable, comprehensive health services 
 84.3   system that: 
 84.4      (1) promotes accessible and quality health care for all 
 84.5   Minnesotans; 
 84.6      (2) assures provision of adequate health care within 
 84.7   limited state and county resources; 
 84.8      (3) avoids shifting funding burdens to county tax 
 84.9   resources; 
 84.10     (4) provides statewide eligibility, benefit, and service 
 84.11  expectations; 
 84.12     (5) manages care, develops risk management strategies, and 
 84.13  contains cost in all health and human services; and 
 84.14     (6) supports effective implementation of publicly funded 
 84.15  health and human services for all areas of the state. 
 84.16     Sec. 7.  Minnesota Statutes 1996, section 256B.0625, 
 84.17  subdivision 13, is amended to read: 
 84.18     Subd. 13.  [DRUGS.] (a) Medical assistance covers drugs, 
 84.19  except for fertility drugs when specifically used to enhance 
 84.20  fertility, if prescribed by a licensed practitioner and 
 84.21  dispensed by a licensed pharmacist, by a physician enrolled in 
 84.22  the medical assistance program as a dispensing physician, or by 
 84.23  a physician or a nurse practitioner employed by or under 
 84.24  contract with a community health board as defined in section 
 84.25  145A.02, subdivision 5, for the purposes of communicable disease 
 84.26  control.  The commissioner, after receiving recommendations from 
 84.27  professional medical associations and professional pharmacist 
 84.28  associations, shall designate a formulary committee to advise 
 84.29  the commissioner on the names of drugs for which payment is 
 84.30  made, recommend a system for reimbursing providers on a set fee 
 84.31  or charge basis rather than the present system, and develop 
 84.32  methods encouraging use of generic drugs when they are less 
 84.33  expensive and equally effective as trademark drugs.  The 
 84.34  formulary committee shall consist of nine members, four of whom 
 84.35  shall be physicians who are not employed by the department of 
 84.36  human services, and a majority of whose practice is for persons 
 85.1   paying privately or through health insurance, three of whom 
 85.2   shall be pharmacists who are not employed by the department of 
 85.3   human services, and a majority of whose practice is for persons 
 85.4   paying privately or through health insurance, a consumer 
 85.5   representative, and a nursing home representative.  Committee 
 85.6   members shall serve three-year terms and shall serve without 
 85.7   compensation.  Members may be reappointed once.  
 85.8      (b) The commissioner shall establish a drug formulary.  Its 
 85.9   establishment and publication shall not be subject to the 
 85.10  requirements of the administrative procedure act, but the 
 85.11  formulary committee shall review and comment on the formulary 
 85.12  contents.  The formulary committee shall review and recommend 
 85.13  drugs which require prior authorization.  The formulary 
 85.14  committee may recommend drugs for prior authorization directly 
 85.15  to the commissioner, as long as opportunity for public input is 
 85.16  provided.  Prior authorization may be requested by the 
 85.17  commissioner based on medical and clinical criteria before 
 85.18  certain drugs are eligible for payment.  Before a drug may be 
 85.19  considered for prior authorization at the request of the 
 85.20  commissioner:  
 85.21     (1) the drug formulary committee must develop criteria to 
 85.22  be used for identifying drugs; the development of these criteria 
 85.23  is not subject to the requirements of chapter 14, but the 
 85.24  formulary committee shall provide opportunity for public input 
 85.25  in developing criteria; 
 85.26     (2) the drug formulary committee must hold a public forum 
 85.27  and receive public comment for an additional 15 days; and 
 85.28     (3) the commissioner must provide information to the 
 85.29  formulary committee on the impact that placing the drug on prior 
 85.30  authorization will have on the quality of patient care and 
 85.31  information regarding whether the drug is subject to clinical 
 85.32  abuse or misuse.  Prior authorization may be required by the 
 85.33  commissioner before certain formulary drugs are eligible for 
 85.34  payment.  The formulary shall not include:  
 85.35     (i) drugs or products for which there is no federal 
 85.36  funding; 
 86.1      (ii) over-the-counter drugs, except for antacids, 
 86.2   acetaminophen, family planning products, aspirin, insulin, 
 86.3   products for the treatment of lice, vitamins for adults with 
 86.4   documented vitamin deficiencies, ~~and~~ vitamins for children under 
 86.5   the age of seven and pregnant or nursing women~~;~~, and 
 86.6      ~~(iii)~~ any other over-the-counter drug identified by the 
 86.7   commissioner, in consultation with the drug formulary committee, 
 86.8   as necessary, appropriate, and cost-effective for the treatment 
 86.9   of certain specified chronic diseases, conditions or disorders, 
 86.10  and this determination shall not be subject to the requirements 
 86.11  of chapter 14; 
 86.12     ~~(iv)~~ (iii) anorectics; and 
 86.13     ~~(v)~~ (iv) drugs for which medical value has not been 
 86.14  established. 
 86.15     The commissioner shall publish conditions for prohibiting 
 86.16  payment for specific drugs after considering the formulary 
 86.17  committee's recommendations.  
 86.18     (c) The basis for determining the amount of payment shall 
 86.19  be the lower of the actual acquisition costs of the drugs plus a 
 86.20  fixed dispensing fee; the maximum allowable cost set by the 
 86.21  federal government or by the commissioner plus the fixed 
 86.22  dispensing fee; or the usual and customary price charged to the 
 86.23  public.  The pharmacy dispensing fee shall be ~~$3.85~~ $3.45.  
 86.24  Actual acquisition cost includes quantity and other special 
 86.25  discounts except time and cash discounts.  The actual 
 86.26  acquisition cost of a drug shall be estimated by the 
 86.27  commissioner, at average wholesale price minus nine percent.  
 86.28  The maximum allowable cost of a multisource drug may be set by 
 86.29  the commissioner and it shall be comparable to, but no higher 
 86.30  than, the maximum amount paid by other third-party payors in 
 86.31  this state who have maximum allowable cost programs.  
 86.32  Establishment of the amount of payment for drugs shall not be 
 86.33  subject to the requirements of the administrative procedure 
 86.34  act.  An additional dispensing fee of $.30 may be added to the 
 86.35  dispensing fee paid to pharmacists for legend drug prescriptions 
 86.36  dispensed to residents of long-term care facilities when a unit 
 87.1   dose blister card system, approved by the department, is used.  
 87.2   Under this type of dispensing system, the pharmacist must 
 87.3   dispense a 30-day supply of drug.  The National Drug Code (NDC) 
 87.4   from the drug container used to fill the blister card must be 
 87.5   identified on the claim to the department.  The unit dose 
 87.6   blister card containing the drug must meet the packaging 
 87.7   standards set forth in Minnesota Rules, part 6800.2700, that 
 87.8   govern the return of unused drugs to the pharmacy for reuse.  
 87.9   The pharmacy provider will be required to credit the department 
 87.10  for the actual acquisition cost of all unused drugs that are 
 87.11  eligible for reuse.  Over-the-counter medications must be 
 87.12  dispensed in the manufacturer's unopened package.  The 
 87.13  commissioner may permit the drug clozapine to be dispensed in a 
 87.14  quantity that is less than a 30-day supply.  Whenever a 
 87.15  generically equivalent product is available, payment shall be on 
 87.16  the basis of the actual acquisition cost of the generic drug, 
 87.17  unless the prescriber specifically indicates "dispense as 
 87.18  written - brand necessary" on the prescription as required by 
 87.19  section 151.21, subdivision 2.  
 87.20     Sec. 8.  Minnesota Statutes 1996, section 256B.0625, 
 87.21  subdivision 15, is amended to read: 
 87.22     Subd. 15.  [HEALTH PLAN PREMIUMS AND COPAYMENTS.] Medical 
 87.23  assistance covers health care prepayment plan premiums, 
 87.24  insurance premiums, and copayments if determined to be 
 87.25  cost-effective by the commissioner.  Effective for all premium 
 87.26  payments due on or after January 1, 1998, medical assistance 
 87.27  does not cover premiums for health insurance policies offered by 
 87.28  the Minnesota comprehensive health association under chapter 62E.
 87.29  For purposes of obtaining Medicare part A and part B, and 
 87.30  copayments, expenditures may be made even if federal funding is 
 87.31  not available. 
 87.32     Sec. 9.  Minnesota Statutes 1996, section 256B.0627, is 
 87.33  amended by adding a subdivision to read: 
 87.34     Subd. 8.  [PERSONAL CARE ASSISTANT SERVICES.] Recipients of 
 87.35  personal care assistant services may share staff and the 
 87.36  commissioner shall provide a rate system for shared personal 
 88.1   care assistant services.  The rate system shall not exceed 1-1/2 
 88.2   the amount paid for providing services to one person, and shall 
 88.3   increase incrementally by one-half the cost of serving a single 
 88.4   person, for each person served.  A personal care assistant may 
 88.5   not serve more than three children in a single setting. 
 88.6      Nothing in this subdivision shall be construed to reduce 
 88.7   the total number of hours authorized for an individual recipient.
 88.8      Sec. 10.  Minnesota Statutes 1996, section 256B.0912, is 
 88.9   amended by adding a subdivision to read: 
 88.10     Subd. 3.  [RATE CONSOLIDATION AND EQUALIZATION.] (a) The 
 88.11  commissioner of human services shall use one maximum 
 88.12  reimbursement rate for personal care services rendered after 
 88.13  June 30, 1997, regardless of whether the services are provided 
 88.14  through the medical assistance program, the alternative care 
 88.15  program, and the elderly, the community alternatives for 
 88.16  disabled individuals, the community alternative care, and the 
 88.17  traumatic brain injury waiver programs.  The maximum 
 88.18  reimbursement rate to be paid must be the reimbursement rate 
 88.19  paid for personal care services received under the medical 
 88.20  assistance program on June 30, 1997. 
 88.21     (b) The maximum reimbursement rates for behavior 
 88.22  programming and cognitive therapy services provided through the 
 88.23  traumatic brain injury waiver must be equivalent to the medical 
 88.24  assistance reimbursement rates for mental health services. 
 88.25     Sec. 11.  Minnesota Statutes 1996, section 256B.0913, is 
 88.26  amended by adding a subdivision to read: 
 88.27     Subd. 16.  [CONVERSION OF ENROLLMENT.] Upon approval of the 
 88.28  elderly waiver amendments described in section 12, persons 
 88.29  currently receiving services shall have their eligibility for 
 88.30  the elderly waiver program determined under section 256B.0915.  
 88.31  Persons currently receiving alternative care services whose 
 88.32  income is under the special income standard according to Code of 
 88.33  Federal Regulations, title 42, section 435.236, who are eligible 
 88.34  for the elderly waiver program shall be transferred to that 
 88.35  program and shall receive priority access to elderly waiver 
 88.36  slots for six months after implementation of this subdivision.  
 89.1   Persons currently enrolled in the alternative care program who 
 89.2   are not eligible for the elderly waiver program shall continue 
 89.3   to be eligible for the alternative care program as long as 
 89.4   continuous eligibility is maintained.  Continued eligibility for 
 89.5   the alternative care program shall be reviewed every six 
 89.6   months.  Persons who apply for the alternative care program 
 89.7   after approval of the elderly waiver amendments in section 12 
 89.8   are not eligible for alternative care if they would qualify for 
 89.9   the elderly waiver, with or without a spenddown.  
 89.10     Sec. 12.  Minnesota Statutes 1996, section 256B.0915, is 
 89.11  amended by adding a subdivision to read: 
 89.12     Subd. 1d.  [POST-ELIGIBILITY TREATMENT OF INCOME AND 
 89.13  RESOURCES FOR ELDERLY WAIVER.] (a) Notwithstanding the 
 89.14  provisions of section 256B.056, the commissioner shall make the 
 89.15  following amendment to the medical assistance elderly waiver 
 89.16  program effective July 1, 1997, or upon federal approval, 
 89.17  whichever is later. 
 89.18     A recipient's maintenance needs will be an amount equal to 
 89.19  the Minnesota supplemental aid equivalent rate as defined in 
 89.20  section 256I.03, subdivision 5, plus the medical assistance 
 89.21  personal needs allowance as defined in section 256B.35, 
 89.22  subdivision 1, paragraph (a), when applying posteligibility 
 89.23  treatment of income rules to the gross income of elderly waiver 
 89.24  recipients, except for individuals whose income is in excess of 
 89.25  the special income standard according to Code of Federal 
 89.26  Regulations, title 42, section 435.236. 
 89.27     (b) The commissioner of human services shall secure 
 89.28  approval of additional elderly waiver slots sufficient to serve 
 89.29  persons who will qualify under the revised income standard 
 89.30  described in paragraph (a) before implementing section 
 89.31  256B.0913, subdivision 16. 
 89.32     Sec. 13.  Minnesota Statutes 1996, section 256B.0915, 
 89.33  subdivision 3, is amended to read: 
 89.34     Subd. 3.  [LIMITS OF CASES, RATES, REIMBURSEMENT, AND 
 89.35  FORECASTING.] (a) The number of medical assistance waiver 
 89.36  recipients that a county may serve must be allocated according 
 90.1   to the number of medical assistance waiver cases open on July 1 
 90.2   of each fiscal year.  Additional recipients may be served with 
 90.3   the approval of the commissioner. 
 90.4      (b) The monthly limit for the cost of waivered services to 
 90.5   an individual waiver client shall be the statewide average 
 90.6   payment rate of the case mix resident class to which the waiver 
 90.7   client would be assigned under the medical assistance case mix 
 90.8   reimbursement system.  If medical supplies and equipment or 
 90.9   adaptations are or will be purchased for an elderly waiver 
 90.10  services recipient, the costs may be prorated on a monthly basis 
 90.11  throughout the year in which they are purchased.  If the monthly 
 90.12  cost of a recipient's other waivered services exceeds the 
 90.13  monthly limit established in this paragraph, the annual cost of 
 90.14  the waivered services shall be determined.  In this event, the 
 90.15  annual cost of waivered services shall not exceed 12 times the 
 90.16  monthly limit calculated in this paragraph.  The statewide 
 90.17  average payment rate is calculated by determining the statewide 
 90.18  average monthly nursing home rate, effective July 1 of the 
 90.19  fiscal year in which the cost is incurred, less the statewide 
 90.20  average monthly income of nursing home residents who are age 65 
 90.21  or older, and who are medical assistance recipients in the month 
 90.22  of March of the previous state fiscal year.  The annual cost 
 90.23  divided by 12 of elderly or disabled waivered services for a 
 90.24  person who is a nursing facility resident at the time of 
 90.25  requesting a determination of eligibility for elderly or 
 90.26  disabled waivered services shall ~~not exceed~~ be the greater of 
 90.27  the monthly payment for:  (i) the resident class assigned under 
 90.28  Minnesota Rules, parts 9549.0050 to 9549.0059, for that resident 
 90.29  in the nursing facility where the resident currently resides; or 
 90.30  (ii) the statewide average payment of the case mix resident 
 90.31  class to which the resident would be assigned under the medical 
 90.32  assistance case mix reimbursement system, provided that the 
 90.33  limit under this clause only applies to persons discharged from 
 90.34  a nursing facility and found eligible for waivered services on 
 90.35  or after July 1, 1997.  The following costs must be included in 
 90.36  determining the total monthly costs for the waiver client: 
 91.1      (1) cost of all waivered services, including extended 
 91.2   medical supplies and equipment; and 
 91.3      (2) cost of skilled nursing, home health aide, and personal 
 91.4   care services reimbursable by medical assistance.  
 91.5      (c) Medical assistance funding for skilled nursing 
 91.6   services, private duty nursing, home health aide, and personal 
 91.7   care services for waiver recipients must be approved by the case 
 91.8   manager and included in the individual care plan. 
 91.9      (d) For both the elderly waiver and the nursing facility 
 91.10  disabled waiver, a county may purchase extended supplies and 
 91.11  equipment without prior approval from the commissioner when 
 91.12  there is no other funding source and the supplies and equipment 
 91.13  are specified in the individual's care plan as medically 
 91.14  necessary to enable the individual to remain in the community 
 91.15  according to the criteria in Minnesota Rules, part 9505.0210, 
 91.16  items A and B.  A county is not required to contract with a 
 91.17  provider of supplies and equipment if the monthly cost of the 
 91.18  supplies and equipment is less than $250.  
 91.19     (e) For the fiscal year beginning on July 1, 1993, and for 
 91.20  subsequent fiscal years, the commissioner of human services 
 91.21  shall not provide automatic annual inflation adjustments for 
 91.22  home and community-based waivered services.  The commissioner of 
 91.23  finance shall include as a budget change request in each 
 91.24  biennial detailed expenditure budget submitted to the 
 91.25  legislature under section 16A.11, annual adjustments in 
 91.26  reimbursement rates for home and community-based waivered 
 91.27  services, based on the forecasted percentage change in the Home 
 91.28  Health Agency Market Basket of Operating Costs, for the fiscal 
 91.29  year beginning July 1, compared to the previous fiscal year, 
 91.30  unless otherwise adjusted by statute.  The Home Health Agency 
 91.31  Market Basket of Operating Costs is published by Data Resources, 
 91.32  Inc.  The forecast to be used is the one published for the 
 91.33  calendar quarter beginning January 1, six months prior to the 
 91.34  beginning of the fiscal year for which rates are set.  The adult 
 91.35  foster care rate shall be considered a difficulty of care 
 91.36  payment and shall not include room and board. 
 92.1      (f) The adult foster care daily rate for the elderly and 
 92.2   disabled waivers shall be negotiated between the county agency 
 92.3   and the foster care provider.  The rate established under this 
 92.4   section shall not exceed the state average monthly nursing home 
 92.5   payment for the case mix classification to which the individual 
 92.6   receiving foster care is assigned; the rate must allow for other 
 92.7   waiver and medical assistance home care services to be 
 92.8   authorized by the case manager. 
 92.9      (g) The assisted living and residential care service rates 
 92.10  for elderly and community alternatives for disabled individuals 
 92.11  (CADI) waivers shall be made to the vendor as a monthly rate 
 92.12  negotiated with the county agency.  The rate shall not exceed 
 92.13  the nonfederal share of the greater of either the statewide or 
 92.14  any of the geographic groups' weighted average monthly medical 
 92.15  assistance nursing facility payment rate of the case mix 
 92.16  resident class to which the elderly or disabled client would be 
 92.17  assigned under Minnesota Rules, parts 9549.0050 to 9549.0059.  
 92.18  For alternative care assisted living projects established under 
 92.19  Laws 1988, chapter 689, article 2, section 256, monthly rates 
 92.20  may not exceed 65 percent of the greater of either the statewide 
 92.21  or any of the geographic groups' weighted average monthly 
 92.22  medical assistance nursing facility payment rate for the case 
 92.23  mix resident class to which the elderly or disabled client would 
 92.24  be assigned under Minnesota Rules, parts 9549.0050 to 
 92.25  9549.0059.  The rate may not cover direct rent or food costs. 
 92.26     (h) The county shall negotiate individual rates with 
 92.27  vendors and may be reimbursed for actual costs up to the greater 
 92.28  of the county's current approved rate or 60 percent of the 
 92.29  maximum rate in fiscal year 1994 and 65 percent of the maximum 
 92.30  rate in fiscal year 1995 for each service within each program. 
 92.31     (i) On July 1, 1993, the commissioner shall increase the 
 92.32  maximum rate for home-delivered meals to $4.50 per meal. 
 92.33     (j) Reimbursement for the medical assistance recipients 
 92.34  under the approved waiver shall be made from the medical 
 92.35  assistance account through the invoice processing procedures of 
 92.36  the department's Medicaid Management Information System (MMIS), 
 93.1   only with the approval of the client's case manager.  The budget 
 93.2   for the state share of the Medicaid expenditures shall be 
 93.3   forecasted with the medical assistance budget, and shall be 
 93.4   consistent with the approved waiver.  
 93.5      (k) Beginning July 1, 1991, the state shall reimburse 
 93.6   counties according to the payment schedule in section 256.025 
 93.7   for the county share of costs incurred under this subdivision on 
 93.8   or after January 1, 1991, for individuals who are receiving 
 93.9   medical assistance. 
 93.10     (l) For the community alternatives for disabled individuals 
 93.11  waiver, and nursing facility disabled waivers, county may use 
 93.12  waiver funds for the cost of minor adaptations to a client's 
 93.13  residence or vehicle without prior approval from the 
 93.14  commissioner if there is no other source of funding and the 
 93.15  adaptation: 
 93.16     (1) is necessary to avoid institutionalization; 
 93.17     (2) has no utility apart from the needs of the client; and 
 93.18     (3) meets the criteria in Minnesota Rules, part 9505.0210, 
 93.19  items A and B.  
 93.20  For purposes of this subdivision, "residence" means the client's 
 93.21  own home, the client's family residence, or a family foster 
 93.22  home.  For purposes of this subdivision, "vehicle" means the 
 93.23  client's vehicle, the client's family vehicle, or the client's 
 93.24  family foster home vehicle. 
 93.25     (m) The commissioner shall establish a maximum rate unit 
 93.26  for baths provided by an adult day care provider that are not 
 93.27  included in the provider's contractual daily or hourly rate.  
 93.28  This rate must equal the home health aide extended rate and 
 93.29  shall be paid for baths provided to clients served under the 
 93.30  elderly and disabled waivers.  The commissioner shall eliminate 
 93.31  the daily adult day care rate for the alternative care and 
 93.32  elderly waiver program.  
 93.33     Sec. 14.  Minnesota Statutes 1996, section 256B.49, is 
 93.34  amended by adding a subdivision to read: 
 93.35     Subd. 9.  [PREVOCATIONAL AND SUPPORT EMPLOYMENT 
 93.36  SERVICES.] The commissioner shall seek to amend the community 
 94.1   alternatives for disabled individuals waivers and the traumatic 
 94.2   brain injury waivers to include prevocational and support 
 94.3   employment services. 
 94.4      Sec. 15.  Minnesota Statutes 1996, section 256B.69, 
 94.5   subdivision 2, is amended to read: 
 94.6      Subd. 2.  [DEFINITIONS.] For the purposes of this section, 
 94.7   the following terms have the meanings given.  
 94.8      (a) "Commissioner" means the commissioner of human services.
 94.9   For the remainder of this section, the commissioner's 
 94.10  responsibilities for methods and policies for implementing the 
 94.11  project will be proposed by the project advisory committees and 
 94.12  approved by the commissioner.  
 94.13     (b) "Demonstration provider" means ~~an individual, agency,~~ 
 94.14  ~~organization, or group of these entities~~ a health maintenance 
 94.15  organization or community integrated service network authorized 
 94.16  and operating under chapter 62D or 62N that participates in the 
 94.17  demonstration project according to criteria, standards, methods, 
 94.18  and other requirements established for the project and approved 
 94.19  by the commissioner.  Notwithstanding the above, Itasca county 
 94.20  may continue to participate as a demonstration provider until 
 94.21  July 1, 2000. 
 94.22     (c) "Eligible individuals" means those persons eligible for 
 94.23  medical assistance benefits as defined in sections 256B.055, 
 94.24  256B.056, and 256B.06. 
 94.25     (d) "Limitation of choice" means suspending freedom of 
 94.26  choice while allowing eligible individuals to choose among the 
 94.27  demonstration providers.  
 94.28     (e) This paragraph supersedes paragraph (c) as long as the 
 94.29  Minnesota health care reform waiver remains in effect.  When the 
 94.30  waiver expires, this paragraph expires and the commissioner of 
 94.31  human services shall publish a notice in the State Register and 
 94.32  notify the revisor of statutes.  "Eligible individuals" means 
 94.33  those persons eligible for medical assistance benefits as 
 94.34  defined in sections 256B.055, 256B.056, and 256B.06.  
 94.35  Notwithstanding sections 256B.055, 256B.056, and 256B.06, an 
 94.36  individual who becomes ineligible for the program because of 
 95.1   failure to submit income reports or recertification forms in a 
 95.2   timely manner, shall remain enrolled in the prepaid health plan 
 95.3   and shall remain eligible to receive medical assistance coverage 
 95.4   through the last day of the month following the month in which 
 95.5   the enrollee became ineligible for the medical assistance 
 95.6   program. 
 95.7      Sec. 16.  Minnesota Statutes 1996, section 256B.69, 
 95.8   subdivision 3a, is amended to read: 
 95.9      Subd. 3a.  [COUNTY AUTHORITY.] (a) The commissioner, when 
 95.10  implementing the general assistance medical care, or medical 
 95.11  assistance prepayment program within a county, must include the 
 95.12  county board in the process of development, approval, and 
 95.13  issuance of the request for proposals to provide services to 
 95.14  eligible individuals within the proposed county.  County boards 
 95.15  must be given reasonable opportunity to make recommendations 
 95.16  regarding the development, issuance, review of responses, and 
 95.17  changes needed in the request for proposals.  The commissioner 
 95.18  must provide county boards the opportunity to review each 
 95.19  proposal based on the identification of community needs under 
 95.20  chapters 145A and 256E and county advocacy activities.  If a 
 95.21  county board finds that a proposal does not address certain 
 95.22  community needs, the county board and commissioner shall 
 95.23  continue efforts for improving the proposal and network prior to 
 95.24  the approval of the contract.  The county board shall make 
 95.25  recommendations regarding the approval of local networks and 
 95.26  their operations to ensure adequate availability and access to 
 95.27  covered services.  The provider or health plan must respond 
 95.28  directly to county advocates and the state prepaid medical 
 95.29  assistance ombudsperson regarding service delivery and must be 
 95.30  accountable to the state regarding contracts with medical 
 95.31  assistance and general assistance medical care funds.  The 
 95.32  county board may recommend a maximum number of participating 
 95.33  health plans after considering the size of the enrolling 
 95.34  population; ensuring adequate access and capacity; considering 
 95.35  the client and county administrative complexity; and considering 
 95.36  the need to promote the viability of locally developed health 
 96.1   plans.  The county board or a single entity representing a group 
 96.2   of county boards and the commissioner shall mutually select 
 96.3   health plans for participation at the time of initial 
 96.4   implementation of the prepaid medical assistance program in that 
 96.5   county or group of counties and at the time of contract renewal. 
 96.6   The commissioner shall also seek input for contract requirements 
 96.7   from the county or single entity representing a group of county 
 96.8   boards at each contract renewal and incorporate those 
 96.9   recommendations into the contract negotiation process.  The 
 96.10  commissioner, in conjunction with the county board, shall 
 96.11  actively seek to develop a mutually agreeable timetable prior to 
 96.12  the development of the request for proposal, but counties must 
 96.13  agree to initial enrollment beginning on or before January 1, 
 96.14  1999, in either the prepaid medical assistance and general 
 96.15  assistance medical care programs or county-based purchasing 
 96.16  under section 256B.692.  At least 90 days before enrollment in 
 96.17  the medical assistance and general assistance medical care 
 96.18  prepaid programs begins in a county in which the prepaid 
 96.19  programs have not been established, the commissioner shall 
 96.20  provide a report to the chairs of senate and house committees 
 96.21  having jurisdiction over state health care programs which 
 96.22  verifies that the commissioner complied with the requirements 
 96.23  for county involvement that are specified in this subdivision. 
 96.24     (b) The commissioner shall seek a federal waiver to allow a 
 96.25  fee-for-service plan option to MinnesotaCare enrollees.  The 
 96.26  commissioner shall develop an increase of the premium fees 
 96.27  required under section 256.9356 up to 20 percent of the premium 
 96.28  fees for the enrollees who elect the fee-for-service option.  
 96.29  Prior to implementation, the commissioner shall submit this fee 
 96.30  schedule to the chair and ranking minority member of the senate 
 96.31  health care committee, the senate health care and family 
 96.32  services funding division, the house of representatives health 
 96.33  and human services committee, and the house of representatives 
 96.34  health and human services finance division. 
 96.35     (c) At the option of the county board, the board may 
 96.36  develop contract requirements related to the achievement of 
 97.1   local public health goals to meet the health needs of medical 
 97.2   assistance and general assistance medical care enrollees.  These 
 97.3   requirements must be reasonably related to the performance of 
 97.4   health plan functions and within the scope of the medical 
 97.5   assistance and general assistance medical care benefit sets.  If 
 97.6   the county board and the commissioner mutually agree to such 
 97.7   requirements, the department shall include such requirements in 
 97.8   all health plan contracts governing the prepaid medical 
 97.9   assistance and general assistance medical care programs in that 
 97.10  county at initial implementation of the program in that county 
 97.11  and at the time of contract renewal.  The county board may 
 97.12  participate in the enforcement of the contract provisions 
 97.13  related to local public health goals. 
 97.14     (d) For counties in which prepaid medical assistance and 
 97.15  general assistance medical care programs have not been 
 97.16  established, the commissioner shall not implement those programs 
 97.17  if a county board submits acceptable and timely preliminary and 
 97.18  final proposals under section 256B.692, until county-based 
 97.19  purchasing is no longer operational in that county.  For 
 97.20  counties in which prepaid medical assistance and general 
 97.21  assistance medical care programs are in existence on or after 
 97.22  September 1, 1997, the commissioner must terminate contracts 
 97.23  with health plans according to section 256B.692, subdivision 5, 
 97.24  if the county board submits and the commissioner accepts 
 97.25  preliminary and final proposals according to that subdivision. 
 97.26     (e) In the event that a county board or a single entity 
 97.27  representing a group of county boards and the commissioner 
 97.28  cannot reach agreement regarding:  (i) the selection of 
 97.29  participating health plans in that county; (ii) contract 
 97.30  requirements; or (iii) implementation and enforcement of county 
 97.31  requirements including provisions regarding local public health 
 97.32  goals, the commissioner shall resolve all disputes after taking 
 97.33  into account the recommendations of a three-person mediation 
 97.34  panel.  The panel shall be composed of one designee of the 
 97.35  president of the association of Minnesota counties, one designee 
 97.36  of the commissioner of human services, and one designee of the 
 98.1   commissioner of health. 
 98.2      Sec. 17.  Minnesota Statutes 1996, section 256B.69, 
 98.3   subdivision 5, is amended to read: 
 98.4      Subd. 5.  [PROSPECTIVE PER CAPITA PAYMENT.] The 
 98.5   commissioner shall establish the method and amount of payments 
 98.6   for services.  The commissioner shall annually contract with 
 98.7   demonstration providers to provide services consistent with 
 98.8   these established methods and amounts for payment.  
 98.9   ~~Notwithstanding section 62D.02, subdivision 1, payments for~~ 
 98.10  ~~services rendered as part of the project may be made to~~ 
 98.11  ~~providers that are not licensed health maintenance organizations~~ 
 98.12  ~~on a risk-based, prepaid capitation basis.~~  
 98.13     If allowed by the commissioner, a demonstration provider 
 98.14  may contract with an insurer, health care provider, nonprofit 
 98.15  health service plan corporation, or the commissioner, to provide 
 98.16  insurance or similar protection against the cost of care 
 98.17  provided by the demonstration provider or to provide coverage 
 98.18  against the risks incurred by demonstration providers under this 
 98.19  section.  The recipients enrolled with a demonstration provider 
 98.20  are a permissible group under group insurance laws and chapter 
 98.21  62C, the Nonprofit Health Service Plan Corporations Act.  Under 
 98.22  this type of contract, the insurer or corporation may make 
 98.23  benefit payments to a demonstration provider for services 
 98.24  rendered or to be rendered to a recipient.  Any insurer or 
 98.25  nonprofit health service plan corporation licensed to do 
 98.26  business in this state is authorized to provide this insurance 
 98.27  or similar protection.  
 98.28     Payments to providers participating in the project are 
 98.29  exempt from the requirements of sections 256.966 and 256B.03, 
 98.30  subdivision 2.  The commissioner shall complete development of 
 98.31  capitation rates for payments before delivery of services under 
 98.32  this section is begun.  For payments made during calendar year 
 98.33  1990 and later years, the commissioner shall contract with an 
 98.34  independent actuary to establish prepayment rates. 
 98.35     By January 15, 1996, the commissioner shall report to the 
 98.36  legislature on the methodology used to allocate to participating 
 99.1   counties available administrative reimbursement for advocacy and 
 99.2   enrollment costs.  The report shall reflect the commissioner's 
 99.3   judgment as to the adequacy of the funds made available and of 
 99.4   the methodology for equitable distribution of the funds.  The 
 99.5   commissioner must involve participating counties in the 
 99.6   development of the report. 
 99.7      Sec. 18.  Minnesota Statutes 1996, section 256B.69, 
 99.8   subdivision 5b, is amended to read: 
 99.9      Subd. 5b.  [PROSPECTIVE REIMBURSEMENT RATES.] For prepaid 
 99.10  medical assistance and general assistance medical care program 
 99.11  contract rates set by the commissioner under subdivision 5 and 
 99.12  effective on or after January 1, ~~1997, through December 31,~~ 
 99.13  1998, capitation rates for nonmetropolitan counties shall on a 
 99.14  weighted average be no less than ~~85~~ 90 percent of the capitation 
 99.15  rates for metropolitan counties, excluding Hennepin county.  The 
 99.16  commissioner shall make a pro rata adjustment in capitation 
 99.17  rates paid to counties other than nonmetropolitan counties in 
 99.18  order to make this provision budget neutral. 
 99.19     Sec. 19.  Minnesota Statutes 1996, section 256B.69, is 
 99.20  amended by adding a subdivision to read: 
 99.21     Subd. 5c.  [MEDICAL EDUCATION AND RESEARCH TRUST 
 99.22  FUND.] Beginning January 1998 and each month after: 
 99.23     (a) The commissioner of human services shall transfer 4.2 
 99.24  percent of the prepaid medical assistance and prepaid general 
 99.25  assistance medical care payment, excluding nursing facility and 
 99.26  elderly waiver payments, and 2.2 percent of the MinnesotaCare 
 99.27  payment made for the same month to the medical education and 
 99.28  research trust fund established under section 62J.69.  
 99.29     (b) The county medical assistance and general assistance 
 99.30  medical care capitation base rate prior to plan specific 
 99.31  adjustments shall be reduced 6.3 percent for Hennepin county, 
 99.32  two percent for the remaining metropolitan counties, and 1.6 
 99.33  percent for the nonmetropolitan Minnesota counties, and 2.2 
 99.34  percent for MinnesotaCare in all counties.  
 99.35     (c) The amount calculated under paragraph (a) shall not be 
 99.36  adjusted for subsequent changes to the capitation payments for 
100.1   periods already paid.  This subdivision shall be effective each 
100.2   month a federal waiver allows federal financial participation in 
100.3   the medical education and research fund.  If the waiver delays 
100.4   implementation beyond January 1998, the transfer shall include 
100.5   all payments that would have been made under this subdivision if 
100.6   approved in the waiver. 
100.7      Sec. 20.  Minnesota Statutes 1996, section 256B.69, is 
100.8   amended by adding a subdivision to read: 
100.9      Subd. 24.  [ENROLLMENT PROHIBITION.] Persons eligible for 
100.10  services under section 256B.0915 who have income in excess of 
100.11  the level permitted under section 256B.056 without a spenddown 
100.12  but below the MSA equivalent rate as defined in section 256I.03, 
100.13  subdivision 5, plus the medical assistance personal needs 
100.14  allowance as defined in section 256B.35, subdivision 1, 
100.15  paragraph (a), shall not be enrolled in the prepaid medical 
100.16  assistance program under this section without the approval of 
100.17  the legislature.  People who were enrolled in PMAP prior to the 
100.18  effective date of section 12 shall not be required to disenroll 
100.19  from PMAP.  
100.20     Sec. 21.  [256B.692] [COUNTY-BASED PURCHASING.] 
100.21     Subdivision 1.  [IN GENERAL.] County boards or groups of 
100.22  county boards may elect to purchase or provide health care 
100.23  services on behalf of persons eligible for medical assistance 
100.24  and general assistance medical care who would otherwise be 
100.25  required to or may elect to participate in the prepaid medical 
100.26  assistance or prepaid general assistance medical care programs 
100.27  according to sections 256B.69 and 256D.03.  Counties that elect 
100.28  to purchase or provide health care under this section must 
100.29  provide all services included in prepaid managed care programs 
100.30  according to sections 256B.69, subdivisions 1 to 22, and 
100.31  256D.03.  County-based purchasing under this section is governed 
100.32  by section 256B.69, unless otherwise provided for under this 
100.33  section. 
100.34     Subd. 2.  [DUTIES OF THE COMMISSIONER OF HEALTH.] 
100.35  Notwithstanding chapters 62D and 62N, a county that elects to 
100.36  purchase medical assistance and general assistance medical care 
101.1   in return for a fixed sum without regard to the frequency or 
101.2   extent of services furnished to any particular enrollee is not 
101.3   required to obtain a certificate of authority under chapter 62D 
101.4   or 62N.  A county that elects to purchase medical assistance and 
101.5   general assistance medical care services under this section must 
101.6   satisfy the commissioner of health that the requirements of 
101.7   chapter 62D, applicable to health maintenance organizations, or 
101.8   chapter 62N, applicable to community integrated service 
101.9   networks, will be met.  A county must also ensure the 
101.10  commissioner of health that the requirements of section 72A.201 
101.11  will be met.  All enforcement and rulemaking powers available 
101.12  under chapters 62D and 62N are hereby granted to the 
101.13  commissioner of health with respect to counties that purchase 
101.14  medical assistance and general assistance medical care services 
101.15  under this section. 
101.16     Subd. 3.  [REQUIREMENTS OF THE COUNTY BOARD.] A county 
101.17  board that intends to purchase or provide health care under this 
101.18  section, which may include purchasing all or part of these 
101.19  services from health plans or individual providers on a 
101.20  fee-for-service basis, or providing these services directly, 
101.21  must demonstrate the ability to follow and agree to the 
101.22  following requirements: 
101.23     (1) purchase all covered services for a fixed payment from 
101.24  the state that does not exceed the estimated state and federal 
101.25  cost that would have occurred under the prepaid medical 
101.26  assistance and general assistance medical care programs; 
101.27     (2) ensure that covered services are accessible to all 
101.28  enrollees and that enrollees have a reasonable choice of 
101.29  providers, health plans, or networks when possible.  If the 
101.30  county is also a provider of service, the county board shall 
101.31  develop a process to ensure that providers employed by the 
101.32  county are not the sole referral source and are not the sole 
101.33  provider of health care services if other providers, which meet 
101.34  the same quality and cost requirements are available; 
101.35     (3) issue payments to participating vendors or networks in 
101.36  a timely manner; 
102.1      (4) establish a process to ensure and improve the quality 
102.2   of care provided; 
102.3      (5) provide appropriate quality and other required data in 
102.4   a format required by the state; 
102.5      (6) provide a system for advocacy, enrollee protection, and 
102.6   complaints and appeals that is independent of care providers or 
102.7   other risk bearers and complies with section 256B.69; 
102.8      (7) for counties within the seven-county metropolitan area, 
102.9   ensure that the implementation and operation of the Minnesota 
102.10  senior health options demonstration project, authorized under 
102.11  section 256B.69, subdivision 23, will not be impeded; 
102.12     (8) ensure that all recipients that are enrolled in the 
102.13  prepaid medical assistance or general assistance medical care 
102.14  program will be transferred to county-based purchasing without 
102.15  utilizing the department's fee-for-service claims payment 
102.16  system; 
102.17     (9) ensure that all recipients who are required to 
102.18  participate in county-based purchasing are given sufficient 
102.19  information prior to enrollment in order to make informed 
102.20  decisions; and 
102.21     (10) ensure that the state and the medical assistance and 
102.22  general assistance medical care recipients will be held harmless 
102.23  for the payment of obligations incurred by the county if the 
102.24  county, or a health plan providing services on behalf of the 
102.25  county, or a provider participating in county-based purchasing 
102.26  becomes insolvent, and the state has made the payments due to 
102.27  the county under this section. 
102.28     Subd. 4.  [PAYMENTS TO COUNTIES.] The commissioner shall 
102.29  pay counties that are purchasing or providing health care under 
102.30  this section a per capita payment for all enrolled recipients.  
102.31  Payments shall not exceed payments that otherwise would have 
102.32  been paid to health plans under medical assistance and general 
102.33  assistance medical care for that county or region.  This payment 
102.34  is in addition to any administrative allocation to counties for 
102.35  education, enrollment, and advocacy.  The state of Minnesota and 
102.36  the United States Department of Health and Human Services are 
103.1   not liable for any costs incurred by a county that exceed the 
103.2   payments to the county made under this subdivision.  A county 
103.3   may assign risk for the cost of care to a third party. 
103.4      Subd. 5.  [COUNTY PROPOSALS.] (a) On or before September 1, 
103.5   1997, a county board that wishes to purchase or provide health 
103.6   care under this section must submit a preliminary proposal that 
103.7   substantially demonstrates the county's ability to meet all the 
103.8   requirements of this section in response to criteria for 
103.9   proposals issued by the department on or before July 1, 1997.  
103.10  Counties submitting preliminary proposals must establish a local 
103.11  planning process that involves input from medical assistance and 
103.12  general assistance medical care recipients, recipient advocates, 
103.13  providers and representatives of local school districts, labor, 
103.14  and tribal government to advise on the development of a final 
103.15  proposal and its implementation.  
103.16     (b) The county board must submit a final proposal on or 
103.17  before July 1, 1998, that demonstrates the ability to meet all 
103.18  the requirements of this section, including beginning enrollment 
103.19  on January 1, 1999.  
103.20     (c) After January 1, 1999, for a county in which the 
103.21  prepaid medical assistance program is in existence, the county 
103.22  board must submit a preliminary proposal at least 15 months 
103.23  prior to termination of health plan contracts in that county and 
103.24  a final proposal six months prior to the health plan contract 
103.25  termination date in order to begin enrollment after the 
103.26  termination.  Nothing in this section shall impede or delay 
103.27  implementation or continuation of the prepaid medical assistance 
103.28  and general assistance medical care programs in counties for 
103.29  which the board does not submit a proposal, or submits a 
103.30  proposal that is not in compliance with this section. 
103.31     Subd. 6.  [COMMISSIONER'S AUTHORITY.] The commissioner may: 
103.32     (1) reject any preliminary or final proposal that 
103.33  substantially fails to meet the requirements of this section, or 
103.34  that the commissioner determines would substantially impair the 
103.35  state's ability to purchase health care services in other areas 
103.36  of the state, or would substantially impair an enrollee's choice 
104.1   of care systems when reasonable choice is possible, or would 
104.2   substantially impair the implementation and operation of the 
104.3   Minnesota senior health options demonstration project authorized 
104.4   under section 256B.69, subdivision 23; and 
104.5      (2) assume operation of a county's purchasing of health 
104.6   care for enrollees in medical assistance and general assistance 
104.7   medical care in the event that the contract with the county is 
104.8   terminated. 
104.9      Subd. 7.  [DISPUTE RESOLUTION.] In the event the 
104.10  commissioner rejects a proposal under subdivision 6, the county 
104.11  board may request the recommendation of a three-person mediation 
104.12  panel.  The commissioner shall resolve all disputes after taking 
104.13  into account the recommendations of the mediation panel.  The 
104.14  panel shall be composed of one designee of the president of the 
104.15  association of Minnesota counties, one designee of the 
104.16  commissioner of human services, and one designee of the 
104.17  commissioner of health. 
104.18     Subd. 8.  [APPEALS.] A county that conducts county-based 
104.19  purchasing shall be considered to be a prepaid health plan for 
104.20  purposes of section 256.045. 
104.21     Subd. 9.  [FEDERAL APPROVAL.] The commissioner shall 
104.22  request any federal waivers and federal approval required to 
104.23  implement this section.  County-based purchasing shall not be 
104.24  implemented without obtaining all federal approval required to 
104.25  maintain federal matching funds in the medical assistance 
104.26  program. 
104.27     Subd. 10.  [REPORT TO THE LEGISLATURE.] The commissioner 
104.28  shall submit a report to the legislature by February 1, 1998, on 
104.29  the preliminary proposals submitted on or before September 1, 
104.30  1997. 
104.31     Sec. 22.  Minnesota Statutes 1996, section 256D.03, 
104.32  subdivision 3b, is amended to read: 
104.33     Subd. 3b.  [COOPERATION.] General assistance or general 
104.34  assistance medical care applicants and recipients must cooperate 
104.35  with the state and local agency to identify potentially liable 
104.36  third-party payors and assist the state in obtaining third-party 
105.1   payments.  Cooperation includes identifying any third party who 
105.2   may be liable for care and services provided under this chapter 
105.3   to the applicant, recipient, or any other family member for whom 
105.4   application is made and providing relevant information to assist 
105.5   the state in pursuing a potentially liable third party.  General 
105.6   assistance medical care applicants and recipients must cooperate 
105.7   by providing information about any group health plan in which 
105.8   they may be eligible to enroll.  They must cooperate with the 
105.9   state and local agency in determining if the plan is 
105.10  cost-effective.  If the plan is determined cost-effective and 
105.11  the premium will be paid by the state or local agency or is 
105.12  available at no cost to the person, they must enroll or remain 
105.13  enrolled in the group health plan.  Effective for all premium 
105.14  payments due on or after January 1, 1998, general assistance 
105.15  medical care does not pay for premiums for health insurance 
105.16  offered by the Minnesota comprehensive health association under 
105.17  chapter 62E.  Cost-effective insurance premiums approved for 
105.18  payment by the state agency and paid by the local agency are 
105.19  eligible for reimbursement according to subdivision 6.  
105.20     Sec. 23.  Minnesota Statutes 1996, section 256G.05, 
105.21  subdivision 2, is amended to read: 
105.22     Subd. 2.  [NON-MINNESOTA RESIDENTS.] State residence is not 
105.23  required for receiving emergency assistance in the general 
105.24  assistance~~, general assistance medical care,~~ and Minnesota 
105.25  supplemental aid programs only.  The receipt of emergency 
105.26  assistance must not be used as a factor in determining county or 
105.27  state residence. 
105.28     Sec. 24.  Laws 1995, chapter 207, article 6, section 115, 
105.29  is amended to read: 
105.30     Sec. 115.  [CONTINUATION OF PILOT PROJECTS.] 
105.31     The alternative care pilot projects authorized in Laws 
105.32  1993, First Special Session chapter 1, article 5, section 133, 
105.33  shall not expire on June 30, 1995, but shall continue until June 
105.34  30, ~~1997~~ 2001, except that the three percent rate increases 
105.35  authorized in Laws 1993, First Special Session chapter 1, 
105.36  article 1, section 2, subdivision 4, and any subsequent rate 
106.1   increases shall be incorporated in average monthly cost 
106.2   effective July 1, 1995.  Beginning July 1, 1997, a county may 
106.3   spend up to ten percent of grant funds for needed client 
106.4   services that are not listed under Minnesota Statutes, section 
106.5   256B.0913, subdivision 5.  The commissioner shall allow 
106.6   additional counties at their option to implement the alternative 
106.7   care program within the parameters established in Laws 1993, 
106.8   First Special Session chapter 1, article 5, section 133.  If 
106.9   more than five counties exercise this option, the commissioner 
106.10  may require counties to make this change on a phased schedule if 
106.11  necessary in order to implement this provision within the limit 
106.12  of available resources.  For newly participating counties, the 
106.13  previous fiscal year shall be the base year. 
106.14     Sec. 25.  [STUDY OF ELDERLY WAIVER EXPANSION.] 
106.15     The commissioner of human services shall appoint a task 
106.16  force that includes representatives of counties, health plans, 
106.17  consumers, and legislators to study the impact of the expansion 
106.18  of the elderly waiver program under section 3 and to make 
106.19  recommendations for any changes in law necessary to facilitate 
106.20  an efficient and equitable relationship between the elderly 
106.21  waiver program and the Minnesota senior health options project.  
106.22  The commissioner shall report the results of the task force 
106.23  study to the legislature by January 15, 1998. 
106.24     Sec. 26.  [FEDERAL WAIVER REQUEST.] 
106.25     The commissioner of human services, in consultation with 
106.26  the state waivered services advisory committee, shall prepare a 
106.27  federal medical assistance waiver request to be submitted by 
106.28  October 1, 1997, seeking broad flexibility to define eligible 
106.29  services while maintaining accountability by limiting average 
106.30  waiver client costs to 97 percent of the statewide average 
106.31  payment rate of the case mix resident class to which the waiver 
106.32  client would be assigned.  The goal of the waiver is to 
106.33  authorize the flexible use of medical assistance funds for 
106.34  community support to prevent or delay nursing home admissions.  
106.35  Flexibility should be sought in order to allow the elderly 
106.36  waiver program to more quickly adopt new cost effective 
107.1   therapies and services that will better achieve desired client 
107.2   outcome and cost containment goals.  The commissioner must seek 
107.3   authority to delegate the fiscal management responsibility for 
107.4   the elderly waiver program to counties or groups of counties.  
107.5   Upon approval of the waiver, the commissioner, in consultation 
107.6   with the advisory committee, shall prepare an implementation 
107.7   proposal for presentation to the 1998 legislature.  
107.8      Sec. 27.  [MCHA TERMINATION NOTICE.] 
107.9      (a) The Minnesota comprehensive health association, in 
107.10  consultation with the commissioner of human services, shall 
107.11  provide written notice to all persons whose coverage under the 
107.12  comprehensive health insurance plan terminates due to the change 
107.13  in policy described in Minnesota Statutes, sections 256B.0625, 
107.14  subdivision 19, and 256D.03, subdivision 3b. 
107.15     The notice must include the following information: 
107.16     (1) the reason for termination; 
107.17     (2) a description of the eligibility requirements for the 
107.18  comprehensive health insurance plan; 
107.19     (3) a description of medical assistance and general 
107.20  assistance medical care eligibility categories; 
107.21     (4) a description of the participation requirements to the 
107.22  prepaid medical assistance program, prepaid general assistance 
107.23  medical care, and exemptions from participation due to 
107.24  disability as determined by the social security administration; 
107.25  and 
107.26     (5) a telephone number for the department of human services 
107.27  for specific questions regarding the medical assistance and 
107.28  general assistance medical care program. 
107.29  Notice must be given at least six months before coverage is 
107.30  terminated. 
107.31     (b) The commissioner of human services shall release to the 
107.32  association any data necessary to provide the notice required in 
107.33  paragraph (a). 
107.34     Sec. 28.  [PERSONAL CARE SERVICES STUDY.] 
107.35     The commissioner of human services shall formulate 
107.36  recommendations on how to allow recipients of medical assistance 
108.1   who have been diagnosed with autism or other disabilities to use 
108.2   personal care services with more flexibility to meet individual 
108.3   client needs and preferences.  The commissioner may convene an 
108.4   advisory task force as authorized under Minnesota Statutes, 
108.5   section 15.014, subdivision 2, to assist in formulating these 
108.6   recommendations.  If a task force is convened, it shall be 
108.7   comprised of department of human services staff from the adult 
108.8   mental health, children's mental health, home- and 
108.9   community-based services, and developmental disabilities 
108.10  divisions, as well as consumers of personal care services, 
108.11  advocates, and providers of personal care attendant services.  A 
108.12  report with recommendations that outlines how consumer-centered 
108.13  planning and flexible use of funds can be implemented by July 1, 
108.14  1998, must be presented to the legislature by December 15, 1997. 
108.15     Sec. 29.  [INTEGRATION OF MINNESOTACARE WITH COUNTY-BASED 
108.16  PURCHASING.] 
108.17     The commissioner of human services shall develop a plan to 
108.18  integrate the MinnesotaCare program with county-based 
108.19  purchasing.  The plan must permit a county that elects to 
108.20  implement county-based purchasing to elect to purchase or 
108.21  provide health services on behalf of persons eligible for the 
108.22  MinnesotaCare program.  The commissioner shall submit the plan 
108.23  to the legislature by February 1, 1998. 
108.24     Sec. 30.  [OMBUDSPERSON SERVICES.] 
108.25     The commissioner shall make recommendations to the 
108.26  legislature by January 15, 1998, on how the ombudsperson 
108.27  services and prepayment coordinator services established in 
108.28  Minnesota Statutes, section 256B.69, subdivisions 20 and 21, 
108.29  could be reorganized to ensure that the ombudsman and county 
108.30  prepayment coordinator are independent of the department of 
108.31  human services, county authorities, health plans, or other 
108.32  health care providers.  The commissioner must seek input from 
108.33  recipients, advocates, and counties in reorganizing the 
108.34  ombudsman and county advocate system. 
108.35     Sec. 31.  [REPEALER.] 
108.36     (a) Minnesota Statutes 1996, section 256B.0625, subdivision 
109.1   13b, is repealed the day following final enactment. 
109.2      (b) Minnesota Rules, part 9505.1000, is repealed July 1, 
109.3   1997. 
109.4      (c) Minnesota Statutes 1996, sections 144.0721, subdivision 
109.5   3; and 256B.0911, subdivision 4, are repealed. 
109.6                              ARTICLE 5
109.7                         CHILDREN'S PROGRAMS
109.8      Section 1.  Minnesota Statutes 1996, section 245.4882, 
109.9   subdivision 5, is amended to read: 
109.10     Subd. 5.  [SPECIALIZED RESIDENTIAL TREATMENT SERVICES.] The 
109.11  commissioner of human services shall continue efforts to further 
109.12  interagency collaboration to develop a comprehensive system of 
109.13  services, including family community support and specialized 
109.14  residential treatment services for children.  The services shall 
109.15  be designed for children with emotional disturbance who exhibit 
109.16  violent or destructive behavior and for whom local treatment 
109.17  services are not feasible due to the small number of children 
109.18  statewide who need the services and the specialized nature of 
109.19  the services required.  The services shall be located in 
109.20  community settings.  ~~If no appropriate services are available in~~ 
109.21  ~~Minnesota or within the geographical area in which the residents~~ 
109.22  ~~of the county normally do business, the commissioner is~~ 
109.23  ~~responsible, effective July 1, 1997, for 50 percent of the~~ 
109.24  ~~nonfederal costs of out-of-state treatment of children for whom~~ 
109.25  ~~no appropriate resources are available in Minnesota.  Counties~~ 
109.26  ~~are eligible to receive enhanced state funding under this~~ 
109.27  ~~section only if they have established juvenile screening teams~~ 
109.28  ~~under section 260.151, subdivision 3, and if the out-of-state~~ 
109.29  ~~treatment has been approved by the commissioner.  By January 1,~~ 
109.30  ~~1995, the commissioners of human services and corrections shall~~ 
109.31  ~~jointly develop a plan, including a financing strategy, for~~ 
109.32  ~~increasing the in-state availability of treatment within a~~ 
109.33  ~~secure setting.  By July 1, 1994, the commissioner of human~~ 
109.34  ~~services shall also:~~ 
109.35     ~~(1) conduct a study and develop a plan to meet the needs of~~ 
109.36  ~~children with both a developmental disability and severe~~ 
110.1   ~~emotional disturbance; and~~ 
110.2      ~~(2) study the feasibility of expanding medical assistance~~ 
110.3   ~~coverage to include specialized residential treatment for the~~ 
110.4   ~~children described in this subdivision.~~  
110.5      Sec. 2.  Minnesota Statutes 1996, section 245.493, 
110.6   subdivision 1, is amended to read: 
110.7      Subdivision 1.  [REQUIREMENTS TO QUALIFY AS A LOCAL 
110.8   CHILDREN'S MENTAL HEALTH COLLABORATIVE.] In order to qualify as 
110.9   a local children's mental health collaborative and be eligible 
110.10  to receive start-up funds, the representatives of the local 
110.11  system of care, including entities provided under section 
110.12  245.4875, subdivision 6, and nongovernmental entities such as 
110.13  parents of children in the target population; parent and 
110.14  consumer organizations; community, civic, and religious 
110.15  organizations; private and nonprofit mental and physical health 
110.16  care providers; culturally specific organizations; local 
110.17  foundations; and businesses, or at a minimum one county, one 
110.18  school district or special education cooperative, ~~and~~ one mental 
110.19  health entity, and, by July 1, 1998, one juvenile justice or 
110.20  corrections entity, must agree to the following: 
110.21     (1) to establish a local children's mental health 
110.22  collaborative and develop an integrated service system; and 
110.23     (2) to commit resources to providing services through the 
110.24  local children's mental health collaborative. 
110.25     Sec. 3.  Minnesota Statutes 1996, section 245.493, is 
110.26  amended by adding a subdivision to read: 
110.27     Subd. 1a.  [DUTIES OF CERTAIN COORDINATING BODIES.] By 
110.28  mutual agreement of the collaborative and a coordinating body 
110.29  listed in this subdivision, a children's mental health 
110.30  collaborative or a collaborative established by the merger of a 
110.31  children's mental health collaborative and a family services 
110.32  collaborative under section 121.8355, may assume the duties of a 
110.33  community transition interagency committee established under 
110.34  section 120.17, subdivision 16; an interagency early 
110.35  intervention committee established under 120.1701, subdivision 
110.36  5; a local advisory council established under section 245.4875, 
111.1   subdivision 5; or a local coordinating council established under 
111.2   section 245.4875, subdivision 6. 
111.3      Sec. 4.  Minnesota Statutes 1996, section 256.01, 
111.4   subdivision 2, is amended to read: 
111.5      Subd. 2.  [SPECIFIC POWERS.] Subject to the provisions of 
111.6   section 241.021, subdivision 2, the commissioner of human 
111.7   services shall: 
111.8      (1) Administer and supervise all forms of public assistance 
111.9   provided for by state law and other welfare activities or 
111.10  services as are vested in the commissioner.  Administration and 
111.11  supervision of human services activities or services includes, 
111.12  but is not limited to, assuring timely and accurate distribution 
111.13  of benefits, completeness of service, and quality program 
111.14  management.  In addition to administering and supervising human 
111.15  services activities vested by law in the department, the 
111.16  commissioner shall have the authority to: 
111.17     (a) require county agency participation in training and 
111.18  technical assistance programs to promote compliance with 
111.19  statutes, rules, federal laws, regulations, and policies 
111.20  governing human services; 
111.21     (b) monitor, on an ongoing basis, the performance of county 
111.22  agencies in the operation and administration of human services, 
111.23  enforce compliance with statutes, rules, federal laws, 
111.24  regulations, and policies governing welfare services and promote 
111.25  excellence of administration and program operation; 
111.26     (c) develop a quality control program or other monitoring 
111.27  program to review county performance and accuracy of benefit 
111.28  determinations; 
111.29     (d) require county agencies to make an adjustment to the 
111.30  public assistance benefits issued to any individual consistent 
111.31  with federal law and regulation and state law and rule and to 
111.32  issue or recover benefits as appropriate; 
111.33     (e) delay or deny payment of all or part of the state and 
111.34  federal share of benefits and administrative reimbursement 
111.35  according to the procedures set forth in section 256.017; and 
111.36     (f) make contracts with and grants to public and private 
112.1   agencies and organizations, both profit and nonprofit, and 
112.2   individuals, using appropriated funds. 
112.3      (2) Inform county agencies, on a timely basis, of changes 
112.4   in statute, rule, federal law, regulation, and policy necessary 
112.5   to county agency administration of the programs. 
112.6      (3) Administer and supervise all child welfare activities; 
112.7   promote the enforcement of laws protecting handicapped, 
112.8   dependent, neglected and delinquent children, and children born 
112.9   to mothers who were not married to the children's fathers at the 
112.10  times of the conception nor at the births of the children; 
112.11  license and supervise child-caring and child-placing agencies 
112.12  and institutions; supervise the care of children in boarding and 
112.13  foster homes or in private institutions; and generally perform 
112.14  all functions relating to the field of child welfare now vested 
112.15  in the state board of control. 
112.16     (4) Administer and supervise all noninstitutional service 
112.17  to handicapped persons, including those who are visually 
112.18  impaired, hearing impaired, or physically impaired or otherwise 
112.19  handicapped.  The commissioner may provide and contract for the 
112.20  care and treatment of qualified indigent children in facilities 
112.21  other than those located and available at state hospitals when 
112.22  it is not feasible to provide the service in state hospitals. 
112.23     (5) Assist and actively cooperate with other departments, 
112.24  agencies and institutions, local, state, and federal, by 
112.25  performing services in conformity with the purposes of Laws 
112.26  1939, chapter 431. 
112.27     (6) Act as the agent of and cooperate with the federal 
112.28  government in matters of mutual concern relative to and in 
112.29  conformity with the provisions of Laws 1939, chapter 431, 
112.30  including the administration of any federal funds granted to the 
112.31  state to aid in the performance of any functions of the 
112.32  commissioner as specified in Laws 1939, chapter 431, and 
112.33  including the promulgation of rules making uniformly available 
112.34  medical care benefits to all recipients of public assistance, at 
112.35  such times as the federal government increases its participation 
112.36  in assistance expenditures for medical care to recipients of 
113.1   public assistance, the cost thereof to be borne in the same 
113.2   proportion as are grants of aid to said recipients. 
113.3      (7) Establish and maintain any administrative units 
113.4   reasonably necessary for the performance of administrative 
113.5   functions common to all divisions of the department. 
113.6      (8) Act as designated guardian of both the estate and the 
113.7   person of all the wards of the state of Minnesota, whether by 
113.8   operation of law or by an order of court, without any further 
113.9   act or proceeding whatever, except as to persons committed as 
113.10  mentally retarded.  For children under the guardianship of the 
113.11  commissioner whose interests would be best served by adoptive 
113.12  placement, the commissioner may contract with a licensed 
113.13  child-placing agency to provide adoption services.  A contract 
113.14  with a licensed child-placing agency must be designed to 
113.15  supplement existing county efforts and may not replace existing 
113.16  county programs, unless the replacement is agreed to by the 
113.17  county board and the appropriate exclusive bargaining 
113.18  representative or the commissioner has evidence that child 
113.19  placements of the county continue to be substantially below that 
113.20  of other counties. 
113.21     (9) Act as coordinating referral and informational center 
113.22  on requests for service for newly arrived immigrants coming to 
113.23  Minnesota. 
113.24     (10) The specific enumeration of powers and duties as 
113.25  hereinabove set forth shall in no way be construed to be a 
113.26  limitation upon the general transfer of powers herein contained. 
113.27     (11) Establish county, regional, or statewide schedules of 
113.28  maximum fees and charges which may be paid by county agencies 
113.29  for medical, dental, surgical, hospital, nursing and nursing 
113.30  home care and medicine and medical supplies under all programs 
113.31  of medical care provided by the state and for congregate living 
113.32  care under the income maintenance programs. 
113.33     (12) Have the authority to conduct and administer 
113.34  experimental projects to test methods and procedures of 
113.35  administering assistance and services to recipients or potential 
113.36  recipients of public welfare.  To carry out such experimental 
114.1   projects, it is further provided that the commissioner of human 
114.2   services is authorized to waive the enforcement of existing 
114.3   specific statutory program requirements, rules, and standards in 
114.4   one or more counties.  The order establishing the waiver shall 
114.5   provide alternative methods and procedures of administration, 
114.6   shall not be in conflict with the basic purposes, coverage, or 
114.7   benefits provided by law, and in no event shall the duration of 
114.8   a project exceed four years.  It is further provided that no 
114.9   order establishing an experimental project as authorized by the 
114.10  provisions of this section shall become effective until the 
114.11  following conditions have been met: 
114.12     (a) The proposed comprehensive plan, including estimated 
114.13  project costs and the proposed order establishing the waiver, 
114.14  shall be filed with the secretary of the senate and chief clerk 
114.15  of the house of representatives at least 60 days prior to its 
114.16  effective date. 
114.17     (b) The secretary of health, education, and welfare of the 
114.18  United States has agreed, for the same project, to waive state 
114.19  plan requirements relative to statewide uniformity. 
114.20     (c) A comprehensive plan, including estimated project 
114.21  costs, shall be approved by the legislative advisory commission 
114.22  and filed with the commissioner of administration.  
114.23     (13) In accordance with federal requirements, establish 
114.24  procedures to be followed by local welfare boards in creating 
114.25  citizen advisory committees, including procedures for selection 
114.26  of committee members. 
114.27     (14) Allocate federal fiscal disallowances or sanctions 
114.28  which are based on quality control error rates for the aid to 
114.29  families with dependent children, medical assistance, or food 
114.30  stamp program in the following manner:  
114.31     (a) One-half of the total amount of the disallowance shall 
114.32  be borne by the county boards responsible for administering the 
114.33  programs.  For the medical assistance and AFDC programs, 
114.34  disallowances shall be shared by each county board in the same 
114.35  proportion as that county's expenditures for the sanctioned 
114.36  program are to the total of all counties' expenditures for the 
115.1   AFDC and medical assistance programs.  For the food stamp 
115.2   program, sanctions shall be shared by each county board, with 50 
115.3   percent of the sanction being distributed to each county in the 
115.4   same proportion as that county's administrative costs for food 
115.5   stamps are to the total of all food stamp administrative costs 
115.6   for all counties, and 50 percent of the sanctions being 
115.7   distributed to each county in the same proportion as that 
115.8   county's value of food stamp benefits issued are to the total of 
115.9   all benefits issued for all counties.  Each county shall pay its 
115.10  share of the disallowance to the state of Minnesota.  When a 
115.11  county fails to pay the amount due hereunder, the commissioner 
115.12  may deduct the amount from reimbursement otherwise due the 
115.13  county, or the attorney general, upon the request of the 
115.14  commissioner, may institute civil action to recover the amount 
115.15  due. 
115.16     (b) Notwithstanding the provisions of paragraph (a), if the 
115.17  disallowance results from knowing noncompliance by one or more 
115.18  counties with a specific program instruction, and that knowing 
115.19  noncompliance is a matter of official county board record, the 
115.20  commissioner may require payment or recover from the county or 
115.21  counties, in the manner prescribed in paragraph (a), an amount 
115.22  equal to the portion of the total disallowance which resulted 
115.23  from the noncompliance, and may distribute the balance of the 
115.24  disallowance according to paragraph (a).  
115.25     (15) Develop and implement special projects that maximize 
115.26  reimbursements and result in the recovery of money to the 
115.27  state.  For the purpose of recovering state money, the 
115.28  commissioner may enter into contracts with third parties.  Any 
115.29  recoveries that result from projects or contracts entered into 
115.30  under this paragraph shall be deposited in the state treasury 
115.31  and credited to a special account until the balance in the 
115.32  account reaches $1,000,000.  When the balance in the account 
115.33  exceeds $1,000,000, the excess shall be transferred and credited 
115.34  to the general fund.  All money in the account is appropriated 
115.35  to the commissioner for the purposes of this paragraph. 
115.36     (16) Have the authority to make direct payments to 
116.1   facilities providing shelter to women and their children 
116.2   pursuant to section 256D.05, subdivision 3.  Upon the written 
116.3   request of a shelter facility that has been denied payments 
116.4   under section 256D.05, subdivision 3, the commissioner shall 
116.5   review all relevant evidence and make a determination within 30 
116.6   days of the request for review regarding issuance of direct 
116.7   payments to the shelter facility.  Failure to act within 30 days 
116.8   shall be considered a determination not to issue direct payments.
116.9      (17) Have the authority to establish and enforce the 
116.10  following county reporting requirements:  
116.11     (a) The commissioner shall establish fiscal and statistical 
116.12  reporting requirements necessary to account for the expenditure 
116.13  of funds allocated to counties for human services programs.  
116.14  When establishing financial and statistical reporting 
116.15  requirements, the commissioner shall evaluate all reports, in 
116.16  consultation with the counties, to determine if the reports can 
116.17  be simplified or the number of reports can be reduced. 
116.18     (b) The county board shall submit monthly or quarterly 
116.19  reports to the department as required by the commissioner.  
116.20  Monthly reports are due no later than 15 working days after the 
116.21  end of the month.  Quarterly reports are due no later than 30 
116.22  calendar days after the end of the quarter, unless the 
116.23  commissioner determines that the deadline must be shortened to 
116.24  20 calendar days to avoid jeopardizing compliance with federal 
116.25  deadlines or risking a loss of federal funding.  Only reports 
116.26  that are complete, legible, and in the required format shall be 
116.27  accepted by the commissioner.  
116.28     (c) If the required reports are not received by the 
116.29  deadlines established in clause (b), the commissioner may delay 
116.30  payments and withhold funds from the county board until the next 
116.31  reporting period.  When the report is needed to account for the 
116.32  use of federal funds and the late report results in a reduction 
116.33  in federal funding, the commissioner shall withhold from the 
116.34  county boards with late reports an amount equal to the reduction 
116.35  in federal funding until full federal funding is received.  
116.36     (d) A county board that submits reports that are late, 
117.1   illegible, incomplete, or not in the required format for two out 
117.2   of three consecutive reporting periods is considered 
117.3   noncompliant.  When a county board is found to be noncompliant, 
117.4   the commissioner shall notify the county board of the reason the 
117.5   county board is considered noncompliant and request that the 
117.6   county board develop a corrective action plan stating how the 
117.7   county board plans to correct the problem.  The corrective 
117.8   action plan must be submitted to the commissioner within 45 days 
117.9   after the date the county board received notice of noncompliance.
117.10     (e) The final deadline for fiscal reports or amendments to 
117.11  fiscal reports is one year after the date the report was 
117.12  originally due.  If the commissioner does not receive a report 
117.13  by the final deadline, the county board forfeits the funding 
117.14  associated with the report for that reporting period and the 
117.15  county board must repay any funds associated with the report 
117.16  received for that reporting period. 
117.17     (f) The commissioner may not delay payments, withhold 
117.18  funds, or require repayment under paragraph (c) or (e) if the 
117.19  county demonstrates that the commissioner failed to provide 
117.20  appropriate forms, guidelines, and technical assistance to 
117.21  enable the county to comply with the requirements.  If the 
117.22  county board disagrees with an action taken by the commissioner 
117.23  under paragraph (c) or (e), the county board may appeal the 
117.24  action according to sections 14.57 to 14.69. 
117.25     (g) Counties subject to withholding of funds under 
117.26  paragraph (c) or forfeiture or repayment of funds under 
117.27  paragraph (e) shall not reduce or withhold benefits or services 
117.28  to clients to cover costs incurred due to actions taken by the 
117.29  commissioner under paragraph (c) or (e). 
117.30     (18) Allocate federal fiscal disallowances or sanctions for 
117.31  audit exceptions when federal fiscal disallowances or sanctions 
117.32  are based on a statewide random sample for the foster care 
117.33  program under title IV-E of the Social Security Act, United 
117.34  States Code, title 42, in direct proportion to each county's 
117.35  title IV-E foster care maintenance claim for that period. 
117.36     Sec. 5.  Minnesota Statutes 1996, section 256.01, is 
118.1   amended by adding a subdivision to read: 
118.2      Subd. 14.  [CHILD WELFARE REFORM PILOTS.] The commissioner 
118.3   of human services shall encourage local reforms in the delivery 
118.4   of child welfare services and is authorized to approve local 
118.5   pilot programs which focus on reforming the child protection and 
118.6   child welfare systems in Minnesota.  Authority to approve pilots 
118.7   includes authority to waive existing state rules as needed to 
118.8   accomplish reform efforts.  Notwithstanding section 626.556, 
118.9   subdivision 10, 10b, or 10d, the commissioner may authorize 
118.10  programs to use alternative methods of investigating and 
118.11  assessing reports of child maltreatment, provided that the 
118.12  programs comply with the provisions of section 626.556 dealing 
118.13  with the rights of individuals who are subjects of reports or 
118.14  investigations, including notice and appeal rights and data 
118.15  practices requirements.  Pilot programs must be required to 
118.16  address responsibility for safety and protection of children, be 
118.17  time limited, and include evaluation of the pilot program. 
118.18     Sec. 6.  Minnesota Statutes 1996, section 256.045, 
118.19  subdivision 3, is amended to read: 
118.20     Subd. 3.  [STATE AGENCY HEARINGS.] (a) State agency 
118.21  hearings are available for the following:  (1) any person 
118.22  applying for, receiving or having received public assistance or 
118.23  a program of social services granted by the state agency or a 
118.24  county agency under sections 252.32, 256.031 to 256.036, and 
118.25  256.72 to 256.879, chapters 256B, 256D, 256E, 261, or the 
118.26  federal Food Stamp Act whose application for assistance is 
118.27  denied, not acted upon with reasonable promptness, or whose 
118.28  assistance is suspended, reduced, terminated, or claimed to have 
118.29  been incorrectly paid; (2) any patient or relative aggrieved by 
118.30  an order of the commissioner under section 252.27; (3) a party 
118.31  aggrieved by a ruling of a prepaid health plan; (4) any 
118.32  individual or facility determined by a lead agency to have 
118.33  maltreated a vulnerable adult under section 626.557 after they 
118.34  have exercised their right to administrative reconsideration 
118.35  under section 626.557; (5) any person whose claim for foster 
118.36  care payment pursuant to a placement of the child resulting from 
119.1   a child protection assessment under section 626.556 is denied or 
119.2   not acted upon with reasonable promptness, regardless of funding 
119.3   source; (6) any person to whom a right of appeal pursuant to 
119.4   this section is given by other provision of law; ~~or~~ (7) an 
119.5   applicant aggrieved by an adverse decision to an application for 
119.6   a hardship waiver under section 256B.15; or (8) an individual or 
119.7   facility determined to have maltreated a minor under section 
119.8   626.556 after they have exercised their right to administrative 
119.9   reconsideration under section 626.556.  The failure to exercise 
119.10  the right to an administrative reconsideration shall not be a 
119.11  bar to a hearing under this section if federal law provides an 
119.12  individual the right to a hearing to dispute a finding of 
119.13  maltreatment.  Individuals and organizations specified in this 
119.14  section may contest the specified action, decision, or final 
119.15  disposition before the state agency by submitting a written 
119.16  request for a hearing to the state agency within 30 days after 
119.17  receiving written notice of the action, decision, or final 
119.18  disposition, or within 90 days of such written notice if the 
119.19  applicant, recipient, patient, or relative shows good cause why 
119.20  the request was not submitted within the 30-day time limit. 
119.21     The hearing for an individual or facility under clause (4) 
119.22  or (8) is the only administrative appeal to the final ~~lead~~ 
119.23  agency ~~disposition~~ determination specifically, including a 
119.24  challenge to the accuracy and completeness of data under section 
119.25  13.04.  Hearings requested under clause (4) apply only to 
119.26  incidents of maltreatment that occur on or after October 1, 
119.27  1995.  Hearings requested by nursing assistants in nursing homes 
119.28  alleged to have maltreated a resident prior to October 1, 1995, 
119.29  shall be held as a contested case proceeding under the 
119.30  provisions of chapter 14.  Hearings requested under clause (8) 
119.31  apply only to incidents of maltreatment that occur on or after 
119.32  July 1, 1997.  A hearing for an individual or facility under 
119.33  clause (8) is only available when there is no juvenile court or 
119.34  adult criminal action pending.  If such action is filed in 
119.35  either court while an administrative review is pending, the 
119.36  administrative review must be suspended until the judicial 
120.1   actions are completed.  If the juvenile court action or criminal 
120.2   charge is dismissed or the criminal action overturned, the 
120.3   matter may be considered in an administrative hearing. 
120.4      For purposes of this section, bargaining unit grievance 
120.5   procedures are not an administrative appeal. 
120.6      The scope of hearings involving claims to foster care 
120.7   payments under clause (5) shall be limited to the issue of 
120.8   whether the county is legally responsible for a child's 
120.9   placement under court order or voluntary placement agreement 
120.10  and, if so, the correct amount of foster care payment to be made 
120.11  on the child's behalf and shall not include review of the 
120.12  propriety of the county's child protection determination or 
120.13  child placement decision. 
120.14     (b) ~~Except for a prepaid health plan,~~ A vendor of medical 
120.15  care as defined in section 256B.02, subdivision 7, or a vendor 
120.16  under contract with a county agency to provide social services 
120.17  under section 256E.08, subdivision 4, is not a party and may not 
120.18  request a hearing under this section, except if assisting a 
120.19  recipient as provided in subdivision 4. 
120.20     (c) An applicant or recipient is not entitled to receive 
120.21  social services beyond the services included in the amended 
120.22  community social services plan developed under section 256E.081, 
120.23  subdivision 3, if the county agency has met the requirements in 
120.24  section 256E.081. 
120.25     Sec. 7.  Minnesota Statutes 1996, section 256.045, 
120.26  subdivision 3b, is amended to read: 
120.27     Subd. 3b.  [STANDARD OF EVIDENCE FOR MALTREATMENT 
120.28  HEARINGS.] The state human services referee shall determine that 
120.29  maltreatment has occurred if a preponderance of evidence exists 
120.30  to support the final disposition under ~~section~~ sections 626.556 
120.31  and 626.557. 
120.32     The state human services referee shall recommend an order 
120.33  to the commissioner of health or human services, as applicable, 
120.34  who shall issue a final order.  The commissioner shall affirm, 
120.35  reverse, or modify the final disposition.  Any order of the 
120.36  commissioner issued in accordance with this subdivision is 
121.1   conclusive upon the parties unless appeal is taken in the manner 
121.2   provided in subdivision 7.  In any licensing appeal under 
121.3   chapter 245A and sections 144.50 to 144.58 and 144A.02 to 
121.4   144A.46, the commissioner's ~~findings~~ determination as to ~~whether~~ 
121.5   maltreatment ~~occurred~~ is conclusive. 
121.6      Sec. 8.  Minnesota Statutes 1996, section 256.045, 
121.7   subdivision 4, is amended to read: 
121.8      Subd. 4.  [CONDUCT OF HEARINGS.] (a) All hearings held 
121.9   pursuant to subdivision 3, 3a, 3b, or 4a shall be conducted 
121.10  according to the provisions of the federal Social Security Act 
121.11  and the regulations implemented in accordance with that act to 
121.12  enable this state to qualify for federal grants-in-aid, and 
121.13  according to the rules and written policies of the commissioner 
121.14  of human services.  County agencies shall install equipment 
121.15  necessary to conduct telephone hearings.  A state human services 
121.16  referee may schedule a telephone conference hearing when the 
121.17  distance or time required to travel to the county agency offices 
121.18  will cause a delay in the issuance of an order, or to promote 
121.19  efficiency, or at the mutual request of the parties.  Hearings 
121.20  may be conducted by telephone conferences unless the applicant, 
121.21  recipient, former recipient, person, or facility contesting 
121.22  maltreatment objects.  The hearing shall not be held earlier 
121.23  than five days after filing of the required notice with the 
121.24  county or state agency.  The state human services referee shall 
121.25  notify all interested persons of the time, date, and location of 
121.26  the hearing at least five days before the date of the hearing.  
121.27  Interested persons may be represented by legal counsel or other 
121.28  representative of their choice, including a provider of therapy 
121.29  services, at the hearing and may appear personally, testify and 
121.30  offer evidence, and examine and cross-examine witnesses.  The 
121.31  applicant, recipient, former recipient, person, or facility 
121.32  contesting maltreatment shall have the opportunity to examine 
121.33  the contents of the case file and all documents and records to 
121.34  be used by the county or state agency at the hearing at a 
121.35  reasonable time before the date of the hearing and during the 
121.36  hearing.  ~~In cases alleging discharge for maltreatment,~~ In 
122.1   hearings under subdivision 3, paragraph (a), clause (4) or (8), 
122.2   either party may subpoena the private data relating to the 
122.3   investigation ~~memorandum~~ prepared by the ~~lead~~ agency under 
122.4   section 626.556 or 626.557 that is not otherwise accessible 
122.5   under section 13.04, provided the ~~name~~ identity of the reporter 
122.6   may not be disclosed. 
122.7      (b) The private data obtained according to a subpoena in a 
122.8   hearing under subdivision 3, paragraph (a), clause (4) or (8), 
122.9   must be subject to a protective order which prohibits its 
122.10  disclosure for any other purpose outside the hearing provided 
122.11  for in this section without prior order of the district court.  
122.12  Disclosure without court order is punishable by a sentence of 
122.13  not more than 90 days imprisonment or a fine of not more than 
122.14  $700, or both.  These restrictions on the use of private data do 
122.15  not prohibit access to the data under section 13.03, subdivision 
122.16  6.  Except for appeals under subdivision 3, paragraph (a), 
122.17  clauses (4), (5), and (8), upon request, the county agency shall 
122.18  provide reimbursement for transportation, child care, 
122.19  photocopying, medical assessment, witness fee, and other 
122.20  necessary and reasonable costs incurred by the applicant, 
122.21  recipient, or former recipient in connection with the appeal~~,~~ 
122.22  ~~except in appeals brought under subdivision 3b~~.  All evidence, 
122.23  except that privileged by law, commonly accepted by reasonable 
122.24  people in the conduct of their affairs as having probative value 
122.25  with respect to the issues shall be submitted at the hearing and 
122.26  such hearing shall not be "a contested case" within the meaning 
122.27  of section 14.02, subdivision 3.  The agency must present its 
122.28  evidence prior to or at the hearing, and may not submit evidence 
122.29  after the hearing except by agreement of the parties at the 
122.30  hearing, provided the ~~recipient~~ petitioner has the opportunity 
122.31  to respond. 
122.32     Sec. 9.  Minnesota Statutes 1996, section 256.045, 
122.33  subdivision 5, is amended to read: 
122.34     Subd. 5.  [ORDERS OF THE COMMISSIONER OF HUMAN SERVICES.] 
122.35  ~~This subdivision does not apply to appeals under subdivision~~ 
122.36  ~~3b.~~  A state human services referee shall conduct a hearing on 
123.1   the appeal and shall recommend an order to the commissioner of 
123.2   human services.  The recommended order must be based on all 
123.3   relevant evidence and must not be limited to a review of the 
123.4   propriety of the state or county agency's action.  A referee may 
123.5   take official notice of adjudicative facts.  The commissioner of 
123.6   human services may accept the recommended order of a state human 
123.7   services referee and issue the order to the county agency and 
123.8   the applicant, recipient, former recipient, or prepaid health 
123.9   plan.  The commissioner on refusing to accept the recommended 
123.10  order of the state human services referee, shall notify the 
123.11  ~~county~~ petitioner, the agency ~~and the applicant, recipient,~~ 
123.12  ~~former recipient~~, or prepaid health plan of that fact and shall 
123.13  state reasons therefor and shall allow each party ten days' time 
123.14  to submit additional written argument on the matter.  After the 
123.15  expiration of the ten-day period, the commissioner shall issue 
123.16  an order on the matter to the ~~county~~ petitioner, the agency ~~and~~ 
123.17  ~~the applicant, recipient, former recipient~~, or prepaid health 
123.18  plan. 
123.19     A party aggrieved by an order of the commissioner may 
123.20  appeal under subdivision 7, or request reconsideration by the 
123.21  commissioner within 30 days after the date the commissioner 
123.22  issues the order.  The commissioner may reconsider an order upon 
123.23  request of any party or on the commissioner's own motion.  A 
123.24  request for reconsideration does not stay implementation of the 
123.25  commissioner's order.  Upon reconsideration, the commissioner 
123.26  may issue an amended order or an order affirming the original 
123.27  order. 
123.28     Any order of the commissioner issued under this subdivision 
123.29  shall be conclusive upon the parties unless appeal is taken in 
123.30  the manner provided by subdivision 7.  Any order of the 
123.31  commissioner is binding on the parties and must be implemented 
123.32  by the state agency ~~or~~, a county agency, or a prepaid health 
123.33  plan according to subdivision 3a, until the order is reversed by 
123.34  the district court, or unless the commissioner or a district 
123.35  court orders monthly assistance or aid or services paid or 
123.36  provided under subdivision 10. 
124.1      ~~Except for a prepaid health plan,~~ A vendor of medical care 
124.2   as defined in section 256B.02, subdivision 7, or a vendor under 
124.3   contract with a county agency to provide social services under 
124.4   section 256E.08, subdivision 4, is not a party and may not 
124.5   request a hearing or seek judicial review of an order issued 
124.6   under this section, unless assisting a recipient as provided in 
124.7   subdivision 4.  A prepaid health plan is a party to an appeal 
124.8   under subdivision 3a, but cannot seek judicial review of an 
124.9   order issued under this section. 
124.10     Sec. 10.  Minnesota Statutes 1996, section 256.045, 
124.11  subdivision 8, is amended to read: 
124.12     Subd. 8.  [HEARING.] Any party may obtain a hearing at a 
124.13  special term of the district court by serving a written notice 
124.14  of the time and place of the hearing at least ten days prior to 
124.15  the date of the hearing.  ~~Except for appeals under subdivision~~ 
124.16  ~~3b,~~ The court may consider the matter in or out of chambers, and 
124.17  shall take no new or additional evidence unless it determines 
124.18  that such evidence is necessary for a more equitable disposition 
124.19  of the appeal. 
124.20     Sec. 11.  Minnesota Statutes 1996, section 256.82, is 
124.21  amended by adding a subdivision to read: 
124.22     Subd. 5.  [DIFFICULTY OF CARE ASSESSMENT PILOT 
124.23  PROJECT.] Notwithstanding any law to the contrary, the 
124.24  commissioner of human services shall conduct a two-year 
124.25  statewide pilot project beginning July 1, 1997, to conduct a 
124.26  difficulty of care assessment process which both assesses an 
124.27  individual child's current functioning and identifies needs in a 
124.28  variety of life situations.  The pilot project must take into 
124.29  consideration existing difficulty of care payments so that, to 
124.30  the extent possible, no child for whom a difficulty of care rate 
124.31  is currently established will be adversely affected.  The pilot 
124.32  project must include an evaluation and an interim report to the 
124.33  legislature by January 15, 1999. 
124.34     Sec. 12.  Minnesota Statutes 1996, section 256F.11, 
124.35  subdivision 2, is amended to read: 
124.36     Subd. 2.  [FUND DISTRIBUTION.] In distributing funds, the 
125.1   commissioner shall give priority consideration to agencies and 
125.2   organizations with experience in working with abused or 
125.3   neglected children and their families, and with children at high 
125.4   risk of abuse and neglect and their families, and serve 
125.5   communities which demonstrate the greatest need for these 
125.6   services.  Funds shall be distributed to crisis nurseries 
125.7   according to a formula mutually agreed upon by the commissioner 
125.8   and the Minnesota crisis nursery association.  This formula 
125.9   shall include funding for all existing crisis nursery programs 
125.10  that meet program requirements as specified in paragraph (a), 
125.11  and consideration of factors reflecting the need for services in 
125.12  each service area, including, but not limited to, the number of 
125.13  children 18 years of age and under living in the service area, 
125.14  the percent of children 18 years of age and under living in 
125.15  poverty in the service area, and factors reflecting the cost of 
125.16  providing services, including, but not limited to, the number of 
125.17  days of service provided in the previous year.  At least 25 
125.18  percent of available funds for state fiscal year 1998 shall be 
125.19  set aside to accomplish any of the following:  establish new 
125.20  crisis nursery programs; increase statewide availability of 
125.21  crisis nursery services; and enhance or expand services at 
125.22  existing crisis nursery programs. 
125.23     (a) The crisis nurseries must:  
125.24     (1) be available 24 hours a day, seven days a week; 
125.25     (2) provide services for children up to three days at any 
125.26  one time; 
125.27     (3) make referrals for parents to counseling services and 
125.28  other community resources to help alleviate the underlying cause 
125.29  of the precipitating stress or crisis; 
125.30     (4) provide services without a fee for a maximum of 30 days 
125.31  in any year; 
125.32     (5) provide services to children from birth to 12 years of 
125.33  age; 
125.34     (6) provide an initial assessment and intake interview 
125.35  conducted by a skilled professional who will identify the 
125.36  presenting problem and make an immediate referral to an 
126.1   appropriate agency or program to prevent maltreatment and 
126.2   out-of-home placement of children; 
126.3      (7) maintain the clients' confidentiality to the extent 
126.4   required by law, and also comply with statutory reporting 
126.5   requirements which may mandate a report to child protective 
126.6   services; 
126.7      (8) contain a volunteer component; 
126.8      (9) provide preservice training and ongoing training to 
126.9   providers and volunteers; 
126.10     (10) evaluate the services provided by documenting use of 
126.11  services, the result of family referrals made to community 
126.12  resources, and how the services reduced the risk of 
126.13  maltreatment; 
126.14     (11) provide age appropriate programming; 
126.15     (12) provide developmental assessments; 
126.16     (13) provide medical assessments as determined by using a 
126.17  risk screening tool; 
126.18     (14) meet United States Department of Agriculture 
126.19  regulations concerning meals and provide three meals a day and 
126.20  three snacks during a 24-hour period; and 
126.21     (15) provide appropriate sleep and nap arrangements for 
126.22  children.  
126.23     (b) The crisis nurseries are encouraged to provide:  
126.24     (1) on-site support groups for facility model programs, or 
126.25  agency sponsored parent support groups for volunteer family 
126.26  model programs; 
126.27     (2) parent education classes or programs that include 
126.28  parent-child interaction; and 
126.29     (3) opportunities for parents to volunteer, if appropriate, 
126.30  to assist with child care in a supervised setting in order to 
126.31  enhance their parenting skills and self-esteem, in addition to 
126.32  providing them the opportunity to give something back to the 
126.33  program.  
126.34     (c) Parents shall retain custody of their children during 
126.35  placement in a crisis facility.  
126.36     The crisis nurseries are encouraged to include one or more 
127.1   parents who have used the crisis nursery services on the 
127.2   program's multidisciplinary advisory board. 
127.3      Sec. 13.  [257.85] [RELATIVE CUSTODY ASSISTANCE.] 
127.4      Subdivision 1.  [CITATION.] This section may be cited as 
127.5   the "Relative Custody Assistance Act." 
127.6      Subd. 2.  [SCOPE.] The provisions of this section apply to 
127.7   those situations in which the legal and physical custody of a 
127.8   child is established with a relative according to section 
127.9   260.191, subdivision 3b, by a court order issued on or after 
127.10  July 1, 1997.  
127.11     Subd. 3.  [DEFINITIONS.] For purposes of this section, the 
127.12  terms defined in this subdivision shall have the meanings given 
127.13  them. 
127.14     (a) "AFDC or MFIP standard" means the monthly standard of 
127.15  need used to calculate assistance under the AFDC program, the 
127.16  transitional standard used to calculate assistance under the 
127.17  MFIP-S program, or, if neither of those is applicable, the 
127.18  analogous standard used to calculate assistance under the MFIP 
127.19  or MFIP-R programs. 
127.20     (b) "Local agency" means the local social service agency 
127.21  with legal custody of a child prior to the transfer of permanent 
127.22  legal and physical custody to a relative. 
127.23     (c) "Permanent legal and physical custody" means permanent 
127.24  legal and physical custody ordered by a Minnesota juvenile court 
127.25  under section 260.191, subdivision 3b. 
127.26     (d) "Relative" means an individual, other than a parent, 
127.27  who is related to a child by blood, marriage, or adoption. 
127.28     (e) "Relative custodian" means a relative of a child for 
127.29  whom the relative has permanent legal and physical custody. 
127.30     (f) "Relative custody assistance agreement" means an 
127.31  agreement entered into between a local agency and the relative 
127.32  of a child who has been or will be awarded permanent legal and 
127.33  physical custody of the child. 
127.34     (g) "Relative custody assistance payment" means a monthly 
127.35  cash grant made to a relative custodian pursuant to a relative 
127.36  custody assistance agreement and in an amount calculated under 
128.1   subdivision 8. 
128.2      (h) "Remains in the physical custody of the relative 
128.3   custodian" means that the relative custodian is providing 
128.4   day-to-day care for the child and that the child lives with the 
128.5   relative custodian; absence from the relative custodian's home 
128.6   for a period of more than 120 days raises a presumption that the 
128.7   child no longer remains in the physical custody of the relative 
128.8   custodian. 
128.9      Subd. 4.  [DUTIES OF LOCAL AGENCY.] When a local agency 
128.10  seeks a court order under section 260.191, subdivision 3b, to 
128.11  establish permanent legal and physical custody of a child with a 
128.12  relative, or if such an order is issued by the court, the local 
128.13  agency shall perform the duties specified in this subdivision. 
128.14     (a) As soon as possible after the local agency determines 
128.15  that it will seek to establish permanent legal and physical 
128.16  custody of the child with a relative or, if the agency did not 
128.17  seek to establish custody, as soon as possible after the 
128.18  issuance of the court order establishing custody, the local 
128.19  agency shall inform the relative about the relative custody 
128.20  assistance program, including eligibility criteria and payment 
128.21  levels.  Anytime prior to, but not later than seven days after, 
128.22  the date the court issues the order establishing permanent legal 
128.23  and physical custody of the child with a relative, the local 
128.24  agency shall determine whether the eligibility criteria in 
128.25  subdivision 7 are met to allow the relative to receive relative 
128.26  custody assistance.  Not later than seven days after determining 
128.27  whether the eligibility criteria are met, the local agency shall 
128.28  inform the relative custodian of its determination and of the 
128.29  process for appealing that determination under subdivision 10. 
128.30     (b) If the local agency determines that the relative 
128.31  custodian is eligible to receive relative custody assistance, 
128.32  the local agency shall prepare the relative custody assistance 
128.33  agreement and assure that it meets the requirements of 
128.34  subdivision 5. 
128.35     (c) The local agency shall make monthly payments to the 
128.36  relative as specified in the relative custody assistance 
129.1   agreement.  On a quarterly basis and on a form to be provided by 
129.2   the commissioner, the local agency shall make claims for 
129.3   reimbursement from the commissioner for relative custody 
129.4   assistance payments made. 
129.5      (d) For a relative custody assistance agreement that is in 
129.6   place for longer than one year, and as long as the agreement 
129.7   remains in effect, the local agency shall send an annual 
129.8   affidavit form to the relative custodian of the eligible child 
129.9   within the month before the anniversary date of the agreement.  
129.10  The local agency shall monitor whether the annual affidavit is 
129.11  returned by the relative custodian within 30 days following the 
129.12  anniversary date of the agreement.  The local agency shall 
129.13  review the affidavit and any other information in its possession 
129.14  to assure continuing eligibility for relative custody assistance 
129.15  and that the amount of payment made pursuant to the agreement is 
129.16  correct. 
129.17     (e) When the local agency determines that a relative 
129.18  custody assistance agreement should be terminated or modified, 
129.19  it shall provide notice of the proposed termination or 
129.20  modification to the relative custodian at least ten days before 
129.21  the proposed action along with information about the process for 
129.22  appealing the proposed action. 
129.23     Subd. 5.  [RELATIVE CUSTODY ASSISTANCE AGREEMENT.] (a) A 
129.24  relative custody assistance agreement will not be effective, 
129.25  unless it is signed by the local agency and the relative 
129.26  custodian no later than 30 days after the date of the order 
129.27  establishing permanent legal and physical custody with the 
129.28  relative, except that a local agency may enter into a relative 
129.29  custody assistance agreement with a relative custodian more than 
129.30  30 days after the date of the order if it certifies that the 
129.31  delay in entering the agreement was through no fault of the 
129.32  relative custodian.  There must be a separate agreement for each 
129.33  child for whom the relative custodian is receiving relative 
129.34  custody assistance. 
129.35     (b) Regardless of when the relative custody assistance 
129.36  agreement is signed by the local agency and relative custodian, 
130.1   the effective date of the agreement shall be the first day of 
130.2   the month following the date of the order establishing permanent 
130.3   legal and physical custody or the date that the last party signs 
130.4   the agreement, whichever occurs later. 
130.5      (c) If MFIP-S is not the applicable program for a child at 
130.6   the time that a relative custody assistance agreement is entered 
130.7   on behalf of the child, at such time as MFIP-S becomes the 
130.8   applicable program, if the relative custodian had been receiving 
130.9   custody assistance payments calculated based upon a different 
130.10  program, the amount of relative custody assistance payment under 
130.11  subdivision 8 shall be recalculated under the MFIP-S program. 
130.12     (d) The relative custody assistance agreement shall be in a 
130.13  form specified by the commissioner and shall include provisions 
130.14  relating to the following: 
130.15     (1) the responsibilities of all parties to the agreement; 
130.16     (2) the payment terms, including the financial 
130.17  circumstances of the relative custodian, the needs of the child, 
130.18  the amount and calculation of the relative custody assistance 
130.19  payments and that the amount of the payments shall be 
130.20  reevaluated annually; 
130.21     (3) the effective date of the agreement, which shall also 
130.22  be the anniversary date for the purpose of submitting the annual 
130.23  affidavit under subdivision 8; 
130.24     (4) that failure to submit the affidavit as required by 
130.25  subdivision 8 will be grounds for terminating the agreement; 
130.26     (5) the agreement's expected duration, which shall in no 
130.27  case extend beyond the child's 18th birthday; 
130.28     (6) any specific known circumstances that could cause the 
130.29  agreement or payments to be modified, reduced, or terminated and 
130.30  the relative custodian's appeal rights under subdivision 9; 
130.31     (7) that the relative custodian must notify the local 
130.32  agency within 30 days of any of the following: 
130.33     (i) a change in the child's status; 
130.34     (ii) a change in the relationship between the relative 
130.35  custodian and the child; 
130.36     (iii) a change in composition or level of income of the 
131.1   relative custodian's family; 
131.2      (iv) a change in eligibility or receipt of benefits under 
131.3   AFDC, MFIP-S, or other assistance program; and 
131.4      (v) any other change that could effect eligibility for or 
131.5   amount of relative custody assistance; 
131.6      (8) that failure to provide notice of a change as required 
131.7   by clause (7) will be grounds for terminating the agreement; 
131.8      (9) that the amount of relative custody assistance is 
131.9   subject to the availability of state funds to reimburse the 
131.10  local agency making the payments; 
131.11     (10) that the relative custodian may choose to temporarily 
131.12  stop receiving payments under the agreement at any time by 
131.13  providing 30 days notice to the local agency and may choose to 
131.14  begin receiving payments again by providing the same notice, but 
131.15  that any payments the relative custodian chooses not to receive 
131.16  are forfeit; and 
131.17     (11) that the local agency will continue to be responsible 
131.18  for making relative custody assistance payments under the 
131.19  agreement regardless of the relative custodian's place of 
131.20  residence. 
131.21     Subd. 6.  [ELIGIBILITY CRITERIA.] A local agency shall 
131.22  enter into a relative custody assistance agreement under 
131.23  subdivision 5 if it certifies that the following criteria are 
131.24  met: 
131.25     (1) the juvenile court has determined or is expected to 
131.26  determine that the child, under the former or current custody of 
131.27  the local agency, cannot return to the home of the child's 
131.28  parents; 
131.29     (2) the court, upon determining that it is in the child's 
131.30  best interests, has issued or is expected to issue an order 
131.31  transferring permanent legal and physical custody of the child 
131.32  to the relative; and 
131.33     (3) the child either: 
131.34     (i) is a member of a sibling group to be placed together; 
131.35  or 
131.36     (ii) has a physical, mental, emotional, or behavioral 
132.1   disability that will require financial support. 
132.2      When the local agency bases its certification that the 
132.3   criteria in clause (1) or (2) are met upon the expectation that 
132.4   the juvenile court will take a certain action, the relative 
132.5   custody assistance agreement does not become effective until and 
132.6   unless the court acts as expected. 
132.7      Subd. 7.  [AMOUNT OF RELATIVE CUSTODY ASSISTANCE 
132.8   PAYMENTS.] (a) The amount of a monthly relative custody 
132.9   assistance payment shall be determined according to the 
132.10  provisions of this paragraph. 
132.11     (1) The total maximum assistance rate is equal to the base 
132.12  assistance rate plus, if applicable, the supplemental assistance 
132.13  rate. 
132.14     (i)  The base assistance rate is equal to the maximum 
132.15  amount that could be received as basic maintenance for a child 
132.16  of the same age under the adoption assistance program. 
132.17     (ii) The local agency shall determine whether the child has 
132.18  physical, mental, emotional, or behavioral disabilities that 
132.19  require care, supervision, or structure beyond that ordinarily 
132.20  provided in a family setting to children of the same age such 
132.21  that the child would be eligible for supplemental maintenance 
132.22  payments under the adoption assistance program if an adoption 
132.23  assistance agreement were entered on the child's behalf.  If the 
132.24  local agency determines that the child has such a disability, 
132.25  the supplemental assistance rate shall be the maximum amount of 
132.26  monthly supplemental maintenance payment that could be received 
132.27  on behalf of a child of the same age, disabilities, and 
132.28  circumstances under the adoption assistance program. 
132.29     (2) The net maximum assistance rate is equal to the total 
132.30  maximum assistance rate from clause (1) less the following 
132.31  offsets: 
132.32     (i) if the child is or will be part of an assistance unit 
132.33  receiving an AFDC, MFIP-S, or other MFIP grant, the portion of 
132.34  the AFDC or MFIP standard relating to the child; 
132.35     (ii) Supplemental Security Income payments received by or 
132.36  on behalf of the child; 
133.1      (iii) veteran's benefits received by or on behalf of the 
133.2   child; and 
133.3      (iv) any other income of the child. 
133.4      (3) The relative custody assistance payment to be made to 
133.5   the relative custodian shall be a percentage of the net maximum 
133.6   assistance rate calculated in clause (2) based upon the gross 
133.7   income of the relative custodian's family, including the child 
133.8   for whom the relative has permanent legal and physical custody.  
133.9   In no case shall the amount of the relative custody assistance 
133.10  payment exceed that which the child could qualify for under the 
133.11  adoption assistance program if an adoption assistance agreement 
133.12  were entered on the child's behalf.  The relative custody 
133.13  assistance payment shall be calculated as follows: 
133.14     (i) if the relative custodian's gross family income is less 
133.15  than or equal to 200 percent of federal poverty guidelines, the 
133.16  relative custody assistance payment shall be the full amount of 
133.17  the net maximum assistance rate; 
133.18     (ii) if the relative custodian's gross family income is 
133.19  greater than 200 percent and less than or equal to 225 percent 
133.20  of federal poverty guidelines, the relative custody assistance 
133.21  payment shall be 80 percent of the next maximum assistance rate; 
133.22     (iii) if the relative custodian's gross family income is 
133.23  greater than 225 percent and less than or equal to 250 percent 
133.24  of federal poverty guidelines, the relative custody assistance 
133.25  payment shall be 60 percent of the next maximum assistance rate; 
133.26     (iv) if the relative custodian's gross family income is 
133.27  greater than 250 percent and less than or equal to 275 percent 
133.28  of federal poverty guidelines, the relative custody assistance 
133.29  payment shall be 40 percent of the net maximum assistance rate; 
133.30     (v) if the relative custodian's gross family income is 
133.31  greater than 275 percent and less than or equal to 300 percent 
133.32  of federal poverty guidelines, the relative custody assistance 
133.33  payment shall be 20 percent of the net maximum assistance rate; 
133.34  or 
133.35     (vi) if the relative custodian's gross family income is 
133.36  greater than 300 percent of federal poverty guidelines, no 
134.1   relative custody assistance payment shall be made. 
134.2      (b) This paragraph sets forth the provisions pertaining to 
134.3   the relationship between relative custody assistance and AFDC, 
134.4   MFIP-S, or other MFIP programs: 
134.5      (1) the relative custodian of a child for whom the relative 
134.6   is receiving relative custody assistance is expected to seek 
134.7   whatever assistance is available for the child through the AFDC, 
134.8   MFIP-S, or other MFIP programs.  If a relative custodian fails 
134.9   to apply for assistance through AFDC, MFIP-S, or other MFIP 
134.10  program for which the child is eligible, the child's portion of 
134.11  the AFDC or MFIP standard will be calculated as if application 
134.12  had been made and assistance received; 
134.13     (2) the portion of the AFDC or MFIP standard relating to 
134.14  each child for whom relative custody assistance is being 
134.15  received shall be calculated as follows: 
134.16     (i) determine the total AFDC or MFIP standard for the 
134.17  assistance unit; 
134.18     (ii) determine the amount that the AFDC or MFIP standard 
134.19  would have been if the assistance unit had not included the 
134.20  children for whom relative custody assistance is being received; 
134.21     (iii) subtract the amount determined in item (ii) from the 
134.22  amount determined in item (i); and 
134.23     (iv) divide the result in item (iii) by the number of 
134.24  children for whom relative custody assistance is being received 
134.25  that are part of the assistance unit; or 
134.26     (3) if a child for whom relative custody assistance is 
134.27  being received is not eligible for assistance through the AFDC, 
134.28  MFIP-S, or other MFIP programs, the portion of AFDC or MFIP 
134.29  standard relating to that child shall be equal to zero. 
134.30     Subd. 8.  [ANNUAL AFFIDAVIT.] When a relative custody 
134.31  assistance agreement remains in effect for more than one year, 
134.32  the local agency shall require the relative custodian to 
134.33  annually submit an affidavit in a form to be specified by the 
134.34  commissioner.  The affidavit must be submitted to the local 
134.35  agency each year no later than 30 days after the relative 
134.36  custody assistance agreement's anniversary date.  The affidavit 
135.1   shall document the following: 
135.2      (1) that the child remains in the physical custody of the 
135.3   relative custodian; 
135.4      (2) that there is a continuing need for the relative 
135.5   custody assistance payments due to the child's physical, mental, 
135.6   emotional, or behavioral needs; and 
135.7      (3) the current gross income of the relative custodian's 
135.8   family. 
135.9      The relative custody assistance agreement may be modified 
135.10  based on information or documentation presented to the local 
135.11  agency under this requirement and as required by annual 
135.12  adjustments to the federal poverty guidelines. 
135.13     Subd. 9.  [RIGHT OF APPEAL.] A relative custodian who 
135.14  enters into a relative custody assistance agreement with a local 
135.15  agency has the right to appeal to the commissioner according to 
135.16  section 256.045 when the local agency establishes, denies, 
135.17  terminates, or modifies the agreement.  Upon appeal, the 
135.18  commissioner may review only: 
135.19     (1) whether the local agency has met the legal requirements 
135.20  imposed by this chapter for establishing, denying, terminating, 
135.21  or modifying the agreement; 
135.22     (2) whether the amount of the relative custody assistance 
135.23  payment was correctly calculated under the method set forth in 
135.24  subdivision 7; 
135.25     (3) whether the local agency paid for correct time periods 
135.26  under the relative custody assistance agreement; 
135.27     (4) whether the child remains in the physical custody of 
135.28  the relative custodian; 
135.29     (5) whether the local agency correctly calculated the 
135.30  amount of the supplemental assistance rate based on a change in 
135.31  the child's physical, mental, emotional, or behavioral needs, 
135.32  the relative custodian's failure to document the continuing need 
135.33  for the supplemental assistance rate after the local agency has 
135.34  requested such documentation; and 
135.35     (6) whether the local agency correctly calculated or 
135.36  terminated the amount of relative custody assistance based on 
136.1   the relative custodian's failure to provide documentation of the 
136.2   gross income of the relative custodian's family after the local 
136.3   agency has requested such documentation. 
136.4      Subd. 10.  [CHILD'S COUNTY OF RESIDENCE.] For the purposes 
136.5   of the unitary residency act, time spent by a child in the 
136.6   custody of a relative custodian receiving payments under this 
136.7   section is not excluded time.  A child is a resident of the 
136.8   county where the relative custodian is a resident. 
136.9      Subd. 11.  [FINANCIAL CONSIDERATIONS.] (a) Payment of 
136.10  relative custody assistance pursuant to a relative custody 
136.11  assistance agreement is subject to the availability of state 
136.12  funds and payments may be reduced or suspended on order of the 
136.13  commissioner if insufficient funds are available. 
136.14     (b) Upon receipt from a local agency of a claim for 
136.15  reimbursement, the commissioner shall reimburse the local agency 
136.16  in an amount equal to 100 percent of the relative custody 
136.17  assistance payments provided to relative custodians.  The local 
136.18  agency may not seek and the commissioner shall not provide 
136.19  reimbursement for the administrative costs associated with 
136.20  performing the duties described in subdivision 4. 
136.21     (c) For the purposes of determining eligibility or payment 
136.22  amounts under the AFDC, MFIP-S, and other MFIP programs, 
136.23  relative custody assistance payments shall be considered 
136.24  excluded income. 
136.25     Sec. 14.  Minnesota Statutes 1996, section 393.07, 
136.26  subdivision 2, is amended to read: 
136.27     Subd. 2.  [ADMINISTRATION OF PUBLIC WELFARE.] The local 
136.28  social services agency, subject to the supervision of the 
136.29  commissioner of human services, shall administer all forms of 
136.30  public welfare, both for children and adults, responsibility for 
136.31  which now or hereafter may be imposed on the commissioner of 
136.32  human services by law, including general assistance, aid to 
136.33  dependent children, county supplementation, if any, or state aid 
136.34  to recipients of supplemental security income for aged, blind 
136.35  and disabled, child welfare services, mental health services, 
136.36  and other public assistance or public welfare services, provided 
137.1   that the local social services agency shall not employ public 
137.2   health nursing or home health service personnel other than 
137.3   homemaker-home help aides, but shall contract for or purchase 
137.4   the necessary services from existing community agencies.  The 
137.5   duties of the local social services agency shall be performed in 
137.6   accordance with the standards and rules which may be promulgated 
137.7   by the commissioner of human services to achieve the purposes 
137.8   intended by law and in order to comply with the requirements of 
137.9   the federal Social Security Act in respect to public assistance 
137.10  and child welfare services, so that the state may qualify for 
137.11  grants-in-aid available under that act.  To avoid administrative 
137.12  penalties under section 256.017, the local social services 
137.13  agency must comply with (1) policies established by state law 
137.14  and (2) instructions from the commissioner relating (i) to 
137.15  public assistance program policies consistent with federal law 
137.16  and regulation and state law and rule and (ii) to local agency 
137.17  program operations.  The commissioner may enforce local social 
137.18  services agency compliance with the instructions, and may delay, 
137.19  withhold, or deny payment of all or part of the state and 
137.20  federal share of benefits and federal administrative 
137.21  reimbursement, according to the provisions under section 
137.22  256.017.  The local social services agency shall supervise wards 
137.23  of the commissioner and, when so designated, act as agent of the 
137.24  commissioner of human services in the placement of the 
137.25  commissioner's wards in adoptive homes or in other foster care 
137.26  facilities.  The local social services agency shall cooperate as 
137.27  needed when the commissioner contracts with a licensed child 
137.28  placement agency for adoption services for a child under the 
137.29  commissioner's guardianship.  The local social services agency 
137.30  may contract with a bank or other financial institution to 
137.31  provide services associated with the processing of public 
137.32  assistance checks and pay a service fee for these services, 
137.33  provided the fee charged does not exceed the fee charged to 
137.34  other customers of the institution for similar services. 
137.35     Sec. 15.  Minnesota Statutes 1996, section 466.01, 
137.36  subdivision 1, is amended to read: 
138.1      Subdivision 1.  [MUNICIPALITY.] For the purposes of 
138.2   sections 466.01 to 466.15, "municipality" means any city, 
138.3   whether organized under home rule charter or otherwise, any 
138.4   county, town, public authority, public corporation, nonprofit 
138.5   firefighting corporation that has associated with it a relief 
138.6   association as defined in section 424A.001, subdivision 4, 
138.7   special district, school district, however organized, county 
138.8   agricultural society organized pursuant to chapter 38, joint 
138.9   powers board or organization created under section 471.59 or 
138.10  other statute, public library, regional public library system, 
138.11  multicounty multitype library system, family services 
138.12  collaborative established under section 121.8355, children's 
138.13  mental health collaboratives established under sections 245.491 
138.14  to 245.496, or a collaborative established by the merger of a 
138.15  children's mental health collaborative and a family services 
138.16  collaborative, other political subdivision, or community action 
138.17  agency. 
138.18     Sec. 16.  Minnesota Statutes 1996, section 471.59, 
138.19  subdivision 11, is amended to read: 
138.20     Subd. 11.  [JOINT POWERS BOARD.] (a) Two or more 
138.21  governmental units, through action of their governing bodies, by 
138.22  adoption of a joint powers agreement that complies with the 
138.23  provisions of subdivisions 1 to 5, may establish a joint board 
138.24  to issue bonds or obligations under any law by which any of the 
138.25  governmental units establishing the joint board may 
138.26  independently issue bonds or obligations and may use the 
138.27  proceeds of the bonds or obligations to carry out the purposes 
138.28  of the law under which the bonds or obligations are issued.  A 
138.29  joint board established under this section may issue obligations 
138.30  and other forms of indebtedness only in accordance with express 
138.31  authority granted by the action of the governing bodies of the 
138.32  governmental units that established the joint board.  Except as 
138.33  provided in paragraph (b), the joint board established under 
138.34  this subdivision must be composed solely of members of the 
138.35  governing bodies of the governmental unit that established the 
138.36  joint board.  A joint board established under this subdivision 
139.1   may not pledge the full faith and credit or taxing power of any 
139.2   of the governmental units that established the joint board.  The 
139.3   obligations or other forms of indebtedness must be obligations 
139.4   of the joint board issued on behalf of the governmental units 
139.5   creating the joint board.  The obligations or other forms of 
139.6   indebtedness must be issued in the same manner and subject to 
139.7   the same conditions and limitations that would apply if the 
139.8   obligations were issued or indebtedness incurred by one of the 
139.9   governmental units that established the joint board, provided 
139.10  that any reference to a governmental unit in the statute, law, 
139.11  or charter provision authorizing the issuance of the bonds or 
139.12  the incurring of the indebtedness is considered a reference to 
139.13  the joint board. 
139.14     (b) Notwithstanding paragraph (a), one school district, one 
139.15  county, and one public health entity, through action of their 
139.16  governing bodies, may establish a joint board to establish and 
139.17  govern a family services collaborative under section 121.8355.  
139.18  The school district, county, and public health entity may 
139.19  include other governmental entities at their discretion.  The 
139.20  membership of a board established under this paragraph, in 
139.21  addition to members of the governing bodies of the participating 
139.22  governmental units, must include the representation required by 
139.23  section 121.8355, subdivision 1, paragraph (a), selected in 
139.24  accordance with section 121.8355, subdivision 1, paragraph (c). 
139.25     (c) Notwithstanding paragraph (a), one county, one school 
139.26  district, and one mental health entity, through action of their 
139.27  governing bodies, may establish a joint board to establish and 
139.28  govern a children's mental health collaborative under sections 
139.29  245.491 to 245.496, or a collaborative established by the merger 
139.30  of a children's mental health collaborative and a family 
139.31  services collaborative under section 121.8355.  The county, 
139.32  school district, and mental health entity may include other 
139.33  entities at their discretion.  The membership of a board 
139.34  established under this paragraph, in addition to members of the 
139.35  governing bodies of the participating governmental units, must 
139.36  include the representation provided by section 245.493, 
140.1   subdivision 1. 
140.2      Sec. 17.  Minnesota Statutes 1996, section 626.556, 
140.3   subdivision 10b, is amended to read: 
140.4      Subd. 10b.  [DUTIES OF COMMISSIONER; NEGLECT OR ABUSE IN A 
140.5   FACILITY.] (a) The commissioner shall immediately investigate if 
140.6   the report alleges that: 
140.7      (1) a child who is in the care of a facility as defined in 
140.8   subdivision 2 is neglected, physically abused, or sexually 
140.9   abused by an individual in that facility, or has been so 
140.10  neglected or abused by an individual in that facility within the 
140.11  three years preceding the report; or 
140.12     (2) a child was neglected, physically abused, or sexually 
140.13  abused by an individual in a facility defined in subdivision 2, 
140.14  while in the care of that facility within the three years 
140.15  preceding the report.  
140.16     The commissioner shall arrange for the transmittal to the 
140.17  commissioner of reports received by local agencies and may 
140.18  delegate to a local welfare agency the duty to investigate 
140.19  reports.  In conducting an investigation under this section, the 
140.20  commissioner has the powers and duties specified for local 
140.21  welfare agencies under this section.  The commissioner or local 
140.22  welfare agency may interview any children who are or have been 
140.23  in the care of a facility under investigation and their parents, 
140.24  guardians, or legal custodians. 
140.25     (b) Prior to any interview, the commissioner or local 
140.26  welfare agency shall notify the parent, guardian, or legal 
140.27  custodian of a child who will be interviewed in the manner 
140.28  provided for in subdivision 10d, paragraph (a).  If reasonable 
140.29  efforts to reach the parent, guardian, or legal custodian of a 
140.30  child in an out-of-home placement have failed, the child may be 
140.31  interviewed if there is reason to believe the interview is 
140.32  necessary to protect the child or other children in the 
140.33  facility.  The commissioner or local agency must provide the 
140.34  information required in this subdivision to the parent, 
140.35  guardian, or legal custodian of a child interviewed without 
140.36  parental notification as soon as possible after the interview.  
141.1   When the investigation is completed, any parent, guardian, or 
141.2   legal custodian notified under this subdivision shall receive 
141.3   the written memorandum provided for in subdivision 10d, 
141.4   paragraph (c). 
141.5      (c) In conducting investigations under this subdivision the 
141.6   commissioner or local welfare agency shall obtain access to 
141.7   information consistent with subdivision 10, paragraphs (h), (i), 
141.8   and (j). 
141.9      (d) Except for foster care and family child care, the 
141.10  commissioner has the primary responsibility for the 
141.11  investigations and notifications required under subdivisions 10d 
141.12  and 10f for reports that allege maltreatment related to the care 
141.13  provided by or in facilities licensed by the commissioner.  The 
141.14  commissioner may request assistance from the local social 
141.15  service agency. 
141.16     Sec. 18.  Minnesota Statutes 1996, section 626.556, 
141.17  subdivision 10d, is amended to read: 
141.18     Subd. 10d.  [NOTIFICATION OF NEGLECT OR ABUSE IN A 
141.19  FACILITY.] (a) When a report is received that alleges neglect, 
141.20  physical abuse, or sexual abuse of a child while in the care of 
141.21  a facility required to be licensed pursuant to ~~sections 245A.01~~ 
141.22  ~~to 245A.16~~ chapter 245A, the commissioner or local welfare 
141.23  agency investigating the report shall provide the following 
141.24  information to the parent, guardian, or legal custodian of a 
141.25  child alleged to have been neglected, physically abused, or 
141.26  sexually abused:  the name of the facility; the fact that a 
141.27  report alleging neglect, physical abuse, or sexual abuse of a 
141.28  child in the facility has been received; the nature of the 
141.29  alleged neglect, physical abuse, or sexual abuse; that the 
141.30  agency is conducting an investigation; any protective or 
141.31  corrective measures being taken pending the outcome of the 
141.32  investigation; and that a written memorandum will be provided 
141.33  when the investigation is completed. 
141.34     (b) The commissioner or local welfare agency may also 
141.35  provide the information in paragraph (a) to the parent, 
141.36  guardian, or legal custodian of any other child in the facility 
142.1   if the investigative agency knows or has reason to believe the 
142.2   alleged neglect, physical abuse, or sexual abuse has occurred. 
142.3   In determining whether to exercise this authority, the 
142.4   commissioner or local welfare agency shall consider the 
142.5   seriousness of the alleged neglect, physical abuse, or sexual 
142.6   abuse; the number of children allegedly neglected, physically 
142.7   abused, or sexually abused; the number of alleged perpetrators; 
142.8   and the length of the investigation.  The facility shall be 
142.9   notified whenever this discretion is exercised. 
142.10     (c) When the commissioner or local welfare agency has 
142.11  completed its investigation, every parent, guardian, or legal 
142.12  custodian notified of the investigation by the commissioner or 
142.13  local welfare agency shall be provided with the following 
142.14  information in a written memorandum:  the name of the facility 
142.15  investigated; the nature of the alleged neglect, physical abuse, 
142.16  or sexual abuse; the investigator's name; a summary of the 
142.17  investigation findings; a statement whether maltreatment was 
142.18  found; and the protective or corrective measures that are being 
142.19  or will be taken.  The memorandum shall be written in a manner 
142.20  that protects the identity of the reporter and the child and 
142.21  shall not contain the name, or to the extent possible, reveal 
142.22  the identity of the alleged perpetrator or of those interviewed 
142.23  during the investigation.  The commissioner or local welfare 
142.24  agency shall also provide the written memorandum to the parent, 
142.25  guardian, or legal custodian of each child in the facility if 
142.26  maltreatment is determined to exist. 
142.27     Sec. 19.  Minnesota Statutes 1996, section 626.556, 
142.28  subdivision 10e, is amended to read: 
142.29     Subd. 10e.  [DETERMINATIONS.] Upon the conclusion of every 
142.30  assessment or investigation it conducts, the local welfare 
142.31  agency shall make two determinations:  first, whether 
142.32  maltreatment has occurred; and second, whether child protective 
142.33  services are needed.  When maltreatment is determined in an 
142.34  investigation involving a facility, the investigating agency 
142.35  shall also determine whether the facility or individual was 
142.36  responsible for the maltreatment using the mitigating factors in 
143.1   paragraph (d).  Determinations under this subdivision must be 
143.2   made based on a preponderance of the evidence. 
143.3      (a) For the purposes of this subdivision, "maltreatment" 
143.4   means any of the following acts or omissions committed by a 
143.5   person responsible for the child's care: 
143.6      (1) physical abuse as defined in subdivision 2, paragraph 
143.7   (d); 
143.8      (2) neglect as defined in subdivision 2, paragraph (c); 
143.9      (3) sexual abuse as defined in subdivision 2, paragraph 
143.10  (a); or 
143.11     (4) mental injury as defined in subdivision 2, paragraph 
143.12  (k). 
143.13     (b) For the purposes of this subdivision, a determination 
143.14  that child protective services are needed means that the local 
143.15  welfare agency has documented conditions during the assessment 
143.16  or investigation sufficient to cause a child protection worker, 
143.17  as defined in section 626.559, subdivision 1, to conclude that a 
143.18  child is at significant risk of maltreatment if protective 
143.19  intervention is not provided and that the individuals 
143.20  responsible for the child's care have not taken or are not 
143.21  likely to take actions to protect the child from maltreatment or 
143.22  risk of maltreatment. 
143.23     (c) This subdivision does not mean that maltreatment has 
143.24  occurred solely because the child's parent, guardian, or other 
143.25  person responsible for the child's care in good faith selects 
143.26  and depends upon spiritual means or prayer for treatment or care 
143.27  of disease or remedial care of the child, in lieu of medical 
143.28  care.  However, if lack of medical care may result in serious 
143.29  danger to the child's health, the local welfare agency may 
143.30  ensure that necessary medical services are provided to the child.
143.31     (d) When determining whether the facility or individual is 
143.32  the responsible party for determined maltreatment in a facility, 
143.33  the investigating agency shall consider at least the following 
143.34  mitigating factors: 
143.35     (1) whether the actions of the facility or the individual 
143.36  caregivers were according to, and followed the terms of, an 
144.1   erroneous physician order, prescription, individual care plan, 
144.2   or directive; this is not a mitigating factor when the facility 
144.3   or caregiver was responsible for the issuance of the erroneous 
144.4   order, prescription, plan, or directive or knew or should have 
144.5   known of the errors and took no reasonable measures to correct 
144.6   the defect before administering care; 
144.7      (2) the comparative responsibility between the facility, 
144.8   other caregivers, and requirements placed upon an employee, 
144.9   including the facility's compliance with related regulatory 
144.10  standards; the adequacy of facility policies and procedures, 
144.11  facility training, an individual's participation in the 
144.12  training, caregiver supervision, and facility staffing levels; 
144.13  and the scope of the individual employee's authority and 
144.14  discretion; and 
144.15     (3) whether the facility or individual followed 
144.16  professional standards in exercising professional judgment. 
144.17     Sec. 20.  Minnesota Statutes 1996, section 626.556, 
144.18  subdivision 10f, is amended to read: 
144.19     Subd. 10f.  [NOTICE OF DETERMINATIONS.] Within ten working 
144.20  days of the conclusion of an assessment, the local welfare 
144.21  agency shall notify the parent or guardian of the child, the 
144.22  person determined to be maltreating the child, and if 
144.23  applicable, the director of the facility, of the determination 
144.24  and a summary of the specific reasons for the determination.  
144.25  The notice must also include a certification that the 
144.26  information collection procedures under subdivision 10, 
144.27  paragraphs (h), (i), and (j), were followed and a notice of the 
144.28  right of a data subject to obtain access to other private data 
144.29  on the subject collected, created, or maintained under this 
144.30  section.  In addition, the notice shall include the length of 
144.31  time that the records will be kept under subdivision 11c.  When 
144.32  there is no determination of either maltreatment or a need for 
144.33  services, the notice shall also include the alleged 
144.34  perpetrator's right to have the records destroyed.  The 
144.35  investigating agency shall notify the designee of the child who 
144.36  is the subject of the report, and any person or facility 
145.1   determined to have maltreated a child, of their appeal rights 
145.2   under this section. 
145.3      Sec. 21.  Minnesota Statutes 1996, section 626.556, is 
145.4   amended by adding a subdivision to read: 
145.5      Subd. 10i.  [ADMINISTRATIVE RECONSIDERATION OF THE FINAL 
145.6   DETERMINATION OF MALTREATMENT.] (a) An individual or facility 
145.7   that the commissioner or a local social service agency 
145.8   determines has maltreated a child, or the child's designee, 
145.9   regardless of the determination, who contests the investigating 
145.10  agency's final determination regarding maltreatment, may request 
145.11  the investigating agency to reconsider its final determination 
145.12  regarding maltreatment.  The request for reconsideration must be 
145.13  submitted in writing to the investigating agency within 15 
145.14  calendar days after receipt of notice of the final determination 
145.15  regarding maltreatment. 
145.16     (b) If the investigating agency denies the request or fails 
145.17  to act upon the request within 15 calendar days after receiving 
145.18  the request for reconsideration, the person or facility entitled 
145.19  to a fair hearing under section 256.045, may submit to the 
145.20  commissioner of human services a written request for a hearing 
145.21  under that statute. 
145.22     (c) If, as a result of the reconsideration, the 
145.23  investigating agency changes the final determination of 
145.24  maltreatment, it shall notify the parties specified in 
145.25  subdivisions 10b, 10d, and 10f. 
145.26     Sec. 22.  Minnesota Statutes 1996, section 626.556, 
145.27  subdivision 11c, is amended to read: 
145.28     Subd. 11c.  [WELFARE, COURT SERVICES AGENCY, AND SCHOOL 
145.29  RECORDS MAINTAINED.] Notwithstanding sections 138.163 and 
145.30  138.17, records maintained or records derived from reports of 
145.31  abuse by local welfare agencies, court services agencies, or 
145.32  schools under this section shall be destroyed as provided in 
145.33  paragraphs (a) to (d) by the responsible authority. 
145.34     (a) If upon assessment or investigation there is no 
145.35  determination of maltreatment or the need for child protective 
145.36  services, the records may be maintained for a period of four 
146.1   years.  After the individual alleged to have maltreated a child 
146.2   is notified under subdivision 10f of the determinations at the 
146.3   conclusion of the assessment or investigation, upon that 
146.4   individual's request, records shall be destroyed within 30 
146.5   days or after the appeal rights under subdivision 10i have been 
146.6   concluded, whichever is later. 
146.7      (b) All records relating to reports which, upon assessment 
146.8   or investigation, indicate either maltreatment or a need for 
146.9   child protective services shall be maintained for at least ten 
146.10  years after the date of the final entry in the case record. 
146.11     (c) All records regarding a report of maltreatment, 
146.12  including any notification of intent to interview which was 
146.13  received by a school under subdivision 10, paragraph (d), shall 
146.14  be destroyed by the school when ordered to do so by the agency 
146.15  conducting the assessment or investigation.  The agency shall 
146.16  order the destruction of the notification when other records 
146.17  relating to the report under investigation or assessment are 
146.18  destroyed under this subdivision. 
146.19     (d) Private or confidential data released to a court 
146.20  services agency under subdivision 10h must be destroyed by the 
146.21  court services agency when ordered to do so by the local welfare 
146.22  agency that released the data.  The local welfare agency shall 
146.23  order destruction of the data when other records relating to the 
146.24  assessment or investigation are destroyed under this subdivision.
146.25     Sec. 23.  Minnesota Statutes 1996, section 626.558, 
146.26  subdivision 1, is amended to read: 
146.27     Subdivision 1.  [ESTABLISHMENT OF THE TEAM.] A county shall 
146.28  establish a multidisciplinary child protection team that may 
146.29  include, but not be limited to, the director of the local 
146.30  welfare agency or designees, the county attorney or designees, 
146.31  the county sheriff or designees, representatives of health and 
146.32  education, representatives of mental health or other appropriate 
146.33  human service or community-based agencies, and parent groups.  
146.34  As used in this section, a "community-based agency" may include, 
146.35  but is not limited to, schools, social service agencies, family 
146.36  service and mental health collaboratives, early childhood and 
147.1   family education programs, Head Start, or other agencies serving 
147.2   children and families. 
147.3      Sec. 24.  Minnesota Statutes 1996, section 626.558, 
147.4   subdivision 2, is amended to read: 
147.5      Subd. 2.  [DUTIES OF TEAM.] A multidisciplinary child 
147.6   protection team may provide public and professional education, 
147.7   develop resources for prevention, intervention, and treatment, 
147.8   and provide case consultation to the local welfare agency ~~to~~ 
147.9   ~~better enable the agency to carry out its child protection~~ 
147.10  ~~functions under section 626.556 and the community social~~ 
147.11  ~~services act.~~ or other interested community-based agencies.  The 
147.12  community-based agencies may request case consultation from the 
147.13  multidisciplinary child protection team regarding a child or 
147.14  family for whom the community-based agency is providing 
147.15  services.  As used in this section, "case consultation" means a 
147.16  case review process in which recommendations are made concerning 
147.17  services to be provided to the identified children and family.  
147.18  Case consultation may be performed by a committee or 
147.19  subcommittee of members representing human services, including 
147.20  mental health and chemical dependency; law enforcement, 
147.21  including probation and parole; the county attorney; health 
147.22  care; education; community-based agencies and other necessary 
147.23  agencies; and persons directly involved in an individual case as 
147.24  designated by other members performing case consultation. 
147.25     Sec. 25.  Minnesota Statutes 1996, section 626.559, 
147.26  subdivision 5, is amended to read: 
147.27     Subd. 5.  [~~TRAINING~~ REVENUE.] The commissioner of human 
147.28  services shall add the following funds to the funds appropriated 
147.29  under section 626.5591, subdivision 2, to develop and support 
147.30  training: 
147.31     (a) The commissioner of human services shall submit claims 
147.32  for federal reimbursement earned through the activities and 
147.33  services supported through department of human services child 
147.34  protection or child welfare training funds.  Federal revenue 
147.35  earned must be used to improve and expand training services by 
147.36  the department.  The department expenditures eligible for 
148.1   federal reimbursement under this section must not be made from 
148.2   federal funds or funds used to match other federal funds. 
148.3      (b) Each year, the commissioner of human services shall 
148.4   withhold from funds distributed to each county under Minnesota 
148.5   Rules, parts 9550.0300 to 9550.0370, an amount equivalent to 1.5 
148.6   percent of each county's annual Title XX allocation under 
148.7   section 256E.07.  The commissioner must use these funds to 
148.8   ensure decentralization of training. 
148.9      (c) The federal revenue ~~earned~~ under this subdivision is 
148.10  available for these purposes until the funds are expended. 
148.11     Sec. 26.  [MALTREATMENT OF MINORS ADVISORY COMMITTEE.] 
148.12     The commissioner of human services, with the cooperation of 
148.13  the commissioners of health, children, families, and learning, 
148.14  and the attorney general, shall establish an advisory committee 
148.15  to review the Maltreatment of Minors Act, Minnesota Statutes, 
148.16  section 626.556, to determine whether existing state policy and 
148.17  procedures for protecting children who are at risk of 
148.18  maltreatment in the home, school, or community are effective. 
148.19     The committee shall include consumers, advocacy and 
148.20  provider organizations, county practitioners and administrators, 
148.21  school districts, law enforcement agencies, communities of 
148.22  color, professional associations, labor organizations, office of 
148.23  the ombudsman for mental health and mental retardation, and the 
148.24  commissioners of health, human services, and children, families, 
148.25  and learning. 
148.26     In making recommendations, the advisory committee shall 
148.27  review all services and protections available under existing 
148.28  state and federal laws with the focus on eliminating duplication 
148.29  of effort among various local, state, and federal agencies and 
148.30  minimizing possible conflicts of interest by establishing a 
148.31  statewide process of coordination of responsibilities.  The 
148.32  advisory committee shall submit a report to the legislature by 
148.33  February 15, 1998, that includes a detailed plan with specific 
148.34  law, rule, or administrative procedure changes to implement the 
148.35  recommendations.  
148.36     Sec. 27.  [UNIFORM CONTRIBUTION SCHEDULE FOR OUT-OF-HOME 
149.1   PLACEMENT; REPORT.] 
149.2      The commissioner of human services shall prepare 
149.3   recommendations and report to the 1998 legislature regarding a 
149.4   uniform relative contribution schedule to reimburse costs 
149.5   associated with out-of-home placement.  The commissioner shall 
149.6   use the child support guidelines in Minnesota Statutes, chapter 
149.7   518, as the basis for the uniform contribution schedule.  The 
149.8   recommendations and report are due December 1, 1997. 
149.9      Sec. 28.  [EVALUATION REPORT REQUIRED.] 
149.10     The commissioner shall report the results of the evaluation 
149.11  required under section 5 to the chairs of the house of 
149.12  representatives and senate health and human services policy 
149.13  committees by January 1, 1999. 
149.14                             ARTICLE 6
149.15                    ACCELERATING STATE PAYMENTS 
149.16     Section 1.  Minnesota Statutes 1996, section 256.025, 
149.17  subdivision 2, is amended to read: 
149.18     Subd. 2.  [COVERED PROGRAMS AND SERVICES.] The procedures 
149.19  in this section govern payment of county agency expenditures for 
149.20  benefits and services distributed under the following programs: 
149.21     (1) aid to families with dependent children in effect until 
149.22  June 30, 1997, under sections 256.82, subdivision 1, and 
149.23  256.935, subdivision 1, for assistance costs incurred prior to 
149.24  July 1, 1997; 
149.25     (2) medical assistance under sections 256B.041, subdivision 
149.26  5, and 256B.19, subdivision 1, for assistance costs incurred 
149.27  prior to July 1, 1997; 
149.28     (3) general assistance medical care under section 256D.03, 
149.29  subdivision 6, for assistance costs incurred prior to July 1, 
149.30  1997; 
149.31     (4) general assistance under section 256D.03, subdivision 
149.32  2, for assistance costs incurred prior to July 1, 1997; 
149.33     (5) work readiness under section 256D.03, subdivision 2, 
149.34  for assistance costs incurred prior to July 1, 1995; 
149.35     (6) emergency assistance under section 256.871, subdivision 
149.36  6, for assistance costs incurred prior to July 1, 1997; 
150.1      (7) Minnesota supplemental aid under section 256D.36, 
150.2   subdivision 1, for assistance costs incurred prior to July 1, 
150.3   1997; 
150.4      (8) preadmission screening and alternative care grants for 
150.5   assistance costs incurred prior to July 1, 1997; 
150.6      (9) work readiness services under section 256D.051 for 
150.7   employment and training services costs incurred prior to July 1, 
150.8   1995; 
150.9      (10) case management services under section 256.736, 
150.10  subdivision 13, for case management service costs incurred prior 
150.11  to July 1, 1995; 
150.12     (11) general assistance claims processing, medical 
150.13  transportation and related costs for assistance costs incurred 
150.14  prior to July 1, 1997; 
150.15     (12) medical assistance, medical transportation and related 
150.16  costs for assistance costs incurred prior to July 1, 1997; and 
150.17     (13) group residential housing under section 256I.05, 
150.18  subdivision 8, for assistance costs incurred prior to July 1, 
150.19  1997, transferred from programs in clauses (4) and (7). 
150.20     Sec. 2.  Minnesota Statutes 1996, section 256.025, 
150.21  subdivision 4, is amended to read: 
150.22     Subd. 4.  [PAYMENT SCHEDULE.] Except as provided for in 
150.23  subdivision 3, beginning July 1, 1991, the state will reimburse 
150.24  counties, according to the following payment schedule, for the 
150.25  county share of county agency expenditures for the programs 
150.26  specified in subdivision 2. 
150.27     (a) Beginning July 1, 1991, the state will reimburse or pay 
150.28  the county share of county agency expenditures according to the 
150.29  reporting cycle as established by the commissioner, for the 
150.30  programs identified in subdivision 2.  Payments for the period 
150.31  of January 1 through July 31, for calendar years 1991, 1992, 
150.32  1993, 1994, and 1995 shall be made on or before July 10 in each 
150.33  of those years.  Payments for the period August through December 
150.34  for calendar years 1991, 1992, 1993, 1994, and 1995 shall be 
150.35  made on or before the third of each month thereafter through 
150.36  December 31 in each of those years. 
151.1      (b) Payment for 1/24 of the base amount and the January 
151.2   1996 county share of county agency expenditures growth amount 
151.3   for the programs identified in subdivision 2 shall be made on or 
151.4   before January 3, 1996.  For the period of February 1, 1996 
151.5   through July 31, 1996, payment of the base amount shall be made 
151.6   on or before July 10, 1996, and payment of the growth amount 
151.7   over the base amount shall be made on or before July 10, 1996.  
151.8   Payments for the period August 1996 through December 1996 shall 
151.9   be made on or before the third of each month thereafter through 
151.10  December 31, 1996. 
151.11     (c) Payment for the county share of county agency 
151.12  expenditures during January 1997 shall be made on or before 
151.13  January 3, 1997.  Payment for 1/24 of the base amount and the 
151.14  February 1997 county share of county agency expenditures growth 
151.15  amount for the programs identified in subdivision 2 shall be 
151.16  made on or before February 3, 1997.  For the period of March 1, 
151.17  1997 through ~~July 31~~ June 30, 1997, payment of the base amount 
151.18  shall be made on or before July 10, 1997, and payment of the 
151.19  growth amount over the base amount shall be made on or before 
151.20  July 10, 1997.  ~~Payments for the period August 1997 through~~ 
151.21  ~~December 1997 shall be made on or before the third of each month~~ 
151.22  ~~thereafter through December 31, 1997.~~ 
151.23     ~~(d) Monthly payments for the county share of county agency~~ 
151.24  ~~expenditures from January 1998 through February 1998 shall be~~ 
151.25  ~~made on or before the third of each month through February~~ 
151.26  ~~1998.  Payment for 1/24 of the base amount and the March 1998~~ 
151.27  ~~county share of county agency expenditures growth amount for the~~ 
151.28  ~~programs identified in subdivision 2 shall be made on or before~~ 
151.29  ~~March 1998.  For the period of April 1, 1998 through July 31,~~ 
151.30  ~~1998, payment of the base amount shall be made on or before July~~ 
151.31  ~~10, 1998, and payment of the growth amount over the base amount~~ 
151.32  ~~shall be made on or before July 10, 1998.  Payments for the~~ 
151.33  ~~period August 1998 through December 1998 shall be made on or~~ 
151.34  ~~before the third of each month thereafter through December 31,~~ 
151.35  ~~1998.~~ 
151.36     ~~(e) Monthly payments for the county share of county agency~~ 
152.1   ~~expenditures from January 1999 through March 1999 shall be made~~ 
152.2   ~~on or before the third of each month through March 1999.~~  
152.3   ~~Payment for 1/24 of the base amount and the April 1999 county~~ 
152.4   ~~share of county agency expenditures growth amount for the~~ 
152.5   ~~programs identified in subdivision 2 shall be made on or before~~ 
152.6   ~~April 3, 1999.  For the period of May 1, 1999 through July 31,~~ 
152.7   ~~1999, payment of the base amount shall be made on or before July~~ 
152.8   ~~10, 1999, and payment of the growth amount over the base amount~~ 
152.9   ~~shall be made on or before July 10, 1999.  Payments for the~~ 
152.10  ~~period August 1999 through December 1999 shall be made on or~~ 
152.11  ~~before the third of each month thereafter through December 31,~~ 
152.12  ~~1999.~~  
152.13     ~~(f) Monthly payments for the county share of county agency~~ 
152.14  ~~expenditures from January 2000 through April 2000 shall be made~~ 
152.15  ~~on or before the third of each month through April 2000.~~  
152.16  ~~Payment for 1/24 of the base amount and the May 2000 county~~ 
152.17  ~~share of county agency expenditures growth amount for the~~ 
152.18  ~~programs identified in subdivision 2 shall be made on or before~~ 
152.19  ~~May 3, 2000.  For the period of June 1, 2000 through July 31,~~ 
152.20  ~~2000, payment of the base amount shall be made on or before July~~ 
152.21  ~~10, 2000, and payment of the growth amount over the base amount~~ 
152.22  ~~shall be made on or before July 10, 2000.  Payments for the~~ 
152.23  ~~period August 2000 through December 2000 shall be made on or~~ 
152.24  ~~before the third of each month thereafter through December 31,~~ 
152.25  ~~2000.~~  
152.26     ~~(g) Monthly payments for the county share of county agency~~ 
152.27  ~~expenditures from January 2001 through May 2001 shall be made on~~ 
152.28  ~~or before the third of each month through May 2001.  Payment for~~ 
152.29  ~~1/24 of the base amount and the June 2001 county share of county~~ 
152.30  ~~agency expenditures growth amount for the programs identified in~~ 
152.31  ~~subdivision 2 shall be made on or before June 3, 2001.  Payments~~ 
152.32  ~~for the period July 2001 through December 2001 shall be made on~~ 
152.33  ~~or before the third of each month thereafter through December~~ 
152.34  ~~31, 2001.~~ 
152.35     ~~(h) Effective January 1, 2002, monthly payments for the~~ 
152.36  ~~county share of county agency expenditures shall be made~~ 
153.1   ~~subsequent to the first of each month.~~ 
153.2      ~~Payments under this subdivision are subject to the~~ 
153.3   ~~provisions of section 256.017.~~  
153.4      Sec. 3.  Minnesota Statutes 1996, section 256.82, 
153.5   subdivision 1, is amended to read: 
153.6      Subdivision 1.  [DIVISION OF COSTS AND PAYMENTS.] Based 
153.7   upon estimates submitted by the county agency to the state 
153.8   agency, which shall state the estimated required expenditures 
153.9   for the succeeding month, upon the direction of the state 
153.10  agency, payment shall be made monthly in advance by the state to 
153.11  the counties of all federal funds available for that purpose for 
153.12  such succeeding month.  The state share of the nonfederal 
153.13  portion of county agency expenditures shall be ~~85~~ 100 percent.  
153.14  ~~and the county share shall be 15 percent.  Benefits shall be~~ 
153.15  ~~issued to recipients by the state or county and funded according~~ 
153.16  ~~to section 256.025, subdivision 3, subject to provisions of~~ 
153.17  ~~section 256.017.  Beginning July 1, 1991, the state will~~ 
153.18  ~~reimburse counties according to the payment schedule in section~~ 
153.19  ~~256.025 for the county share of county agency expenditures under~~ 
153.20  ~~this subdivision from January 1, 1991, on.~~  Payment to counties 
153.21  under this subdivision is subject to the provisions of section 
153.22  256.017.  Adjustment of any overestimate or underestimate made 
153.23  by any county shall be paid upon the direction of the state 
153.24  agency in any succeeding month.  
153.25     Sec. 4.  Minnesota Statutes 1996, section 256.871, 
153.26  subdivision 6, is amended to read: 
153.27     Subd. 6.  [REPORTS OF ESTIMATED EXPENDITURES; PAYMENTS.] 
153.28  The county agency shall submit to the state agency reports 
153.29  required under section 256.01, subdivision 2, paragraph (17).  
153.30  Fiscal reports shall estimate expenditures for each succeeding 
153.31  month in such form as required by the state agency.  The state 
153.32  share of the nonfederal portion of eligible expenditures shall 
153.33  be ~~ten~~ 100 percent ~~and the county share shall be 90 percent~~.  
153.34  ~~Benefits shall be issued to recipients by the state or county~~ 
153.35  ~~and funded according to section 256.025, subdivision 3, subject~~ 
153.36  ~~to provisions of section 256.017.  Beginning July 1, 1991, the~~ 
154.1   ~~state will reimburse counties according to the payment schedule~~ 
154.2   ~~set forth in section 256.025 for the county share of county~~ 
154.3   ~~agency expenditures made under this subdivision from January 1,~~ 
154.4   ~~1991, on.  Payment under this subdivision is subject to the~~ 
154.5   ~~provisions of section 256.017.~~  Adjustment of any overestimate 
154.6   or underestimate made by any county shall be paid upon the 
154.7   direction of the state agency in any succeeding month. 
154.8      Sec. 5.  Minnesota Statutes 1996, section 256.935, is 
154.9   amended to read: 
154.10     256.935 [FUNERAL EXPENSES, PAYMENT BY COUNTY AGENCY.] 
154.11     Subdivision 1.  On the death of any person receiving public 
154.12  assistance through aid to dependent children, the county agency 
154.13  shall pay an amount for funeral expenses not exceeding the 
154.14  amount paid for comparable services under section 261.035 plus 
154.15  actual cemetery charges.  No funeral expenses shall be paid if 
154.16  the estate of the deceased is sufficient to pay such expenses or 
154.17  if the spouse, who was legally responsible for the support of 
154.18  the deceased while living, is able to pay such expenses; 
154.19  provided, that the additional payment or donation of the cost of 
154.20  cemetery lot, interment, religious service, or for the 
154.21  transportation of the body into or out of the community in which 
154.22  the deceased resided, shall not limit payment by the county 
154.23  agency as herein authorized.  Freedom of choice in the selection 
154.24  of a funeral director shall be granted to persons lawfully 
154.25  authorized to make arrangements for the burial of any such 
154.26  deceased recipient.  In determining the sufficiency of such 
154.27  estate, due regard shall be had for the nature and marketability 
154.28  of the assets of the estate.  The county agency may grant 
154.29  funeral expenses where the sale would cause undue loss to the 
154.30  estate.  Any amount paid for funeral expenses shall be a prior 
154.31  claim against the estate, as provided in section 524.3-805, and 
154.32  any amount recovered shall be reimbursed to the agency which 
154.33  paid the expenses.  The commissioner shall specify requirements 
154.34  for reports, including fiscal reports, according to section 
154.35  256.01, subdivision 2, paragraph (17).  The state share shall 
154.36  pay the entire amount of county agency expenditures ~~shall be 50~~ 
155.1   ~~percent and the county share shall be 50 percent~~.  Benefits 
155.2   shall be issued to recipients by the state or county ~~and funded~~ 
155.3   ~~according to section 256.025, subdivision 3,~~ subject to 
155.4   provisions of section 256.017. 
155.5      ~~Beginning July 1, 1991, the state will reimburse counties~~ 
155.6   ~~according to the payment schedule set forth in section 256.025~~ 
155.7   ~~for the county share of county agency expenditures made under~~ 
155.8   ~~this subdivision from January 1, 1991, on.  Payment under this~~ 
155.9   ~~subdivision is subject to the provisions of section 256.017.~~ 
155.10     Sec. 6.  Minnesota Statutes 1996, section 256B.0913, 
155.11  subdivision 14, is amended to read: 
155.12     Subd. 14.  [REIMBURSEMENT AND RATE ADJUSTMENTS.] (a) 
155.13  Reimbursement for expenditures for the alternative care services 
155.14  as approved by the client's case manager shall be through the 
155.15  invoice processing procedures of the department's Medicaid 
155.16  Management Information System (MMIS).  To receive reimbursement, 
155.17  the county or vendor must submit invoices within 12 months 
155.18  following the date of service.  The county agency and its 
155.19  vendors under contract shall not be reimbursed for services 
155.20  which exceed the county allocation. 
155.21     (b) If a county collects less than 50 percent of the client 
155.22  premiums due under subdivision 12, the commissioner may withhold 
155.23  up to three percent of the county's final alternative care 
155.24  program allocation determined under subdivisions 10 and 11. 
155.25     ~~(c) Beginning July 1, 1991, the state will reimburse~~ 
155.26  ~~counties, up to the limits of state appropriations, according to~~ 
155.27  ~~the payment schedule in section 256.025 for the county share of~~ 
155.28  ~~costs incurred under this subdivision on or after January 1,~~ 
155.29  ~~1991, for individuals who would be eligible for medical~~ 
155.30  ~~assistance within 180 days of admission to a nursing home.~~ 
155.31     ~~(d)~~ (c) For fiscal years beginning on or after July 1, 
155.32  1993, the commissioner of human services shall not provide 
155.33  automatic annual inflation adjustments for alternative care 
155.34  services.  The commissioner of finance shall include as a budget 
155.35  change request in each biennial detailed expenditure budget 
155.36  submitted to the legislature under section 16A.11 annual 
156.1   adjustments in reimbursement rates for alternative care services 
156.2   based on the forecasted percentage change in the Home Health 
156.3   Agency Market Basket of Operating Costs, for the fiscal year 
156.4   beginning July 1, compared to the previous fiscal year, unless 
156.5   otherwise adjusted by statute.  The Home Health Agency Market 
156.6   Basket of Operating Costs is published by Data Resources, Inc.  
156.7   The forecast to be used is the one published for the calendar 
156.8   quarter beginning January 1, six months prior to the beginning 
156.9   of the fiscal year for which rates are set. 
156.10     ~~(e)~~ (d) The county shall negotiate individual rates with 
156.11  vendors and may be reimbursed for actual costs up to the greater 
156.12  of the county's current approved rate or 60 percent of the 
156.13  maximum rate in fiscal year 1994 and 65 percent of the maximum 
156.14  rate in fiscal year 1995 for each alternative care service.  
156.15  Notwithstanding any other rule or statutory provision to the 
156.16  contrary, the commissioner shall not be authorized to increase 
156.17  rates by an annual inflation factor, unless so authorized by the 
156.18  legislature. 
156.19     ~~(f)~~ (e) On July 1, 1993, the commissioner shall increase 
156.20  the maximum rate for home delivered meals to $4.50 per meal. 
156.21     Sec. 7.  Minnesota Statutes 1996, section 256B.19, 
156.22  subdivision 1, is amended to read: 
156.23     Subdivision 1.  [DIVISION OF COST.] (a) The state and 
156.24  county share of medical assistance costs not paid by federal 
156.25  funds ~~shall be as follows:~~  
156.26     ~~(1) ninety percent state funds and ten percent county~~ 
156.27  ~~funds, unless otherwise provided below;~~ 
156.28     ~~(2)~~ beginning January 1, 1992, shall be 50 percent state 
156.29  funds and 50 percent county funds for the cost of placement of 
156.30  severely emotionally disturbed children in regional treatment 
156.31  centers.  
156.32     ~~For counties that participate in a Medicaid demonstration~~ 
156.33  ~~project under sections 256B.69 and 256B.71, the division of the~~ 
156.34  ~~nonfederal share of medical assistance expenses for payments~~ 
156.35  ~~made to prepaid health plans or for payments made to health~~ 
156.36  ~~maintenance organizations in the form of prepaid capitation~~ 
157.1   ~~payments, this division of medical assistance expenses shall be~~ 
157.2   ~~95 percent by the state and five percent by the county of~~ 
157.3   ~~financial responsibility.~~  
157.4      (b) In counties where prepaid health plans are under 
157.5   contract to the commissioner to provide services to medical 
157.6   assistance recipients, the cost of court ordered treatment 
157.7   ordered without consulting the prepaid health plan that does not 
157.8   include diagnostic evaluation, recommendation, and referral for 
157.9   treatment by the prepaid health plan is the responsibility of 
157.10  the county of financial responsibility.  
157.11     Sec. 8.  Minnesota Statutes 1996, section 256B.19, 
157.12  subdivision 2a, is amended to read: 
157.13     Subd. 2a.  [DIVISION OF COSTS.] ~~Beginning July 1, 1991, the~~ 
157.14  ~~state shall reimburse counties according to the payment schedule~~ 
157.15  ~~in section 256.025 for the nonfederal share of costs incurred~~ 
157.16  ~~for medical assistance common carrier transportation and related~~ 
157.17  ~~travel expenses provided for medical purposes to medical~~ 
157.18  ~~assistance recipients from January 1, 1991, on.  For purposes of~~ 
157.19  ~~this subdivision, transportation shall have the meaning given it~~ 
157.20  ~~in Code of Federal Regulations, title 42, section 440.170(a), as~~ 
157.21  ~~amended through October 1, 1987, and travel expenses shall have~~ 
157.22  ~~the meaning given in Code of Federal Regulations, title 42,~~ 
157.23  ~~section 440.170(a)(3), as amended through October 1, 1987.~~ 
157.24     The county shall ensure that only the least costly, most 
157.25  appropriate transportation and travel expenses are used.  The 
157.26  state may enter into volume purchase contracts, or use a 
157.27  competitive bidding process, whenever feasible, to minimize the 
157.28  costs of transportation services.  If the state has entered into 
157.29  a volume purchase contract or used the competitive bidding 
157.30  procedures of chapter 16B to arrange for transportation 
157.31  services, the county may be required to use such arrangements ~~to~~ 
157.32  ~~be eligible for state reimbursement of the 50 percent county~~ 
157.33  ~~share of medical assistance common carrier transportation and~~ 
157.34  ~~related travel expenses provided for medical purposes~~. 
157.35     Sec. 9.  Minnesota Statutes 1996, section 256B.19, 
157.36  subdivision 2b, is amended to read: 
158.1      Subd. 2b.  [PILOT PROJECT REIMBURSEMENT.] In counties where 
158.2   a pilot or demonstration project is operated under the medical 
158.3   assistance program, the state may pay 100 percent of the 
158.4   administrative costs for the pilot or demonstration project 
158.5   after June 30, 1990.  ~~Reimbursement for these costs is subject~~ 
158.6   ~~to section 256.025.~~ 
158.7      Sec. 10.  Minnesota Statutes 1996, section 256D.03, 
158.8   subdivision 2, is amended to read: 
158.9      Subd. 2.  ~~After December 31, 1980,~~ State aid shall be paid 
158.10  for ~~75 percent of~~ all general assistance and grants up to the 
158.11  standards of section 256D.01, subdivision 1a, and according to 
158.12  procedures established by the commissioner, except as provided 
158.13  for under section 256.017.  ~~Benefits shall be issued to~~ 
158.14  ~~recipients by the state or county and funded according to~~ 
158.15  ~~section 256.025, subdivision 3.~~  
158.16     ~~Beginning July 1, 1991, the state will reimburse counties~~ 
158.17  ~~according to the payment schedule in section 256.025 for the~~ 
158.18  ~~county share of county agency expenditures made under this~~ 
158.19  ~~subdivision from January 1, 1991, on.  Payment to counties under~~ 
158.20  ~~this subdivision is subject to the provisions of section 256.017.~~
158.21     Sec. 11.  Minnesota Statutes 1996, section 256D.03, 
158.22  subdivision 2a, is amended to read: 
158.23     Subd. 2a.  [COUNTY AGENCY OPTIONS.] Any county agency may, 
158.24  from its own resources, make payments of general assistance: (a) 
158.25  at a standard higher than that established by the commissioner 
158.26  without reference to the standards of section 256D.01, 
158.27  subdivision 1; or (b) to persons not meeting the eligibility 
158.28  standards set forth in section 256D.05, subdivision 1, but for 
158.29  whom the aid would further the purposes established in the 
158.30  general assistance program ~~in accordance with~~ according to rules 
158.31  adopted by the commissioner ~~pursuant~~ according to the 
158.32  administrative procedure act.  The Minnesota department of human 
158.33  services may maintain client records and issue these payments, 
158.34  providing the cost of benefits is paid by the counties to the 
158.35  department of human services ~~in accordance with~~ 
158.36  ~~sections~~ according to section 256.01 ~~and 256.025, subdivision 3~~. 
159.1      Sec. 12.  Minnesota Statutes 1996, section 256D.03, 
159.2   subdivision 6, is amended to read: 
159.3      Subd. 6.  [DIVISION OF COSTS.] The state share of county 
159.4   agency expenditures for general assistance medical care shall be 
159.5   ~~90~~ 100 percent ~~and the county share shall be ten percent~~.  
159.6   Payments made under this subdivision shall be made ~~in accordance~~ 
159.7   ~~with~~ according to sections 256B.041, subdivision 5 and 256B.19, 
159.8   subdivision 1.  In counties where a pilot or demonstration 
159.9   project is operated for general assistance medical care 
159.10  services, the state may pay 100 percent of the costs of 
159.11  administering the pilot or demonstration project.  ~~Reimbursement~~ 
159.12  ~~for these costs is subject to section 256.025.~~ 
159.13     ~~Beginning July 1, 1991, the state will reimburse counties~~ 
159.14  ~~according to the payment schedule in section 256.025 for the~~ 
159.15  ~~county share of costs incurred under this subdivision from~~ 
159.16  ~~January 1, 1991, on.  Payment to counties under this subdivision~~ 
159.17  ~~is subject to the provisions of section 256.017.~~ 
159.18     Notwithstanding any provision to the contrary, beginning 
159.19  July 1, 1991, the state shall pay 100 percent of the costs for 
159.20  centralized claims processing by the department of 
159.21  administration relative to claims beginning January 1, 1991, and 
159.22  submitted on behalf of general assistance medical care 
159.23  recipients by vendors in the general assistance medical care 
159.24  program. 
159.25     Beginning July 1, 1991, the state shall reimburse counties 
159.26  up to the limit of state appropriations for general assistance 
159.27  medical care common carrier transportation and related travel 
159.28  expenses provided for medical purposes after December 31, 1990.  
159.29  ~~Reimbursement shall be provided according to the payment~~ 
159.30  ~~schedule set forth in section 256.025.~~  For purposes of this 
159.31  subdivision, transportation shall have the meaning given it in 
159.32  Code of Federal Regulations, title 42, section 440.170(a), as 
159.33  amended through October 1, 1987, and travel expenses shall have 
159.34  the meaning given in Code of Federal Regulations, title 42, 
159.35  section 440.170(a)(3), as amended through October 1, 1987. 
159.36     The county shall ensure that only the least costly most 
160.1   appropriate transportation and travel expenses are used.  The 
160.2   state may enter into volume purchase contracts, or use a 
160.3   competitive bidding process, whenever feasible, to minimize the 
160.4   costs of transportation services.  If the state has entered into 
160.5   a volume purchase contract or used the competitive bidding 
160.6   procedures of chapter 16B to arrange for transportation 
160.7   services, the county may be required to use such arrangements to 
160.8   be eligible for state reimbursement for general assistance 
160.9   medical care common carrier transportation and related travel 
160.10  expenses provided for medical purposes. 
160.11     In counties where prepaid health plans are under contract 
160.12  to the commissioner to provide services to general assistance 
160.13  medical care recipients, the cost of court ordered treatment 
160.14  that does not include diagnostic evaluation, recommendation, or 
160.15  referral for treatment by the prepaid health plan is the 
160.16  responsibility of the county of financial responsibility. 
160.17     Sec. 13.  Minnesota Statutes 1996, section 256D.36, is 
160.18  amended to read: 
160.19     256D.36 [STATE PARTICIPATION.] 
160.20     Subdivision 1.  [STATE PARTICIPATION.] The state share of 
160.21  aid paid shall be ~~85~~ 100 percent. ~~and the county share shall be~~ 
160.22  ~~15 percent.  Benefits shall be issued to recipients by the state~~ 
160.23  ~~or county and funded according to section 256.025, subdivision~~ 
160.24  ~~3, subject to provisions of section 256.017.~~ 
160.25     ~~Beginning July 1, 1991, the state will reimburse counties~~ 
160.26  ~~according to the payment schedule in section 256.025 for the~~ 
160.27  ~~county share of county agency expenditures for financial~~ 
160.28  ~~benefits to individuals under this subdivision from January 1,~~ 
160.29  ~~1991, on.  Payment to counties under this subdivision is subject~~ 
160.30  ~~to the provisions of section 256.017.~~ 
160.31     Sec. 14.  [REPEALER.] 
160.32     Minnesota Statutes 1996, sections 256.026; 256.82, 
160.33  subdivision 1; 256B.041, subdivision 5; and 256B.19, subdivision 
160.34  1a, are repealed. 
160.35                             ARTICLE 7
160.36                    LIFE SKILLS SELF-SUFFICIENCY
161.1      Section 1.  [256B.095] [THREE-YEAR QUALITY ASSURANCE PILOT 
161.2   PROJECT ESTABLISHED.] 
161.3      Effective July 1, 1998, an alternative quality assurance 
161.4   licensing system pilot project for programs for persons with 
161.5   developmental disabilities is established in Dodge, Fillmore, 
161.6   Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, 
161.7   Wabasha, and Winona counties for the purpose of improving the 
161.8   quality of services provided to persons with developmental 
161.9   disabilities.  A county, at its option, may choose to have all 
161.10  programs for persons with developmental disabilities located 
161.11  within the county licensed under chapter 245A using standards 
161.12  determined under the alternative quality assurance licensing 
161.13  system pilot project or may continue regulation of these 
161.14  programs under the licensing system operated by the 
161.15  commissioner.  The pilot project expires on June 30, 2001. 
161.16     Sec. 2.  [256B.0951] [QUALITY ASSURANCE COMMISSION.] 
161.17     Subdivision 1.  [MEMBERSHIP.] The region 10 quality 
161.18  assurance commission is established.  The commission consists of 
161.19  at least 13 but not more than 20 members as follows:  at least 
161.20  three but not more than five members representing advocacy 
161.21  organizations; at least three but not more than five members 
161.22  representing consumers, families, and their legal 
161.23  representatives; at least three but not more than five members 
161.24  representing service providers; and at least three but not more 
161.25  than five members representing counties.  Initial membership of 
161.26  the commission shall be recruited and approved by the region 10 
161.27  stakeholders group.  Prior to approving the commission's 
161.28  membership, the stakeholders group shall provide to the 
161.29  commissioner a list of the membership in the stakeholders group, 
161.30  as of February 1, 1997, a brief summary of meetings held by the 
161.31  group since July 1, 1996, and copies of any materials prepared 
161.32  by the group for public distribution.  The first commission 
161.33  shall establish membership guidelines for the transition and 
161.34  recruitment of membership for the commission's ongoing 
161.35  existence.  Members of the commission who do not receive a 
161.36  salary or wages from an employer for time spent on commission 
162.1   duties may receive a per diem payment when performing commission 
162.2   duties and functions.  All members may be reimbursed for 
162.3   expenses related to commission activities.  Notwithstanding the 
162.4   provisions of section 15.059, subdivision 5, the commission 
162.5   expires on June 30, 2001. 
162.6      Subd. 2.  [AUTHORITY TO HIRE STAFF.] The commission may 
162.7   hire staff to perform the duties assigned in this section.  
162.8      Subd. 3.  [COMMISSION DUTIES.] (a) By October 1, 1997, the 
162.9   commission, in cooperation with the commissioners of human 
162.10  services and health, shall do the following:  (1) approve an 
162.11  alternative quality assurance licensing system based on the 
162.12  evaluation of outcomes; (2) approve measurable outcomes in the 
162.13  areas of health and safety, consumer evaluation, education and 
162.14  training, providers, and systems that shall be evaluated during 
162.15  the alternative licensing process; and (3) establish variable 
162.16  licensure periods not to exceed three years based on outcomes 
162.17  achieved.  For purposes of this subdivision, "outcome" means the 
162.18  behavior, action, or status of a person that can be observed or 
162.19  measured and can be reliably and validly determined. 
162.20     (b) By January 15, 1998, the commission shall approve, in 
162.21  cooperation with the commissioner of human services, a training 
162.22  program for members of the quality assurance teams established 
162.23  under section 8. 
162.24     Subd. 4.  [COMMISSION'S AUTHORITY TO RECOMMEND VARIANCES OF 
162.25  LICENSING STANDARDS.] The commission may recommend to the 
162.26  commissioners of human services and health variances from the 
162.27  standards governing licensure of programs for persons with 
162.28  developmental disabilities in order to implement an alternative 
162.29  developmental disabilities licensing system if the commission 
162.30  determines that the alternative licensing system does not affect 
162.31  the health or safety of persons being served by the licensed 
162.32  program nor compromise the qualifications of staff to provide 
162.33  services. 
162.34     Subd. 5.  [VARIANCE OF CERTAIN STANDARDS PROHIBITED.] The 
162.35  safety standards, rights, or procedural protections under 
162.36  sections 245.825; 245.91 to 245.97; 245A.04, subdivisions 3, 3a, 
163.1   3b, and 3c; 245A.09, subdivision 2, paragraph (c), clauses (2) 
163.2   and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, 
163.3   subdivisions 1b, clause (7), and 10; 626.556; 626.557, or 
163.4   procedures for the monitoring of psychotropic medications shall 
163.5   not be varied under the alternative licensing system pilot 
163.6   project.  The commission may make recommendations to the 
163.7   commissioners of human services and health or to the legislature 
163.8   regarding alternatives to or modifications of the rules 
163.9   referenced in this subdivision. 
163.10     Subd. 6.  [PROGRESS REPORT.] The commission shall submit a 
163.11  progress report to the legislature on pilot project development 
163.12  by January 15, 1998.  The report shall include recommendations 
163.13  on any legislative changes necessary to improve cooperation 
163.14  between the commission and the commissioners of human services 
163.15  and health. 
163.16     Sec. 3.  [256B.0952] [COUNTY DUTIES; QUALITY ASSURANCE 
163.17  TEAMS.] 
163.18     Subdivision 1.  [NOTIFICATION.] By January 15, 1998, each 
163.19  affected county shall notify the commission and the 
163.20  commissioners of human services and health as to whether it 
163.21  chooses to implement on July 1, 1998, the alternative licensing 
163.22  system for the pilot project.  A county that does not implement 
163.23  the alternative licensing system on July 1, 1998, may give 
163.24  notice to the commission and the commissioners by January 15, 
163.25  1999, or January 15, 2000, that it will implement the 
163.26  alternative licensing system on the following July 1.  A county 
163.27  that implements the alternative licensing system commits to 
163.28  participate until June 30, 2001.  
163.29     Subd. 2.  [APPOINTMENT OF REVIEW COUNCIL; DUTIES OF 
163.30  COUNCIL.] A county or group of counties that choose to 
163.31  participate in the alternative licensing system shall appoint a 
163.32  quality assurance review council comprised of advocates; 
163.33  consumers, families, and their legal representatives; providers; 
163.34  and county staff.  The council shall: 
163.35     (1) review summary reports from quality assurance team 
163.36  reviews and make recommendations to counties regarding program 
164.1   licensure; 
164.2      (2) make recommendations to the commission regarding the 
164.3   alternative licensing system and quality assurance process; and 
164.4      (3) resolve complaints between the quality assurance teams, 
164.5   counties, providers, and consumers, families, and their legal 
164.6   representatives. 
164.7      Subd. 3.  [NOTICE TO COMMISSIONERS.] The county, based on 
164.8   reports from quality assurance managers and recommendations from 
164.9   the quality assurance review council regarding the findings of 
164.10  quality assurance teams, shall notify the commissioners of human 
164.11  services and health regarding whether facilities, programs, or 
164.12  services have met the outcome standards for licensure and are 
164.13  eligible for payment. 
164.14     Subd. 4.  [APPOINTMENT OF QUALITY ASSURANCE MANAGER.] (a) A 
164.15  county or group of counties that choose to participate in the 
164.16  alternative licensing system shall designate a quality assurance 
164.17  manager and shall establish quality assurance teams according to 
164.18  subdivision 5.  The manager shall recruit, train, and assign 
164.19  duties to the quality assurance team members.  In assigning team 
164.20  members to conduct the quality assurance process at a facility, 
164.21  program, or service, the manager shall take into account the 
164.22  size of the service provider, the number of services to be 
164.23  reviewed, the skills necessary for team members to complete the 
164.24  process, and other relevant factors.  The manager shall ensure 
164.25  that no team member has a financial, personal, or family 
164.26  relationship with the facility, program, or service being 
164.27  reviewed or with any clients of the facility, program, or 
164.28  service. 
164.29     (b) Quality assurance teams shall report the findings of 
164.30  their quality assurance reviews to the quality assurance manager.
164.31  The quality assurance manager shall provide the report from the 
164.32  quality assurance team to the county and commissioners of human 
164.33  services and health and a summary of the report to the quality 
164.34  assurance review council.  
164.35     Subd. 5.  [QUALITY ASSURANCE TEAMS.] Quality assurance 
164.36  teams shall be comprised of county staff; providers; consumers, 
165.1   families, and their legal representatives; members of advocacy 
165.2   organizations; and other involved community members.  Team 
165.3   members must satisfactorily complete the training program 
165.4   approved by the commission and must demonstrate 
165.5   performance-based competency.  Team members are not considered 
165.6   to be county employees for purposes of workers' compensation, 
165.7   unemployment compensation, or state retirement laws solely on 
165.8   the basis of participation on a quality assurance team.  The 
165.9   county may pay a per diem to team members who do not receive a 
165.10  salary or wages from an employer for time spent on alternative 
165.11  quality assurance process matters.  All team members may be 
165.12  reimbursed for expenses related to their participation in the 
165.13  alternative process. 
165.14     Subd. 6.  [LICENSING FUNCTIONS.] Participating counties 
165.15  shall perform licensing functions and activities as delegated by 
165.16  the commissioner of human services according to section 245A.16. 
165.17     Sec. 4.  [256B.0953] [QUALITY ASSURANCE PROCESS.] 
165.18     Subdivision 1.  [PROCESS COMPONENTS.] (a) The quality 
165.19  assurance licensing process consists of an evaluation by a 
165.20  quality assurance team of the facility, program, or service 
165.21  according to outcome-based measurements.  The process must 
165.22  include an evaluation of a random sample of program consumers.  
165.23  The sample must be representative of each service provided.  The 
165.24  sample size must be at least five percent of consumers but not 
165.25  less than three consumers.  
165.26     (b) All consumers must be given the opportunity to be 
165.27  included in the quality assurance process in addition to those 
165.28  chosen for the random sample. 
165.29     Subd. 2.  [LICENSURE PERIODS.] (a) In order to be licensed 
165.30  under the alternative quality assurance process, a facility, 
165.31  program, or service must satisfy the health and safety outcomes 
165.32  approved for the pilot project. 
165.33     (b) Licensure shall be approved for periods of one to three 
165.34  years for a facility, program, or service that satisfies the 
165.35  requirements of paragraph (a) and achieves the outcome 
165.36  measurements in the categories of consumer evaluation, education 
166.1   and training, providers, and systems. 
166.2      Subd. 3.  [APPEALS PROCESS.] A facility, program, or 
166.3   service may contest a licensing decision of the quality 
166.4   assurance team as permitted under chapter 245A. 
166.5      Sec. 5.  [256B.0954] [CERTAIN PERSONS DEFINED AS MANDATED 
166.6   REPORTERS.] 
166.7      Members of the quality assurance commission established 
166.8   under section 7, members of quality assurance review councils 
166.9   established under section 8, quality assurance managers 
166.10  appointed under section 8, and members of quality assurance 
166.11  teams established under section 8 are mandated reporters as that 
166.12  term is defined in sections 626.556, subdivision 3, and 
166.13  626.5572, subdivision 16. 
166.14     Sec. 6.  [256B.0955] [DUTIES OF THE COMMISSIONER OF HUMAN 
166.15  SERVICES.] 
166.16     (a) Effective July 1, 1998, the commissioner of human 
166.17  services shall delegate authority to perform licensing functions 
166.18  and activities, according to section 245A.16, to counties 
166.19  participating in the alternative licensing system.  The 
166.20  commissioner shall not license or reimburse a facility, program, 
166.21  or service for persons with developmental disabilities in a 
166.22  county that participates in the alternative licensing system if 
166.23  the commissioner has received from the appropriate county 
166.24  notification that the facility, program, or service has been 
166.25  reviewed by a quality assurance team and has failed to qualify 
166.26  for licensure. 
166.27     (b) The commissioner may conduct random licensing 
166.28  inspections based on outcomes adopted under section 7 at 
166.29  facilities, programs, and services governed by the alternative 
166.30  licensing system.  The role of such random inspections shall be 
166.31  to verify that the alternative licensing system protects the 
166.32  safety and well-being of consumers and maintains the 
166.33  availability of high-quality services for persons with 
166.34  developmental disabilities.  
166.35     (c) The commissioner shall provide technical assistance and 
166.36  support or training to the alternative licensing system pilot 
167.1   project. 
167.2      (d) The commissioner and the commission shall establish an 
167.3   ongoing evaluation process for the alternative licensing system. 
167.4      (e) The commissioner shall contract with an independent 
167.5   entity to conduct a financial review of the alternative 
167.6   licensing system, including an evaluation of possible budgetary 
167.7   savings within the department of human services and the 
167.8   department of health as a result of implementation of the 
167.9   alternative quality assurance licensing system.  This review 
167.10  must be completed by December 15, 2000.  
167.11     (f) The commissioner and the commission shall submit a 
167.12  report to the legislature by January 15, 2001, on the results of 
167.13  the evaluation process of the alternative licensing system, a 
167.14  summary of the results of the independent financial review, and 
167.15  a recommendation on whether the pilot project should be extended 
167.16  beyond June 30, 2001. 
167.17     Sec. 7.  [REQUEST FOR WAIVER.] 
167.18     By January 1, 1998, the commissioner of human services or 
167.19  health shall request a waiver from the federal Department of 
167.20  Health and Human Services to permit the use of the alternative 
167.21  quality assurance system to license and certify intermediate 
167.22  care facilities for persons with mental retardation. 
167.23                             ARTICLE 8
167.24       COMMUNITY MENTAL HEALTH AND REGIONAL TREATMENT CENTERS
167.25     Section 1.  Minnesota Statutes 1996, section 246.02, 
167.26  subdivision 2, is amended to read: 
167.27     Subd. 2.  The commissioner of human services shall act with 
167.28  the advice of the medical policy directional committee on mental 
167.29  health in the appointment and removal of the chief executive 
167.30  officers of the following institutions:  Anoka-Metro Regional 
167.31  Treatment Center, Ah-Gwah-Ching Center, Fergus Falls Regional 
167.32  Treatment Center, St. Peter Regional Treatment Center and 
167.33  Minnesota Security Hospital, Willmar Regional Treatment Center, 
167.34  ~~Faribault Regional Center,~~ Cambridge Regional Human Services 
167.35  Center, Brainerd Regional Human Services Center, ~~and until June~~ 
167.36  ~~30, 1995, Moose Lake Regional Treatment Center, and after June~~ 
168.1   ~~30, 1995,~~ Minnesota Sexual Psychopathic Personality Treatment 
168.2   Center and until June 30, 1998, Faribault Regional Center. 
168.3      Sec. 2.  Minnesota Statutes 1996, section 252.025, 
168.4   subdivision 1, is amended to read: 
168.5      Subdivision 1.  [REGIONAL TREATMENT CENTERS.] State 
168.6   hospitals for persons with mental retardation shall be 
168.7   established and maintained at Faribault until June 30, 1998, 
168.8   Cambridge and Brainerd, and notwithstanding any provision to the 
168.9   contrary they shall be respectively known as the Faribault 
168.10  regional center, the Cambridge regional human services center, 
168.11  and the Brainerd regional human services center.  Each of the 
168.12  foregoing state hospitals shall also be known by the name of 
168.13  regional center at the discretion of the commissioner of human 
168.14  services.  The terms "human services" or "treatment" may be 
168.15  included in the designation. 
168.16     Sec. 3.  Minnesota Statutes 1996, section 252.025, 
168.17  subdivision 4, is amended to read: 
168.18     Subd. 4.  [STATE-PROVIDED SERVICES.] (a) It is the policy 
168.19  of the state to capitalize and recapitalize the regional 
168.20  treatment centers as necessary to prevent depreciation and 
168.21  obsolescence of physical facilities and to ensure they retain 
168.22  the physical capability to provide residential programs.  
168.23  Consistent with that policy and with section 252.50, and within 
168.24  the limits of appropriations made available for this purpose, 
168.25  the commissioner may establish, by June 30, 1991, the following 
168.26  state-operated, community-based programs for the least 
168.27  vulnerable regional treatment center residents:  at Brainerd 
168.28  regional services center, two residential programs and two day 
168.29  programs; at Cambridge regional treatment center, four 
168.30  residential programs and two day programs; at Faribault regional 
168.31  treatment center, ten residential programs and six day programs; 
168.32  at Fergus Falls regional treatment center, two residential 
168.33  programs and one day program; at Moose Lake regional treatment 
168.34  center, four residential programs and two day programs; and at 
168.35  Willmar regional treatment center, two residential programs and 
168.36  one day program. 
169.1      (b) By January 15, 1991, the commissioner shall report to 
169.2   the legislature a plan to provide continued regional treatment 
169.3   center capacity and state-operated, community-based residential 
169.4   and day programs for persons with developmental disabilities at 
169.5   Brainerd, Cambridge, ~~Faribault,~~ Fergus Falls, St. Peter, and 
169.6   Willmar, as follows: 
169.7      (1) by July 1, 1998, continued regional treatment center 
169.8   capacity to serve 350 persons with developmental disabilities as 
169.9   follows:  at Brainerd, 80 persons; at Cambridge, 12 persons; ~~at~~ 
169.10  ~~Faribault, 110 persons;~~ at Fergus Falls, 60 persons; at St. 
169.11  Peter, 35 persons; at Willmar, 25 persons; and up to 16 crisis 
169.12  beds in the Twin Cities metropolitan area; and 
169.13     (2) by July 1, 1999, continued regional treatment center 
169.14  capacity to serve 254 persons with developmental disabilities as 
169.15  follows:  at Brainerd, 57 persons; at Cambridge, 12 persons; ~~at~~ 
169.16  ~~Faribault, 80 persons;~~ at Fergus Falls, 35 persons; at St. 
169.17  Peter, 30 persons; at Willmar, 12 persons, and up to 16 crisis 
169.18  beds in the Twin Cities metropolitan area.  In addition, the 
169.19  plan shall provide for the capacity to provide residential 
169.20  services to 570 persons with developmental disabilities in 95 
169.21  state-operated, community-based residential programs. 
169.22     The commissioner is subject to a mandamus action under 
169.23  chapter 586 for any failure to comply with the provisions of 
169.24  this subdivision. 
169.25     Sec. 4.  Minnesota Statutes 1996, section 254B.02, 
169.26  subdivision 1, is amended to read: 
169.27     Subdivision 1.  [CHEMICAL DEPENDENCY TREATMENT ALLOCATION.] 
169.28  The chemical dependency funds appropriated for allocation shall 
169.29  be placed in a special revenue account.  ~~For the fiscal year~~ 
169.30  ~~beginning July 1, 1987, funds shall be transferred to operate~~ 
169.31  ~~the vendor payment, invoice processing, and collections system~~ 
169.32  ~~for one year.~~  The commissioner shall annually transfer funds 
169.33  from the chemical dependency fund to pay for operation of the 
169.34  drug and alcohol abuse normative evaluation system and to pay 
169.35  for all costs incurred by adding two positions for licensing of 
169.36  chemical dependency treatment and rehabilitation programs 
170.1   located in hospitals for which funds are not otherwise 
170.2   appropriated.  For each year of the biennium ending June 30, 
170.3   1999, the commissioner shall allocate funds to the American 
170.4   Indian chemical dependency tribal account for treatment of 
170.5   American Indians by eligible vendors under section 254B.05, 
170.6   equal to the amount allocated in fiscal year 1997.  The 
170.7   commissioner shall annually divide the money available in the 
170.8   chemical dependency fund that is not held in reserve by counties 
170.9   from a previous allocation, or allocated to the American Indian 
170.10  chemical dependency tribal account.  ~~Twelve~~ Six percent of the 
170.11  remaining money must be reserved for the nonreservation American 
170.12  Indian chemical dependency allocation for treatment of American 
170.13  Indians by eligible vendors under section 254B.05, subdivision 
170.14  1.  The remainder of the money must be allocated among the 
170.15  counties according to the following formula, using state 
170.16  demographer data and other data sources determined by the 
170.17  commissioner: 
170.18     (a) For purposes of this formula, American Indians and 
170.19  children under age 14 are subtracted from the population of each 
170.20  county to determine the restricted population. 
170.21     (b) The amount of chemical dependency fund expenditures for 
170.22  entitled persons for services not covered by prepaid plans 
170.23  governed by section 256B.69 in the previous year is divided by 
170.24  the amount of chemical dependency fund expenditures for entitled 
170.25  persons for all services to determine the proportion of exempt 
170.26  service expenditures for each county. 
170.27     (c) The prepaid plan months of eligibility is multiplied by 
170.28  the proportion of exempt service expenditures to determine the 
170.29  adjusted prepaid plan months of eligibility for each county. 
170.30     (d) The adjusted prepaid plan months of eligibility is 
170.31  added to the number of restricted population fee for service 
170.32  months of eligibility for aid to families with dependent 
170.33  children, general assistance, and medical assistance and divided 
170.34  by the county restricted population to determine county per 
170.35  capita months of covered service eligibility. 
170.36     (e) The number of adjusted prepaid plan months of 
171.1   eligibility for the state is added to the number of fee for 
171.2   service months of eligibility for aid to families with dependent 
171.3   children, general assistance, and medical assistance for the 
171.4   state restricted population and divided by the state restricted 
171.5   population to determine state per capita months of covered 
171.6   service eligibility. 
171.7      (f) The county per capita months of covered service 
171.8   eligibility is divided by the state per capita months of covered 
171.9   service eligibility to determine the county welfare caseload 
171.10  factor. 
171.11     (g) The median married couple income for the most recent 
171.12  three-year period available for the state is divided by the 
171.13  median married couple income for the same period for each county 
171.14  to determine the income factor for each county. 
171.15     (h) The county restricted population is multiplied by the 
171.16  sum of the county welfare caseload factor and the county income 
171.17  factor to determine the adjusted population. 
171.18     (i) $15,000 shall be allocated to each county.  
171.19     (j) The remaining funds shall be allocated proportional to 
171.20  the county adjusted population. 
171.21     Sec. 5.  Minnesota Statutes 1996, section 254B.09, 
171.22  subdivision 4, is amended to read: 
171.23     Subd. 4.  [TRIBAL ALLOCATION.] ~~Forty-two and one-half~~ 
171.24  Eighty-five percent of the American Indian chemical dependency 
171.25  tribal account must be allocated to the federally recognized 
171.26  American Indian tribal governing bodies that have entered into 
171.27  an agreement under subdivision 2 as follows:  $10,000 must be 
171.28  allocated to each governing body and the remainder must be 
171.29  allocated in direct proportion to the population of the 
171.30  reservation according to the most recently available estimates 
171.31  from the federal Bureau of Indian Affairs.  When a tribal 
171.32  governing body has not entered into an agreement with the 
171.33  commissioner under subdivision 2, the county may use funds 
171.34  allocated to the reservation to pay for chemical dependency 
171.35  services for a current resident of the county and of the 
171.36  reservation. 
172.1      Sec. 6.  Minnesota Statutes 1996, section 254B.09, 
172.2   subdivision 5, is amended to read: 
172.3      Subd. 5.  [TRIBAL RESERVE ACCOUNT.] The commissioner shall 
172.4   reserve ~~7.5~~ 15 percent of the American Indian chemical 
172.5   dependency tribal account.  The reserve must be allocated to 
172.6   those tribal units that have used all money allocated under 
172.7   subdivision 4 according to agreements made under subdivision 2 
172.8   and to counties submitting invoices for American Indians under 
172.9   subdivision 1 when all money allocated under subdivision 4 has 
172.10  been used.  An American Indian tribal governing body or a county 
172.11  submitting invoices under subdivision 1 may receive not more 
172.12  than 30 percent of the reserve account in a year.  The 
172.13  commissioner may refuse to make reserve payments for persons not 
172.14  eligible under section 254B.04, subdivision 1, if the tribal 
172.15  governing body responsible for treatment placement has exhausted 
172.16  its allocation.  Money must be allocated as invoices are 
172.17  received. 
172.18     Sec. 7.  Minnesota Statutes 1996, section 254B.09, 
172.19  subdivision 7, is amended to read: 
172.20     Subd. 7.  [NONRESERVATION INDIAN ACCOUNT.] ~~Fifty percent of~~ 
172.21  The nonreservation American Indian chemical dependency 
172.22  allocation must be held in reserve by the commissioner in an 
172.23  account for treatment of Indians not residing on lands of a 
172.24  reservation receiving money under subdivision 4.  This money 
172.25  must be used to pay for services certified by county invoice to 
172.26  have been provided to an American Indian eligible recipient.  
172.27  Money allocated under this subdivision may be used for payments 
172.28  on behalf of American Indian county residents only if, in 
172.29  addition to other placement standards, the county certifies that 
172.30  the placement was appropriate to the cultural orientation of the 
172.31  client.  Any funds for treatment of nonreservation Indians 
172.32  remaining at the end of a fiscal year shall be reallocated under 
172.33  section 254B.02. 
172.34     Sec. 8.  Laws 1995, chapter 207, article 8, section 41, 
172.35  subdivision 2, is amended to read: 
172.36     Subd. 2.  [PROGRAM DESIGN AND IMPLEMENTATION.] (a) The 
173.1   pilot projects shall be established to design, plan, and improve 
173.2   the mental health service delivery system for adults with 
173.3   serious and persistent mental illness that would: 
173.4      (1) provide an expanded array of services from which 
173.5   clients can choose services appropriate to their needs; 
173.6      (2) be based on purchasing strategies that improve access 
173.7   and coordinate services without cost shifting; 
173.8      (3) incorporate existing state facilities and resources 
173.9   into the community mental health infrastructure through creative 
173.10  partnerships with local vendors; and 
173.11     (4) utilize existing categorical funding streams and 
173.12  reimbursement sources in combined and creative ways, except 
173.13  appropriations to regional treatment centers and all funds that 
173.14  are attributable to the operation of state-operated services are 
173.15  excluded unless appropriated specifically by the legislature for 
173.16  a purpose consistent with this section. 
173.17     (b) All projects funded by January 1, 1997, must complete 
173.18  ~~their~~ the planning phase and be operational by June 30, 1997; 
173.19  all projects funded by January 1, 1998, must be operational by 
173.20  June 30, 1998. 
173.21                             ARTICLE 9
173.22            HUMAN SERVICES TECHNICAL AND POLICY CHANGES
173.23     Section 1.  Minnesota Statutes 1996, section 16A.124, 
173.24  subdivision 4b, is amended to read: 
173.25     Subd. 4b.  [HEALTH CARE PAYMENTS.] The commissioner of 
173.26  human services must pay or deny a valid vendor obligation for 
173.27  health services under the medical assistance, general assistance 
173.28  medical care, or MinnesotaCare program within 30 days after 
173.29  receipt.  A "valid vendor obligation" means a clean claim 
173.30  submitted directly to the commissioner by an eligible health 
173.31  care provider for health services provided to an eligible 
173.32  recipient.  A "clean claim" means an original paper or 
173.33  electronic claim with correct data elements, prepared in 
173.34  accordance with the commissioner's published specifications for 
173.35  claim preparation, that does not require an attachment or text 
173.36  information to pay or deny the claim.  Adjustment claims, claims 
174.1   with attachments and text information, and claims submitted to 
174.2   the commissioner as the secondary or tertiary payer, that have 
174.3   been prepared in accordance with the commissioner's published 
174.4   specifications, must be adjudicated within 90 days after 
174.5   receipt.  For purposes of this subdivision, paragraphs (a) to (c)
174.6   shall apply. 
174.7      (a) The rate of interest paid by the agency shall be the 
174.8   rate set by the treasury department for Medicare intermediaries 
174.9   paying interest on Medicare claims failing the prompt payment 
174.10  requirements established by the health care financing 
174.11  administration. 
174.12     (b) The agency is not required to make an interest penalty 
174.13  payment of less than $2. 
174.14     (c) The agency is not required to make an interest penalty 
174.15  payment on claims for which payment has been delayed for 
174.16  purposes of review by the attorney general of potentially 
174.17  fraudulent or abusive billing practices.  Interest must be paid 
174.18  for claims that are delayed with no eventual finding of fraud or 
174.19  abuse. 
174.20     Sec. 2.  Minnesota Statutes 1996, section 62D.04, 
174.21  subdivision 5, is amended to read: 
174.22     Subd. 5.  [PARTICIPATION; GOVERNMENT PROGRAMS.] Health 
174.23  maintenance organizations shall, as a condition of receiving and 
174.24  retaining a certificate of authority, participate in the medical 
174.25  assistance, general assistance medical care, and MinnesotaCare 
174.26  programs.  A health maintenance organization is required to 
174.27  submit proposals in good faith that meet the requirements of the 
174.28  request for proposal provided that the requirements can be 
174.29  reasonably met by a health maintenance organization to serve 
174.30  individuals eligible for the above programs in a geographic 
174.31  region of the state if, at the time of publication of a request 
174.32  for proposal, the percentage of recipients in the public 
174.33  programs in the region who are enrolled in the health 
174.34  maintenance organization is less than the health maintenance 
174.35  organization's percentage of the total number of individuals 
174.36  enrolled in health maintenance organizations in the same 
175.1   region.  Geographic regions shall be defined by the commissioner 
175.2   of human services in the request for proposals. 
175.3      Sec. 3.  Minnesota Statutes 1996, section 144.0721, 
175.4   subdivision 3, is amended to read: 
175.5      Subd. 3.  [LEVEL OF CARE CRITERIA; MODIFICATIONS.] The 
175.6   commissioner shall seek appropriate federal waivers to implement 
175.7   this subdivision.  Notwithstanding any laws or rules to the 
175.8   contrary, effective July 1, ~~1996~~ 1997, Minnesota's level of care 
175.9   criteria for admission of any person to a nursing facility 
175.10  licensed under chapter 144A, or a boarding care home licensed 
175.11  under sections 144.50 to 144.56, are modified as follows: 
175.12     (1) the resident reimbursement classifications and 
175.13  terminology established by rule under sections 256B.41 to 
175.14  256B.48 are the basis for applying the level of care criteria 
175.15  changes; 
175.16     (2) an applicant to a certified nursing facility or 
175.17  certified boarding care home who is dependent in zero, one, or 
175.18  two case mix activities of daily living, is classified as a case 
175.19  mix A, and is independent in orientation and self-preservation, 
175.20  is reclassified as a high function class A person and is not 
175.21  eligible for admission to Minnesota certified nursing facilities 
175.22  or certified boarding care homes; 
175.23     (3) applicants in clause (2) who are dependent in one or 
175.24  two case mix activities of daily living, who are eligible for 
175.25  assistance as determined under sections 256B.055 and 256B.056 or 
175.26  meet eligibility criteria for section 256B.0913 are eligible for 
175.27  a service allowance under section 256B.0913, subdivision 15, and 
175.28  are not eligible for services under sections 256B.0913, 
175.29  subdivisions 1 to 14, and 256B.0915.  ~~Applicants in clause (2)~~ 
175.30  ~~shall have the option of receiving personal care assistant and~~ 
175.31  ~~home health aide services under section 256B.0625, if otherwise~~ 
175.32  ~~eligible, or of receiving the service allowance option, but not~~ 
175.33  ~~both.~~  Applicants in clause (2) shall have the option of 
175.34  residing in community settings under sections 256I.01 to 
175.35  256I.06, if otherwise eligible, or receiving the services 
175.36  allowance option under section 256B.0913, subdivision 15, but 
176.1   not both; 
176.2      (4) residents of a certified nursing facility or certified 
176.3   boarding care home who were admitted before July 1, ~~1996~~ 1997, 
176.4   or individuals receiving services under section 256B.0913, 
176.5   subdivisions 1 to 14, or 256B.0915, before July 1, ~~1996~~ 1997, 
176.6   are not subject to the new level of care criteria unless the 
176.7   resident is discharged home or to another service setting other 
176.8   than a certified nursing facility or certified boarding care 
176.9   home and applies for admission to a certified nursing facility 
176.10  or certified boarding care home after June 30, ~~1996~~ 1997; 
176.11     (5) the local screening teams under section 256B.0911 ~~shall~~ 
176.12  ~~make preliminary determinations concerning~~ may determine the 
176.13  existence of extraordinary circumstances which render 
176.14  nonadmission to a certified nursing or certified boarding care 
176.15  home a serious threat to the health and safety of applicants in 
176.16  clause (2) and may authorize ~~an~~ admission ~~for a short-term stay~~ 
176.17  ~~at~~ to a certified nursing facility or certified boarding care 
176.18  home in accordance with a treatment and discharge plan ~~for up to~~ 
176.19  ~~30 days per year~~; and 
176.20     (6) an individual deemed ineligible for admission to 
176.21  Minnesota certified nursing facilities is entitled to an appeal 
176.22  under section 256.045, subdivision 3. 
176.23     If the commissioner determines upon appeal that an 
176.24  applicant in clause (2) presents extraordinary circumstances 
176.25  including but not limited to the absence or inaccessibility of 
176.26  suitable alternatives, contravening family circumstances, ~~and~~ or 
176.27  protective service issues, the applicant may be eligible for 
176.28  admission to Minnesota certified nursing facilities or certified 
176.29  boarding care homes. 
176.30     Sec. 4.  Minnesota Statutes 1996, section 245.03, 
176.31  subdivision 2, is amended to read: 
176.32     Subd. 2.  [MISSION; EFFICIENCY.] It is part of the 
176.33  department's mission that within the department's resources the 
176.34  commissioner shall endeavor to: 
176.35     (1) prevent the waste or unnecessary spending of public 
176.36  money; 
177.1      (2) use innovative fiscal and human resource practices to 
177.2   manage the state's resources and operate the department as 
177.3   efficiently as possible, including the authority to consolidate 
177.4   different nonentitlement grant programs, having similar 
177.5   functions or serving similar populations, as may be determined 
177.6   by the commissioner, while protecting the original purposes of 
177.7   the programs.  With approval of the commissioner, vendors who 
177.8   are eligible for funding from any of the commissioner's granting 
177.9   authority under section 256.01, subdivision 2, paragraph (1), 
177.10  clause (f), may submit a single application for a grant 
177.11  agreement including multiple awards; 
177.12     (3) coordinate the department's activities wherever 
177.13  appropriate with the activities of other governmental agencies; 
177.14     (4) use technology where appropriate to increase agency 
177.15  productivity, improve customer service, increase public access 
177.16  to information about government, and increase public 
177.17  participation in the business of government; 
177.18     (5) utilize constructive and cooperative labor-management 
177.19  practices to the extent otherwise required by chapters 43A and 
177.20  179A; 
177.21     (6) include specific objectives in the performance report 
177.22  required under section 15.91 to increase the efficiency of 
177.23  agency operations, when appropriate; and 
177.24     (7) recommend to the legislature, in the performance report 
177.25  of the department required under section 15.91, appropriate 
177.26  changes in law necessary to carry out the mission of the 
177.27  department. 
177.28     Sec. 5.  Minnesota Statutes 1996, section 245.652, 
177.29  subdivision 1, is amended to read: 
177.30     Subdivision 1.  [PURPOSE.] The regional treatment centers 
177.31  shall provide services designed to end a person's reliance on 
177.32  chemical use or a person's chemical abuse and increase effective 
177.33  and chemical-free functioning.  Clinically effective programs 
177.34  must be provided in accordance with section 246.64.  Services 
177.35  may be offered on the regional center campus or at sites 
177.36  elsewhere in the ~~catchment~~ area served by the regional treatment 
178.1   center. 
178.2      Sec. 6.  Minnesota Statutes 1996, section 245.652, 
178.3   subdivision 2, is amended to read: 
178.4      Subd. 2.  [SERVICES OFFERED.] Services provided ~~must~~ may 
178.5   include, but are not limited to, the following: 
178.6      (1) primary and extended residential care, including 
178.7   residential treatment programs of varied duration intended to 
178.8   deal with a person's chemical dependency or chemical abuse 
178.9   problems; 
178.10     (2) follow-up care to persons discharged from regional 
178.11  treatment center programs or other chemical dependency programs; 
178.12     (3) outpatient treatment programs; and 
178.13     (4) other treatment services, as appropriate and as 
178.14  provided under contract or shared service agreements. 
178.15     Sec. 7.  Minnesota Statutes 1996, section 245.98, is 
178.16  amended by adding a subdivision to read: 
178.17     Subd. 5.  [STANDARDS.] The commissioner shall create 
178.18  standards for treatment and provider qualifications for the 
178.19  treatment component of the compulsive gambling program. 
178.20     Sec. 8.  Minnesota Statutes 1996, section 252.025, is 
178.21  amended by adding a subdivision to read: 
178.22     Subd. 7.  [MINNESOTA EXTENDED TREATMENT OPTIONS.] The 
178.23  commissioner shall develop by July 1, 1997, the Minnesota 
178.24  extended treatment options to serve Minnesotans who have mental 
178.25  retardation and exhibit severe behaviors which present a risk to 
178.26  public safety.  This program will provide specialized 
178.27  residential services on the Cambridge campus and an array of 
178.28  community support services statewide. 
178.29     Sec. 9.  [252.294] [CRITERIA FOR DOWNSIZING OF FACILITIES.] 
178.30     The commissioner of human services shall develop a process 
178.31  to evaluate and rank proposals for the voluntary downsizing or 
178.32  closure of intermediate care facilities for persons with mental 
178.33  retardation or related conditions using the following guidelines:
178.34     (1) the extent to which the option matches overall policy 
178.35  direction of the department; 
178.36     (2) the extent to which the option demonstrates respect for 
179.1   individual needs and allows implementation of individual choice; 
179.2      (3) the extent to which the option addresses safety, 
179.3   privacy, and other programmatic issues; 
179.4      (4) the extent to which the option appropriately redesigns 
179.5   the overall community capacity; and 
179.6      (5) the cost of each option. 
179.7      The process shall, to the extent feasible, be modeled on 
179.8   the nursing home moratorium exception process, including 
179.9   procedures for administrative evaluation and approval of 
179.10  projects within the limit of appropriations made available by 
179.11  the legislature. 
179.12     Sec. 10.  Minnesota Statutes 1996, section 252.32, 
179.13  subdivision 1a, is amended to read: 
179.14     Subd. 1a.  [SUPPORT GRANTS.] (a) Provision of support 
179.15  grants must be limited to families who require support and whose 
179.16  dependents are under the age of 22 and who have mental 
179.17  retardation or who have a related condition and who have been 
179.18  determined by a screening team established under section 
179.19  256B.092 to be at risk of institutionalization.  Families who 
179.20  are receiving home and community-based waivered services for 
179.21  persons with mental retardation or related conditions are not 
179.22  eligible for support grants.  Families whose annual adjusted 
179.23  gross income is $60,000 or more are not eligible for support 
179.24  grants except in cases where extreme hardship is demonstrated.  
179.25  Beginning in state fiscal year 1994, the commissioner shall 
179.26  adjust the income ceiling annually to reflect the projected 
179.27  change in the average value in the United States Department of 
179.28  Labor Bureau of Labor Statistics consumer price index (all 
179.29  urban) for that year. 
179.30     (b) Support grants may be made available as monthly subsidy 
179.31  grants and lump sum grants. 
179.32     (c) Support grants may be issued in the form of cash, 
179.33  voucher, and direct county payment to a vendor.  
179.34     (d) Applications for the support grant shall be made by the 
179.35  legal guardian to the county social service agency ~~to the~~ 
179.36  ~~department of human services~~.  The application shall specify the 
180.1   needs of the families, the form of the grant requested by the 
180.2   families, and that the families have agreed to use the support 
180.3   grant for items and services within the designated reimbursable 
180.4   expense categories and recommendations of the county.  
180.5      (e) Families who were receiving subsidies on the date of 
180.6   implementation of the $60,000 income limit in paragraph (a) 
180.7   continue to be eligible for a family support grant until 
180.8   December 31, 1991, if all other eligibility criteria are met.  
180.9   After December 31, 1991, these families are eligible for a grant 
180.10  in the amount of one-half the grant they would otherwise 
180.11  receive, for as long as they remain eligible under other 
180.12  eligibility criteria. 
180.13     Sec. 11.  Minnesota Statutes 1996, section 252.32, 
180.14  subdivision 3, is amended to read: 
180.15     Subd. 3.  [AMOUNT OF SUPPORT GRANT; USE.] Support grant 
180.16  amounts shall be determined by the ~~commissioner of human~~ 
180.17  ~~services~~ county social service agency.  Each service and item 
180.18  purchased with a support grant must: 
180.19     (1) be over and above the normal costs of caring for the 
180.20  dependent if the dependent did not have a disability; 
180.21     (2) be directly attributable to the dependent's disabling 
180.22  condition; and 
180.23     (3) enable the family to delay or prevent the out-of-home 
180.24  placement of the dependent. 
180.25     The design and delivery of services and items purchased 
180.26  under this section must suit the dependent's chronological age 
180.27  and be provided in the least restrictive environment possible, 
180.28  consistent with the needs identified in the individual service 
180.29  plan. 
180.30     Items and services purchased with support grants must be 
180.31  those for which there are no other public or private funds 
180.32  available to the family.  Fees assessed to parents for health or 
180.33  human services that are funded by federal, state, or county 
180.34  dollars are not reimbursable through this program. 
180.35     The maximum monthly amount shall be $250 per eligible 
180.36  dependent, or $3,000 per eligible dependent per state fiscal 
181.1   year, within the limits of available funds.  ~~During fiscal year~~ 
181.2   ~~1992 and 1993, the maximum monthly grant awarded to families who~~ 
181.3   ~~are eligible for medical assistance shall be $200, except in~~ 
181.4   ~~cases where extreme hardship is demonstrated.~~  The ~~commissioner~~ 
181.5   county social service agency may consider the dependent's 
181.6   supplemental security income in determining the amount of the 
181.7   support grant.  ~~A variance~~ The county social service agency may 
181.8   ~~be granted by the commissioner to~~ exceed $3,000 per state fiscal 
181.9   year per eligible dependent for emergency circumstances in cases 
181.10  where exceptional resources of the family are required to meet 
181.11  the health, welfare-safety needs of the child.  The ~~commissioner~~ 
181.12  county social service agency may set aside up to five percent of 
181.13  ~~the appropriation~~ their allocation to fund emergency situations. 
181.14     Effective July 1, 1997, county social service agencies 
181.15  shall continue to provide funds to families receiving state 
181.16  grants on June 30, 1997, if eligibility criteria continue to be 
181.17  met.  Any adjustments to their monthly grant amount must be 
181.18  based on the needs of the family and funding availability. 
181.19     Sec. 12.  Minnesota Statutes 1996, section 252.32, 
181.20  subdivision 3a, is amended to read: 
181.21     Subd. 3a.  [REPORTS AND ~~REIMBURSEMENT~~ ALLOCATIONS.] (a) The 
181.22  commissioner shall specify requirements for quarterly fiscal and 
181.23  annual program reports according to section 256.01, subdivision 
181.24  2, paragraph (17).  Program reports shall include data which 
181.25  will enable the commissioner to evaluate program effectiveness 
181.26  and to audit compliance.  The commissioner shall reimburse 
181.27  county costs on a quarterly basis. 
181.28     (b) Beginning January 1, 1998, the commissioner shall 
181.29  allocate state funds made available under this section to county 
181.30  social service agencies on a calendar year basis.  The 
181.31  commissioner shall allocate to each county first in amounts 
181.32  equal to each county's guaranteed floor as described in clause 
181.33  (1), and second, any remaining funds, after the allocation of 
181.34  funds to the newly participating counties as provided for in 
181.35  clause (3), shall be allocated in proportion to each county's 
181.36  total number of families receiving a grant on July 1 of the most 
182.1   recent calendar year.  
182.2      (1) Each county's guaranteed floor shall be calculated as 
182.3   follows:  
182.4      (i) 95 percent of the county's allocation received in the 
182.5   preceding calendar year.  For the calendar year 1998 allocation, 
182.6   the preceding calendar year shall be considered to be double the 
182.7   six-month allocation as provided in clause (2); and 
182.8      (ii) when the amount of funds available for allocation is 
182.9   less than the amount available in the preceding year, each 
182.10  county's previous year allocation shall be reduced in proportion 
182.11  to the reduction in statewide funding, for the purpose of 
182.12  establishing the guaranteed floor.  
182.13     (2) For the period July 1, 1997, to December 31, 1997, the 
182.14  commissioner shall allocate to each county an amount equal to 
182.15  the actual, state approved, grants issued to the families for 
182.16  the month of January 1997, multiplied by six.  This six-month 
182.17  allocation shall be combined with the calendar year 1998 
182.18  allocation and be administered as an 18-month allocation.  
182.19     (3) At the commissioner's discretion, funds may be 
182.20  allocated to any nonparticipating county that requests an 
182.21  allocation under this section.  Allocations to newly 
182.22  participating counties are dependent upon the availability of 
182.23  funds, as determined by the actual expenditure amount of the 
182.24  participating counties for the most recently completed calendar 
182.25  year.  
182.26     (4) The commissioner shall regularly review the use of 
182.27  family support fund allocations by county.  The commissioner may 
182.28  reallocate unexpended or unencumbered money at any time to those 
182.29  counties that have a demonstrated need for additional funding.  
182.30     (c) County allocations under this section will be adjusted 
182.31  for transfers that occur pursuant to section 256.476. 
182.32     Sec. 13.  Minnesota Statutes 1996, section 252.32, 
182.33  subdivision 3c, is amended to read: 
182.34     Subd. 3c.  [COUNTY BOARD RESPONSIBILITIES.] County boards 
182.35  receiving funds under this section shall:  
182.36     (1) determine the needs of families for services in 
183.1   accordance with section 256B.092 or 256E.08 and any rules 
183.2   adopted under those sections; 
183.3      (2) determine the eligibility of all persons proposed for 
183.4   program participation; 
183.5      (3) ~~recommend for approval all~~ approve a plan for items and 
183.6   services to be reimbursed and inform families of 
183.7   the ~~commissioner's~~ county's approval decision; 
183.8      (4) issue support grants directly to, or on behalf of, 
183.9   eligible families; 
183.10     (5) inform recipients of their right to appeal under 
183.11  subdivision 3e; 
183.12     (6) submit quarterly financial reports under subdivision 3b 
183.13  and a report on the families approved and the amount of each 
183.14  grant, the families denied and the amount of the grants denied, 
183.15  and the families eligible but waiting for funding; and 
183.16     (7) coordinate services with other programs offered by the 
183.17  county. 
183.18     Sec. 14.  Minnesota Statutes 1996, section 252.32, 
183.19  subdivision 5, is amended to read: 
183.20     Subd. 5.  [COMPLIANCE.] If a county board or grantee does 
183.21  not comply with this section ~~and the rules adopted by the~~ 
183.22  ~~commissioner of human services~~, the commissioner may recover, 
183.23  suspend, or withhold payments. 
183.24     Sec. 15.  Minnesota Statutes 1996, section 254.04, is 
183.25  amended to read: 
183.26     254.04 [TREATMENT OF CHEMICALLY DEPENDENT PERSONS.] 
183.27     The commissioner of human services is hereby authorized to 
183.28  continue the treatment of chemically dependent persons at 
183.29  Ah-Gwah-Ching and Moose Lake area programs as well as at the 
183.30  regional treatment centers located at Anoka, Brainerd, Fergus 
183.31  Falls, ~~Moose Lake,~~ St. Peter, and Willmar as specified in 
183.32  section 245.652.  ~~During the year ending June 30, 1994, the~~ 
183.33  ~~commissioner shall relocate, in the catchment area served by the~~ 
183.34  ~~Moose Lake regional treatment center, two state-operated~~ 
183.35  ~~off-campus programs designed to serve patients who are relocated~~ 
183.36  ~~from the Moose Lake regional treatment center.  One program~~ 
184.1   ~~shall be a 35-bed program for women who are chemically~~ 
184.2   ~~dependent; the other shall be a 25-bed program for men who are~~ 
184.3   ~~chemically dependent.  The facility space housing the Liberalis~~ 
184.4   ~~chemical dependency program (building C-35) and the men's~~ 
184.5   ~~chemical dependency program (4th floor main) may not be vacated~~ 
184.6   ~~until suitable off-campus space for the women's chemical~~ 
184.7   ~~dependency program of 35 beds and the men's chemical dependency~~ 
184.8   ~~program of 25 beds is located and clients and staff are~~ 
184.9   ~~relocated.~~ 
184.10     Sec. 16.  Minnesota Statutes 1996, section 256.045, 
184.11  subdivision 7, is amended to read: 
184.12     Subd. 7.  [JUDICIAL REVIEW.] Except for a prepaid health 
184.13  plan, any party who is aggrieved by an order of the commissioner 
184.14  of human services, or the commissioner of health in appeals 
184.15  within the commissioner's jurisdiction under subdivision 3b, may 
184.16  appeal the order to the district court of the county responsible 
184.17  for furnishing assistance, or, in appeals under subdivision 3b, 
184.18  the county where the maltreatment occurred, by serving a written 
184.19  copy of a notice of appeal upon the commissioner and any adverse 
184.20  party of record within 30 days after the date the commissioner 
184.21  issued the order, the amended order, or order affirming the 
184.22  original order, and by filing the original notice and proof of 
184.23  service with the court administrator of the district court.  
184.24  Service may be made personally or by mail; service by mail is 
184.25  complete upon mailing; no filing fee shall be required by the 
184.26  court administrator in appeals taken pursuant to this 
184.27  subdivision, with the exception of appeals taken under 
184.28  subdivision 3b.  The commissioner may elect to become a party to 
184.29  the proceedings in the district court.  Except for appeals under 
184.30  subdivision 3b, any party may demand that the commissioner 
184.31  furnish all parties to the proceedings with a copy of the 
184.32  decision, and a transcript of any testimony, evidence, or other 
184.33  supporting papers from the hearing held before the human 
184.34  services referee, by serving a written demand upon the 
184.35  commissioner within 30 days after service of the notice of 
184.36  appeal.  Any party aggrieved by the failure of an adverse party 
185.1   to obey an order issued by the commissioner under subdivision 5 
185.2   may compel performance according to the order in the manner 
185.3   prescribed in sections 586.01 to 586.12. 
185.4      Sec. 17.  Minnesota Statutes 1996, section 256.045, 
185.5   subdivision 10, is amended to read: 
185.6      Subd. 10.  [PAYMENTS PENDING APPEAL.] If the commissioner 
185.7   of human services or district court orders monthly assistance or 
185.8   aid or services paid or provided in any proceeding under this 
185.9   section, it shall be paid or provided pending appeal to the 
185.10  commissioner of human services, district court, court of 
185.11  appeals, or supreme court.  The human services referee may order 
185.12  the local human services agency to reduce or terminate medical 
185.13  assistance or general assistance medical care to a recipient 
185.14  before a final order is issued under this section if:  (1) the 
185.15  human services referee determines at the hearing that the sole 
185.16  issue on appeal is one of a change in state or federal law; and 
185.17  (2) the commissioner or the local agency notifies the recipient 
185.18  before the action.  The state or county agency has a claim for 
185.19  food stamps, cash payments, medical assistance, general 
185.20  assistance medical care, and MinnesotaCare program payments made 
185.21  to or on behalf of a recipient or former recipient while an 
185.22  appeal is pending if the recipient or former recipient is 
185.23  determined ineligible for the food stamps, cash payments, 
185.24  medical assistance, general assistance medical care, or 
185.25  MinnesotaCare as a result of the appeal~~, except for medical~~ 
185.26  ~~assistance and general assistance medical care made on behalf of~~ 
185.27  ~~a recipient pursuant to a court order~~.  In enforcing a claim on 
185.28  MinnesotaCare program payments, the state or county agency shall 
185.29  reduce the claim amount by the value of any premium payments 
185.30  made by a recipient or former recipient during the period for 
185.31  which the recipient or former recipient has been determined to 
185.32  be ineligible. 
185.33     Sec. 18.  Minnesota Statutes 1996, section 256.476, 
185.34  subdivision 2, is amended to read: 
185.35     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
185.36  following terms have the meanings given them: 
186.1      (a) "County board" means the county board of commissioners 
186.2   for the county of financial responsibility as defined in section 
186.3   256G.02, subdivision 4, or its designated representative.  When 
186.4   a human services board has been established under sections 
186.5   402.01 to 402.10, it shall be considered the county board for 
186.6   the purposes of this section. 
186.7      (b) "Family" means the person's birth parents, adoptive 
186.8   parents or stepparents, siblings or stepsiblings, children or 
186.9   stepchildren, grandparents, grandchildren, niece, nephew, aunt, 
186.10  uncle, or spouse.  For the purposes of this section, a family 
186.11  member is at least 18 years of age. 
186.12     (c) "Functional limitations" means the long-term inability 
186.13  to perform an activity or task in one or more areas of major 
186.14  life activity, including self-care, understanding and use of 
186.15  language, learning, mobility, self-direction, and capacity for 
186.16  independent living.  For the purpose of this section, the 
186.17  inability to perform an activity or task results from a mental, 
186.18  emotional, psychological, sensory, or physical disability, 
186.19  condition, or illness. 
186.20     (d) "Informed choice" means a voluntary decision made by 
186.21  the person or the person's legal representative, after becoming 
186.22  familiarized with the alternatives to: 
186.23     (1) select a preferred alternative from a number of 
186.24  feasible alternatives; 
186.25     (2) select an alternative which may be developed in the 
186.26  future; and 
186.27     (3) refuse any or all alternatives. 
186.28     (e) "Local agency" means the local agency authorized by the 
186.29  county board to carry out the provisions of this section. 
186.30     (f) "Person" or "persons" means a person or persons meeting 
186.31  the eligibility criteria in subdivision 3. 
186.32     (g) ~~"Responsible individual"~~ "Authorized representative" 
186.33  means an individual designated by the person or their legal 
186.34  representative to act on their behalf.  This individual may be a 
186.35  family member, guardian, representative payee, or other 
186.36  individual designated by the person or their legal 
187.1   representative, if any, to assist in purchasing and arranging 
187.2   for supports.  For the purposes of this section, ~~a responsible~~ 
187.3   ~~individual~~ an authorized representative is at least 18 years of 
187.4   age. 
187.5      (h) "Screening" means the screening of a person's service 
187.6   needs under sections 256B.0911 and 256B.092. 
187.7      (i) "Supports" means services, care, aids, home 
187.8   modifications, or assistance purchased by the person or the 
187.9   person's family.  Examples of supports include respite care, 
187.10  assistance with daily living, and adaptive aids.  For the 
187.11  purpose of this section, notwithstanding the provisions of 
187.12  section 144A.43, supports purchased under the consumer support 
187.13  program are not considered home care services. 
187.14     (j) "Program of origination" means the program the 
187.15  individual transferred from when approved for the consumer 
187.16  support grant program. 
187.17     Sec. 19.  Minnesota Statutes 1996, section 256.476, 
187.18  subdivision 3, is amended to read: 
187.19     Subd. 3.  [ELIGIBILITY TO APPLY FOR GRANTS.] (a) A person 
187.20  is eligible to apply for a consumer support grant if the person 
187.21  meets all of the following criteria: 
187.22     (1) the person is eligible for and has been approved to 
187.23  receive services under medical assistance as determined under 
187.24  sections 256B.055 and 256B.056 or the person is eligible for and 
187.25  has been approved to receive services under alternative care 
187.26  services as determined under section 256B.0913 or the person has 
187.27  been approved to receive a grant under the developmental 
187.28  disability family support program under section 252.32; 
187.29     (2) the person is able to direct and purchase the person's 
187.30  own care and supports, or the person has a family member, legal 
187.31  representative, or other ~~responsible individual~~ authorized 
187.32  representative who can purchase and arrange supports on the 
187.33  person's behalf; 
187.34     (3) the person has functional limitations, requires ongoing 
187.35  supports to live in the community, and is at risk of or would 
187.36  continue institutionalization without such supports; and 
188.1      (4) the person will live in a home.  For the purpose of 
188.2   this section, "home" means the person's own home or home of a 
188.3   person's family member.  These homes are natural home settings 
188.4   and are not licensed by the department of health or human 
188.5   services. 
188.6      (b) Persons may not concurrently receive a consumer support 
188.7   grant if they are: 
188.8      (1) receiving home and community-based services under 
188.9   United States Code, title 42, section 1396h(c); personal care 
188.10  attendant and home health aide services under section 256B.0625; 
188.11  a developmental disability family support grant; or alternative 
188.12  care services under section 256B.0913; or 
188.13     (2) residing in an institutional or congregate care setting.
188.14     (c) A person or person's family receiving a consumer 
188.15  support grant shall not be charged a fee or premium by a local 
188.16  agency for participating in the program.  A person or person's 
188.17  family is not eligible for a consumer support grant if their 
188.18  income is at a level where they are required to pay a parental 
188.19  fee under sections 252.27, 256B.055, subdivision 12, and 256B.14 
188.20  and rules adopted under those sections for medical assistance 
188.21  services to a disabled child living with at least one parent.  
188.22     (d) The commissioner may limit the participation of nursing 
188.23  facility residents, residents of intermediate care facilities 
188.24  for persons with mental retardation, and the recipients of 
188.25  services from federal waiver programs in the consumer support 
188.26  grant program if the participation of these individuals will 
188.27  result in an increase in the cost to the state. 
188.28     (e) The commissioner shall establish a budgeted 
188.29  appropriation each fiscal year for the consumer support grant 
188.30  program.  The number of individuals participating in the program 
188.31  will be adjusted so the total amount allocated to counties does 
188.32  not exceed the amount of the budgeted appropriation.  The 
188.33  budgeted appropriation will be adjusted annually to accommodate 
188.34  changes in demand for the consumer support grants. 
188.35     Sec. 20.  Minnesota Statutes 1996, section 256.476, 
188.36  subdivision 4, is amended to read: 
189.1      Subd. 4.  [SUPPORT GRANTS; CRITERIA AND LIMITATIONS.] (a) A 
189.2   county board may choose to participate in the consumer support 
189.3   grant program.  If a county board chooses to participate in the 
189.4   program, the local agency shall establish written procedures and 
189.5   criteria to determine the amount and use of support grants.  
189.6   These procedures must include, at least, the availability of 
189.7   respite care, assistance with daily living, and adaptive aids.  
189.8   The local agency may establish monthly or annual maximum amounts 
189.9   for grants and procedures where exceptional resources may be 
189.10  required to meet the health and safety needs of the person on a 
189.11  time-limited basis, however, the total amount awarded to each 
189.12  individual may not exceed the limits established in subdivision 
189.13  5, paragraph (f). 
189.14     (b) Support grants to a person or a person's family ~~may~~ 
189.15  will be provided through a monthly subsidy ~~or lump sum~~ payment 
189.16  ~~basis~~ and be in the form of cash, voucher, or direct county 
189.17  payment to vendor.  Support grant amounts must be determined by 
189.18  the local agency.  Each service and item purchased with a 
189.19  support grant must meet all of the following criteria:  
189.20     (1) it must be over and above the normal cost of caring for 
189.21  the person if the person did not have functional limitations; 
189.22     (2) it must be directly attributable to the person's 
189.23  functional limitations; 
189.24     (3) it must enable the person or the person's family to 
189.25  delay or prevent out-of-home placement of the person; and 
189.26     (4) it must be consistent with the needs identified in the 
189.27  service plan, when applicable. 
189.28     (c) Items and services purchased with support grants must 
189.29  be those for which there are no other public or private funds 
189.30  available to the person or the person's family.  Fees assessed 
189.31  to the person or the person's family for health and human 
189.32  services are not reimbursable through the grant. 
189.33     (d) In approving or denying applications, the local agency 
189.34  shall consider the following factors:  
189.35     (1) the extent and areas of the person's functional 
189.36  limitations; 
190.1      (2) the degree of need in the home environment for 
190.2   additional support; and 
190.3      (3) the potential effectiveness of the grant to maintain 
190.4   and support the person in the family environment or the person's 
190.5   own home. 
190.6      (e) At the time of application to the program or screening 
190.7   for other services, the person or the person's family shall be 
190.8   provided sufficient information to ensure an informed choice of 
190.9   alternatives by the person, the person's legal representative, 
190.10  if any, or the person's family.  The application shall be made 
190.11  to the local agency and shall specify the needs of the person 
190.12  and family, the form and amount of grant requested, the items 
190.13  and services to be reimbursed, and evidence of eligibility for 
190.14  medical assistance or alternative care program. 
190.15     (f) Upon approval of an application by the local agency and 
190.16  agreement on a support plan for the person or person's family, 
190.17  the local agency shall make grants to the person or the person's 
190.18  family.  The grant shall be in an amount for the direct costs of 
190.19  the services or supports outlined in the service agreement.  
190.20     (g) Reimbursable costs shall not include costs for 
190.21  resources already available, such as special education classes, 
190.22  day training and habilitation, case management, other services 
190.23  to which the person is entitled, medical costs covered by 
190.24  insurance or other health programs, or other resources usually 
190.25  available at no cost to the person or the person's family. 
190.26     (h) The state of Minnesota, the county boards participating 
190.27  in the consumer support grant program, or the agencies acting on 
190.28  behalf of the county boards in the implementation and 
190.29  administration of the consumer support grant program shall not 
190.30  be liable for damages, injuries, or liabilities sustained 
190.31  through the purchase of support by the individual, the 
190.32  individual's family, or the authorized representative under this 
190.33  section with funds received through the consumer support grant 
190.34  program.  Liabilities include but are not limited to:  workers' 
190.35  compensation liability, the Federal Insurance Contributions Act 
190.36  (FICA), or the Federal Unemployment Tax Act (FUTA).  
191.1   Notwithstanding section 268.04 for purposes of this section, 
191.2   participating county boards and county administrative entities 
191.3   acting on behalf of county boards are exempt from the provisions 
191.4   of section 268.04. 
191.5      Sec. 21.  Minnesota Statutes 1996, section 256.476, 
191.6   subdivision 5, is amended to read: 
191.7      Subd. 5.  [REIMBURSEMENT, ALLOCATIONS, AND REPORTING.] (a) 
191.8   For the purpose of transferring persons to the consumer support 
191.9   grant program from specific programs or services, such as the 
191.10  developmental disability family support program and alternative 
191.11  care program, personal care attendant, home health aide, or 
191.12  nursing facility services, the amount of funds transferred by 
191.13  the commissioner between the developmental disability family 
191.14  support program account, the alternative care account, the 
191.15  medical assistance account, or the consumer support grant 
191.16  account shall be based on each county's participation in 
191.17  transferring persons to the consumer support grant program from 
191.18  those programs and services. 
191.19     (b) At the beginning of each fiscal year, county 
191.20  allocations for consumer support grants shall be based on: 
191.21     (1) the number of persons to whom the county board expects 
191.22  to provide consumer supports grants; 
191.23     (2) their eligibility for current program and services; 
191.24     (3) the amount of nonfederal dollars expended on those 
191.25  individuals for those programs and services~~;~~ or, in situations 
191.26  where an individual is unable to obtain the support needed from 
191.27  the program of origination due to the unavailability of service 
191.28  providers at the time or the location where the supports are 
191.29  needed, the allocation will be based on the county's best 
191.30  estimate of the nonfederal dollars that would have been expended 
191.31  if the services had been available; and 
191.32     (4) projected dates when persons will start receiving 
191.33  grants.  County allocations shall be adjusted periodically by 
191.34  the commissioner based on the actual transfer of persons or 
191.35  service openings, and the nonfederal dollars associated with 
191.36  those persons or service openings, to the consumer support grant 
192.1   program. 
192.2      (c) The amount of funds transferred by the commissioner 
192.3   from the alternative care account and the medical assistance 
192.4   account for an individual may be changed if it is determined by 
192.5   the county or its agent that the individual's need for support 
192.6   has changed. 
192.7      (d) The authority to utilize funds transferred to the 
192.8   consumer support grant account for the purposes of implementing 
192.9   and administering the consumer support grant program will not be 
192.10  limited or constrained by the spending authority provided to the 
192.11  program of origination. 
192.12     (e) The commissioner shall use up to five percent of each 
192.13  county's allocation, as adjusted, for payments to that county 
192.14  for administrative expenses, to be paid as a proportionate 
192.15  addition to reported direct service expenditures. 
192.16     ~~(d)~~ (f) Except as provided in this paragraph, the county 
192.17  allocation for each individual or individual's family cannot 
192.18  exceed 80 percent of the total nonfederal dollars expended on 
192.19  the individual by the program of origination except for the 
192.20  developmental disabilities family support grant program which 
192.21  can be approved up to 100 percent of the nonfederal dollars and 
192.22  in situations as described in paragraph (b), clause (4).  In 
192.23  situations where exceptional need exists or the individual's 
192.24  need for support increases, up to 100 percent of the nonfederal 
192.25  dollars expended may be allocated to the county.  Allocations 
192.26  that exceed 80 percent of the nonfederal dollars expended on the 
192.27  individual by the program of origination must be approved by the 
192.28  commissioner.  The remainder of the amount expended on the 
192.29  individual by the program of origination will be used in the 
192.30  following proportions:  half will be made available to the 
192.31  consumer support grant program and participating counties for 
192.32  consumer training, resource development, and other costs, and 
192.33  half will be returned to the state general fund. 
192.34     (g) The commissioner may recover, suspend, or withhold 
192.35  payments if the county board, local agency, or grantee does not 
192.36  comply with the requirements of this section. 
193.1      Sec. 22.  Minnesota Statutes 1996, section 256B.037, 
193.2   subdivision 1a, is amended to read: 
193.3      Subd. 1a.  [MULTIPLE DENTAL PLAN AREAS.] After the 
193.4   department has executed contracts with dental plans to provide 
193.5   covered dental care services in a multiple dental plan area, the 
193.6   department shall:  
193.7      (1) inform applicants and recipients, in writing, of 
193.8   available dental plans, when written notice of dental plan 
193.9   selection must be submitted to the department, and when dental 
193.10  plan participation begins; 
193.11     (2) ~~randomly~~ assign to a dental plan recipients who fail to 
193.12  notify the department in writing of their dental plan choice; 
193.13  and 
193.14     (3) notify recipients, in writing, of their assigned dental 
193.15  plan before the effective date of the recipient's dental plan 
193.16  participation.  
193.17     Sec. 23.  Minnesota Statutes 1996, section 256B.056, 
193.18  subdivision 4, is amended to read: 
193.19     Subd. 4.  [INCOME.] To be eligible for medical assistance, 
193.20  a person must not have, or anticipate receiving, semiannual 
193.21  income in excess of 120 percent of the income standards by 
193.22  family size used in the aid to families with dependent children 
193.23  program, except that families and children may have an income up 
193.24  to 133-1/3 percent of the AFDC income standard.  In computing 
193.25  income to determine eligibility of persons who are not residents 
193.26  of long-term care facilities, the commissioner shall disregard 
193.27  increases in income as required by Public Law Numbers 94-566, 
193.28  section 503; 99-272; and 99-509.  Veterans aid and attendance 
193.29  benefits and Veterans Administration unusual medical expense 
193.30  payments are considered income to the recipient. 
193.31     Sec. 24.  Minnesota Statutes 1996, section 256B.056, 
193.32  subdivision 5, is amended to read: 
193.33     Subd. 5.  [EXCESS INCOME.] A person who has excess income 
193.34  is eligible for medical assistance if the person has expenses 
193.35  for medical care that are more than the amount of the person's 
193.36  excess income, computed by deducting incurred medical expenses 
194.1   from the excess income to reduce the excess to the income 
194.2   standard specified in subdivision 4.  The person shall elect to 
194.3   have the medical expenses deducted at the beginning of a 
194.4   one-month budget period or at the beginning of a six-month 
194.5   budget period.  ~~Until June 30, 1993, or the date the Medicaid~~ 
194.6   ~~Management Information System (MMIS) upgrade is implemented,~~ 
194.7   ~~whichever occurs last,~~ The commissioner shall allow persons 
194.8   eligible for assistance on a one-month spenddown basis under 
194.9   this subdivision to elect to pay the monthly spenddown amount in 
194.10  advance of the month of eligibility to the ~~local~~ state agency in 
194.11  order to maintain eligibility on a continuous basis.  If the 
194.12  recipient does not pay the spenddown amount on or before 
194.13  the ~~10th~~ 20th of the month, the recipient is ineligible for this 
194.14  option for the following month.  ~~The local agency must deposit~~ 
194.15  ~~spenddown payments into its treasury and issue a monthly payment~~ 
194.16  ~~to the state agency with the necessary individual account~~ 
194.17  ~~information.~~  The local agency shall code the ~~client eligibility~~ 
194.18  Medicaid Management Information System (MMIS) to indicate that 
194.19  the ~~spenddown obligation has been satisfied for the month~~ 
194.20  ~~paid~~ recipient has elected this option.  The state agency shall 
194.21  convey ~~this information~~ recipient eligibility information 
194.22  relative to the collection of the spenddown to providers through 
194.23  ~~eligibility cards which list no remaining spenddown obligation.~~  
194.24  ~~After the implementation of the MMIS upgrade,~~ the Electronic 
194.25  Verification System (EVS).  A recipient electing advance payment 
194.26  must pay the state agency the monthly spenddown amount on or 
194.27  before the ~~10th~~ 20th of the month in order to be eligible for 
194.28  this option in the following month.  
194.29     Sec. 25.  Minnesota Statutes 1996, section 256B.0626, is 
194.30  amended to read: 
194.31     256B.0626 [ESTIMATION OF 50TH PERCENTILE OF PREVAILING 
194.32  CHARGES.] 
194.33     (a) The 50th percentile of the prevailing charge for the 
194.34  base year identified in statute must be estimated by the 
194.35  commissioner in the following situations: 
194.36     (1) there were less than ~~ten~~ five billings in the calendar 
195.1   year specified in legislation governing maximum payment rates; 
195.2      (2) the service was not available in the calendar year 
195.3   specified in legislation governing maximum payment rates; 
195.4      (3) the payment amount is the result of a provider appeal; 
195.5      (4) the procedure code description has changed since the 
195.6   calendar year specified in legislation governing maximum payment 
195.7   rates, and, therefore, the prevailing charge information 
195.8   reflects the same code but a different procedure description; or 
195.9      (5) the 50th percentile reflects a payment which is grossly 
195.10  inequitable when compared with payment rates for procedures or 
195.11  services which are substantially similar. 
195.12     (b) When one of the situations identified in paragraph (a) 
195.13  occurs, the commissioner shall use the following methodology to 
195.14  reconstruct a rate comparable to the 50th percentile of the 
195.15  prevailing rate: 
195.16     (1) refer to information which exists for the first ~~nine~~ 
195.17  four billings in the calendar year specified in legislation 
195.18  governing maximum payment rates; or 
195.19     (2) refer to surrounding or comparable procedure codes; or 
195.20     (3) refer to the 50th percentile of years subsequent to the 
195.21  calendar year specified in legislation governing maximum payment 
195.22  rates, and reduce that amount by applying an appropriate 
195.23  Consumer Price Index formula; or 
195.24     (4) refer to relative value indexes; or 
195.25     (5) refer to reimbursement information from other third 
195.26  parties, such as Medicare. 
195.27     Sec. 26.  Minnesota Statutes 1996, section 256B.0627, 
195.28  subdivision 5, is amended to read: 
195.29     Subd. 5.  [LIMITATION ON PAYMENTS.] Medical assistance 
195.30  payments for home care services shall be limited according to 
195.31  this subdivision.  
195.32     (a)  [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 
195.33  recipient may receive the following home care services during a 
195.34  calendar year: 
195.35     (1) any initial assessment; ~~and~~ 
195.36     (2) up to two reassessments per year done to determine a 
196.1   recipient's need for personal care services; and 
196.2      (3) up to five skilled nurse visits.  
196.3      (b)  [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 
196.4   services above the limits in paragraph (a) must receive the 
196.5   commissioner's prior authorization, except when: 
196.6      (1) the home care services were required to treat an 
196.7   emergency medical condition that if not immediately treated 
196.8   could cause a recipient serious physical or mental disability, 
196.9   continuation of severe pain, or death.  The provider must 
196.10  request retroactive authorization no later than five working 
196.11  days after giving the initial service.  The provider must be 
196.12  able to substantiate the emergency by documentation such as 
196.13  reports, notes, and admission or discharge histories; 
196.14     (2) the home care services were provided on or after the 
196.15  date on which the recipient's eligibility began, but before the 
196.16  date on which the recipient was notified that the case was 
196.17  opened.  Authorization will be considered if the request is 
196.18  submitted by the provider within 20 working days of the date the 
196.19  recipient was notified that the case was opened; 
196.20     (3) a third-party payor for home care services has denied 
196.21  or adjusted a payment.  Authorization requests must be submitted 
196.22  by the provider within 20 working days of the notice of denial 
196.23  or adjustment.  A copy of the notice must be included with the 
196.24  request; 
196.25     (4) the commissioner has determined that a county or state 
196.26  human services agency has made an error; or 
196.27     (5) the professional nurse determines an immediate need for 
196.28  up to 40 skilled nursing or home health aide visits per calendar 
196.29  year and submits a request for authorization within 20 working 
196.30  days of the initial service date, and medical assistance is 
196.31  determined to be the appropriate payer. 
196.32     (c)  [RETROACTIVE AUTHORIZATION.] A request for retroactive 
196.33  authorization will be evaluated according to the same criteria 
196.34  applied to prior authorization requests.  
196.35     (d)  [ASSESSMENT AND SERVICE PLAN.] Assessments under 
196.36  section 256B.0627, subdivision 1, paragraph (a), shall be 
197.1   conducted initially, and at least annually thereafter, in person 
197.2   with the recipient and result in a completed service plan using 
197.3   forms specified by the commissioner.  Within 30 days of 
197.4   recipient or responsible party request for home care services, 
197.5   the assessment, the service plan, and other information 
197.6   necessary to determine medical necessity such as diagnostic or 
197.7   testing information, social or medical histories, and hospital 
197.8   or facility discharge summaries shall be submitted to the 
197.9   commissioner.  For personal care services: 
197.10     (1) The amount and type of service authorized based upon 
197.11  the assessment and service plan will follow the recipient if the 
197.12  recipient chooses to change providers.  
197.13     (2) If the recipient's medical need changes, the 
197.14  recipient's provider may assess the need for a change in service 
197.15  authorization and request the change from the county public 
197.16  health nurse.  Within 30 days of the request, the public health 
197.17  nurse will determine whether to request the change in services 
197.18  based upon the provider assessment, or conduct a home visit to 
197.19  assess the need and determine whether the change is appropriate. 
197.20     (3) To continue to receive personal care services when the 
197.21  recipient displays no significant change, the county public 
197.22  health nurse has the option to review with the commissioner, or 
197.23  the commissioner's designee, the service plan on record and 
197.24  receive authorization for up to an additional 12 months at a 
197.25  time for up to three years. 
197.26     (e)  [PRIOR AUTHORIZATION.] The commissioner, or the 
197.27  commissioner's designee, shall review the assessment, the 
197.28  service plan, and any additional information that is submitted.  
197.29  The commissioner shall, within 30 days after receiving a 
197.30  complete request, assessment, and service plan, authorize home 
197.31  care services as follows:  
197.32     (1)  [HOME HEALTH SERVICES.] All home health services 
197.33  provided by a licensed nurse or a home health aide must be prior 
197.34  authorized by the commissioner or the commissioner's designee.  
197.35  Prior authorization must be based on medical necessity and 
197.36  cost-effectiveness when compared with other care options.  When 
198.1   home health services are used in combination with personal care 
198.2   and private duty nursing, the cost of all home care services 
198.3   shall be considered for cost-effectiveness.  The commissioner 
198.4   shall limit nurse and home health aide visits to no more than 
198.5   one visit each per day. 
198.6      (2)  [PERSONAL CARE SERVICES.] (i) All personal care 
198.7   services and registered nurse supervision must be prior 
198.8   authorized by the commissioner or the commissioner's designee 
198.9   except for the assessments established in paragraph (a).  The 
198.10  amount of personal care services authorized must be based on the 
198.11  recipient's home care rating.  A child may not be found to be 
198.12  dependent in an activity of daily living if because of the 
198.13  child's age an adult would either perform the activity for the 
198.14  child or assist the child with the activity and the amount of 
198.15  assistance needed is similar to the assistance appropriate for a 
198.16  typical child of the same age.  Based on medical necessity, the 
198.17  commissioner may authorize: 
198.18     (A) up to two times the average number of direct care hours 
198.19  provided in nursing facilities for the recipient's comparable 
198.20  case mix level; or 
198.21     (B) up to three times the average number of direct care 
198.22  hours provided in nursing facilities for recipients who have 
198.23  complex medical needs or are dependent in at least seven 
198.24  activities of daily living and need physical assistance with 
198.25  eating or have a neurological diagnosis; or 
198.26     (C) up to 60 percent of the average reimbursement rate, as 
198.27  of July 1, 1991, for care provided in a regional treatment 
198.28  center for recipients who have Level I behavior, plus any 
198.29  inflation adjustment as provided by the legislature for personal 
198.30  care service; or 
198.31     (D) up to the amount the commissioner would pay, as of July 
198.32  1, 1991, plus any inflation adjustment provided for home care 
198.33  services, for care provided in a regional treatment center for 
198.34  recipients referred to the commissioner by a regional treatment 
198.35  center preadmission evaluation team.  For purposes of this 
198.36  clause, home care services means all services provided in the 
199.1   home or community that would be included in the payment to a 
199.2   regional treatment center; or 
199.3      (E) up to the amount medical assistance would reimburse for 
199.4   facility care for recipients referred to the commissioner by a 
199.5   preadmission screening team established under section 256B.0911 
199.6   or 256B.092; and 
199.7      (F) a reasonable amount of time for the provision of 
199.8   nursing supervision of personal care services.  
199.9      (ii) The number of direct care hours shall be determined 
199.10  according to the annual cost report submitted to the department 
199.11  by nursing facilities.  The average number of direct care hours, 
199.12  as established by May 1, 1992, shall be calculated and 
199.13  incorporated into the home care limits on July 1, 1992.  These 
199.14  limits shall be calculated to the nearest quarter hour. 
199.15     (iii) The home care rating shall be determined by the 
199.16  commissioner or the commissioner's designee based on information 
199.17  submitted to the commissioner by the county public health nurse 
199.18  on forms specified by the commissioner.  The home care rating 
199.19  shall be a combination of current assessment tools developed 
199.20  under sections 256B.0911 and 256B.501 with an addition for 
199.21  seizure activity that will assess the frequency and severity of 
199.22  seizure activity and with adjustments, additions, and 
199.23  clarifications that are necessary to reflect the needs and 
199.24  conditions of recipients who need home care including children 
199.25  and adults under 65 years of age.  The commissioner shall 
199.26  establish these forms and protocols under this section and shall 
199.27  use an advisory group, including representatives of recipients, 
199.28  providers, and counties, for consultation in establishing and 
199.29  revising the forms and protocols. 
199.30     (iv) A recipient shall qualify as having complex medical 
199.31  needs if the care required is difficult to perform and because 
199.32  of recipient's medical condition requires more time than 
199.33  community-based standards allow or requires more skill than 
199.34  would ordinarily be required and the recipient needs or has one 
199.35  or more of the following: 
199.36     (A) daily tube feedings; 
200.1      (B) daily parenteral therapy; 
200.2      (C) wound or decubiti care; 
200.3      (D) postural drainage, percussion, nebulizer treatments, 
200.4   suctioning, tracheotomy care, oxygen, mechanical ventilation; 
200.5      (E) catheterization; 
200.6      (F) ostomy care; 
200.7      (G) quadriplegia; or 
200.8      (H) other comparable medical conditions or treatments the 
200.9   commissioner determines would otherwise require institutional 
200.10  care.  
200.11     (v) A recipient shall qualify as having Level I behavior if 
200.12  there is reasonable supporting evidence that the recipient 
200.13  exhibits, or that without supervision, observation, or 
200.14  redirection would exhibit, one or more of the following 
200.15  behaviors that cause, or have the potential to cause: 
200.16     (A) injury to the recipient's own body; 
200.17     (B) physical injury to other people; or 
200.18     (C) destruction of property. 
200.19     (vi) Time authorized for personal care relating to Level I 
200.20  behavior in subclause (v), items (A) to (C), shall be based on 
200.21  the predictability, frequency, and amount of intervention 
200.22  required. 
200.23     (vii) A recipient shall qualify as having Level II behavior 
200.24  if the recipient exhibits on a daily basis one or more of the 
200.25  following behaviors that interfere with the completion of 
200.26  personal care services under subdivision 4, paragraph (a): 
200.27     (A) unusual or repetitive habits; 
200.28     (B) withdrawn behavior; or 
200.29     (C) offensive behavior. 
200.30     (viii) A recipient with a home care rating of Level II 
200.31  behavior in subclause (vii), items (A) to (C), shall be rated as 
200.32  comparable to a recipient with complex medical needs under 
200.33  subclause (iv).  If a recipient has both complex medical needs 
200.34  and Level II behavior, the home care rating shall be the next 
200.35  complex category up to the maximum rating under subclause (i), 
200.36  item (B). 
201.1      (3)  [PRIVATE DUTY NURSING SERVICES.] All private duty 
201.2   nursing services shall be prior authorized by the commissioner 
201.3   or the commissioner's designee.  Prior authorization for private 
201.4   duty nursing services shall be based on medical necessity and 
201.5   cost-effectiveness when compared with alternative care options.  
201.6   The commissioner may authorize medically necessary private duty 
201.7   nursing services in quarter-hour units when: 
201.8      (i) the recipient requires more individual and continuous 
201.9   care than can be provided during a nurse visit; or 
201.10     (ii) the cares are outside of the scope of services that 
201.11  can be provided by a home health aide or personal care assistant.
201.12     The commissioner may authorize: 
201.13     (A) up to two times the average amount of direct care hours 
201.14  provided in nursing facilities statewide for case mix 
201.15  classification "K" as established by the annual cost report 
201.16  submitted to the department by nursing facilities in May 1992; 
201.17     (B) private duty nursing in combination with other home 
201.18  care services up to the total cost allowed under clause (2); 
201.19     (C) up to 16 hours per day if the recipient requires more 
201.20  nursing than the maximum number of direct care hours as 
201.21  established in item (A) and the recipient meets the hospital 
201.22  admission criteria established under Minnesota Rules, parts 
201.23  9505.0500 to 9505.0540.  
201.24     The commissioner may authorize up to 16 hours per day of 
201.25  medically necessary private duty nursing services or up to 24 
201.26  hours per day of medically necessary private duty nursing 
201.27  services until such time as the commissioner is able to make a 
201.28  determination of eligibility for recipients who are 
201.29  cooperatively applying for home care services under the 
201.30  community alternative care program developed under section 
201.31  256B.49, or until it is determined by the appropriate regulatory 
201.32  agency that a health benefit plan is or is not required to pay 
201.33  for appropriate medically necessary health care services.  
201.34  Recipients or their representatives must cooperatively assist 
201.35  the commissioner in obtaining this determination.  Recipients 
201.36  who are eligible for the community alternative care program may 
202.1   not receive more hours of nursing under this section than would 
202.2   otherwise be authorized under section 256B.49. 
202.3      (4)  [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 
202.4   ventilator-dependent, the monthly medical assistance 
202.5   authorization for home care services shall not exceed what the 
202.6   commissioner would pay for care at the highest cost hospital 
202.7   designated as a long-term hospital under the Medicare program.  
202.8   For purposes of this clause, home care services means all 
202.9   services provided in the home that would be included in the 
202.10  payment for care at the long-term hospital.  
202.11  "Ventilator-dependent" means an individual who receives 
202.12  mechanical ventilation for life support at least six hours per 
202.13  day and is expected to be or has been dependent for at least 30 
202.14  consecutive days.  
202.15     (f)  [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 
202.16  or the commissioner's designee shall determine the time period 
202.17  for which a prior authorization shall be effective.  If the 
202.18  recipient continues to require home care services beyond the 
202.19  duration of the prior authorization, the home care provider must 
202.20  request a new prior authorization.  Under no circumstances, 
202.21  other than the exceptions in paragraph (b), shall a prior 
202.22  authorization be valid prior to the date the commissioner 
202.23  receives the request or for more than 12 months.  A recipient 
202.24  who appeals a reduction in previously authorized home care 
202.25  services may continue previously authorized services, other than 
202.26  temporary services under paragraph (h), pending an appeal under 
202.27  section 256.045.  The commissioner must provide a detailed 
202.28  explanation of why the authorized services are reduced in amount 
202.29  from those requested by the home care provider.  
202.30     (g)  [APPROVAL OF HOME CARE SERVICES.] The commissioner or 
202.31  the commissioner's designee shall determine the medical 
202.32  necessity of home care services, the level of caregiver 
202.33  according to subdivision 2, and the institutional comparison 
202.34  according to this subdivision, the cost-effectiveness of 
202.35  services, and the amount, scope, and duration of home care 
202.36  services reimbursable by medical assistance, based on the 
203.1   assessment, primary payer coverage determination information as 
203.2   required, the service plan, the recipient's age, the cost of 
203.3   services, the recipient's medical condition, and diagnosis or 
203.4   disability.  The commissioner may publish additional criteria 
203.5   for determining medical necessity according to section 256B.04. 
203.6      (h)  [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 
203.7   The agency nurse, the independently enrolled private duty nurse, 
203.8   or county public health nurse may request a temporary 
203.9   authorization for home care services by telephone.  The 
203.10  commissioner may approve a temporary level of home care services 
203.11  based on the assessment, and service or care plan information, 
203.12  and primary payer coverage determination information as required.
203.13  Authorization for a temporary level of home care services 
203.14  including nurse supervision is limited to the time specified by 
203.15  the commissioner, but shall not exceed 45 days, unless extended 
203.16  because the county public health nurse has not completed the 
203.17  required assessment and service plan, or the commissioner's 
203.18  determination has not been made.  The level of services 
203.19  authorized under this provision shall have no bearing on a 
203.20  future prior authorization. 
203.21     (i)  [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 
203.22  Home care services provided in an adult or child foster care 
203.23  setting must receive prior authorization by the department 
203.24  according to the limits established in paragraph (a). 
203.25     The commissioner may not authorize: 
203.26     (1) home care services that are the responsibility of the 
203.27  foster care provider under the terms of the foster care 
203.28  placement agreement and administrative rules.  Requests for home 
203.29  care services for recipients residing in a foster care setting 
203.30  must include the foster care placement agreement and 
203.31  determination of difficulty of care; 
203.32     (2) personal care services when the foster care license 
203.33  holder is also the personal care provider or personal care 
203.34  assistant unless the recipient can direct the recipient's own 
203.35  care, or case management is provided as required in section 
203.36  256B.0625, subdivision 19a; 
204.1      (3) personal care services when the responsible party is an 
204.2   employee of, or under contract with, or has any direct or 
204.3   indirect financial relationship with the personal care provider 
204.4   or personal care assistant, unless case management is provided 
204.5   as required in section 256B.0625, subdivision 19a; 
204.6      (4) home care services when the number of foster care 
204.7   residents is greater than four unless the county responsible for 
204.8   the recipient's foster placement made the placement prior to 
204.9   April 1, 1992, requests that home care services be provided, and 
204.10  case management is provided as required in section 256B.0625, 
204.11  subdivision 19a; or 
204.12     (5) home care services when combined with foster care 
204.13  payments, other than room and board payments that exceed the 
204.14  total amount that public funds would pay for the recipient's 
204.15  care in a medical institution. 
204.16     Sec. 27.  Minnesota Statutes 1996, section 256B.064, 
204.17  subdivision 1a, is amended to read: 
204.18     Subd. 1a.  [GROUNDS FOR MONETARY RECOVERY AND SANCTIONS 
204.19  AGAINST VENDORS.] The commissioner may seek monetary recovery 
204.20  and impose sanctions against vendors of medical care for any of 
204.21  the following:  fraud, theft, or abuse in connection with the 
204.22  provision of medical care to recipients of public assistance; a 
204.23  pattern of presentment of false or duplicate claims or claims 
204.24  for services not medically necessary; a pattern of making false 
204.25  statements of material facts for the purpose of obtaining 
204.26  greater compensation than that to which the vendor is legally 
204.27  entitled; suspension or termination as a Medicare vendor; ~~and~~ 
204.28  refusal to grant the state agency access during regular business 
204.29  hours to examine all records necessary to disclose the extent of 
204.30  services provided to program recipients; and any reason for 
204.31  which a vendor could be excluded from participation in the 
204.32  Medicare program under section 1128, 1128A, or 1866(b)(2) of the 
204.33  Social Security Act.  The determination of services not 
204.34  medically necessary may be made by the commissioner in 
204.35  consultation with a peer advisory task force appointed by the 
204.36  commissioner on the recommendation of appropriate professional 
205.1   organizations.  The task force expires as provided in section 
205.2   15.059, subdivision 5. 
205.3      Sec. 28.  Minnesota Statutes 1996, section 256B.064, 
205.4   subdivision 1c, is amended to read: 
205.5      Subd. 1c.  [METHODS OF MONETARY RECOVERY.] The commissioner 
205.6   may obtain monetary recovery ~~for the conduct described in~~ 
205.7   ~~subdivision 1a by the following~~ from a vendor who has been 
205.8   improperly paid either as a result of conduct described in 
205.9   subdivision 1a or as a result of an error, regardless of the 
205.10  party responsible for the error and regardless of whether the 
205.11  error was intentional.  The commissioner may obtain monetary 
205.12  recovery using methods, including but not limited to the 
205.13  following:  assessing and recovering money ~~erroneously~~ 
205.14  improperly paid and debiting from future payments any 
205.15  money ~~erroneously~~ improperly paid~~, except that~~.  Patterns need 
205.16  not be proven as a precondition to monetary recovery ~~for~~ of 
205.17  erroneous or false claims, duplicate claims, claims for services 
205.18  not medically necessary, or claims based on false statements.  
205.19  The commissioner ~~may~~ shall charge interest on money to be 
205.20  recovered if the recovery is to be made by installment payments 
205.21  or debits.  The interest charged shall be the rate established 
205.22  by the commissioner of revenue under section 270.75. 
205.23     Sec. 29.  Minnesota Statutes 1996, section 256B.064, 
205.24  subdivision 2, is amended to read: 
205.25     Subd. 2.  [IMPOSITION OF MONETARY RECOVERY AND SANCTIONS.] 
205.26  (a) The commissioner shall determine monetary amounts to be 
205.27  recovered and the sanction to be imposed upon a vendor of 
205.28  medical care for conduct described by subdivision 1a.  Except ~~in~~ 
205.29  ~~the case of a conviction for conduct described in subdivision 1a~~ 
205.30  as provided in paragraph (b), neither a monetary recovery nor a 
205.31  sanction will be ~~sought~~ imposed by the commissioner without 
205.32  prior notice and an opportunity for a hearing, ~~pursuant~~ 
205.33  according to chapter 14, on the commissioner's proposed action, 
205.34  provided that the commissioner may suspend or reduce payment to 
205.35  a vendor of medical care, except a nursing home or convalescent 
205.36  care facility, after notice and prior to the hearing if in the 
206.1   commissioner's opinion that action is necessary to protect the 
206.2   public welfare and the interests of the program. 
206.3      (b) Except for a nursing home or convalescent care 
206.4   facility, the commissioner may withhold or reduce payments to a 
206.5   vendor of medical care without providing advance notice of such 
206.6   withholding or reduction if either of the following occurs: 
206.7      (1) the vendor is convicted of a crime involving the 
206.8   conduct described in subdivision 1a; or 
206.9      (2) the commissioner receives reliable evidence of fraud or 
206.10  willful misrepresentation by the vendor. 
206.11     (c) The commissioner must send notice of the withholding or 
206.12  reduction of payments under paragraph (b) within five days of 
206.13  taking such action.  The notice must: 
206.14     (1) state that payments are being withheld according to 
206.15  paragraph (b); 
206.16     (2) except in the case of a conviction for conduct 
206.17  described in subdivision 1a, state that the withholding is for a 
206.18  temporary period and cite the circumstances under which 
206.19  withholding will be terminated; 
206.20     (3) identify the types of claims to which the withholding 
206.21  applies; and 
206.22     (4) inform the vendor of the right to submit written 
206.23  evidence for consideration by the commissioner. 
206.24     The withholding or reduction of payments will not continue 
206.25  after the commissioner determines there is insufficient evidence 
206.26  of fraud or willful misrepresentation by the vendor, or after 
206.27  legal proceedings relating to the alleged fraud or willful 
206.28  misrepresentation are completed, unless the commissioner has 
206.29  sent notice of intention to impose monetary recovery or 
206.30  sanctions under paragraph (a). 
206.31     (d) Upon receipt of a notice under paragraph (a) that a 
206.32  monetary recovery or sanction is to be imposed, a vendor may 
206.33  request a contested case, as defined in section 14.02, 
206.34  subdivision 3, by filing with the commissioner a written request 
206.35  of appeal.  The appeal request must be received by the 
206.36  commissioner no later than 30 days after the date the 
207.1   notification of monetary recovery or sanction was mailed to the 
207.2   vendor.  The appeal request must specify: 
207.3      (1) each disputed item, the reason for the dispute, and an 
207.4   estimate of the dollar amount involved for each disputed item; 
207.5      (2) the computation that the vendor believes is correct; 
207.6      (3) the authority in statute or rule upon which the vendor 
207.7   relies for each disputed item; 
207.8      (4) the name and address of the person or entity with whom 
207.9   contacts may be made regarding the appeal; and 
207.10     (5) other information required by the commissioner. 
207.11     Sec. 30.  Minnesota Statutes 1996, section 256B.0911, 
207.12  subdivision 2, is amended to read: 
207.13     Subd. 2.  [PERSONS REQUIRED TO BE SCREENED; EXEMPTIONS.] 
207.14  All applicants to Medicaid certified nursing facilities must be 
207.15  screened prior to admission, regardless of income, assets, or 
207.16  funding sources, except the following: 
207.17     (1) patients who, having entered acute care facilities from 
207.18  certified nursing facilities, are returning to a certified 
207.19  nursing facility; 
207.20     (2) residents transferred from other certified nursing 
207.21  facilities located within the state of Minnesota; 
207.22     (3) individuals who have a contractual right to have their 
207.23  nursing facility care paid for indefinitely by the veteran's 
207.24  administration; 
207.25     (4) individuals who are enrolled in the Ebenezer/Group 
207.26  Health social health maintenance organization project, or 
207.27  enrolled in a demonstration project under section 256B.69, 
207.28  subdivision 18, at the time of application to a nursing home; ~~or~~ 
207.29     (5) individuals previously screened and currently being 
207.30  served under the alternative care program or under a home and 
207.31  community-based services waiver authorized under section 1915(c) 
207.32  of the Social Security Act; or 
207.33     (6) individuals who are admitted to a certified nursing 
207.34  facility for a short-term stay, which, based upon a physician's 
207.35  certification, is expected to be 14 days or less in duration, 
207.36  and who have been screened and approved for nursing facility 
208.1   admission within the previous six months.  This exemption 
208.2   applies only if the screener determines at the time of the 
208.3   initial screening of the six-month period that it is appropriate 
208.4   to use the nursing facility for short-term stays and that there 
208.5   is an adequate plan of care for return to the home or 
208.6   community-based setting.  If a stay exceeds 14 days, the 
208.7   individual must be referred no later than the first county 
208.8   working day following the 14th resident day for a screening, 
208.9   which must be completed within five working days of the 
208.10  referral.  Payment limitations in subdivision 7 will apply to an 
208.11  individual found at screening to meet the level of care criteria 
208.12  for admission to a certified nursing facility. 
208.13     Regardless of the exemptions in clauses (2) to ~~(4)~~ (6), 
208.14  persons who have a diagnosis or possible diagnosis of mental 
208.15  illness, mental retardation, or a related condition must ~~be~~ 
208.16  ~~screened~~ receive a preadmission screening before admission 
208.17  unless the admission prior to screening is authorized by the 
208.18  local mental health authority or the local developmental 
208.19  disabilities case manager, or unless authorized by the county 
208.20  agency according to Public Law Number 101-508. 
208.21     Before admission to a Medicaid certified nursing home or 
208.22  boarding care home, all persons must be screened and approved 
208.23  for admission through an assessment process.  The nursing 
208.24  facility is authorized to conduct case mix assessments which are 
208.25  not conducted by the county public health nurse under Minnesota 
208.26  Rules, part 9549.0059.  The designated county agency is 
208.27  responsible for distributing the quality assurance and review 
208.28  form for all new applicants to nursing homes. 
208.29     Other persons who are not applicants to nursing facilities 
208.30  must be screened if a request is made for a screening. 
208.31     Sec. 31.  Minnesota Statutes 1996, section 256B.0911, 
208.32  subdivision 7, is amended to read: 
208.33     Subd. 7.  [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.] 
208.34  (a) Medical assistance reimbursement for nursing facilities 
208.35  shall be authorized for a medical assistance recipient only if a 
208.36  preadmission screening has been conducted prior to admission or 
209.1   the local county agency has authorized an exemption.  Medical 
209.2   assistance reimbursement for nursing facilities shall not be 
209.3   provided for any recipient who the local screener has determined 
209.4   does not meet the level of care criteria for nursing facility 
209.5   placement or, if indicated, has not had a level II PASARR 
209.6   evaluation completed unless an admission for a recipient with 
209.7   mental illness is approved by the local mental health authority 
209.8   or an admission for a recipient with mental retardation or 
209.9   related condition is approved by the state mental retardation 
209.10  authority.  The county preadmission screening team may deny 
209.11  certified nursing facility admission using the level of care 
209.12  criteria established under section 144.0721 and deny medical 
209.13  assistance reimbursement for certified nursing facility care.  
209.14  Persons receiving care in a certified nursing facility or 
209.15  certified boarding care home who are reassessed by the 
209.16  commissioner of health according to section 144.0722 and 
209.17  determined to no longer meet the level of care criteria for a 
209.18  certified nursing facility or certified boarding care home may 
209.19  no longer remain a resident in the certified nursing facility or 
209.20  certified boarding care home and must be relocated to the 
209.21  community under paragraphs (b), (c), and (d) if the persons were 
209.22  admitted on or after July 1, ~~1996~~ 1997.  
209.23     (b) A resident who, upon reassessment, is determined to no 
209.24  longer meet the level of care criteria for a certified nursing 
209.25  facility or certified boarding care home is deemed to not need 
209.26  the services provided by a nursing facility.  Such a resident 
209.27  may not receive medical assistance payment for nursing facility 
209.28  or boarding care services and must be discharged under this 
209.29  subdivision.  A resident who is determined to no longer need 
209.30  nursing facility services may ask for a reconsideration of the 
209.31  resident's case mix and level of care assessment under section 
209.32  144.0722.  If reconsideration is not requested, the resident may 
209.33  not appeal the assessment.  If the resident is determined to not 
209.34  meet the level of care criteria for treatment in a nursing 
209.35  facility, the commissioner shall notify the nursing facility 
209.36  that the resident's health has improved sufficiently so the 
210.1   resident no longer needs the services provided by a nursing 
210.2   facility and that the resident must be discharged within 60 days 
210.3   after the facility receives notice, regardless of the source of 
210.4   payment for the resident's care.  The ground for discharge shall 
210.5   be that the resident's health has improved sufficiently so that 
210.6   the resident no longer needs the services of the nursing 
210.7   facility.  The nursing facility shall discharge the resident 
210.8   according to federal regulations that govern discharge of 
210.9   residents of certified nursing facilities.  If the resident's 
210.10  care is paid for by medical assistance, the commissioner must 
210.11  also notify the resident that medical assistance payment for the 
210.12  resident's nursing facility services will terminate 60 days 
210.13  after the resident receives the notice. 
210.14     (c) The resident may request, within 14 days of receiving a 
210.15  notice of discharge or of termination of medical assistance 
210.16  payments, an assessment from the local screening team defined 
210.17  under section 256B.0911 to determine whether extraordinary 
210.18  circumstances as defined in section 144.0721, subdivision 3, 
210.19  exist.  The screening team must issue a written decision within 
210.20  ten days of the resident's request.  If the screening team finds 
210.21  that extraordinary circumstances exist, the resident need not be 
210.22  discharged and medical assistance payments shall not be 
210.23  discontinued on the resident's behalf. 
210.24     (d) A resident notified of discharge of or discontinuance 
210.25  of medical assistance payment under this section may appeal 
210.26  under section 256.045 within 30 days of receiving a notice of 
210.27  discharge or of termination of medical assistance payments, or 
210.28  within 30 days of the screening team's decision that 
210.29  extraordinary circumstances do not exist, whichever is later.  
210.30  Medical assistance payments shall continue and the resident 
210.31  shall not be discharged until the commissioner issues a decision 
210.32  on the appeal.  The nursing facility may participate in the 
210.33  hearing for the limited purpose of proving that the resident 
210.34  meets the level of care criteria.  If, after a hearing, the 
210.35  commissioner of human services determines either that the 
210.36  resident meets the level of care criteria for nursing facility 
211.1   services or that extraordinary circumstances as defined in 
211.2   section 144.0721, subdivision 3, exist, medical assistance shall 
211.3   not be terminated and the resident shall not be discharged.  The 
211.4   burden is on the resident to demonstrate that the resident needs 
211.5   the services provided by a nursing facility or that 
211.6   extraordinary circumstances exist.  The commissioner shall give 
211.7   no deference to the screening team's determination.  A 
211.8   resident's appeal of discharge under this section may be 
211.9   appealed only under section 256.045 and not section 144.135. 
211.10     (e) Persons receiving services under section 256B.0913, 
211.11  subdivisions 1 to 14, or 256B.0915 who are reassessed and found 
211.12  to not meet the level of care criteria for admission to a 
211.13  certified nursing facility or certified boarding care home may 
211.14  no longer receive these services if persons were admitted to the 
211.15  program on or after July 1, ~~1996~~ 1997.  Reassessed individuals 
211.16  ineligible for services under section 256B.0913, subdivisions 1 
211.17  to 14, or 256B.0915, are entitled to an appeal under section 
211.18  256.045, subdivision 3.  The commissioner shall make a request 
211.19  to the health care financing administration for a waiver 
211.20  allowing screening team approval of Medicaid payments for 
211.21  certified nursing facility care.  An individual has a choice and 
211.22  makes the final decision between nursing facility placement and 
211.23  community placement after the screening team's recommendation, 
211.24  except as provided in paragraphs (b) and (c).  
211.25     ~~(b)~~ (f) The local county mental health authority or the 
211.26  state mental retardation authority under Public Law Numbers 
211.27  100-203 and 101-508 may prohibit admission to a nursing 
211.28  facility, if the individual does not meet the nursing facility 
211.29  level of care criteria or needs specialized services as defined 
211.30  in Public Law Numbers 100-203 and 101-508.  For purposes of this 
211.31  section, "specialized services" for a person with mental 
211.32  retardation or a related condition means "active treatment" as 
211.33  that term is defined in Code of Federal Regulations, title 42, 
211.34  section 483.440(a)(1). 
211.35     ~~(c)~~ (g) Upon the receipt by the commissioner of approval by 
211.36  the Secretary of Health and Human Services of the waiver 
212.1   requested under paragraph (a), the local screener shall deny 
212.2   medical assistance reimbursement for nursing facility care for 
212.3   an individual whose long-term care needs can be met in a 
212.4   community-based setting and whose cost of community-based home 
212.5   care services is less than 75 percent of the average payment for 
212.6   nursing facility care for that individual's case mix 
212.7   classification, and who is either: 
212.8      (i) a current medical assistance recipient being screened 
212.9   for admission to a nursing facility; or 
212.10     (ii) an individual who would be eligible for medical 
212.11  assistance within 180 days of entering a nursing facility and 
212.12  who meets a nursing facility level of care. 
212.13     ~~(d)~~ (h) Appeals from the screening team's recommendation or 
212.14  the county agency's final decision shall be made according to 
212.15  section 256.045, subdivision 3. 
212.16     Sec. 32.  Minnesota Statutes 1996, section 256B.0913, 
212.17  subdivision 10, is amended to read: 
212.18     Subd. 10.  [ALLOCATION FORMULA.] (a) The alternative care 
212.19  appropriation for fiscal years 1992 and beyond shall cover only 
212.20  180-day eligible clients. 
212.21     (b) Prior to July 1 of each year, the commissioner shall 
212.22  allocate to county agencies the state funds available for 
212.23  alternative care for persons eligible under subdivision 2.  The 
212.24  allocation for fiscal year 1992 shall be calculated using a base 
212.25  that is adjusted to exclude the medical assistance share of 
212.26  alternative care expenditures.  The adjusted base is calculated 
212.27  by multiplying each county's allocation for fiscal year 1991 by 
212.28  the percentage of county alternative care expenditures for 
212.29  180-day eligible clients.  The percentage is determined based on 
212.30  expenditures for services rendered in fiscal year 1989 or 
212.31  calendar year 1989, whichever is greater. 
212.32     (c) If the county expenditures for 180-day eligible clients 
212.33  are 95 percent or more of its adjusted base allocation, the 
212.34  allocation for the next fiscal year is 100 percent of the 
212.35  adjusted base, plus inflation to the extent that inflation is 
212.36  included in the state budget. 
213.1      (d) If the county expenditures for 180-day eligible clients 
213.2   are less than 95 percent of its adjusted base allocation, the 
213.3   allocation for the next fiscal year is the adjusted base 
213.4   allocation less the amount of unspent funds below the 95 percent 
213.5   level. 
213.6      (e) For fiscal year 1992 only, a county may receive an 
213.7   increased allocation if annualized service costs for the month 
213.8   of May 1991 for 180-day eligible clients are greater than the 
213.9   allocation otherwise determined.  A county may apply for this 
213.10  increase by reporting projected expenditures for May to the 
213.11  commissioner by June 1, 1991.  The amount of the allocation may 
213.12  exceed the amount calculated in paragraph (b).  The projected 
213.13  expenditures for May must be based on actual 180-day eligible 
213.14  client caseload and the individual cost of clients' care plans.  
213.15  If a county does not report its expenditures for May, the amount 
213.16  in paragraph (c) or (d) shall be used. 
213.17     (f) Calculations for paragraphs (c) and (d) are to be made 
213.18  as follows:  for each county, the determination of expenditures 
213.19  shall be based on payments for services rendered from April 1 
213.20  through March 31 in the base year, to the extent that claims 
213.21  have been submitted by June 1 of that year.  Calculations for 
213.22  paragraphs (c) and (d) will also include the funds transferred 
213.23  to the consumer support grant program for clients who have 
213.24  transferred to that program from April 1 through March 31 in the 
213.25  base year. 
213.26     Sec. 33.  Minnesota Statutes 1996, section 256B.0913, 
213.27  subdivision 15, is amended to read: 
213.28     Subd. 15.  [SERVICE ALLOWANCE FUND AVAILABILITY.] (a) 
213.29  Effective July 1, ~~1996~~ 1997, the commissioner may use 
213.30  alternative care funds for services to high function class A 
213.31  persons as defined in section 144.0721, subdivision 3, clause 
213.32  (2).  The county alternative care grant allocation will be 
213.33  supplemented with a special allocation amount ~~based on the~~ 
213.34  ~~projected number of eligible high function class A's and~~ 
213.35  ~~computed on the basis of $240 per month per projected eligible~~ 
213.36  ~~person.  Individual monthly expenditures under the service~~ 
214.1   ~~allowance option are permitted to be either greater or less than~~ 
214.2   ~~the amount of $240 per month based on individual need.  County~~ 
214.3   ~~allocations shall be adjusted periodically based on the actual~~ 
214.4   ~~provision of services to high function class A persons~~.  The 
214.5   allocation will be distributed by a population based formula and 
214.6   shall not exceed the proportion of projected savings made 
214.7   available under section 144.0721, subdivision 3. 
214.8      (b) Counties shall have the option of providing services, 
214.9   cash service allowances, vouchers, or a combination of these 
214.10  options to high function class A persons defined in section 
214.11  144.0721, subdivision 3, clause (2).  High function class A 
214.12  persons may choose services from among the categories of 
214.13  services listed under subdivision 5, except for case management 
214.14  services. 
214.15     (c) If the special allocation under this section to a 
214.16  county is not sufficient to serve all persons who qualify 
214.17  for ~~alternative care services~~ the service allowance, the county 
214.18  is not required to provide any ~~alternative care~~ services to a 
214.19  high function class A person but shall establish a waiting list 
214.20  to provide services as special allocation funding becomes 
214.21  available. 
214.22     Sec. 34.  Minnesota Statutes 1996, section 256B.421, 
214.23  subdivision 1, is amended to read: 
214.24     Subdivision 1.  [SCOPE.] For the purposes of this section 
214.25  and sections 256B.41, 256B.411, 256B.431, 256B.432, 
214.26  256B.433, 256B.434, 256B.435, 256B.47, 256B.48, 256B.50, and 
214.27  256B.502, the following terms and phrases shall have the meaning 
214.28  given to them. 
214.29     Sec. 35.  Minnesota Statutes 1996, section 256B.431, is 
214.30  amended by adding a subdivision to read: 
214.31     Subd. 2s.  [PAYMENTS IN EXCESS OF MEDICAL ASSISTANCE RATE.] 
214.32  (a) For rate years beginning on or after July 1, 1997, a nursing 
214.33  facility that receives a per diem payment in excess of the 
214.34  medical assistance payment rate which is related to routine 
214.35  nursing facility care, and is from a third party through a 
214.36  contractual managed care arrangement, must offset to the nursing 
215.1   category on the provider's cost report either:  
215.2      (i) 90 percent of the per diem payment in excess of the 
215.3   medical assistance payment rate; or 
215.4      (ii) the directly identified costs associated with the per 
215.5   diem payment in excess of the medical assistance rate.  
215.6      (b) The cost of nonroutine nursing facility care shall be 
215.7   determined using the medical assistance allowed charge for each 
215.8   unit of nonroutine service provided to the nursing facility 
215.9   resident while the resident is covered under the managed care 
215.10  contract. 
215.11     Sec. 36.  Minnesota Statutes 1996, section 256B.434, 
215.12  subdivision 2, is amended to read: 
215.13     Subd. 2.  [REQUESTS FOR PROPOSALS.] (a) ~~No later than~~ 
215.14  ~~August 1, 1995,~~ At least twice annually the commissioner shall 
215.15  publish in the State Register a request for proposals to provide 
215.16  nursing facility services according to this section.  ~~The~~ 
215.17  ~~commissioner shall issue two additional requests for proposals~~ 
215.18  ~~prior to July 1, 1997, based upon a timetable established by the~~ 
215.19  ~~commissioner.~~  The commissioner must respond to all proposals in 
215.20  a timely manner. 
215.21     (b) The commissioner may reject any proposal if, in the 
215.22  judgment of the commissioner, a contract with a particular 
215.23  facility is not in the best interests of the residents of the 
215.24  facility or the state of Minnesota.  The commissioner may accept 
215.25  up to the number of proposals that can be adequately supported 
215.26  with available state resources, as determined by the 
215.27  commissioner~~, except that the commissioner shall not contract~~ 
215.28  ~~with more than 40 nursing facilities as part of any request for~~ 
215.29  ~~proposals~~.  The commissioner may accept proposals from a single 
215.30  nursing facility or from a group of facilities through a 
215.31  managing entity.  The commissioner shall seek to ensure that 
215.32  nursing facilities under contract are located in all geographic 
215.33  areas of the state.  ~~The commissioner shall present~~ 
215.34  ~~recommendations to the legislature by February 1, 1996, on the~~ 
215.35  ~~number of nursing facility contracts that may be entered into by~~ 
215.36  ~~the commissioner as a result of a request for proposals.~~ 
216.1      (c) In issuing the request for proposals, the commissioner 
216.2   may develop reasonable requirements which, in the judgment of 
216.3   the commissioner, are necessary to protect residents or ensure 
216.4   that the contractual alternative payment demonstration project 
216.5   furthers the interest of the state of Minnesota.  The request 
216.6   for proposals may include, but need not be limited to, the 
216.7   following: 
216.8      (1) a requirement that a nursing facility make reasonable 
216.9   efforts to maximize Medicare payments on behalf of eligible 
216.10  residents; 
216.11     (2) requirements designed to prevent inappropriate or 
216.12  illegal discrimination against residents enrolled in the medical 
216.13  assistance program as compared to private paying residents; 
216.14     (3) requirements designed to ensure that admissions to a 
216.15  nursing facility are appropriate and that reasonable efforts are 
216.16  made to place residents in home and community-based settings 
216.17  when appropriate; 
216.18     (4) a requirement to agree to participate in a project to 
216.19  develop data collection systems and outcome-based standards ~~for~~ 
216.20  ~~managed care contracting for long-term care services~~.  Among 
216.21  other requirements specified by the commissioner, each facility 
216.22  entering into a contract may be required to pay an annual fee ~~in~~ 
216.23  ~~an amount determined by the commissioner not to exceed $50 per~~ 
216.24  ~~bed~~.  Revenue generated from the fees is appropriated to the 
216.25  commissioner and must be used to contract with a qualified 
216.26  consultant or contractor to develop data collection systems and 
216.27  outcome-based contracting standards; 
216.28     (5) a requirement that contractors agree to maintain 
216.29  Medicare cost reports and to submit them to the commissioner 
216.30  upon request or at times specified by the commissioner; 
216.31     (6) a requirement for demonstrated willingness and ability 
216.32  to develop and maintain data collection and retrieval systems to 
216.33  be used in measuring outcomes; and 
216.34     (7) a requirement to provide all information and assurances 
216.35  required by the terms and conditions of the federal waiver or 
216.36  federal approval. 
217.1      (d) In addition to the information and assurances contained 
217.2   in the submitted proposals, the commissioner may consider the 
217.3   following in determining whether to accept or deny a proposal: 
217.4      (1) the facility's history of compliance with federal and 
217.5   state laws and rules~~;~~, except that a facility deemed to be in 
217.6   substantial compliance with federal and state laws and rules is 
217.7   eligible to respond to a request for proposal.  A facility's 
217.8   compliance history shall not be the sole determining factor in 
217.9   situations where the facility has been sold and the new owners 
217.10  have submitted a proposal; 
217.11     (2) whether the facility has a record of excessive 
217.12  licensure fines or sanctions or fraudulent cost reports; 
217.13     (3) financial history and solvency; and 
217.14     (4) other factors identified by the commissioner that the 
217.15  commissioner deems relevant to a determination that a contract 
217.16  with a particular facility is not in the best interests of the 
217.17  residents of the facility or the state of Minnesota. 
217.18     (e) If the commissioner rejects the proposal of a nursing 
217.19  facility, the commissioner shall provide written notice to the 
217.20  facility of the reason for the rejection, including the factors 
217.21  and evidence upon which the rejection was based. 
217.22     Sec. 37.  Minnesota Statutes 1996, section 256B.434, 
217.23  subdivision 3, is amended to read: 
217.24     Subd. 3.  [DURATION AND TERMINATION OF CONTRACTS.] (a) 
217.25  Subject to available resources, the commissioner may begin to 
217.26  execute contracts with nursing facilities November 1, 1995. 
217.27     (b) All contracts entered into under this section are for a 
217.28  term of ~~four years~~ one year.  Either party may terminate a 
217.29  contract ~~effective July 1 of any year by providing written~~ 
217.30  ~~notice to the other party no later than April 1 of that year~~ at 
217.31  any time without cause by providing 30 calendar days advance 
217.32  written notice to the other party.  The decision to terminate a 
217.33  contract is not appealable.  If neither party provides written 
217.34  notice of termination ~~by April 1, the contract is automatically~~ 
217.35  ~~renewed for the next rate year~~, the contract shall be 
217.36  renegotiated for additional one-year terms, for up to a total of 
218.1   four consecutive one-year terms.  The provisions of the contract 
218.2   shall be renegotiated annually by the parties prior to the 
218.3   expiration date of the contract.  The parties may voluntarily 
218.4   renegotiate the terms of the contract at any time by mutual 
218.5   agreement. 
218.6      (c) If a nursing facility fails to comply with the terms of 
218.7   a contract, the commissioner shall provide reasonable notice 
218.8   regarding the breach of contract and a reasonable opportunity 
218.9   for the facility to come into compliance.  If the facility fails 
218.10  to come into compliance or to remain in compliance, the 
218.11  commissioner may terminate the contract.  If a contract is 
218.12  terminated, the contract payment remains in effect for the 
218.13  remainder of the rate year in which the contract was terminated, 
218.14  but in all other respects the provisions of this section do not 
218.15  apply to that facility effective the date the contract is 
218.16  terminated.  The contract shall contain a provision governing 
218.17  the transition back to the cost-based reimbursement system 
218.18  established under section 256B.431, subdivision 25, and 
218.19  Minnesota Rules, parts 9549.0010 to 9549.0080.  A contract 
218.20  entered into under this section may be amended by mutual 
218.21  agreement of the parties. 
218.22     Sec. 38.  Minnesota Statutes 1996, section 256B.434, 
218.23  subdivision 4, is amended to read: 
218.24     Subd. 4.  [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 
218.25  nursing facilities which have their payment rates determined 
218.26  under this section rather than section 256B.431, subdivision 25, 
218.27  the commissioner shall establish a rate under this subdivision.  
218.28  The nursing facility must enter into a written contract with the 
218.29  commissioner. 
218.30     (b) A nursing facility's case mix payment rate for the 
218.31  first rate year of a facility's contract under this section is 
218.32  the payment rate the facility would have received under section 
218.33  256B.431, subdivision 25. 
218.34     (c) A nursing facility's case mix payment rates for the 
218.35  second and subsequent years of a facility's contract under this 
218.36  section are the previous rate year's contract payment rates plus 
219.1   an inflation adjustment.  The index for the inflation adjustment 
219.2   must be based on the change in the Consumer Price Index-All 
219.3   Items (United States City average) (CPI-U) forecasted by Data 
219.4   Resources, Inc., as forecasted in the fourth quarter of the 
219.5   calendar year preceding the rate year.  The inflation adjustment 
219.6   must be based on the 12-month period from the midpoint of the 
219.7   previous rate year to the midpoint of the rate year for which 
219.8   the rate is being determined. 
219.9      (d) The commissioner ~~may~~ shall develop additional 
219.10  incentive-based payments of up to five percent above the 
219.11  standard contract rate for achieving outcomes specified in each 
219.12  contract.  ~~The incentive system may be implemented for contract~~ 
219.13  ~~rate years beginning on or after July 1, 1996.~~  The specified 
219.14  facility-specific outcomes must be measurable ~~and must be based~~ 
219.15  ~~on criteria to be developed~~ and approved by the commissioner.  
219.16  The commissioner may establish, for each contract, various 
219.17  levels of achievement within an outcome.  After the outcomes 
219.18  have been specified the commissioner shall assign various levels 
219.19  of payment associated with achieving the outcome.  Any 
219.20  incentive-based payment cancels if there is a termination of the 
219.21  contract.  In establishing the specified outcomes and related 
219.22  criteria the commissioner shall consider the following state 
219.23  policy objectives: 
219.24     (1) improved cost effectiveness and quality of life as 
219.25  measured by improved clinical outcomes; 
219.26     (2) successful diversion or discharge to community 
219.27  alternatives; 
219.28     (3) decreased acute care costs; 
219.29     (4) improved consumer satisfaction; 
219.30     (5) the achievement of quality; or 
219.31     (6) any additional outcomes proposed by a nursing facility 
219.32  that the commissioner finds desirable. 
219.33     Sec. 39.  Minnesota Statutes 1996, section 256B.48, 
219.34  subdivision 6, is amended to read: 
219.35     Subd. 6.  [MEDICARE CERTIFICATION.] (a)  [DEFINITION.] For 
219.36  purposes of this subdivision, "nursing facility" means a nursing 
220.1   facility that is certified as a skilled nursing facility or, 
220.2   after September 30, 1990, a nursing facility licensed under 
220.3   chapter 144A that is certified as a nursing facility.  
220.4      (b)  [MEDICARE PARTICIPATION REQUIRED.] All nursing 
220.5   facilities shall participate in Medicare part A and part B 
220.6   unless, after submitting an application, Medicare certification 
220.7   is denied by the federal health care financing administration.  
220.8   Medicare review shall be conducted at the time of the annual 
220.9   medical assistance review.  Charges for Medicare-covered 
220.10  services provided to residents who are simultaneously eligible 
220.11  for medical assistance and Medicare must be billed to Medicare 
220.12  part A or part B before billing medical assistance.  Medical 
220.13  assistance may be billed only for charges not reimbursed by 
220.14  Medicare.  
220.15     (c)  [UNTIL SEPTEMBER 30, 1990.] Until September 30, 1990, 
220.16  a nursing facility satisfies the requirements of paragraph (b) 
220.17  if:  (1) at least 50 percent of the facility's beds that are 
220.18  licensed under section 144A and certified as skilled nursing 
220.19  beds under the medical assistance program are Medicare 
220.20  certified; or (2) if a nursing facility's beds are licensed 
220.21  under section 144A, and some are medical assistance certified as 
220.22  skilled nursing beds and others are medical assistance certified 
220.23  as intermediate care facility I beds, at least 50 percent of the 
220.24  facility's total skilled nursing beds and intermediate care 
220.25  facility I beds or 100 percent of its skilled nursing beds, 
220.26  whichever is less, are Medicare certified. 
220.27     (d)  [AFTER ~~SEPTEMBER 30, 1990~~ JULY 1, 1997.] 
220.28  After ~~September 30, 1990~~ July 1, 1997, a nursing facility 
220.29  satisfies the requirements of paragraph (b) if at least 50 
220.30  percent of the facility's beds certified as nursing facility 
220.31  beds under the medical assistance program are Medicare certified.
220.32     (e)  [CONFLICT WITH MEDICARE DISTINCT PART REQUIREMENTS.] 
220.33  At the request of a facility, the commissioner of human services 
220.34  may reduce the 50 percent Medicare participation requirement in 
220.35  paragraphs (c) and (d) ~~to no less than 20 percent if the~~ 
220.36  ~~commissioner of health determines that, due to the facility's~~ 
221.1   ~~physical plant configuration, the facility cannot satisfy~~ 
221.2   ~~Medicare distinct part requirements at the 50 percent~~ 
221.3   ~~certification level~~.  To receive a reduction in the 
221.4   participation requirement, a facility must demonstrate that the 
221.5   reduction will not adversely affect access of Medicare-eligible 
221.6   residents to Medicare-certified beds. 
221.7      (f)  [INSTITUTIONS FOR MENTAL DISEASE.] The commissioner 
221.8   may grant exceptions to the requirements of paragraph (b) for 
221.9   nursing facilities that are designated as institutions for 
221.10  mental disease. 
221.11     (g)  [NOTICE OF RIGHTS.] The commissioner shall inform 
221.12  recipients of their rights under this subdivision and section 
221.13  144.651, subdivision 29. 
221.14     Sec. 40.  Minnesota Statutes 1996, section 256B.49, 
221.15  subdivision 1, is amended to read: 
221.16     Subdivision 1.  [STUDY; WAIVER APPLICATION.] The 
221.17  commissioner shall authorize a study to assess the need for home 
221.18  and community-based waivers for chronically ill children who 
221.19  have been and will continue to be hospitalized without a waiver, 
221.20  and for disabled individuals under the age of 65 who are likely 
221.21  to reside in an acute care or nursing home facility in the 
221.22  absence of a waiver.  If a need for these waivers can be 
221.23  demonstrated, the commissioner shall apply for federal waivers 
221.24  necessary to secure, to the extent allowed by law, federal 
221.25  participation under United States Code, title 42, sections 
221.26  1396-1396p, as amended through December 31, 1982, for the 
221.27  provision of home and community-based services to chronically 
221.28  ill children who, in the absence of such a waiver, would remain 
221.29  in an acute care setting, and to disabled individuals under the 
221.30  age of 65 who, in the absence of a waiver, would reside in an 
221.31  acute care or nursing home setting.  If the need is 
221.32  demonstrated, the commissioner shall request a waiver under 
221.33  United States Code, title 42, sections 1396-1396p, to allow 
221.34  medicaid eligibility for blind or disabled children with 
221.35  ineligible parents where income deemed from the parents would 
221.36  cause the applicant to be ineligible for supplemental security 
222.1   income if the family shared a household and to furnish necessary 
222.2   services in the home or community to disabled individuals under 
222.3   the age of 65 who would be eligible for medicaid if 
222.4   institutionalized in an acute care or nursing home setting. 
222.5   These waivers are requested to furnish necessary services in the 
222.6   home and community setting to children or disabled adults under 
222.7   age 65 who are medicaid eligible when institutionalized in an 
222.8   acute care or nursing home setting.  The commissioner shall 
222.9   assure that the cost of home and community-based care will not 
222.10  be more than the cost of care if the eligible child or disabled 
222.11  adult under age 65 were to remain institutionalized.  The 
222.12  average monthly limit for the cost of home and community-based 
222.13  services to a community alternative care waiver client, 
222.14  determined on a 12-month basis, shall not exceed the statewide 
222.15  average medical assistance adjusted base year operating cost for 
222.16  nursing and accommodation services under sections 256.9685 to 
222.17  256.969 for the diagnostic category to which the waiver client 
222.18  would be assigned except the admission and outlier rates shall 
222.19  be converted to an overall per diem.  The average monthly limit 
222.20  for the cost of services to a traumatic brain injury 
222.21  neurobehavioral hospital waiver client, determined on a 12-month 
222.22  basis, shall not exceed the statewide average medical assistance 
222.23  adjusted base-year operating cost for nursing and accommodation 
222.24  services of neurobehavioral rehabilitation programs in Medicare 
222.25  designated long-term hospitals under sections 256.9685 to 
222.26  256.969.  The following costs must be included in determining 
222.27  the total average monthly costs for a waiver client:  
222.28     (1) cost of all waivered services; and 
222.29     (2) cost of skilled nursing, private duty nursing, home 
222.30  health aide, and personal care services reimbursable by medical 
222.31  assistance.  
222.32     The commissioner of human services shall seek federal 
222.33  waivers as necessary to implement the average monthly limit.  
222.34  The commissioner shall seek to amend the federal waivers 
222.35  obtained under this section to apply criteria to protect against 
222.36  spousal impoverishment as authorized under United States Code, 
223.1   title 42, section 1396r-5, and as implemented in sections 
223.2   256B.0575, 256B.058, and 256B.059, except that the amendment 
223.3   shall seek to add to the personal needs allowance permitted in 
223.4   section 256B.0575, an amount equivalent to the group residential 
223.5   housing rate as set by section 256I.03, subdivision 5. 
223.6      Sec. 41.  [256B.693] [STATE-OPERATED SERVICES; MANAGED 
223.7   CARE.] 
223.8      Subdivision 1.  [PROPOSALS FOR MANAGED CARE; ROLE OF STATE 
223.9   OPERATED SERVICES.] Any proposal integrating state-operated 
223.10  services with managed care systems for persons with disabilities 
223.11  shall identify the specific role to be assumed by state-operated 
223.12  services and the funding arrangement in which state-operated 
223.13  services shall effectively operate within the managed care 
223.14  initiative.  The commissioner shall not approve or implement the 
223.15  initiative that consolidates funding appropriated for 
223.16  state-operated services with funding for managed care 
223.17  initiatives for persons with disabilities. 
223.18     Subd. 2.  [STUDY BY THE COMMISSIONER.] To help identify 
223.19  appropriate state-operated services for managed care systems, 
223.20  the commissioner of human services shall study the integration 
223.21  of state-operated services into public managed care systems and 
223.22  make recommendations to the legislature.  The commissioner's 
223.23  study and recommendations shall include, but shall not be 
223.24  limited to, the following: 
223.25     (1) identification of persons with disabilities on waiting 
223.26  lists for services, which could be provided by state-operated 
223.27  services; 
223.28     (2) availability of crisis services to persons with 
223.29  disabilities; 
223.30     (3) unmet service needs, which could be met by 
223.31  state-operated services; and 
223.32     (4) deficiencies in managed care contracts and services, 
223.33  which hinder the placement and maintenance of persons with 
223.34  disabilities in community settings. 
223.35     In conducting this study, the commissioner shall survey 
223.36  counties concerning their interest in and need for services that 
224.1   could be provided by state-operated services.  The commissioner 
224.2   shall also consult with the appropriate exclusive bargaining 
224.3   unit representatives.  The commissioner shall report findings to 
224.4   the legislature by February 1, 1998. 
224.5      Sec. 42.  Minnesota Statutes 1996, section 256G.02, 
224.6   subdivision 6, is amended to read: 
224.7      Subd. 6.  [EXCLUDED TIME.] "Excluded time" means: 
224.8      (a) any period an applicant spends in a hospital, 
224.9   sanitarium, nursing home, shelter other than an emergency 
224.10  shelter, halfway house, foster home, semi-independent living 
224.11  domicile or services program, residential facility offering 
224.12  care, board and lodging facility or other institution for the 
224.13  hospitalization or care of human beings, as defined in section 
224.14  144.50, 144A.01, or 245A.02, subdivision 14; maternity home, 
224.15  battered women's shelter, or correctional facility; or any 
224.16  facility based on an emergency hold under sections 253B.05, 
224.17  subdivisions 1 and 2, and 253B.07, subdivision 6; 
224.18     (b) any period an applicant spends on a placement basis in 
224.19  a training and habilitation program, including a rehabilitation 
224.20  facility or work or employment program as defined in section 
224.21  268A.01; or receiving personal care assistant services pursuant 
224.22  to section 256B.0627, subdivision 4; semi-independent living 
224.23  services provided under section 252.275, and Minnesota Rules, 
224.24  parts 9525.0500 to 9525.0660; day training and habilitation 
224.25  programs~~, and community-based services~~ and assisted living 
224.26  services; and 
224.27     (c) any placement for a person with an indeterminate 
224.28  commitment, including independent living. 
224.29     Sec. 43.  Minnesota Statutes 1996, section 469.155, 
224.30  subdivision 4, is amended to read: 
224.31     Subd. 4.  [REFINANCING HEALTH FACILITIES.] It may issue 
224.32  revenue bonds to pay, purchase, or discharge all or any part of 
224.33  the outstanding indebtedness of a contracting party engaged 
224.34  primarily in the operation of one or more nonprofit hospitals or 
224.35  nursing homes previously incurred in the acquisition or 
224.36  betterment of its existing hospital or nursing home facilities 
225.1   to the extent deemed necessary by the governing body of the 
225.2   municipality or redevelopment agency; this may include any 
225.3   unpaid interest on the indebtedness accrued or to accrue to the 
225.4   date on which the indebtedness is finally paid, and any premium 
225.5   the governing body of the municipality or redevelopment agency 
225.6   determines to be necessary to be paid to pay, purchase, or 
225.7   defease the outstanding indebtedness.  If revenue bonds are 
225.8   issued for this purpose, the refinancing and the existing 
225.9   properties of the contracting party shall be deemed to 
225.10  constitute a project under section 469.153, subdivision 2, 
225.11  clause (d).  ~~Revenue bonds may not be issued pursuant to this~~ 
225.12  ~~subdivision unless the application for approval of the project~~ 
225.13  ~~pursuant to section 469.154 shows that a reduction in debt~~ 
225.14  ~~service charges is estimated to result and will be reflected in~~ 
225.15  ~~charges to patients and third-party payors.  Proceeds of revenue~~ 
225.16  ~~bonds issued pursuant to this subdivision may not be used for~~ 
225.17  ~~any purpose inconsistent with the provisions of chapter 256B.~~  
225.18  ~~Nothing in this subdivision prohibits the use of revenue bond~~ 
225.19  ~~proceeds to pay outstanding indebtedness of a contracting party~~ 
225.20  ~~to the extent permitted by law on March 28, 1978.~~  
225.21     Sec. 44.  [TRANSITION FOR THE COMPULSIVE GAMBLING TREATMENT 
225.22  PROGRAM.] 
225.23     The commissioner of human services shall conduct a 
225.24  transition of treatment programs for compulsive gambling from 
225.25  the treatment center model to a model in which reimbursement for 
225.26  treatment of an individual compulsive gambler from an approved 
225.27  provider is on a fee-for-service basis on the following schedule:
225.28     (1) one-third of compulsive gamblers treated through the 
225.29  program must receive services paid for from the individual 
225.30  treatment reimbursement model beginning July 1, 1997; 
225.31     (2) two-thirds of compulsive gamblers treated through the 
225.32  program must receive services paid for from the individual 
225.33  treatment reimbursement model beginning July 1, 1998; and 
225.34     (3) 100 percent of compulsive gamblers treated through the 
225.35  program must receive treatment paid for from the individual 
225.36  treatment reimbursement model beginning July 1, 1999. 
226.1      Sec. 45.  [STUDY ON THE REGULATION OF HEALTH OCCUPATIONS.] 
226.2      Subdivision 1.  [COMMISSIONER OF HEALTH.] The commissioner 
226.3   of health shall study the current credentialing system for 
226.4   health occupations found in Minnesota Statutes, chapter 214, and 
226.5   make recommendations on the developing policies and criteria for 
226.6   the following:  (1) credentialing a health occupation; (2) 
226.7   changing the scope of practice or elements of existing 
226.8   regulatory systems; (3) the appropriate level or type of 
226.9   credentialing; and (4) the administrative agency placement of a 
226.10  credentialing activity.  The commissioner shall include 
226.11  recommendations for funding this evaluation process.  The study 
226.12  shall be completed by January 15, 1998.  
226.13     Subd. 2.  [LEGISLATIVE AUDITOR.] The legislative audit 
226.14  commission is requested to direct the legislative auditor to do 
226.15  the following:  (1) study the regulatory effectiveness and 
226.16  efficiency of the current health-related boards and advisory 
226.17  councils; (2) make recommendations for uniform and ongoing 
226.18  performance measures to evaluate the efficacy of regulatory 
226.19  activities; (3) make recommendations on reorganizing the current 
226.20  health boards and advisory councils in order to improve their 
226.21  effectiveness and efficiency including, the possibility of a 
226.22  centralized regulatory authority for violations by regulated 
226.23  health professionals of statutes and rules relating to business 
226.24  practices and personal conduct; (4) make recommendations on the 
226.25  need for creating an interdisciplinary board to provide 
226.26  oversight of all the health licensing boards; and (5) report its 
226.27  findings and recommendations to the commissioner of health by 
226.28  January 15, 1998.  
226.29     Subd. 3.  [COMMITTEE OF HEALTH-RELATED BOARDS.] A 
226.30  health-related board and advisory council committee is 
226.31  established to study the overlapping scopes of practice among 
226.32  regulated and unregulated health occupations and make 
226.33  recommendations on how to resolve this issue.  The committee 
226.34  shall also study and make recommendations on whether a 
226.35  consistent process for investigation of misconduct by health 
226.36  care professionals should be established for all health 
227.1   occupations and, if recommended, how to establish and implement 
227.2   the process.  The committee shall also make recommendations on 
227.3   policies and methods for recovering the costs of the legal, 
227.4   investigatory, and enforcement services conducted by the boards 
227.5   and the attorney general's office.  The committee shall consist 
227.6   of 12 members.  The committee must include two members appointed 
227.7   by the commissioner of health, two members appointed by the 
227.8   attorney general's office, one member appointed by the board of 
227.9   medical practice, one member appointed by the board of nursing, 
227.10  one member appointed from the health licensing board's 
227.11  administration offices, and five members appointed by the 
227.12  council of executive directors to represent the other 
227.13  health-related boards and advisory councils.  The committee 
227.14  shall report to the commissioner of health its findings and 
227.15  recommendations by January 15, 1998.  The committee expires upon 
227.16  submission of its report.  
227.17     Subd. 4.  [REPORT.] The commissioner of health shall submit 
227.18  a report on the results of the commissioner's study and 
227.19  recommendations and the recommendations of the legislative 
227.20  auditor, the committee of health-related boards and advisory 
227.21  councils to the members of the senate health and family security 
227.22  committee and the house of representatives health and human 
227.23  services committee by February 15, 1998. 
227.24     Sec. 46.  [REPEALER.] 
227.25     Minnesota Statutes 1996, section 469.154, subdivision 6, is 
227.26  repealed. 
227.27     Sec. 47.  [EFFECTIVE DATE.] 
227.28     Sections 18 to 21 and 32 are effective the day following 
227.29  final enactment. 
227.30                             ARTICLE 10
227.31               DEPARTMENT OF HUMAN SERVICES LICENSING
227.32     Section 1.  Minnesota Statutes 1996, section 144.057, 
227.33  subdivision 1, is amended to read: 
227.34     Subdivision 1.  [BACKGROUND STUDIES REQUIRED.] The 
227.35  commissioner of health shall contract with the commissioner of 
227.36  human services to conduct background studies of: 
228.1      (1) individuals providing services which have direct 
228.2   contact, as defined under section 245A.04, subdivision 3, with 
228.3   patients and residents in hospitals, boarding care homes, 
228.4   outpatient surgical centers licensed under sections 144.50 to 
228.5   144.58; nursing homes and home care agencies licensed under 
228.6   chapter 144A; residential care homes licensed under chapter 
228.7   144B, and board and lodging establishments that are registered 
228.8   to provide supportive or health supervision services under 
228.9   section 157.17; and 
228.10     (2) by July 1, 1999, all other employees in nursing homes 
228.11  and home care agencies licensed under chapter 144A, and boarding 
228.12  care homes licensed under sections 144.50 to 144.58.  A 
228.13  disqualification of an individual in this section shall 
228.14  disqualify the individual from positions allowing direct contact 
228.15  or access to patients or residents receiving services.  
228.16     If a facility or program is licensed by the department of 
228.17  human services and subject to the background study provisions of 
228.18  chapter 245A and is also licensed by the department of health, 
228.19  the department of human services is solely responsible for the 
228.20  background studies of individuals in the jointly licensed 
228.21  programs. 
228.22     Sec. 2.  Minnesota Statutes 1996, section 144A.46, 
228.23  subdivision 5, is amended to read: 
228.24     Subd. 5.  [PRIOR CRIMINAL CONVICTIONS.] (a) Before the 
228.25  commissioner issues a license ~~and, as defined in the home care~~ 
228.26  ~~licensure rules promulgated by the commissioner of health~~, an 
228.27  owner or managerial official shall be required to ~~disclose all~~ 
228.28  ~~criminal convictions~~ have a background study under section 
228.29  144.057.  These individuals shall be disqualified under the 
228.30  provisions of chapter 245A.  ~~The commissioner may adopt rules~~ 
228.31  ~~that may require a person who must disclose criminal convictions~~ 
228.32  ~~under this subdivision to provide fingerprints and releases that~~ 
228.33  ~~authorize law enforcement agencies, including the bureau of~~ 
228.34  ~~criminal apprehension and the Federal Bureau of Investigation,~~ 
228.35  ~~to release information about the person's criminal convictions~~ 
228.36  ~~to the commissioner and home care providers.  The bureau of~~ 
229.1   ~~criminal apprehension, county sheriffs, and local chiefs of~~ 
229.2   ~~police shall, if requested, provide the commissioner with~~ 
229.3   ~~criminal conviction data available from local, state, and~~ 
229.4   ~~national criminal record repositories, including the criminal~~ 
229.5   ~~justice data communications network.~~ No person may be involved 
229.6   in the management, operation, or control of a provider, if the 
229.7   person has been convicted of a crime that relates to the 
229.8   provision of home care services or to the position, duties, or 
229.9   responsibilities undertaken by that person in the operation of 
229.10  the home care provider, unless the person can provide sufficient 
229.11  evidence of rehabilitation.  ~~The commissioner shall adopt rules~~ 
229.12  ~~for determining whether a crime relates to home care services~~ 
229.13  ~~and what constitutes sufficient evidence of rehabilitation.  The~~ 
229.14  ~~rules must require consideration of the nature and seriousness~~ 
229.15  ~~of the crime; the relationship of the crime to the purposes of~~ 
229.16  ~~home care licensure and regulation; the relationship of the~~ 
229.17  ~~crime to the ability, capacity, and fitness required to perform~~ 
229.18  ~~the duties and discharge the responsibilities of the person's~~ 
229.19  ~~position; mitigating circumstances or social conditions~~ 
229.20  ~~surrounding the commission of the crime; the length of time~~ 
229.21  ~~elapsed since the crime was committed; the seriousness of the~~ 
229.22  ~~risk to the home care client's person or property; and other~~ 
229.23  ~~factors the commissioner considers appropriate.~~ Data collected 
229.24  under this subdivision shall be classified as private data under 
229.25  section 13.02, subdivision 12. 
229.26     (b) Employees, contractors, and volunteers of a home care 
229.27  provider or hospice are subject to the background study required 
229.28  by section 144.057.  These individuals shall be disqualified 
229.29  under the provisions of chapter 245A and Minnesota Rules, parts 
229.30  9543.3000 to 9543.3090.  ~~Until October 1, 1997, grounds for~~ 
229.31  ~~disqualification shall also include the crimes specified under~~ 
229.32  ~~Minnesota Rules, part 4668.0020, subpart 14, or a comparable~~ 
229.33  ~~crime or act in another jurisdiction.~~  Nothing in this section 
229.34  shall be construed to prohibit a home care provider from 
229.35  requiring self-disclosure of criminal conviction information~~;~~ 
229.36  ~~however, compliance with the provisions of section 144.057~~ 
230.1   ~~constitutes compliance with the provisions of Minnesota Rules,~~ 
230.2   ~~part 4668.0020, subpart 8~~. 
230.3      ~~(c) Notwithstanding the provisions of Minnesota Rules, part~~ 
230.4   ~~4668.0020, subparts 12, 13, and 15, disqualifications under~~ 
230.5   ~~paragraph (b), removal from a direct care position, and the~~ 
230.6   ~~process for reconsiderations shall be governed by the provisions~~ 
230.7   ~~of section 144.057.~~ 
230.8      ~~(d) Unless superseded by the provisions of section 144.057~~ 
230.9   ~~or this section, the provisions of Minnesota Rules, part~~ 
230.10  ~~4668.0020, remain in effect.~~ 
230.11     ~~(e)~~ (c) Termination of an employee in good faith reliance 
230.12  on information or records obtained under paragraph (a) or (b) 
230.13  regarding a confirmed conviction does not subject the home care 
230.14  provider to civil liability or liability for reemployment 
230.15  insurance benefits. 
230.16     Sec. 3.  Minnesota Statutes 1996, section 245A.04, 
230.17  subdivision 3, is amended to read: 
230.18     Subd. 3.  [BACKGROUND STUDY OF THE APPLICANT.] (a) Before 
230.19  the commissioner issues a license, the commissioner shall 
230.20  conduct a study of the individuals specified in paragraph (c), 
230.21  clauses (1) to (5), according to rules of the commissioner.  
230.22     Beginning January 1, 1997, the commissioner shall also 
230.23  conduct a study of employees providing direct contact services 
230.24  for nonlicensed personal care provider organizations described 
230.25  in paragraph (c), clause (5). 
230.26     The commissioner shall recover the cost of these background 
230.27  studies through a fee of no more than $12 per study charged to 
230.28  the personal care provider organization.  
230.29     Beginning August 1, 1997, the commissioner shall conduct 
230.30  all background studies required under this chapter for adult 
230.31  foster care providers who are licensed by the commissioner of 
230.32  human services and registered under chapter 144D.  The 
230.33  commissioner shall conduct these background studies according to 
230.34  this chapter.  The commissioner shall initiate a pilot project 
230.35  to conduct up to 5,000 background studies under this chapter in 
230.36  programs with joint licensure as home and community-based 
231.1   services and adult foster care for people with developmental 
231.2   disabilities when the license holder does not reside in the 
231.3   foster care residence. 
231.4      (b) Beginning July 1, ~~1997~~ 1998, the commissioner shall 
231.5   conduct a background study on individuals specified in paragraph 
231.6   (c), clauses (1) to (5), who perform direct contact services in 
231.7   a nursing home or a home care agency licensed under chapter 144A 
231.8   or a boarding care home licensed under sections 144.50 to 
231.9   144.58, when the subject of the study resides outside Minnesota; 
231.10  the study must be at least as comprehensive as that of a 
231.11  Minnesota resident and include a search of information from the 
231.12  criminal justice data communications network in the state where 
231.13  the subject of the study resides. 
231.14     (c) The applicant, license holder, the bureau of criminal 
231.15  apprehension, the commissioner of health and county agencies, 
231.16  after written notice to the individual who is the subject of the 
231.17  study, shall help with the study by giving the commissioner 
231.18  criminal conviction data and reports about the maltreatment of 
231.19  adults substantiated under section 626.557 and the maltreatment 
231.20  of minors in licensed programs substantiated under section 
231.21  626.556.  The individuals to be studied shall include: 
231.22     (1) the applicant; 
231.23     (2) persons over the age of 13 living in the household 
231.24  where the licensed program will be provided; 
231.25     (3) current employees or contractors of the applicant who 
231.26  will have direct contact with persons served by the facility, 
231.27  agency, or program; 
231.28     (4) volunteers or student volunteers who have direct 
231.29  contact with persons served by the program to provide program 
231.30  services, if the contact is not directly supervised by the 
231.31  individuals listed in clause (1) or (3); and 
231.32     (5) any person who, as an individual or as a member of an 
231.33  organization, exclusively offers, provides, or arranges for 
231.34  personal care assistant services under the medical assistance 
231.35  program as authorized under sections 256B.04, subdivision 16, 
231.36  and 256B.0625, subdivision 19. 
232.1      The juvenile courts shall also help with the study by 
232.2   giving the commissioner existing juvenile court records on 
232.3   individuals described in clause (2) relating to delinquency 
232.4   proceedings held within either the five years immediately 
232.5   preceding the application or the five years immediately 
232.6   preceding the individual's 18th birthday, whichever time period 
232.7   is longer.  The commissioner shall destroy juvenile records 
232.8   obtained pursuant to this subdivision when the subject of the 
232.9   records reaches age 23.  
232.10     For purposes of this section and Minnesota Rules, part 
232.11  9543.3070, a finding that a delinquency petition is proven in 
232.12  juvenile court shall be considered a conviction in state 
232.13  district court. 
232.14     For purposes of this subdivision, "direct contact" means 
232.15  providing face-to-face care, training, supervision, counseling, 
232.16  consultation, or medication assistance to persons served by a 
232.17  program.  For purposes of this subdivision, "directly supervised"
232.18  means an individual listed in clause (1), (3), or (5) is within 
232.19  sight or hearing of a volunteer to the extent that the 
232.20  individual listed in clause (1), (3), or (5) is capable at all 
232.21  times of intervening to protect the health and safety of the 
232.22  persons served by the program who have direct contact with the 
232.23  volunteer. 
232.24     A study of an individual in clauses (1) to (5) shall be 
232.25  conducted at least upon application for initial license and 
232.26  reapplication for a license.  The commissioner is not required 
232.27  to conduct a study of an individual at the time of reapplication 
232.28  for a license or if the individual has been continuously 
232.29  affiliated with a foster care provider licensed by the 
232.30  commissioner of human services and registered under chapter 
232.31  144D, other than a family day care or foster care license, if:  
232.32  (i) a study of the individual was conducted either at the time 
232.33  of initial licensure or when the individual became affiliated 
232.34  with the license holder; (ii) the individual has been 
232.35  continuously affiliated with the license holder since the last 
232.36  study was conducted; and (iii) the procedure described in 
233.1   paragraph (d) has been implemented and was in effect 
233.2   continuously since the last study was conducted.  For the 
233.3   purposes of this section, a physician licensed under chapter 147 
233.4   is considered to be continuously affiliated upon the license 
233.5   holder's receipt from the commissioner of health or human 
233.6   services of the physician's background study results.  For 
233.7   individuals who are required to have background studies under 
233.8   clauses (1) to (5) and who have been continuously affiliated 
233.9   with a foster care provider that is licensed in more than one 
233.10  county, criminal conviction data may be shared among those 
233.11  counties in which the foster care programs are licensed.  A 
233.12  county agency's receipt of criminal conviction data from another 
233.13  county agency shall meet the criminal data background study 
233.14  requirements of this section. 
233.15     The commissioner may also conduct studies on individuals 
233.16  specified in clauses (3) and (4) when the studies are initiated 
233.17  by: 
233.18     (i) personnel pool agencies; 
233.19     (ii) temporary personnel agencies; 
233.20     (iii) educational programs that train persons by providing 
233.21  direct contact services in licensed programs; and 
233.22     (iv) professional services agencies that are not licensed 
233.23  and which contract with licensed programs to provide direct 
233.24  contact services or individuals who provide direct contact 
233.25  services. 
233.26     Studies on individuals in items (i) to (iv) must be 
233.27  initiated annually by these agencies, programs, and 
233.28  individuals.  Except for personal care provider organizations, 
233.29  no applicant, license holder, or individual who is the subject 
233.30  of the study shall pay any fees required to conduct the study. 
233.31     (1) At the option of the licensed facility, rather than 
233.32  initiating another background study on an individual required to 
233.33  be studied who has indicated to the licensed facility that a 
233.34  background study by the commissioner was previously completed, 
233.35  the facility may make a request to the commissioner for 
233.36  documentation of the individual's background study status, 
234.1   provided that: 
234.2      (i) the facility makes this request using a form provided 
234.3   by the commissioner; 
234.4      (ii) in making the request the facility informs the 
234.5   commissioner that either: 
234.6      (A) the individual has been continuously affiliated with a 
234.7   licensed facility since the individual's previous background 
234.8   study was completed, or since October 1, 1995, whichever is 
234.9   shorter; or 
234.10     (B) the individual is affiliated only with a personnel pool 
234.11  agency, a temporary personnel agency, an educational program 
234.12  that trains persons by providing direct contact services in 
234.13  licensed programs, or a professional services agency that is not 
234.14  licensed and which contracts with licensed programs to provide 
234.15  direct contact services or individuals who provide direct 
234.16  contact services; and 
234.17     (iii) the facility provides notices to the individual as 
234.18  required in paragraphs (a) to (d), and that the facility is 
234.19  requesting written notification of the individual's background 
234.20  study status from the commissioner.  
234.21     (2) The commissioner shall respond to each request under 
234.22  paragraph (1) with a written or electronic notice to the 
234.23  facility and the study subject.  If the commissioner determines 
234.24  that a background study is necessary, the study shall be 
234.25  completed without further request from a licensed agency or 
234.26  notifications to the study subject.  
234.27     (3) When a background study is being initiated by a 
234.28  licensed facility or a foster care provider that is also 
234.29  registered under chapter 144D, a study subject affiliated with 
234.30  multiple licensed facilities may attach to the background study 
234.31  form a cover letter indicating the additional facilities' names, 
234.32  addresses, and background study identification numbers.  When 
234.33  the commissioner receives such notices, each facility identified 
234.34  by the background study subject shall be notified of the study 
234.35  results.  The background study notice sent to the subsequent 
234.36  agencies shall satisfy those facilities' responsibilities for 
235.1   initiating a background study on that individual. 
235.2      (d) If an individual who is affiliated with a program or 
235.3   facility regulated by the department of human services or 
235.4   department of health or who is affiliated with a nonlicensed 
235.5   personal care provider organization, is convicted of a crime 
235.6   constituting a disqualification under ~~Minnesota Rules, parts~~ 
235.7   ~~9543.3000 to 9543.3090~~ this section, the probation officer or 
235.8   corrections agent shall notify the commissioner of the 
235.9   conviction.  The commissioner, in consultation with the 
235.10  commissioner of corrections, shall develop forms and information 
235.11  necessary to implement this paragraph and shall provide the 
235.12  forms and information to the commissioner of corrections for 
235.13  distribution to local probation officers and corrections 
235.14  agents.  The commissioner shall inform individuals subject to a 
235.15  background study that criminal convictions for disqualifying 
235.16  crimes will be reported to the commissioner by the corrections 
235.17  system.  A probation officer, corrections agent, or corrections 
235.18  agency is not civilly or criminally liable for disclosing or 
235.19  failing to disclose the information required by this paragraph.  
235.20  Upon receipt of disqualifying information, the commissioner 
235.21  shall provide the notifications required in subdivision 3a, as 
235.22  appropriate to agencies on record as having initiated a 
235.23  background study or making a request for documentation of the 
235.24  background study status of the individual.  This paragraph does 
235.25  not apply to family day care and child foster care programs. 
235.26     (e) The individual who is the subject of the study must 
235.27  provide the applicant or license holder with sufficient 
235.28  information to ensure an accurate study including the 
235.29  individual's first, middle, and last name; home address, city, 
235.30  county, and state of residence for the past five years; zip 
235.31  code; sex; date of birth; and driver's license number.  The 
235.32  applicant or license holder shall provide this information about 
235.33  an individual in paragraph (c), clauses (1) to (5), on forms 
235.34  prescribed by the commissioner.  By January 1, 2000, for 
235.35  background studies conducted by the department of human 
235.36  services, the commissioner shall implement a system for the 
236.1   electronic transmission of:  (1) background study information to 
236.2   the commissioner; and (2) background study results to the 
236.3   license holder.  The commissioner may request additional 
236.4   information of the individual, which shall be optional for the 
236.5   individual to provide, such as the individual's social security 
236.6   number or race. 
236.7      (f) Except for child foster care, adult foster care, and 
236.8   family day care homes, a study must include information related 
236.9   to names of substantiated perpetrators of maltreatment of 
236.10  vulnerable adults that has been received by the commissioner as 
236.11  required under section 626.557, subdivision 9c, paragraph (i), 
236.12  and the commissioner's records relating to the maltreatment of 
236.13  minors in licensed programs, information from juvenile courts as 
236.14  required in paragraph (c) for persons listed in paragraph (c), 
236.15  clause (2), and information from the bureau of criminal 
236.16  apprehension.  For child foster care, adult foster care, and 
236.17  family day care homes, the study must include information from 
236.18  the county agency's record of substantiated maltreatment of 
236.19  adults, and the maltreatment of minors, information from 
236.20  juvenile courts as required in paragraph (c) for persons listed 
236.21  in paragraph (c), clause (2), and information from the bureau of 
236.22  criminal apprehension.  The commissioner may also review arrest 
236.23  and investigative information from the bureau of criminal 
236.24  apprehension, the commissioner of health, a county attorney, 
236.25  county sheriff, county agency, local chief of police, other 
236.26  states, the courts, or the Federal Bureau of Investigation if 
236.27  the commissioner has reasonable cause to believe the information 
236.28  is pertinent to the disqualification of an individual listed in 
236.29  paragraph (c), clauses (1) to (5).  The commissioner is not 
236.30  required to conduct more than one review of a subject's records 
236.31  from the Federal Bureau of Investigation if a review of the 
236.32  subject's criminal history with the Federal Bureau of 
236.33  Investigation has already been completed by the commissioner and 
236.34  there has been no break in the subject's affiliation with the 
236.35  license holder who initiated the background studies. 
236.36     When the commissioner has reasonable cause to believe that 
237.1   further pertinent information may exist on the subject, the 
237.2   subject shall provide a set of classifiable fingerprints 
237.3   obtained from an authorized law enforcement agency.  For 
237.4   purposes of requiring fingerprints, the commissioner shall be 
237.5   considered to have reasonable cause under, but not limited to, 
237.6   the following circumstances: 
237.7      (1) information from the bureau of criminal apprehension 
237.8   indicates that the subject is a multistate offender; 
237.9      (2) information from the bureau of criminal apprehension 
237.10  indicates that multistate offender status is undetermined; or 
237.11     (3) the commissioner has received a report from the subject 
237.12  or a third party indicating that the subject has a criminal 
237.13  history in a jurisdiction other than Minnesota. 
237.14     (g) An applicant's or license holder's failure or refusal 
237.15  to cooperate with the commissioner is reasonable cause 
237.16  to disqualify a subject, deny ~~an~~ a license application or 
237.17  immediately suspend, suspend, or revoke a license.  Failure or 
237.18  refusal of an individual to cooperate with the study is just 
237.19  cause for denying or terminating employment of the individual if 
237.20  the individual's failure or refusal to cooperate could cause the 
237.21  applicant's application to be denied or the license holder's 
237.22  license to be immediately suspended, suspended, or revoked. 
237.23     (h) The commissioner shall not consider an application to 
237.24  be complete until all of the information required to be provided 
237.25  under this subdivision has been received.  
237.26     (i) No person in paragraph (c), clause (1), (2), (3), (4), 
237.27  or (5) who is disqualified as a result of this section may be 
237.28  retained by the agency in a position involving direct contact 
237.29  with persons served by the program. 
237.30     (j) Termination of persons in paragraph (c), clause (1), 
237.31  (2), (3), (4), or (5), made in good faith reliance on a notice 
237.32  of disqualification provided by the commissioner shall not 
237.33  subject the applicant or license holder to civil liability. 
237.34     (k) The commissioner may establish records to fulfill the 
237.35  requirements of this section. 
237.36     (l) The commissioner may not disqualify an individual 
238.1   subject to a study under this section because that person has, 
238.2   or has had, a mental illness as defined in section 245.462, 
238.3   subdivision 20. 
238.4      (m) ~~An individual who is subject to an applicant background~~ 
238.5   ~~study under this section and whose disqualification in~~ 
238.6   ~~connection with a license would be subject to the limitations on~~ 
238.7   ~~reconsideration set forth in subdivision 3b, paragraph (c),~~ 
238.8   ~~shall be disqualified for conviction of the crimes specified in~~ 
238.9   ~~the manner specified in subdivision 3b, paragraph (c).  The~~ 
238.10  ~~commissioner of human services shall amend Minnesota Rules, part~~ 
238.11  ~~9543.3070, to conform to this section.~~ 
238.12     ~~(n)~~ An individual subject to disqualification under this 
238.13  subdivision has the applicable rights in subdivision 3a, 3b, or 
238.14  3c. 
238.15     Sec. 4.  Minnesota Statutes 1996, section 245A.04, 
238.16  subdivision 3a, is amended to read: 
238.17     Subd. 3a.  [NOTIFICATION TO SUBJECT AND LICENSE HOLDER OF 
238.18  STUDY RESULTS; DETERMINATION OF RISK OF HARM.] (a) The 
238.19  commissioner shall notify the applicant or license holder and 
238.20  the individual who is the subject of the study, in writing or by 
238.21  electronic transmission, of the results of the study.  When the 
238.22  study is completed, a notice that the study was undertaken and 
238.23  completed shall be maintained in the personnel files of the 
238.24  program. 
238.25     The commissioner shall notify the individual studied if the 
238.26  information in the study indicates the individual is 
238.27  disqualified from direct contact with persons served by the 
238.28  program.  The commissioner shall disclose the 
238.29  information causing disqualification and instructions on how to 
238.30  request a reconsideration of the disqualification to the 
238.31  individual studied.  An applicant or license holder who is not 
238.32  the subject of the study shall be informed that the commissioner 
238.33  has found information that disqualifies the subject from direct 
238.34  contact with persons served by the program.  However, ~~the~~ 
238.35  ~~applicant or license holder shall not be told what that~~ 
238.36  ~~information is~~ only the individual studied must be informed of 
239.1   the information contained in the subject's background study 
239.2   unless the only basis for the disqualification is failure to 
239.3   cooperate, the data practices act provides for release of the 
239.4   information, or the individual studied authorizes the release of 
239.5   the information. 
239.6      (b) If the commissioner determines that the individual 
239.7   studied has a disqualifying characteristic, the commissioner 
239.8   shall review the information immediately available and make a 
239.9   determination as to the subject's immediate risk of harm to 
239.10  persons served by the program where the individual studied will 
239.11  have direct contact.  The commissioner shall consider all 
239.12  relevant information available, including the following factors 
239.13  in determining the immediate risk of harm:  the recency of the 
239.14  disqualifying characteristic, the recency of discharge from 
239.15  probation for the crimes; the number of disqualifying 
239.16  characteristics; the intrusiveness or violence of the 
239.17  disqualifying characteristic; the vulnerability of the victim 
239.18  involved in the disqualifying characteristic; and the similarity 
239.19  of the victim to the persons served by the program where the 
239.20  individual studied will have direct contact.  The commissioner 
239.21  may determine that the evaluation of the information immediately 
239.22  available gives the commissioner reason to believe one of the 
239.23  following: 
239.24     (1) The individual poses an imminent risk of harm to 
239.25  persons served by the program where the individual studied will 
239.26  have direct contact.  If the commissioner determines that an 
239.27  individual studied poses an imminent risk of harm to persons 
239.28  served by the program where the individual studied will have 
239.29  direct contact, the individual and the license holder must be 
239.30  sent a notice of disqualification.  The commissioner shall order 
239.31  the license holder to immediately remove the individual studied 
239.32  from direct contact.  The notice to the individual studied must 
239.33  include an explanation of the basis of this determination. 
239.34     (2) The individual poses a risk of harm requiring 
239.35  continuous supervision while providing direct contact services 
239.36  during the period in which the subject may request a 
240.1   reconsideration.  If the commissioner determines that an 
240.2   individual studied poses a risk of harm that requires continuous 
240.3   supervision, the individual and the license holder must be sent 
240.4   a notice of disqualification.  The commissioner shall order the 
240.5   license holder to immediately remove the individual studied from 
240.6   direct contact services or assure that the individual studied is 
240.7   within sight or hearing of another staff person when providing 
240.8   direct contact services during the period in which the 
240.9   individual may request a reconsideration of the 
240.10  disqualification.  If the individual studied does not submit a 
240.11  timely request for reconsideration, or the individual submits a 
240.12  timely request for reconsideration, but the disqualification is 
240.13  not set aside for that license holder, the license holder will 
240.14  be notified of the disqualification and ordered to immediately 
240.15  remove the individual from any position allowing direct contact 
240.16  with persons receiving services from the license holder. 
240.17     (3) The individual does not pose an imminent risk of harm 
240.18  or a risk of harm requiring continuous supervision while 
240.19  providing direct contact services during the period in which the 
240.20  subject may request a reconsideration.  If the commissioner 
240.21  determines that an individual studied does not pose a risk of 
240.22  harm that requires continuous supervision, only the individual 
240.23  must be sent a notice of disqualification.  The license holder 
240.24  must be sent a notice that more time is needed to complete the 
240.25  individual's background study.  If the individual studied 
240.26  submits a timely request for reconsideration, and if the 
240.27  disqualification is set aside for that license holder, the 
240.28  license holder will receive the same notification received by 
240.29  license holders in cases where the individual studied has no 
240.30  disqualifying characteristic.  If the individual studied does 
240.31  not submit a timely request for reconsideration, or the 
240.32  individual submits a timely request for reconsideration, but the 
240.33  disqualification is not set aside for that license holder, the 
240.34  license holder will be notified of the disqualification and 
240.35  ordered to immediately remove the individual from any position 
240.36  allowing direct contact with persons receiving services from the 
241.1   license holder.